George Phillip Cammann (1804-1863): A physician's contribution to the modern stethoscope and auscultatory percussion.

In the middle third of the 19th century, George Phillip Cammann became known for the stethoscope improvement that came to bear his name and for the development of the then-popular diagnostic technique of auscultatory percussion. During his postgraduate training at the Paris hospitals in 1828-1830, he acquired a special interest in auscultation while attending lectures given by a friend and colleague of Laennec's, French physician Pierre-Charles-Alexandre Louis (1787-1872). In his New York City practice, caring primarily for the working poor, he recognized the need for a better stethoscope and developed a modification that came to bear his name. He conducted research aimed at increasing the accuracy of physical diagnosis by improving and reporting on the technique of auscultatory percussion. An examination of the medical literature, both textbooks and journals, reveals the extent of influence that Cammann had on clinical practice resulting from his contributions to the improvement of the stethoscope and auscultatory percussion.

"The report of my death ": Exaggerated Predictions on the Demise of the Stethoscope.

The narrative of the rise and fall of the stethoscope is partly written. Medical historians agree on the rise in its use; however, on the decline, they are less certain. This article explores the previously unexamined and surprisingly long history of predictions of the stethoscope's demise. It also provides evidence to show that it is not yet extinct, although its applications are changing as it adapts to newer technology and recent public health measures. Primary sources include medical school curricula, books, medical journals, and popular literature. Trends and projections in patent applications for stethoscope modifications and sales of the instrument provide additional evidence for the robust position of the stethoscope in current American practice.

The Stethoscope in 19th-Century American Practice: Ideas, Rhetoric, and Eventual Adoption.

The stethoscope was invented in 1816 by the French physician R.T.H. Laennec, who, after three years of clinical observations, published his treatise Mediate Auscultation in 1819. In his treatise, Laennec included details of his new method of using the stethoscope to provide physiological and pathological evaluation of patients. American physicians attended lectures and clinics at Paris hospitals and carried this information back to their respective medical schools and practices. This was accomplished by a relatively limited number of elite American physicians who were able to take advantage of travel abroad and whose practices were academically affiliated. However, it is a well-substantiated historical claim that the adoption of the stethoscope by most American physicians was slow. There are many reasons for slow adoption of the stethoscope in America, among which are lack of formal education, including bedside training in the stethoscope, complexity of interpretation of auscultatory information, hesitancy of the patient and physician to have an instrument placed between them, and lack of opportunities for continuing education for physicians after leaving medical school. As the nineteenth century progressed, scientific ideas and rhetoric related to auscultation and the stethoscope became more widespread, reflecting gradual acceptance and adoption of the stethoscope by American practitioners. In this article, I examine the ideas and rhetoric in medical journal articles, advertisements, and medical school textbooks to learn what was thought by physicians to be important in their practice. Advertisement of medical school curricula with mention of specific course work or lectures related to auscultation or the stethoscope is noted, reflecting increased interest in the stethoscope as an adjunct to physical examination. This information introduces evidence to test and bolster the existing historical claims of slow adoption of the stethoscope by addressing in more detail when and why adoption by American physicians became widespread.

Ischemic heart disease in women and the role of hormone therapy.

The prevalence of ischemic heart disease (IHD) has been increasing among the women in developed countries. The well recognized IHD excess in men has often obscured the fact that IHD is the leading cause of death in women. Women have atypical symptoms of IHD that lead to a delay in the diagnosis and an overall poor prognosis. Women have a delay in the onset of IHD due to the beneficial effects of their sex hormones. Postmenopausal women lose this beneficial effect of estrogen and undergo significant changes in their lipid profile, arterial pressure, glucose tolerance, and vascular reactivity that increase their risk for development of IHD. Recently there has been considerable interest in the sex hormones and their role in IHD in women. The general belief that hormone replacement therapy (HRT) has an overall beneficial effect on cardiovascular disease (CVD) in women and hence decreases CVD mortality and morbidity has not been shown in the recent multicenter prospective studies. With the availability of various types of estrogen and progestins, physicians prescribing these agents should take into consideration their varying effects on the cardiovascular system. Risk factor modifications should include diet, weight loss, regular exercise, smoking cessation and adequate control of hypertension (HTN), diabetes (DM) and hyperlipidemia. In the appropriate setting, treatment with proven beneficial agents like aspirin, beta-blockers, angiotensin converting enzyme (ACE) inhibitors and statins will help decrease the burden of IHD in women.