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We are gathered here to mourn the loss of

the stethoscope. Once the very emblem of a physician, stethoscopes served healthcare professionals for almost 200 years before handheld ultrasound devices supplanted them. The stethoscope is survived by the long, white lab coat, and the old leather doctor's bag, which isn't doing so well itself these days.

Despite the stethescope's iconic status, use of the instrument has been on the wane for years. But this year might finally spell the end of the stethoscope, according to an editorial published today in Global Heart, the journal of the World Heart Federation.

"Stethoscopes may remain as a vestige, symbolic of what has become the archetype of the physician," says Bret Nelson, a professor of emergency medicine at Mount Sinai Hospital in New York City and coauthor on the editorial. "But there is almost nothing you can do with a stethoscope that you couldn't better visualize with an ultrasound machine."

They certain had a long run. Back before physicians routinely slung stethoscopes around their shoulders, doctors would place an ear directly on the patient. There is some mention of this practice, called immediate auscultation, in ancient Egyptian literature, Nelson says. And the Greek physician Hippocrates described listening directly to the abdomen and chest. But when Rene Laennec invented a wooden proto-stethoscope in 1816, the resulting amplification changed the course of medicine.

"Even when it was just a wooden tube, there was a quantum leap in the ability to distinguish lung sounds," Nelson says. Simple detection of heart and lung abnormalities allowed physicians who had once relied solely on symptoms to define disease based on actual, physical conditions. "Stethoscopes brought about a new level of physical examination, and the application of a more rigorous science to medicine," he says.

Stethoscopes have come a long way since Laennec's prototype made its debut. Manufacturers experimented with stylish ivory earpieces and chic velvet covers before settling on more Spartan rubber tubing and metal chest pieces. Since Littman set the industry standard with his eponymous model in the early 1960s, stethoscopes have remained largely unchanged.

But progress marches on, and the stethoscope met its match in the form of ultrasound. Portable ultrasound machines are now used for a broad spectrum of medical imaging and diagnostics, from the ambulance to the cardiac ward. A non-invasive, bedside diagnostic tool, handheld ultrasounds bring multimedia to the medical charts, while also guiding physicians during more invasive procedures. Portable ultrasound devices can snap photos of kidney stones and provide instant feedback on intravenous line placement. And the price tag on that tech is in rapid decline.

The last 20 years have seen ultrasound devices transition from bulky, $40,000 machines on wheels to $10,000 gadgets no bigger than an iPhone—partly due to investments by the Defense Advanced Research Projects Agency (DARPA) in ultrasound tech that could be deployed in the field. As more companies release their ultrasound devices, the cost may drop even further.

"In the next two years, maybe half a dozen companies are bringing devices of this size to the market," says Nelson. Once the price dips into the $2000 to 3000 range, Nelson suspects that individual physicians will begin swapping out their stethoscopes for small ultrasound machines.

It may be several years before ultrasound machines completely replace the physician's trusty stethoscope. But according to Nelson, the end is nigh. "It's not much different than leaps that we've seen in other technologies, like computers or cellular phones," he says.

Obsolescence comes for every gadget. Even a medical icon.

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