My stethoscopic body: medical and musical production of bodies

Introduction

Like a tale of “Choose Your Own Adventure,” research and creative practice are full of meaningful convergences and turning points, although these tend to be glossed over or omitted in formal accounts of a project that are oriented toward “outcomes.” (Rodgers 2012, 159)

 Artist and scholarly-method statements can render a messy process retrospectively neat, namely, when the linear progress narrative shows up as a project summary, and a mirage of solemn intentionality covers up occasions of improvisation and surprise. (Rodgers 2012, 160)

The stethoscope: a nexus of technology, sound, medicine, bodies. But what is the stethoscope as a technology in the sense of technology as practice (Franklin 1989), and what kind of knowledges and bodies does it produce? Compelling work has adopted this medical listening device as its object of study, thereby bringing into conversation medical history, technology studies, sound studies, philosophy of science, sociology of medicine, and anthropology of medical spaces and practices, of which Jonathan Sterne (2001), Charles Stankievech (2007), Tom Rice (2010; 2013), Axel Volmar (2013) and Anna Harris (2015) are salient examples. In choosing research-creation to approach the stethoscope, I seek to insert my own sound practice and body in this conversation, in order to also reflect, in the words of Tara Rodgers, ‘how art and research inform one another’ (2012, 155).  I started from a curiosity in finding out what kinds of bodily sounds I could hear from a stethoscope, and how I could record those sounds with a microphone in order to create a sound composition. I could have made an electroacoustic music piece and called it a day. However, research-creation compelled me to attend to the many questions raised throughout the process and about the process itself, fundamental questions about how and what knowledges are produced, what technology means, and how my body is produced and situated in relation to those questions. In the opening chapter of The Sound Studies Reader, Jonathan Sterne calls for sound students to “produce and transform knowledge about sound and in the process reflexively attend to the (cultural, political, environmental, aesthetic…) stakes of that knowledge production” (2012, 4). Reflexivity here implies that I position myself in relation to ‘what I want to know’ as well as attend to the ‘historicity’ of that knowledge (4). For this project, using composition was also a way for thinking through these questions, and situating this work in relation to others, while opening it up to musical possibilities.

As the quotes opening this paper underline, the process of research-creation is everything but neat, and neatness tends to comes from a retrospective ironing out of the wrinkles that formed along the way. With this in mind, I chose to actively cultivate and follow untidy “patterns and knots”(Rodgers 2012, 159) in research-creation work, highlighting their connections as the process offered moments of insight, while making sure that the wrinkles were there to enrich this account. The project and its process of making were shaped by a loop between reading-listening-recording-composing-writing, reflected also in the aesthetic choices within the sound composition. On the subject of looping and research-creation, Samuel Thulin writes: “we can think of processes of research-creation as continually feeding back into our ways of comprehending research-creation” (2015). Here, the dash between ‘research’ and ‘creation’, what happens between the two is a ‘strange loop’ that also questions the hierarchy between theory and practice (2015). Thus, I hope to retain such loopy patterns in the structure of this written account, which I structured through questions and ‘knots’ as they have shaped my process.

Starting point: How do I record my body with the stethoscope, a medical listening device?

(Auto-)auscultation in medicine

Once I acquired a stethoscope and before recording, the first step was auto-auscultation, auscultation practised on one’s own body. The Oxford Dictionary refers to auscultation as “the action of listening to sounds from the heart, lungs, or other organs, typically with a stethoscope, as a part of medical diagnosis.” The emphasis in the definition on diagnosis is important, as this is, as I will discuss, what constitutes the major epistemic assumption behind the stethoscope as medical listening device, framing who can listen, what to listen for, and how to interpret those sounds. The stethoscope was developed and popularized in Europe in the 19th century; it represented an insertion of a technology between patient and doctor (Sterne 2001, 117-123). Formerly, the latter would place an ear on the patient’s body, a practice called direct auscultation (122). With mediate auscultation facilitated by the stethoscope, sonic phenomena previously inaudible were not only made available to physicians’ senses with great clarity, it also meant that each of these ‘new’ sounds were to be made meaningful by physicians and their newly “increased powers of investigation” (120). The stethoscope was popularized in the context of a ‘separation of the senses’ in 18th and 19th century science and philosophy into their own distinct modalities and objects of knowledge, which shaped auscultation as a mode of ‘concentrated’ listening based on the isolation of hearing through the development of the binaural stethoscope (121). The mode of diagnosis, the ‘truth’ of medicine (Foucault 1980, 92-94), shifted from patients’ narrative descriptions of their own symptoms, to the internal sounds of their bodies, whereby physicians’ ability to access these sounds through the stethoscope, to train their ear to listen, and to apply empiric thinking to that mediate listening practice further established the physician as the ‘knower’, and the patient as the ‘known’ (Sterne 2001, 120-123). Moreover, the stethoscope, unlike direct auscultation, established a physical distance between the physician and the patient (120). The stethoscope as a technological practice (Franklin 1989) can therefore be posited as “the physical configuration of a particular form of knowledge” (Sterne 2001, 120) and therefore of power (Foucault 1980, 93), one which placed listening at the center of modern medicine and produced a ‘sounding body’ as site of that knowledge, one now made available for diagnosis (Sterne 2001, 115-120; Volmar 2013). 

In my use of the stethoscope however, the body being auscultated and the one listening were one and the same through auto-auscultation, without, as I will describe, the diagnostic aim of a medical framework. Few studies focused specifically on sound and medicine concentrate on practices of the self; notable examples are the ethnographic studies of Anna Harris (2015) on self-percussion – a clinical examination technique using tapping –and of Tom Rice (2013) on auto-auscultation. As Rice argues, auto-auscultation is an integral part of medical pedagogical practices and is encouraged by instructors in the early stages of the careers of medical students and novice doctors (2013, 37). As soon as I purchased a Littman Classic II SE, a standard model of stethoscope for medical students (Rice 2010, 294), I was curious to try it on myself after watching a brief YouTube tutorial on how to use it (Green 2009), feeling excited to briefly ‘step into’ a field in which I had never been more than a patient. As I previously mentioned, medical discourses tends to produce two bodies, the knower/perceiver/physician and the know/perceived/patient (Sterne 2001, 120-123), yet Harris argues that those bodies become blurred in the case of medical students who are encouraged to practice percussion and auscultation on their own bodies, an embodied practice with emphasizes – unlike previous constructions of the senses as separate – the ‘intertwining of the senses’ (2015, 4-6). A stomach’s growling sounds or a heart thumping become tactile events as well as sonic ones. Thus self-auscultation is an engagement with the body not as abstract, but as ‘my body,’ as it is experienced and felt by the perceiver, a situation in which one is at once inside and outside of themselves (Rice 2013, 137-138).

Furthermore, the bodies produced through self-percussion and self-auscultation become ‘experimental spaces’ crafted through ‘pedagogical events’ (Harris 2015, 22), and this experience can be both comforting as much as disquieting. As I was listening to the steady rhythm of my heart rate and my breath, I felt reassured and fascinated. But what if I had heard a sound that seemed stood out as odd, out of sync? Would I have resorted to a diagnostic model? The pedagogic model of self-auscultation in the context of medical school is also a mode of producing “a sense of what a ‘normal’ heart sounds like” (Rice 2013, 137), emphasizing an assumption and construction of future doctors as healthy and able-bodied (142) and the stethoscope as a medical tool charged with the potential of revealing abnormality, as produced by medical knowledge.

Critical making: the ‘stethoscophone’

After numerous auto-auscultation sessions, it came time to cut the rubber tube connecting the chest piece of my stethoscope to its headphones. This also marked the move away from the historicized medical aspects of the stethoscope, and towards its move into a sound recording device for compositional purposes. Although all kinds of electronic stethoscopes are starting to appear (Shuman 2015), the technical and creative challenge of amplifying an entirely acoustic pickup device that produces a very low sound signal from the physical vibrations of its diaphragm – the stethoscope – was a way for me to mobilize Matt Ratto’s notion of ‘critical making.’ The latter is understood as critical and scholarly reflection about the process, practices, relationships and things produced, simultaneously to the making process (Ratto and Boler 2014, 1-9). After numerous failed attempts with electret condenser microphones that produced no signal, and with a miniature Lavalier microphone that was defective, economic considerations and brainstorming with my partner lead to successfully connecting a dynamic microphone to the stethoscope. With its protective mesh removed, I connected an Audio-Technica ST90 MKII to the tube of the stethoscope by making a funnel with a piece of semi-rigid plastic packaging, abundantly sealing it with electrical tape for air-tightness, a requirement for the sound pressure transmitted to be picked-up from the vibrating diaphragm (Williams 1873, 23). I then connected what I will call the ‘stethoscophone’ via XLR through an external sound card and into Ableton Live 9, a digital audio workstation (DAW), a software for music recording, editing and production.

stethoscophone

Amplification and recording, dialog and improvisation

Not unlike my previous experiences with recorded soundwalking as described by soundscape composers and theorists Hildegard Westerkamp and Andra McCartney, the amplification of sound through a microphone and its affordances heightened certain sounds and affected which ones I converged to and how I moved as a recordist through the landscape, in my case, my own body. My process had a strong affinity to Westerkamp’s: “Rather than beginning with a defined objective (except that of listening), she reacted to interesting sounds, allowing her movements to be affected by events as they happened” (McCartney 2004, 182). Moreover, like for Westerkamp, McCartney and Pierre Shaeffer in the 1940s, what emerged in the process of recording was a “heightening of sound through touch and, conversely, touch through sound when using microphones” (181). The stethoscophone itself, given the necessity of pressing it against skin for it to transmit sound vibrations, was an intensely tactile experience which inevitably amplified handling sounds caused by my hands touching the recording device and moving its position. In the beginning, I tried avoiding such sounds but later opted to keep them, as I will discuss later. Settling on a particular site on the body and avoiding movement for the time of the recording allowed me to capture the heartbeats and the breath. By trying different locations, the neck was the place where the breath was loudest and clearest, which also revealed different sonorous cavities and spaces inside my body, like sounding boxes of acoustic instruments, producing my embodied presence as a ‘resonating body’ (Harris 2015, 17-21). Other sounds were the product of improvisation and chance. The wet, rolling sound of my stomach gurgling[1] is one that I provoked after first hearing it by surprise: I set the stethoscope against my stomach and quickly drank a glass of water which resulted in production of that sound. I thus discovered the sonorities of my body as amplified and framed by a both the stethoscope and the microphone, each with their particular affordances, and entered into active dialog with them.

Moving into composition: How do I keep the relation of the sounds to my body?

Ethics of place’ and studio transformation

Why in fact, would I want to retain a relation of the sounds to my body? For this, I turn to McCartney: “[s]oundwalks thus record a specific interaction with a place, one in which the microphone constructs a particular experience, and within which the recordist’s motion remains audible. These sounds trace the movements of everyday life, and are predicated on an ethics of place” (2004, 183-184, my emphasis). The stethoscophone allowed for the amplification and awareness of certain sounds, framing a particular interaction with the ‘place’ of my body. Abiding by an ‘ethics of place’ means cultivating and conveying an understanding of the ‘social, political and acoustic elements of a place before making a composition with sounds recorded in the place’ (McCartney 2006, 36). In Westerkamp’s view, sounds have their own agency, and compositional practice must demonstrate a mindful tension between sound manipulation and a respect for the context from which the sound was recorded (36). It follows that:

Studio transformation of sound, in Westerkamp's work, is intended not to divorce sound from its context in order to create a different symbolic world or narrative, but rather to emphasize certain aspects of the sound, to enhance the listeners' apprehension of, and their engagement with, the context of the work. Once again, there is a dialogue, this time inside the pieces: between the abstracted sounds that Westerkamp creates, and the original recordings that she listened to (34).

A similar tension between using too much manipulation or too little was an issue I encountered. For instance, the sound of my heartbeat, through the transduction of the microphone, produced a very low signal, barely perceptible through speakers. This problem called for a number of effects to be applied: ‘equalization’ to boost the low end of its frequencies, ‘gate’ to cut the distorted noise artefacts that were produced through transduction, and ‘compression’ to then boost the overall volume of the sound without those artefacts. I transformed the sounds enough so as to work with them compositionally and narratively in aesthetically compelling ways, without however processing them in ways which removed the connectedness to place. Like Westerkamp, my aim was to heighten the listener’s ‘apprehension and engagement with the piece.’ The ‘humming’ sound, derived from a very short sample of the heart beat that I looped[2], is perhaps the only sound which is not easily recognisable, and it meant as narrative sound which connotes to the idea of my body as perpetually sounding, and at low frequencies, which have a tactile quality.

Inspired by Westerkamp’s process and following McCartney’s ‘ethics of place,’ a compositional choice I made was to foreground sounds of handling[3] – that I initially considered undesirable – to frame the composition, looping them several times at the beginning, and playing the full sample at the end. Acknowledging both the materiality and the nature of the stethoscophone as a technique for both framing and producing a sonic interpretation of reality, this compositional gesture was also a way of accounting for tactility (of the recordist/composer’s hands, hence her presence, my presence) and its intimate relationship to sound as vibration (McCartney 2006, 182-184). Including tactility in the composition was a positioning against, on the one hand the ‘separation of the senses’ which medical discourses of the stethoscope promoted as previously discussed, and on the other, the technologically deterministic erasure the stethoscope as a framing tool in the process of auscultation (Sterne 2001, 123).

Another consideration: How do I make my body sounds musical?

I would like to return for a moment to Thulin’s idea of looping in reflecting on the notion of musicality. In my composition, all the sounds used are looped at least twice (see Annex A), only the sound of breathing is present as an extended sample (looped twice). All the other sounds a small sample selected from a longer recording, highlighting the looping, rhythmic aspects of my own body sounds, but also the constructed nature of mediation and composition. I used looping and repetition as an aesthetic effect, connecting my practice to a tradition dating back to musique concrète and extending into contemporary electronic dance music, with its particular technological affordances: the ‘Control + Cs,’ ‘Control + Vs’ and ‘control + Zs’ purveyed by DAWs, also a large part of my compositional process. Given my discussion and position on ‘ethics of place’, this might seems contradictory, yet as Thulin underscores, like composers of musique concrète, soundscape composers used looping and repetition, with the difference that although the latter retained a connection to place, and the former actively looked to sever it, focusing only on the ‘sonorous musical possibilities’ (2015). In looking to make my composition loopy and musical, I hoped that it opened future possibilities for this project to extend its connections into electronic (dance) music production. The idea of reusing the sound palette of this project to produce a piece of techno music came to mind many times, and subtly informed my approach as a point of tension with the ‘ethic of place.’ I thought: what is heart beat but a great bass drum? What is the growling of my stomach but a snare waiting to be sampeld? What is my breath but a perfect texture for dub-infused textures? Are these impulses really opposed to the ethics of place? In asking these questions, I was implicitly winking at Kraftwerk and their single Elektro Kardiogramm (2003), at Taana Gardner and her Heartbeat (1981), or at Japanese noise artist Aube and his Steal Up (1997), all of which make use, in different ways and genres, of the rhythm and sonic qualities of the human heartbeat, making ambiguous the relationship between recorded and synthesized. Through this project then, other parts of my creative practices were set in motion, even if to be fully mobilized in future iterations: DJing, electronic dance music production and performance, installation.

Conclusion

Our bodies always make sounds, they are ‘a hive of activity’ (Rice 2013, 138); the problem becomes interpreting those sounds, and to what epistemic purpose. Sound technologies, whether for listening, recording, production or playback are framing devices: never innocent and always partial, shaped not only by their material nature as artefacts, but also by the social practices that come to inform who can use them legitimately, and what kind of knowledges and bodies are thereby produced (Franklin 1989; Harris 2015).

My process for this project began in a similar way as a medical student first encountering a stethoscope: browsing what brand to purchase, consulting audiovisual materials and guides on how to use it, then experimenting with self-auscultation. The process moved away from a medical framing, and closer to a tradition of soundscape composition in which the ‘place’ was my body, and the sonic palette was recorded from it through a ‘stethoscophone’. The junction of those practices and frameworks was the process of making the stethoscophone, mangling both conceptually and practically the stethoscope, as tool of medicine, and the microphone, as instrument of soundscape composers (for more on mangling art and science methodologies, see Duff 2015).

Through this project, a process of ‘loopy’ research-creation (Thulin, 2015), I have reflected on the ways in which bodies are produced by the stethoscope as a medical listening technology, and how in turn I can produce a different kind of ‘stethoscopically’ mediated body, escaping medical diagnosis along the axis of normality/abnormality, health/sickness. By mobilizing ‘critical making’ to build the ‘stethoscophone,’ and then applying the ‘ethics of place’ of soundscape composers such as Westerkamp and McCartney in the process of recording and composition, I have produced a resonating, knowing, reflexive, tactile, musical body: my own.

December 2015.

References

Aube. 1997. Steal Up. CD. Alien8 Recordings.

“Auscultation.” 2015. Oxford Online. Accessed December 13. http://www.oxforddictionaries.com/definition/english/auscultation.

Drobnick, Jim, and Andra McCartney, eds. 2004. “Soundscape Works, Listening and the Touch of Sound.” In Aural Cultures, 179–85. Toronto, Ont. : Banff, Alta: YYZ Books ; Walter Phillips Gallery Editions.

Foucault, Michel. 1980. Power/knowledge: Selected Interviews and Other Writings, 1972-1977. Edited by Colin Gordon. 1st American ed. New York: Pantheon Books.

Franklin, Ursula. 1989. “The Real World of Technology.” presented at the Massey Lectures. http://www.cbc.ca/player/play/14195315.

Gardner, Taana. 1981. Heartbeat. 7“ vinyl/12” vinyl. West End.

Green, Todd. 2009. Medical Information: How Does a Stethoscope Work? eHowHealth. https://www.youtube.com/watch?v=nnfbOVjG3_4.

Harris, A. 2015. “Listening-Touch, Affect and the Crafting of Medical Bodies through Percussion.” Body & Society, November. doi:10.1177/1357034X15604031.

Kraftwerk. 2003. Elektro Kardiogramm. CD.

McCartney, Andra. 2006. “Gender, Genre and Electroacoustic Soundmaking Practices.” Intersections: Canadian Journal of Music 26 (2): 20. doi:10.7202/1013224ar.

Ratto, Matt, and Megan Boler, eds. 2014. DIY Citizenship: Critical Making and Social Media. Cambridge Massachusetts: The MIT Press.

Rice, Tom. 2010. “‘The Hallmark of a Doctor’: The Stethoscope and the Making of Medical Identity.” Journal of Material Culture 15 (3): 287–301. doi:10.1177/1359183510373985.

———. 2013. Hearing and the Hospital: Sound, Listening, Knowledge and Experience. Canon Pyon: Sean Kingston Publishing.

Rodgers, Tara. 2012. “How Art and Research Inform One Another; Or, Choose Your Own Adventure.” Canadian Journal of Communication 37 (1). http://www.cjc-online.ca/index.php/journal/article/view/2521.

Schuman, Andrew J. 2015. “Electronic Stethoscopes: What’s New for Auscultation.” Contemporary Pediatrics. February 1. http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/news/electronic-stethoscopes-what-s-new-auscultation.

Stankievech, Charles. 2007. “From Stethoscopes to Headphones: An Acoustic Spatialization of Subjectivity.” Leonardo Music Journal - (November): 55–59. doi:10.1162/lmj.2007.17.55.

Sterne, Jonathan. 2001. “Mediate Auscultation, the Stethoscope, and the ‘Autopsy of the Living’: Medicine’s Acoustic Culture.” Journal of Medical Humanities 22 (2): 115–36. doi:10.1023/A:1009067628620.

———. , ed. 2012. The Sound Studies Reader. New York: Routledge.

Thulin, Sam. 2015. “Looping Research-Creation.” NMC/Media-N, Journal of New Media Caucus 11 (3): n.p.

Volmar, Axel. 2013. “Sonic Facts For Sound Arguments: Medicine, Experimental Physiology, and the Auditory Construction of Knowledge in the 19th Century.” Journal of Sonic Studies 4 (1). http://journal.sonicstudies.org/vol04/nr01/a13.

Williams, Charles J. B. 1873. “On the Acoustic Principles and Construction of Stethoscopes and Ear Trumpets.

[1] Starting at 00:23 and ending at 00:40 in the composition.

[2] Starting at 00:11 and ending at 00:37 in the composition.

[3] Starting at 00:00 and ending at 00:25, then starting again at 01:34 and closing the piece at 01:38