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Seeing, hearing, tasting and touching disease: the use of the senses in medical diagnosis

Urinal, Europe, 1801-1900

Urinal, Europe, 1801-1900

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Doctors use seeing, hearing, touch, smell and sometimes even taste to discover more about a patient’s complaint. Practitioners in different medical cultures developed ways to use their bodies as instruments in diagnosis.

Greek, Islamic and Chinese medicine

In ancient Greek medicine a person’s environment was important for his or her health. Greek doctors observed the patient’s physical condition. This meant the body’s ‘symptoms’ (’happenings’ in Greek) and also the patient’s everyday life and environment. Practitioners such as Galen used all five senses of vision, touch, hearing, smell and taste in their observations. A doctor watched how the patient moved and observed skin colour; touched the patient to determine body temperature and observe the pulse; listened to a rumbling stomach; smelled the patient’s breath or the odour of his or her faeces; and even tasted the patient’s sweat or urine. Islamic scientists also believed diagnosis should use all senses. Egyptian scholar Ali Ibn Ridwan (c. 988 - c. 1061) reminded colleagues and students: ‘For your diagnosis ... you should always choose things that are extremely powerful and easy to recognise, and these are what can be perceived by sight, touch, hearing, smell, taste and by the intellect.’

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Traditional Chinese Medicine developed extensive classifications of pulses. It also used charts to interpret the appearance of body parts such as the face, eyes and tongue as clues to internal diseases.

The patient-practitioner relationship

Diagnosis took different forms depending on the social status of doctor and patient. Doctors in early modern Europe were scholars who considered hands-on practice unacceptable to their high social standing. Few of these learned practitioners, including anatomist Giovanni Battista Morgagni, used techniques such as palpation to make a diagnosis. Most preferred looking at patients and interrogating them. Male doctors interacting with female patients was particularly difficult. French physician Laennec even invented the stethoscope to avoid indecency.

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Other medical traditions had similar concerns. This may explain why pulse diagnosis looks similar worldwide. For example, early practitioners in Traditional Chinese Medicine felt different pulses at points all around the patient’s body. Over centuries, they focused on the wrists. They argued a trained physician could feel 12 different pulses there. This change allowed practitioners to diagnose ailments by touching only the patient’s wrists.

Instruments to support the senses

Doctors also employ instruments to support their senses. Doctors in ancient Greece and Rome, and in medieval Europe used instruments such as probes and speculums to access hidden parts of a patient’s body. French physician Laennec developed the stethoscope in the early 1800s to help listen to the heartbeat. German scientist Helmholtz invented the ophthalmoscope a few decades later to aid eye inspections. Other instruments were adapted from science for medical purposes. These include the microscope, which revealed the presence of germs. The discovery of X-rays around 1900 made the inside of the body visible. Today, technologies from ultrasound to CAT scanning visualise the body.

Do instruments replace the senses?

Doctors increasingly introduced measurement and quantification to medical practice from the 1800s. The doctor’s use of touch to determine body temperature was replaced by the thermometer. Medical scientists and practitioners argued these new technologies improved diagnostic practice. They were more objective and reliable than doctors’ subjective sense impressions. They saved time because tests and measurements were administered by a nurse or technician. And they also improved communication because instruments produced numbers or curves which were shared and discussed. For instance, the sphygmometer visualised the patient’s pulse and more than one person could look at it simultaneously. Permanent visual traces such as the curves of the electrocardiogram (ECG) were shared, compared, preserved and circulated.

Doctors became more skilled at using scientific techniques as instruments and tests replaced the senses. However, practitioners argue they simultaneously lose the ability to interpret their own sense impressions. Different means of diagnosis resulting in conflicting clues also raise questions. Should practitioners trust their senses, patients’ descriptions of their symptoms, or tests and instruments?

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Bibliography

W F Bynum and R Porter (eds), Medicine and the Five Senses (Cambridge: Cambridge University Press, 1993)

M Nicolson, ‘The art of diagnosis: medicine and the five senses’, in W F Bynum and R Porter (eds), Companion Encyclopedia of the History of Medicine, Vol. 2 (London: Routledge, 1993), pp 801-25

S J Reiser, ‘The science of diagnosis: diagnostic technology’, in W F Bynum and R Porter (eds), Companion Encyclopedia of the History of Medicine, Vol. 2 (London: Routledge, 1993), pp 826-51

A B Davis, Medicine and Its Technology: An Introduction to the History of Medical Instrumentation (Westport, CT: Greenwood Press, 1981)

 

Glossary:

Probe

medical tool used during diagnostic process

Germ

Tiny organisms that cause disease. 'Germ' is now a term that is applied loosely to many micro-organisms, including bacteria, viruses and fungi.