Feb 172019
 

Today is the birthday (1781) of René-Théophile-Hyacinthe Laennec, a French physician who invented the stethoscope in 1816, while working at the Hôpital Necker, and pioneered its use in diagnosing various chest conditions. Laennec was born in Quimper in Brittany. His mother died of tuberculosis when he was five years old, and he went to live with his great-uncle the Abbé Laennec. As a child, Laennec became ill with chronic fatigue, repeated fever, and possibly asthma. At the age of 12, he went to Nantes, where his uncle, Guillaime-François Laennec, worked in the faculty of medicine at the university. He learned English and German and began his medical studies under his uncle’s direction.

His father (a lawyer) later discouraged him from continuing as a doctor and René then had a period of time where he took long walks in the country, danced, studied Greek and wrote poetry. However, in 1799 he returned to study. Laennec studied medicine at the University of Paris under several famous physicians, including Dupuytren and Jean-Nicolas Corvisart-Desmarets. There he was trained to use sound as a diagnostic aid. Corvisart advocated the re-introduction of diagnostic percussion during the French Revolution. At the time, doctors put their ears to a patient’s chest (direct auscultation) to listen for chest sounds.

In De l’Auscultation Médiate (1819) he wrote:

In 1816, I was consulted by a young woman laboring 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 [direct auscultation] being rendered inadmissible by the age and sex of the patient, I happened to recollect a simple and well-known fact in acoustics, the great distinctness with which we hear the scratch of a pin at one end of a piece of wood on applying our ear to the other. Immediately, on this suggestion, I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and 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 the immediate application of my ear.

Laennec is said to have seen schoolchildren playing with long, hollow sticks in the days leading up to his innovation. The children held their ear to one end of the stick while the opposite end was scratched with a pin, the stick transmitted and amplified the scratch. His skill as a flautist may also have inspired him. He built his first instrument as a 25 cm by 2.5 cm hollow wooden cylinder, which he later refined to comprise three detachable parts. The refined design featured a funnel-shaped cavity to augment the sound, separable from the body of the stethoscope.

His clinical work allowed him to follow chest patients from the first onset of illness to recovery or death. He was therefore able to correlate sounds captured by his new instruments with specific pathological changes in the chest, pioneering a new non-invasive diagnostic tool. Pulmonary phthisis, for example, was one ailment he could more clearly identify using his knowledge of typical and atypical chest sounds. Laennec was the first to classify and discuss the terms rales, rhonchi, crepitance, and egophony – terms that doctors now routinely use in physical exams and diagnoses. Laennec presented his findings and research on the stethoscope to the Academy of Sciences in Paris, and in 1819 he published his masterpiece, De l’auscultation médiate ou Traité du Diagnostic des Maladies des Poumon et du Coeur.

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). He named his instrument the stethoscope, from the Greek words στήθος [stethos] (chest), and σκοπός [skopos] (examination). The stethoscope quickly gained popularity as De l’Auscultation Médiate was translated and distributed across France, England, Italy and Germany in the early 1820s. However, not all doctors readily embraced the new stethoscope. Although the New England Journal of Medicine reported the invention of the stethoscope two years later in 1821, as late as 1885, a professor of medicine stated, “He that hath ears to hear, let him use his ears and not a stethoscope.” Even the founder of the American Heart Association, L. A. Connor (1866–1950) carried a silk handkerchief with him to place on the wall of the chest for ear auscultation.

Laennec often referred to the stethoscope as “the cylinder,” and as he neared death only a few years later, he bequeathed his own stethoscope to his nephew, referring to it as “the greatest legacy of my life.” He also worked on the understanding of peritonitis and cirrhosis. Although the disease of cirrhosis was known, Laennec gave cirrhosis its name, using the Greek word (kirrhos, tawny) that referred to the tawny, yellow nodules characteristic of the disease. He coined the term melanoma and described metastases of melanoma to the lungs. In 1804, while still a medical student, he was the first person to lecture on melanoma. This lecture was subsequently published in 1805. Laennec actually used the term ‘melanose,’ which he derived from the Greek (melan) for “black.” Over the years, there were bitter exchanges between Laennec and Dupuytren, the latter objecting that there was no mention of his work in this area and his role in its discovery.

He also studied tuberculosis. Coincidentally, his nephew, Mériadec Laennec, is said to have diagnosed tuberculosis in Laennec using Laennec’s stethoscope. Laennec wrote A Treatise on the Disease of the Chest, in which he focused on diseases of the chest such as Phthisis pulmonalis and diagnostics such as Pectoriloquy. He discussed the symptoms of Phthisis pulmonalis and what parts of the body it affects. Laennec ought to be a household name given the profound advances in medicine that the stethoscope afforded, yet I guarantee that not even medical students know it. The stethoscope is just taken for granted as a basic and essential tool.

Since Laennec was from Brittany, I can use that as an excuse to give one of my favorite Breton recipes – cotriade – a fish and potato soup. Use whole fish cut in large pieces and not fillets and use at least three different kinds of fish.

Cotriade

Ingredients

80 gm/ 3 oz butter
1 onion, peeled and chopped
1 leek, chopped
2 garlic cloves, peeled and chopped
3 sprigs thyme
6  medium potatoes, peeled and quartered
1 liter cold water
salt and freshly ground pepper
1½ kg / 3 lb whole fish (monkfish, flathead, john dory, whiting), cleaned and cut into 3 cm/ 1 in pieces
12 mussels
chopped fresh parsley

Instructions

Heat the butter in a large saucepan. Add the onion and stir for 2 minutes. Add the leek and garlic and stir for a further 2 minutes. Add the thyme and potatoes and stir for another minute. Cover with 1 liter of cold water, season with salt and pepper, bring to the boil and cook for 5 minutes. Add the fish pieces, reduce the heat, and simmer for about 5 minutes.

Add the mussels, cover with a lid and cook for 2-3 minutes until the mussels have opened.

Serve the cotriade in large bowls with a sprinkle of chopped parsley and crusty bread.

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