Rene-Theophile-Hyacinthe Laennec (1781-1826), the French physician hailed as the father of thoracic medicine, forever transformed the diagnosis of chest disease through his invention of the stethoscope. His creative genius and tireless dedication to medicine have resulted in much of our modern day understanding of pathology.
Rene Laennec's contributions to the medical world were many. His commitment to keen listening (perhaps inspired by his training as a flutist) and careful observation of the patient allowed him to recognize diseases like pneumonia that had been previously overlooked or misdiagnosed, and were historically deadly. His most classic publication is a book entitled De l'Auscultation Mediate (On Mediate Auscultation, also referred to as the Treatise). Although he was most famous for his discovery of "mediate auscultation" (a term he coined, referring to the use of an instrument, or mediator that allowed one to hear sounds within the human body), Laennec also published thousands of pages and gave hundreds of lectures reflecting his lesser-known findings. Among other things, he showed the existence of the skin tumors we know as melanomas, described the role that organ tissues play in disease, named the liver disease we now know as cirrhosis, and showed that tuberculosis was marked by lesions called tubercles that could be found in any of the body's organs. Ironically, despite his vast knowledge and unfailing commitment to the study of disease, Laennec was himself a victim of the "white death" of tuberculosis, and died at the age of 45.
Britanny, The Early Years
Rene Laennec was born to Michelle and Theophile Laennec in the Breton country town of Quimper, France on February 17, 1781. During his early childhood he suffered the loss of his mother to tuberculosis, and was sent off by his father to live with various family members. In a small way, this period of his life mirrored the tumult of the approaching French Revolution. Only six years old at the time of his mother's death, the young Laennec (along with his brother, Michaud) was soon placed in the care of an uncle, Dr. Guillaume Laennec. The man who raised the young boys in the nearby town of Nantes was a dedicated caregiver and highly respected doctor at the Hotel Dieu. He encouraged and influenced his nephew's life and medical studies, which started at the age of 14.
Living in Nantes during the last decade of the 18th century placed Laennec in the heart of the land of revolution. As Paul Kligfield, M.D. wrote in The American Journal of Medicine, "His childhood in Nantes was spent amidst the turbulence of the [French] Revolution and subsequent chaos of the [Reign of] Terror, and Laennec pursued his early academic studies in the shadow of a nearby guillotine." From his window, the young student probably witnessed 50 out of the 3,000 executions that occurred in Nantes. Despite the grim reality of a nation in upheaval, Laennec successfully continued his diligent schooling, and decided to make medicine his profession. He did briefly consider a career in engineering and might have been swayed by his father's encouragement towards more prestigious endeavors than becoming a physician, but his admiration for his uncle as well as his deep interest in nature drew him towards medicine. One wonders if his mother's deadly illness and the sight of so many beheadings might not also have motivated his choice. Laennec studied chemistry and physics, Greek, Latin, art, dancing, and even learned how to play the flute-a talent which may have had a pivotal role in his future discovery of the stethoscope.
Laennec was a painfully gaunt, diminutive man (his full height was 5 ′ 3 ″ ). The first signs of his physical weakness appeared in the spring of 1798, when he was 17. His studies and hard work were taking their toll, and he suffered from a prolonged fever accompanied by exhaustion and difficulty breathing. He finally recovered from the illness with a strong determination to follow his calling as a healer. He spent the next few years taking small jobs, treating those who had been wounded during the French civil war, and finally got his break in April of 1801 when his father gave him 600 francs. It was then that he began his 200-mile walk to Paris. The ten exhausting days on foot were a small price to pay for Laennec, who was on his way to realizing his dream.
Paris, Student Days
Upon his arrival in Paris, Laennec wasted no time enrolling as a medical student in the city's finest hospital, the Charite. There he began working with the greatly renowned teacher, Jean-Nicolas Corvisart, who went on to become the emperor Napoleon Bonaparte's personal physician in 1804. Corvisart's approach to medicine was radically objective, focussing on observing diagnostic signs and discovering their relationship to disease. Laennec's training was marked by the principle, "Read little, see much, do much." He was often found in the dissecting room during post-mortem examinations or on daily rounds with his teacher. His fervent work paid off, and he was honored with two highly coveted distinctions. First, he was invited by his instructors to join the Societe d'Instruction Medicale (in which students critiqued one another's clinical and autopsy work) and then he passed the selective examination that allowed him entrance into a medical training program for special students at the Ecole Pratique.
In 1802, when he was 21, Laennec started publishing important scientific papers on a variety of topics, including one on peritonitis (inflammation of the abdominal cavity's lining) that Nuland referred to as, "an epochal contribution." In 1803 he was honored by the government with First Prize in Medicine and Sole Prize in Surgery. Laennec continued to suffer from shortness of breath, an indication of progressing tuberculosis, which the young medical student attributed to asthma. Despite his sickness, or ironically because of it, he continued with his relentless work, teaching private classes on pathology in which he first defined the tubercle as the small lump whose presence signified the existence of tuberculosis. Laennec's successes continued one right after another, and his doctoral thesis on the relationship of the ancient Greek Hippocratic doctrine to practical medicine was accepted in 1804. He was elected to the Societe de l'Ecole de Medecine, formerly the Royal Society of Medicine, and became an editor and contributor to the esteemed Journal of Medicine, Surgery, and Pharmacy. The time had come for Laennec to begin developing his own private practice. Then, in 1810, Laennec's life was shaken by the death of yet another loved one who had succumbed to tuberculosis. This time it was his brother Michaud. The disease seemed to pervade every aspect of the young physician's life, yet he still denied the fact of his own illness even when he began experiencing chest pains.
Invented the Stethoscope
After a couple of years of building his private practice, Laennec was finally offered an academic post in 1816. He had been waiting for a prestigious institution to accept him as a physician, but he instead found himself situated at Hospital Necker-a small facility with a poor reputation. It was there, however, that Laennec was to make history through his invention of the stethoscope. In his Treatise, Laennec described the pivotal moment thus, "In 1816, I was consulted by a young woman labouring under general symptoms of diseased heart, and in whose case percussion and the application of the hand were of little avail on account of the great degree of fatness. The other method just mentioned [the application of the ear to the chest] being rendered inadmissable by the age and sex of the patient, I happened to recollect a simple and well-known fact in acoustics, and fancied, at the same time, that it might be turned to some use on the present occasion." Laennec's recollection alluded to the way in which sound is amplified when transmitted through certain solid objects. He proceeded to roll up a quire (24 sheets of paper) into a cylindrical tube and place one end of it to the woman's chest. He wrote, " [I] was not a little surprised and pleased to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by immediate application of the ear."
He named the new instrument "stethoscope," based on the Greek words stethos (meaning chest) and skopos (observer). Usually, however, Laennec referred to it simply as le Cylindre, and made a more permanent wooden version that was designed to come apart into two segments. As Sherwin B. Nuland stated in his book Doctors: The Biography of Medicine, "Here was a tool that taught the healer that [s]he could separate the objective evidences of his [or her] own senses from the subjective responses of a sick person, and that [s]he could do it while the person was still living." In the autopsy room, Laennec could see the abnormality that was responsible for the sounds he had heard.
Laennec's embarrassment at the prospect of getting too close to the female anatomy of an attractive young woman may have motivated his invention at that moment, but he had long since been aware of another method of physical diagnosis which preceded and set the stage for his discovery of mediate auscultation. In 1761, the Austrian physician, Leopold Auenbrugger described percussion for the first time in his Inventum Novum. The text was a brief pamphlet that was translated into French and popularized by Laennec's own teacher, Corvisart, almost 30 years later. Auenbrugger invented the thumping technique which doctors use to determine whether the underlying area of either the chest or abdomen holds a hollow or solid structure. His background as an innkeeper's son (tapping on beer kegs to see how full they were) and a musician gave him the necessary knowledge and experience with resonance, pitch, and tonal quality to understand how to tap out the differences in tissue density. Auenbrugger's story of inventing percussion is not unlike Laennec's. Both men found creative methods of diagnosis by employing their highly trained ears in order to gain a clearer picture of the body's interior.
Following his great discovery, in 1819 Laennec published the famous Treatise. In it, he described the results of experiments he had done with the stethoscope. The two-volume work, which was received with mixed reviews, was often sold along with the new instrument Soon Laennec's teachings were widely known and had gained respect all over the Western world. Unfortunately, Laennec was unable to enjoy the accomplishment of his widely acclaimed masterpiece in good health. The writing of the book had fully exhausted him, and a month before publication he was forced to resign his hospital post and give up his practice. Laennec left Paris and arrived on October 8, 1819 at the small family estate in the Breton countryside called Kerlournec. He spent two years living the life of a country squire: taking walks and horseback rides, providing medical care to neighboring farmers, going to church, and practicing his Breton speech.
In November of 1821, Laennec's highly driven nature got the better of him once again, and he found himself back in Paris, resuming his old life as a physician and academic. A series of huge professional successes followed. Within a year he was appointed sole professor of medicine and royal lecturer at the College de France. In 1823 he was elected a full member of the Academy of Medicine, and in 1824 he became a knight of the Legion of Honor. He moved his clinical work to the Charite, the hospital where he had been a medical student, and became a highly reputed teacher, not unlike his mentor, Corvisart. He was largely responsible for making Paris the world's hub of medical study, as hundreds of international students gathered at the Charite in order to attend lectures, work with him in the autopsy room, and make hospital rounds.
Returned to Brittany
Laennec's physical well-being was rapidly deteriorating along with his increased fame. On December 16, 1824, at the age of 43, he married the widow Jaqueline Argou, who had previously been his housekeeper. Less than a year later, she was pregnant, and Laennec was excitedly planning for his first child. Only a few months into the pregnancy, however, Mme. Argou lost the baby. This hard blow, along with the added stress of creating the second edition of his Treatise, was too much for Laennec to handle. On April 20, 1826 he drew up his will after being diagnosed by his nephew, Meriadec Laennec, who heard the fateful sounds of tuberculosis by using Laennec's stethoscope. He left Paris for the last time on May 30 when he returned home to beloved Brittany.
During his last days Laennec had added a codicil to his will, bequeathing his stethoscope, which he referred to as, "the best part of my legacy," to his nephew. Like so many he had known and loved, Laennec was killed by tuberculosis—a disease which he understood like no physician before him. Regardless of his ever-present sickness, he dedicated his life to knowledge and healing. His Uncle Guillaume once told him, "Our calling is like a set of chains that one must carry at all hours of the day and night."
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