What use is a stethoscope

History of medicine: inventor of the stethoscope


Laënnec (1781–1826) at the bedside of a sick man in Necker Hospital, Paris. He is holding an early tubular stethoscope in his hand. Engraving after a painting in the Sorbonne Photo: picture-alliance / KPA / HIP
René Théophile Hyacinthe Laënnec was born 225 years ago.

What the urine glass was in the Middle Ages is today the stethoscope: a symbol of the doctor and medical activity. It was invented and described by the French doctor René Théophile Hyacinthe Laënnec almost two hundred years ago.
Laënnec was born on February 12, 1781, the eldest of four siblings in Quimper, Brittany. When he was five years old, his mother died, probably of tuberculosis.
During the Revolutionary Wars, the twelve-year-old experienced the siege of Nantes, where he and his brother grew up with an uncle. Two years later, in 1795, Laënnec began to work in medicine. At the Hotel-Dieu he learns how to bandage wounds and takes his first anatomy courses. His father and young stepmother try to talk him out of the medical profession, "a job for fools compared to the money you can make as a decent businessman". But Laënnec is not deterred. From 1801 he continued his studies in Paris.
No longer directly with the ear on the chest
At the beginning of the 19th century, general practitioners largely still correspond to the image that Molière painted of them: enthusiastic devotees
guesswork and dark doctrines about the causes of disease instead of exact observation and empiricism. The treatments are as strange as the diagnoses: bloodletting, leeches, enemas, laxatives. In Paris, however, the revolution created good conditions for new forms of research and teaching. The old institutions are being replaced by the École de Santé, where clinical research is experiencing a significant boom. The ideas of Giovanni Battista Morgagni are consequently put into practice and the findings on the corpse are used to clarify and differentiate between diseases. Xavier Bichat describes the types of tissue recurring in all organs and thus brings the pathological anatomy a good step forward. Laënnec has the choice between the Salpêtrière under Philippe Pinel and the Charité under Jean Nicolas Corvisart. He chooses the Charité. Corvisart, Napoleon's personal physician, recognized the value of the percussion described by Leopold Auenbrugger in 1761 and made it the basis of general diagnostics.
Since Hippocrates, doctors have thought about auscultation over and over again. In the Middle Ages, some of them put their ears directly to the thorax. Gaspard-Laurent Bayle, longtime friend and companion of Laënnec, auscultates the heartbeat in this way with reference to a text by Hippocrates. According to Laënnec's own words, the invention of indirect auscultation and the stethoscope is based on the following story:
“In 1816 I was consulted by a young woman who showed signs of general heart disease (...) The age and gender of the sick person forbade me to put my ear directly on my chest. I remembered a well-known acoustic phenomenon, namely that the scratching noise at the end of a tree trunk can be heard very precisely, even amplified, over many meters at the other end. (...) So I took a piece of paper, rolled it up tightly, placed one end on the precordium and the other end on my ear. I was amazed how clearly I could hear the beating of the heart, more clearly and precisely than if I had placed my ear directly on my chest. "
In August 1819 Laënnec's main work appears in two volumes, the "Treatise on indirect auscultation". The price is thirteen francs, and thanks to the enterprising publisher you can buy a stethoscope for three francs. Laënnec not only describes the phenomenon and device, but also normal breathing, bronchial breathing, rattling noises and heart sounds, systolic, diastolic noises and the gallop rhythm in mitral stenosis. The new method is also used in an unconventional way: supporting the deaf and mute as well as localizing fractures, liver abscesses and bladder stones. There is also a detailed description of lung and pleural diseases: bronchiectasis, pneumonia, pulmonary infarction, emphysema and tuberculosis. Laënnec suffers from it herself. He supplements the abundance of remedies common at the time with holidays by the sea in warm or mild climates: Nice, Hyères, Madeira, the Canary Islands and the coast of Brittany. When Laënnec is the first to focus on the role that psychological factors such as grief and disappointment play in the development and course of the disease, he also speaks from his own painful experience.
Laënnec's discovery quickly found recognition
Laënnec is inconceivable without Brittany, his beloved homeland, to which he remains connected throughout his life. His ailing health improves significantly and quickly if he only breathes fresh air for a few days and takes long walks here. With his own self-irony, he noted in 1813: “It is indeed strange, especially against the background of my weak constitution, that I have such extraordinary stamina in walking. (...) But unfortunately this talent (...) Is of little use to a Parisian doctor who spends his days in the consulting room or in the cab. "
Auenbrugger's percussion took over forty years to become widely used in clinical practice. Even if his main work did not sell as well for a time, Laënnec's discovery met with widespread approval and recognition almost immediately. In the history of medicine he also has his place as the founder of a modern science of the respiratory organs and their diseases. René Théophile Hyacinthe Laënnec died on August 13, 1826 in his house in Kerlouarnec in Brittany. Dr. med. Christof Goddemeier
History of medicine: inventor of the stethoscope

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