Comment on how the author’s word choices convey both the scientific and the literary

approaches to the topic.

Before stethoscopes were invented, physicians would listen to their patients’ hearts by laying one ear
directly onto the skin of the chest. We’re accustomed to laying our heads against the breasts of our
lovers, our parents or our children, but once or twice when I’ve rushed out on an urgent house call,
leaving my stethoscope behind, I’ve had to rediscover the traditional method. It’s an odd sensation –
intimate yet detached – to apply your ear to the chest of a stranger. It helps if you stick a finger in the
unoccupied ear. Once you tune out all the background noise you begin to hear the sound of blood as it
makes its way through the chambers and valves of the heart. The classical belief was that blood travelled
to the heart in order to be mixed with vital spirit, or pneuma, rarefied from the air by the lungs. The
ancients must have imagined a churning within; air frothing with blood the way wind whips up waves on
the sea. The first time I placed my ear to a patient’s chest I was reminded of holding a conch shell as a
child, listening to the imagined ocean within. When any fluid is forced through a narrow opening there is
turbulence, and just as a river flooding through a narrow canyon can be deafening, turbulence within the
heart generates noise. Medical students are trained to listen very closely to the subtleties of those noises,
and to infer from them how narrow – or obstructed – are the canyons of the heart. There are four valves in
the human heart. When they close, you hear two separate sounds. The first sound is made as the two
largest valves – the mitral and the tricuspid – close at the same time during the active part of the beat
(known as the ​systole)​ , when blood is forced out of the ventricles and into the arteries. These valves are
so broad they have thick cords like harp strings attached to their cusps to reinforce them. The second
sound is made by the other two valves – the pulmonary and aortic – as they prevent backflow whilst the
ventricles refill (​diastole​). Healthy cardiac valves close with a soft percussive noise, like a gloved finger
tapping on a leather-topped desk. If they are stiffened or incompetent there are additional sounds:
murmurs that can be high-pitched or low, loud or soft, depending on the steepness of the pressure
gradient across the diseased valve, and how turbulent the flow.
Starting out in medicine I learned to tell the difference between valve pathologies by listening to a
CD of murmurs. I’d put it on while studying, hoping that my subconscious would come to distinguish a
‘seagull’ from a ‘musical’ murmur, recognise the grate of mitral regurgitation from the trill of aortic
stenosis. There was something comforting in listening to the gurgle of blood as I worked. I wondered if it
recalled the sound of the sea, or hearing a storm outside while wrapped up warm, but the sounds were
too rhythmic for that. Perhaps it’s the womb, I thought, a deep memory of my mother’s pulse.
A pregnant woman came to my clinic who hadn’t felt her baby move for a day or so, and wanted
me to reassure her by listening to its heartbeat. Normal stethoscopes are no use for listening to the
heartbeat of a baby in the womb; the sound is too fast, quiet and high-pitched. Midwives often use an
electronic Doppler probe to find the foetal heart, but I used a modified tube called a Pinard stethoscope,
like an old-fashioned ear trumpet, wedged between one ear and the swollen contour of the woman’s belly.
The best place to lay the trumpet is where you think you’ve felt the convex curve of the baby’s spine.
Even with one finger in my other ear it took a while to find the heart – an agonising couple of minutes for
the mother. But there it was: a rhapsodic, syncopated interleaving​1​ of her heartbeat with her baby’s. The
foetal heartbeat was distinct, fluttering fast like a bird over the oceanic swell of the mother’s pulse, an
allegro​ played over an ​adagio​. I paused for a moment listening to the two rhythms within one, two lives
within one body.

Gavin Francis, in the ​London Review of Books2​​ (6 March 2014). Used with permission.

1
rhapsodic, syncopated interleaving: an interplay of sounds
2
London Review of Books: literary magazine with book reviews and topical articles on politics,
history, science and the arts
Comment on how the author’s word choices convey both the scientific and the literary
approaches to the topic.

Text 1, an expository-essay article by Gavin Francis written in the ​London Review of Books​ in
2014; the book is a literary magazine containing articles and book reviews on politics, history,
science and the arts, thus, aims towards readers with a broader approach to learning and
discovering new academic topics. He explores the sensational aspect of listening and
interpreting the human heart within his patients. Francis uses stylistic devices, such as semantic
and lexical fields, phonetics and archaic language, to effectively convey his message to the
readers that traditional methods in examining the cardiovascular system is still the most intricate
and best method.

Francis uses metaphors and similes to link semantic fields in nature, music and medical science
together to engage his readers to the traditional methods of detecting heartbeats and flow of
blood. For example, he wrote “like a bird over the oceanic swell of the mother’s pulse, an ​allegro
played over an ​adagio​.” The simile used provides imagery to the audience and further
persuades the reader to fantastical capabilities of using a traditional instrument, which
outweighed the dull and materialistic modern instruments. The semantic fields relating to music,
such as ‘allegro’ and ‘adagio’ is interwoven with semantic field of nature such as ‘a bird over the
oceanic swell of the mother’s pulse’ because both phrases describes the same meaning
(overlapping of pulsating sounds in the mother’s womb), but the second phrase is restated to
link with topic of music instead. This technique mimicked the notion of the same meaning by
overlapping semantic fields too, ensuring the reader to notice the multiperspective a doctor sees
when using a traditional pinard stethoscope, proving its imaginetory capabilities over a normal
stethoscope. Secondly, He uses metaphors when he wrote “I wondered if it recalled the sound
of the sea, or hearing a storm outside while wrapped up warm,” ‘it’ refers to the heart, and he
metaphorically symbolizes the blood gushing out as a storm outside the heart and juxtaposes
the ‘storm’ with the flesh that surrounds the heart to be ‘wrapped up warm’ from the chaos
happening outside. Francis also personifies the heart as if it is able to think and have a mind of
its own as wrote “I wondered if it recalled…” suggesting that the heart has the ability to recall
memory like Francis’s own personal anecdote of his own mother’s pulse. The metaphor and
personification was to dive the readers into a first-person perspective in his job, whilst
describing the traditional methods and its effectiveness in displaying intricate detail within the
medical process. As if the readers got first hand experience in utilising the traditional method,
further promoting the practicality of the method.

Francis also uses lexical fields to refer closely to medical science and human anatomy. The
lexical field within the use of body part diction such as, ‘ear’, ‘skin’, ‘chest’, ‘heads’ and ‘breasts’
suggests the perplexity of the human body and how traditional methods of using the human
senses can detect even the most perplexed body part: the human heart. For example, he wrote
“It’s an odd sensation – intimate yet detached – to apply your ear to the chest of a stranger.”
The ‘ear’ is a key body part in determining the sounds of the body, thus, Francis emphasises the
sensual and sensational feeling that comes with the traditional method of hearing. He describes
the process to be almost sexual and alluring, as you want to listen to the inside of someone’s
body but a layer of skin blocks your interference. As we all know human response to sexual
pleasure is enticing, thus, Francis uses captivating language to lure the readers in feeling the
Comment on how the author’s word choices convey both the scientific and the literary
approaches to the topic.

intimacy too by exploiting this human psychological weakness; this technique is largely archaic,
when seduction and sexual appeal was entertainment that captivates an audience. The
continuation of the lexical field in body parts (e.g ear and chest) allows the reader to further
understand the situation by imagining their own ear or chest on a stranger. The poetic and
sensual approach to the language promotes use of the traditional method as if the method is the
gateway to these guilty pleasures. Furthermore, the use of lexical archaism such as ‘Midwives’
and ‘vital spirit’ further emphasises the old-fashioned traditional method that Francis is trying to
promote. Francis did not wrote ‘nurse’ or ‘surgeon’ but ‘midwives’ and he wrote ‘vital spirit’ than
‘cardiovascular system’, this creates the notion of poetry and beautifying the language used to
conform to the literary magazine format, but most importantly showcase the traditional methods
of detecting heartbeat and flow of blood. Also, the use of medical jargon to depict his medical
skills and wisdom, for example, “(known as the ​systole​)” or “(​diastole)​ .” however, Francis wrote
them in brackets as if they are lesser-known or new words that should be introduced instead of
flowing with his writing. Most modern journals and research articles have terminologies mixed in
with the flow of their writing and only new words in the academic field are presented in brackets.
Therefore, Francis must of did it on purpose to illustrate the archaic writing style as if he was a
scientist in the 18th century and only first discovered these words in his research and study of
the human heart. This further accentuates the promotion of traditional methods in examining the
heart.

Francis also uses phonetics in his language to effectively convey the sounds of hearing the
heart using traditional instruments and methods. Francis uses sibilance many times at the first
paragraph, for example, “physicians would listen to their patients’ hearts by laying one
ear directly onto the skin of the chest. We’re accustomed to laying our heads against the
breasts of our lovers, our parents or our children, but once or twice when I’ve rushed out on an
urgent house call, leaving my stethoscope behind,” the sibilant consonant in the words
‘physicians’, ‘listen’, ‘patients’’, ‘hearts’, ‘skin’, ‘chest’, ‘accustomed’, ‘heads’, ‘against’, ‘breasts’,
‘lovers’, ‘parents’, ‘once’, ‘twice’, ‘rushed’ and ‘stethoscope’ are all producing a hissing sound
when the consonance is pronounced. There are also assonances, for example in ‘hearts’,
‘chest’ and ‘heads’ with stressing of the vowel consonant sound ‘e’. The sibilance within these
words resembles the movement of water and blood, how natural water streams meander
through the land, linking with how blood meanders through our flesh in the form of blood vessels
- like the shape of the letter ‘s’. The hissing sound created also provides a sense of
seductiveness, where I unpacked in paragraph 2. The repetition of the ‘s’ sound accentuates
connection with music and the topic of article ‘stethoscope’, Francis introduces and excites
fundamental sense of hearing to the audience right at the beginning by incorporating phonetics
into his language and writing, foreshadowing the focus and purpose of listening to the human
heart with traditional methods. Proving to the audience that traditional methods can bolster our
sense of hearing and is fun too! Also the climax created from ‘....our lovers, our parents or our
children,...’ demonstrates the life journey of one's romance, further foreshadowing the sensual
and seductive effect of using traditional methods and his paragraph on a pregnant woman. The
climax brings the reader back down to our natural evolutionary instincts and purpose: finding a
partner and reproduction. The returning of one’s self to its roots and basic human instincts,
Comment on how the author’s word choices convey both the scientific and the literary
approaches to the topic.

further emphasis the archaic language used and re-establish the use of traditional methods of
looking in the heart. Onomatopoeia is also used, when he wrote “air frothing with blood the way
wind whips up waves on the sea.” The word ‘frothing’ sounds similar to the action, and the
alliteration in ‘the way wind whips up waves….” demonstrates how sounds make up many of our
way of life and the way of the natural world; over the culmination of new technologies, old
methods are discarded. Sounds symbolise the old-world as humans rely on our own senses to
determine the world around us - whereas modern technology has A.I. and computation
algorithms that do the work. Francis makes an effort to re-establish these old-methods by using
sounds to engage the audience’s senses and promote the effectiveness of traditional
instruments in listening to the heart.

In conclusion, Francis uses semantic and lexical fields, phonetics and archaic language to
demonstrate the importance of traditional methods in detecting heartbeat and flow of blood.
Francis advocates the superiority in effectiveness of treatment and intriguing process within use
of traditional methods. He mystifies the human body and opens the mindset toward medical
science and human anatomy through his creative writing style and re-establishing old ways in
detecting the heart, but also with his language too.