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It is opposed to immediate auscultation, directly placing the ear on the body.
Originally, there was a distinction between immediate auscultation (unaided) and mediate auscultation (using an instrument).
Immediate auscultation is an antiquated medical term for listening (auscultation) to the internal sounds of the body, directly placing the ear on the body.
Laennec coined the phrase 'mediate auscultation', (indirect listening) as opposed to the popular practice at the time of directly placing the ear on the chest (immediate auscultation).