“One day he told me that the whole universe seemed spread before him like a great black ocean, where there was nothing to see and nothing to hear, except that at intervals, a silver trumpet seemed to sound across the waters.”
So went one of the last visions of the mathematician George Boole as documented by his wife Mary Everest Boole.
In the winter of 1864, George had lay dying of what was later entered on his death-certificate as pleuro-pneumonia.
It is unlikely that Mary, a budding homoeopathist, used the age-old practice of auscultation - the practice of listening to sounds arising from within the organs - to determine the level of consolidation - literally the extent to which the lungs are filled with fluid - in George’s lungs and therefore estimate the extent of the illness.
In what has historically, and somewhat unfairly, become her downfall, Mary, using Hahnemann's theory of infinitesimal doses, attempted to cure George by treating the illness, caused by a hefty downpour, with doses of rainwater.
As Ethel Voynich, one of Booleís daughters later wrote, “ ...the cause of Father’s early death was believed to have been the Missus’ belief in a certain crank doctor who advocated cold water cures for everything. Someone - I can’t remember who - is reported to have come in and found Father shivering between wet sheets.”
But, as Boole’s biographer writes, “ìt is probable, however, that orthodox medical treatment was not tried until it was much too late and it is doubtful, given Boole’s state of health, if any nineteenth century physician could have saved his life.”
It is unknown whether Dr Dennis Bullen, called in towards the end, used a stethoscope, some 78 years after its invention by Rene Laennec, to ascertain the state of poor George's lungs, or whether, he rejected it like Dr Winter in Arthur Conan Doyle’s 1894 text 'Behind the Times':
“…he always clicks with his tongue when it is mentioned and has even been known to say vain things about Laennec, and to refer to the stethoscope as "a new-fangled French toy." He carries one in his hat out of deference to the expectations of his patients, but he is very hard of hearing, so that it makes little difference whether he uses it or not.”
What we can be sure of is that George’s lungs were consolidated through an accumulation of exudate - consisting of serum, fibrin and white blood cells - in the alveoli and adjoining ducts.
Had Dr Bullen used a stethoscope, he might, having made reference to the section on Broncophony in Laennec's 'Treatise on Mediate Auscultation', have requested George say eeeee or eeeeee - the vowels containing formants i.e. a pair of partials independent of the fundamental note of the vowel - which, in the healthy lung, are so attenuated and filtered that speech heard over the stethoscope becomes a meaningless low pitched mumble. In the consolidated lung, they are clearly transmitted when the lung between the trachea and the point of auscultation is airless.
Or perhaps he would have asked George to whisper 'ssss' or 'shhhh' - the turbulent flow of sibilants inaudible through the air filled lung but fully intelligible in the airless lung.
Boole fell silent towards the end and joined the ocean in his vision, the immobilised flow of his lungs interrupted on occasion, by the silver trumpet of Dr. Bullen's stethoscope and the silvery trickles of Mary's hydropathic treatments.
~
In a recent edition of Balzac's 'The Unknown Masterpiece, ' the chaos of the Master's painting is echoed by, as Balzac had intended, a second text 'Gambara' , in which an insane composer's opera eclipses his everyday madness:
“there was no hint of a poetic or musical idea in the deafening cacophony... the principles of harmony, the most elementary rules of composition were totally alien to this formless creation... a jumble of discordant sounds flung out at random as though combined to rend the least delicate ear... new words would be required in order to give a sense of this impossible music.”
Returning to The Unknown Masterpiece, the two younger painters eventually stand before Frenhofer's painting:
“The old fraud's pulling our leg” Poussin murmured, returning to face the so-called painting, “all I see are colours daubed on top of the other and contained by a mass of lines forming a wall of paint.”
“We must be missing something” Porbus insisted.
Coming closer, they discerned, in one corner of the canvas, the tip of a bare foot, emerging from this chaos of colours, shapes and vague shadings, a kind of incoherent mist ; but a delightful foot, a living foot! They stood stock-still with admiration before this fragment which had escaped from an incredible, slow, and advancing destruction.”
In a detailed analysis of Balzac's fiction, the philosopher Michel Serres traces the etmylogy of noise to nausea and its nautical roots in seasickness - the nautical murmur:
“So many mariners never saw anything in the noise of the sea; only felt nauseous, organisms teaming with the sound...”
“We never hear what we call background noise at the seaside. Space is assailed, as a whole, by the murmur; we are utterly taken over by this same murmuring. This restlessness is within hearing, just shy of definite signals, just shy of silence. Background noise may well be the ground of our being.”
It transpires that Balzac erased the name of the painting - La Belle Noiseuse - from the final version of his text.
La Belle Noiseuse - the beautiful clamourer, the querolous beauty, is for Serres, the roar of a ceaseless and chaotic ebb and flow, the background noise that prefigures rationality.
“As soon as a phenomenon appears, it leaves the noise, as soon as a form looms up or pokes through , it reveals itself by veiling noise.”
and again,
“...la belle noiseuse is the multiple, a thundering mix, chaos... The raucous, anarchic, noise, variegated,tiger-striped, zebra-streaked, jumbled-up, mixed-up multiple, criss-crossed by myriad colours and myriad shades is possibility itself, it is a set of possible things, it may be the set of possible things.”
Lung sounds are produced either by rapid fluctuations of gas pressure or by the oscillations of solid tissues.
The sound generated by these rapid fluctuations of gas pressure is a noise varying at random in amplitude, with an even frequency distribution between 200 and 2000 Hz - the standard definition of white noise.
If, as Serres suggests, noise is the background of being, could respiration - flowing from the laminar to white noise - be a part of it?
~
Laennec’s contribution to morbid anatomy, a major part of the rationalisation of medical practice in the nineteenth century, was based on a comparison of observations at the bedside with the appearance of the viscera - the internal organs situated in the trunk of the body - to the naked eye at necropsy or post mortem examination.
If we for a moment reconfigure Frenhofer's masterpiece as a portrait of the lung, the point of the foot is Laennec's at the outset of his journey to bring order to the interior of the body. His case studies at the hospital Necker ìa multitude of eccentric lines of footprints across the undifferentiated chaos of the body now partially mapped and inscribed within the history of medicine.
When Laennec published his observations on auscultation, there was no accepted terminology for the various musical and explosive sounds heard through the stethoscope.
He proposed that all of these sounds should be called Rales (rattles) - a word already in colloquial use to describe the rattling of sputum in the airways of moribund patients
The classification system Laennec invented is simple, possibly because, as Dr. Paul Forgacs, has succinctly pointed out “the sound repertoire of a wet sponge such as the lung is limited.”
Laennec classified rales into four groups accompanied by descriptive alternate headings:
Moist / Crepitations - short explosive high pitched sounds
Mucous / Gargling - short explosive low pitched sounds<
Sonorous / Snoring - low pitched continuous musical notes
Sibilant / Whistling - long and short high pitched musical sounds
A fifth group was appended sometime later:
Dry Crepitant Rales / Crackling - said to resemble the sound made by the inflating of a dried bladder.
The simplicity of classification however, merely conceals another set of complexities, the technology of mediate auscultation, its replication of the sounds of the body brought to the ear by the stethoscope, conceals the fact that the stethoscope does not amplify or enhance the listening process.
It does not prothestically enhance the faculty of the ears - in fact, in certain cases, such as when working on a noisy ward, if you haven't recently cleaned your ears or like Dr. Winter, you are a little hard of hearing, many of the noises you hear are not produced by the lungs.
Dr Graham Easton, on BBC radio last year, referred to the stethoscope as 'Guessing Tubes' and technically speaking, this is most accurate reproduction that I will make today.
In fact, even with the cleanest ears and the quietest ward, Lung sounds are so attenuated and filtered in transmission from their source to the stethoscope, that only a part of their total energy and frequency spectrum reaches the ear.
So not only do we not derive an improved faculty by using the stethoscope, but we also only ever hear the last gasp of the sounds, their decay as it were.
~
There are, then, a number of concepts at risk from this lack of fidelity:
When fidelity is constituted by the accurate reproduction of a sound source, what becomes of the stethoscope when the source it presents to us is never heard, when only a vestige, a footprint, a trace is left after being washed away in the turbulent vortices of the passages of the lung.
What then happens to that mass of lines that constitute Laennec's classifications, the rational linguistic system through which we engage with the sounds of the lung?
And what happens to the image of the doctor, incomplete without that ubiquitous aural accessory, when we know that the stethoscope is a fake, that it never delivers the entirety of what it purports to reveal.
That 'the window it places in the chest through which the precise state of things within can be seen' always first presents its own frame.
What if we should subject the veil of auscultation and its rationality to another method of auscultatory practice, succussion - the action of shaking the body to aurally determine its contents - would it throw up its secrets?
Given at ISEA Tallin, Estonia, 2004