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.

Jan 292019
 

Today is the feast day of St Gildas  — also known as Gildas the Wise or Gildas Sapiens — a 6th-century British monk best known for his scathing religious polemic De Excidio et Conquestu Britanniae, which recounts the history of the Britons before and during the coming of the Saxons. He is one of the best-documented figures of the Christian church in the British Isles during the period after the Romans had left when Celts and Anglo-Saxons were battling for control of territory, and was renowned for his Biblical knowledge and literary style. In his later life, he emigrated to Brittany where he founded a monastery known as St. Gildas de Rhuys.

Differing versions of the life of Gildas exist, but they agree that he was born in what is now Scotland on the banks of the River Clyde, and that he was the son of a royal family. However, these works were written in the 9th and 12th centuries and are regarded by scholars as historically inaccurate. Gildas is now thought to have been born further south. In his own work, he claims to have been born the same year as the Battle of Mount Badon. He was educated at a monastic center, possibly Cor Tewdws under St. Illtud, where he chose to forsake his royal heritage and embrace monasticism. He became a renowned teacher, converting many to Christianity and founding numerous churches and monasteries throughout Britain and Ireland. He is thought to have made a pilgrimage to Rome before emigrating to Brittany, where he took on the life of a hermit. However, his life of solitude was short-lived, and pupils soon sought him out and begged him to teach them. He eventually founded a monastery for these students at Rhuys, where he wrote De Excidio Britanniae, criticising British rulers and exhorting them to put off their sins and embrace true Christian faith. He is thought to have died at Rhuys, and was buried there.

The first life of St. Gildas was written in the 9th century by an unnamed monk at the monastery which Gildas founded in Rhuys in Brittany. According to this account, Gildas was the son of Caunus, king of Alt Clut in the Hen Ogledd, the Brythonic-speaking region of northern Britain. He had four brothers; his brother Cuillum ascended to the throne on the death of his father, but the rest became monks. Gildas was sent as a child to the College of Theodosius (Cor Tewdws) in Glamorgan, under the care of St. Illtud, and was a companion of St. Sampson and St. Paul of Léon. His master St. Illtud loved him and taught him with special zeal. He was supposed to be educated in liberal arts and divine scripture, but elected to study only holy doctrine, and to forsake his noble birth in favor of a religious life.

After completing his studies under St. Illtud, Gildas went to Ireland where he was ordained as a priest. He returned to his native lands in northern Britain where he acted as a missionary, preaching to the pagan people and converting many of them to Christianity. He was then asked by Ainmericus, high king of Ireland (Ainmuire mac Sétnai, 566–569), to restore order to the church in Ireland, which had altogether lost the Christian faith. Gildas obeyed the king’s summons and traveled all over the island, converting the inhabitants, building churches, and establishing monasteries. He then traveled to Rome and Ravenna where he performed many miracles, including slaying a dragon while in Rome. Intending to return to Britain, he instead settled on the Isle of Houat off Brittany where he led a solitary, austere life. At around this time, he also preached to Nonnita, the mother of Saint David, while she was pregnant with the saint.

He was eventually sought out by those who wished to study under him, and was entreated to establish a monastery in Brittany. He built an oratory on the bank of the River Blavetum (River Blavet), today known as St. Gildas de Rhuys. Fragments of letters that he wrote reveal that he composed a Rule for monastic life that was somewhat less austere than the Rule written by Saint David. Ten years after leaving Britain, he wrote an epistolary book in which he reproved five of the British kings. He died at Rhuys on 29th January 570, and his body was placed on a boat and allowed to drift, according to his wishes. Three months later, on 11th May, men from Rhuys found the ship in a creek with the body of Gildas still intact. They took the body back to Rhuys and buried it there.

The second life of St. Gildas was written by Caradoc of Llancarfan, a friend of Geoffrey of Monmouth and his Norman patrons. Llancarfan’s work is most probably historically inaccurate, as his hagiographies tend towards the fictitious, rather than the strictly historical. Llancarfan’s life of Gildas was written in the 12th century, and includes many elements of what have come to be known as pseudo-histories, involving king Arthur, Guinevere, and Glastonbury Abbey, leading to the general opinion that this “life” is less historically accurate than the earlier version. For example, according to the dates in the Annales Cambriae, Gildas would have been a contemporary of king Arthur: however, Gildas’ own work never mentions Arthur by name, even though he gives a history of the Britons, and states that he was born in the same year as the Battle of Badon Hill, in which Arthur is supposed to have vanquished the Saxons.

In the Llancarfan life, St. Gildas was the son of Nau, king of Scotia. Nau had 24 sons, all victorious warriors. Gildas studied literature as a youth, before leaving his homeland for Gaul, where he studied for seven years. When he returned, he brought back an extensive library with him, and was sought after as a master teacher. He became the most renowned teacher in all of the three kingdoms of Britain. Gildas was a subject of  king Arthur, whom he loved and desired to obey. However, his 23 brothers were always rising up against their rightful king, and his eldest brother, Hueil, would submit to no rightful high king, not even Arthur. Hueil would often swoop down from Scotland to fight battles and carry off spoils, and during one of these raids, Hueil was pursued and killed by king Arthur. When news of his brother’s death reached Gildas in Ireland, he was greatly grieved, but was able to forgive Arthur, and pray for the salvation of his soul. Gildas then travelled to Britain, where he met Arthur face to face, and kissed him as he prayed for forgiveness, and Arthur accepted penance for killing Gildas’ brother.

After this, Gildas taught at the school of St. Cadoc, before retiring to a secret island for seven years. Pirates from the Orkney Islands came and sacked his island, carrying off goods and his friends as slaves. In distress, he left the island, and went to Glastonbury, then ruled by Melvas, king of the ‘Summer Country’ (Gwlad yr Haf, Somerset). Gildas intervened between Arthur and Melvas, who had abducted and raped Arthur’s wife Guinevere and brought her to his stronghold at Glastonbury. Arthur soon arrived to besiege him, but, the peacemaking saint persuaded Melvas to release Guinevere and the two kings made peace. Then desiring to live a hermit’s life, Gildas built a hermitage devoted to the Trinity on the banks of the river at Glastonbury. He died, and was buried at Glastonbury Abbey, in the floor of St. Mary’s Church.

Gildas is best known for his polemic De Excidio et Conquestu Britanniae, which recounts the post-Roman history of Britain, and is the only substantial source for history of this period written by a near-contemporary. The work is a sermon in three parts condemning the acts of his contemporaries, both secular and religious. The first part consists of Gildas’ explanation for his work and a brief narrative of Roman Britain from its conquest under the Principate to Gildas’ time. He describes the doings of the Romans and the Groans of the Britons, in which the Britons make one last request for military aid from the departed Roman military. He excoriates his fellow Britons for their sins, while at the same time lauding heroes such as Ambrosius Aurelianus, whom he is the first to describe as a leader of the resistance to the Saxons. He mentions the victory at the Battle of Mons Badonicus, a feat attributed to King Arthur in later texts, though Gildas is unclear as to who led the battle. Part two consists of a condemnation of five British kings, Constantine, Aurelius Conanus, Vortiporius, Cuneglas, and Maelgwn. As it is the only contemporary information about them, it is of particular interest to scholars of British history. Part three is a similar attack on the clergy of the time. De Excidio is usually dated to the 540s, but a handful of historians prefer earlier dates.

Gildas’ relics were venerated in the abbey which he founded in Rhuys, until the 10th century, when they were removed to Berry. In the 18th century, they were said to be moved to the cathedral at Vannes and then hidden during the French Revolution. The various relics survived the revolution and have all since been returned to Saint-Gildas-de-Rhuys where they are visible at various times of the year at a dedicated “treasury” in the village. The body of Saint Gildas (minus the pieces incorporated into various reliquaries) is buried behind the altar in the church of Saint Gildas de Rhuys.

The gold and silver covered relics of Saint Gildas include:

A reliquary head containing parts of the saint’s skull

An arm reliquary containing bone pieces, topped with a blessing hand

A reliquary femur and knee

The embroidered miter supposedly worn by Gildas is also kept with these relics.  Gildas is the patron saint of several churches and monasteries in Brittany.

Gildas is credited with a hymn called the Lorica, or Breastplate, a prayer for deliverance from evil, which contains specimens of Hiberno-Latin.

 

I thought a humble Breton recipe might suit a Celtic saint who spent his final years in Brittany, and since there are no recipes from the 6th century, this one for Breton marriage soup is much more recent, but could actually be from any era. The mixture of milk, garlic, and onions, is actually being touted these days as something of a cure-all – befitting a saint also.

Breton Marriage Soup

Ingredients

1 tbsp butter
1 onion, peeled and thinly
1 clove garlic, peeled and thinly sliced
1 quart whole milk
sea salt
white pepper
stale bread, sliced thin

Instructions

In a large skillet over medium heat, melt the butter and brown it.  Add the sliced onions and sauté them until  browned. Add the garlic and sauté until it is softened. Pour in the milk, and add salt and pepper to taste. Bring to a boil, then reduce the heat and simmer gently for 10 minutes. Pour the soup over thin slices of bread in deep bowls and serve.

Oct 292014
 

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On this date in 1959 Asterix or The Adventures of Asterix first appeared in the Franco-Belgian comics magazine Pilote. It was written by René Goscinny and illustrated by Albert Uderzo until the death of Goscinny in 1977. Uderzo then took over the writing until 2009, when he sold the rights to publishing company Hachette. As of 2013, 35 volumes had been released. I have loved Asterix since I was a teenager and am glad to honor the strip today.

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The series follows the exploits of a village of indomita