The Stethoscope and those memories of a lifetime By Dr Nihal D Amerasekera

The Stethoscope and those memories of a lifetime

By Dr Nihal D Amerasekera

“If you cry because the sun has gone out of your life, your tears will prevent you from seeing the stars.”― Rabindranath Tagore

My early childhood was spent in Nugegoda. I stayed with my grandparents smothered with love and affection. My father was helping to grease the wheels of the government far away from the Metropolis. My grandpa was an apothecary caring for the sick and the suffering. He was often seen leaving the house with his stethoscope. Whenever I fell ill he used this instrument to listen to my chest. I was simply fascinated and intrigued by this device with its brown tubes and black bell. These are my earliest recollections of an awesome instrument that changed the way doctors diagnosed heart and lung disease.

Laennec painted by ND

The stethoscope has become a talisman and so much of a part of every doctor. The word stethoscope comes from the Greek words stethos, meaning chest, and skopein, meaning to explore. The amazing story of the invention of this astounding instrument is steeped in history. 

In the autumn of 1816, Dr. Rene Theophile Hyacinthe Laënnec, a French Physician was walking in the courtyard of the Le Louvre Palace in Paris. He observed two children playing. Each one had a piece of wood placed on the ear. The pieces of wood were connected by a taut string. The taps from one piece of wood reached the other piece. In those early days the heart sounds and beathing was heard by the doctor placing the ear on the patient’s chest. Once when a young lady came to Dr Laënnec for treatment, he was bashful and felt uneasy to place his ear on her chest. He made a tube with a sheet of paper and placed one end on the chest to listen. This wasn’t perfect but caused less embarrassment to the patient and the doctor. He remembered the acoustic phenomenon used by the 2 boys. 

Laënnec spent several years trying to perfect an instrument and decided on a hollow wooden tube that amplified the sounds. This became the forerunner to the modern stethoscope. Doctors used wooden tubes as stethoscopes until the latter half of the 19^th century. It took many more years to develop the modern bell and diaphragm type of stethoscope. In 1861 an Irish physician named Arthur Leared created a binaural model with two earpieces on the ends of stiff metal tubes. In 1862, George P. Camman of New York perfected the design using flexible tubes with smaller ear connections. 

This binaural stethoscope was commercially produced. In appearance, his instrument is similar to the ones used today.

After I entered the faculty of Medicine in Colombo, I learnt the inherent magic of this device and how to use it as a diagnostic tool. No other symbol so strongly identifies a doctor than a stethoscope. In Sri Lanka the device became an icon of intellect and skill. Hence, doctors enjoyed great esteem from the public. Some of this adulation filtered down to medical students. Even as a student I took great pride in displaying my stethoscope prominently. I had it round my neck on my long walks in the hospital wards and corridors. This self-assured hubris among medics have now waned. The stethoscope is ubiquitously used in hospitals and surgeries by many different healthcare workers.

After I ended my professional life, there is always an irresistible desire to return to my roots. As a Diagnostic Radiologist, I never used a stethoscope. Now, when I see a stethoscope, it takes me back many decades to the time I spent with my grandparents. It is now a symbol of my childhood more than my profession. This transports me back to Nugegoda and those happy years.  

My grandparents

Nugegoda then was a sleepy little town that prided itself on its peaceful ambience. People were charming, friendly and helpful. They were religious and converged on the temple and the church for refuge and direction. The landscape was green and its beauty touched us with grace. The mornings were magical as the dew on the grass shone brightly. The shady streets were lined with tall flamboyant trees. The town was a paradise for birds. There were vast stretches of uncultivated green land through which ran a few narrow dusty gravel roads. There were hardly any cars. Heavy commerce and trade hadn’t arrived here yet. There was no large industry in and around Nugegoda and jobs were scarce.

As darkness descended hundreds of bats took over the skies. I still recall how quiet and dark the nights were. We heard the eerie croaking of frogs and the din of crickets. The fireflies always remind me of Nugegoda of the 1950’s. It was only the rumblings of the Kelani Valley trains that punctuated the silence. There was no respite from the mosquitoes that tormented us every night.

My grandpa was a softly spoken, quiet, noble man from Kandy. From the time I can remember he had grey hair. He took life easy but worked diligently. The locals knew he was a medical man and came to him at all hours for help. He was much more, a philosopher, an expert in country lore, an amateur astrologer and an old character of a type that was endangered and nearly extinct. He was not interested in money except the bare minimum to sustain his family. The people respected him enormously and he relished the adulation.

My grandma was a qualified nurse in the Mold of Florence Nightingale. She was kind and caring and grew up in Ibbagamuwa near Kurunegala. Grandma was a sprightly, intelligent woman with lots of courage and foresight. She helped to drive the family forward through uncertain times.

Time passed swiftly and relentlessly. The ravages of time affected my grandparents. In the autumn of their lives, they had the respect and love of the extended family. As their eyesight and hearing gradually failed, they were mostly confined to home. Whenever I visited them, I saw their decline. They had a huge repertoire of old family stories and amusing anecdotes which they shared on our visits. Grandma kept touching mementoes of our family, like photographs and paper cuttings, which she cherished immensely. To her every photo spoke volumes.

Their end came peacefully. Grandpa passed away aged 89. I was then in London and felt the loss deeply. After his death, for grandma life became an ordeal. She led a quiet life and remained fit but frail. I have often seen her sitting alone wrapped in her own thoughts. Memories of the past stared at her from every room, as did photographs and family occasions. The great void in her life could never be filled. Grandma passed away at the age of 86 years. They both served their communities with pride and worked for the Health Service with dedication and devotion. I will always remember grandma’s diligence, energy and enthusiasm and grandpa’s calm, reflective kindness. To me it was an end of an era.

More than seven decades have passed since I first set foot on Nugegoda. During the past 50 years I have lived in the UK and visited Sri Lanka occasionally. On a visit to Nugegoda in 2012, the changes that greeted me were astonishing. Our former house didn’t survive the wrath of the bulldozers. It was demolished and became a car park. The town is now bustling and busy. Prosperity has come to the town with better shops, fine supermarkets, wider roads, modern communications and good transport. Bristling billboards and signposts line the roads. Many of the old houses have been pulled down. The few that remained look like relics from a lost civilisation. The nouveau riche preferred to live in large, detached houses, behind high walls and security gates.

Urbanisation of a town is inevitable but seemingly it has taken place randomly. Nugegoda has experienced a devastatingly rapid, unsympathetic expansion. The industrial and residential areas are mixed with office space. There is no designated green belt to preserve as an area for peace and relaxation. The result is a cauldron of light, noise and environmental pollution, a serious health hazard. This is what remains of the once austere, puritanical Nugegoda of the fifties. Its past elegance lay buried under layers of asphalt and concrete.

I have rambled on and revived ancient and half-forgotten memories of a town with its own personality, heart and soul. Although the magic of the old Nugegoda still haunts me, the loveliness and enchantment of that peaceful town I knew is now a distant memory. Within the time frame of a single generation, it has changed beyond recognition. It hurts when I think about its former glory and the people who made it so special.

I have painted a portrait to honour and respect Dr. Rene Theophile Hyacinthe Laënnec for his brilliant and important invention. The Stethoscope transformed healthcare. But I dedicate this narrative to the memory of my grandparents. They both gave me life and hope. It is only now I realise the depth of their influence on my life. Their love, warmth and encouragement will never be forgotten.