Thorax: first published as 10.1136/thx.36.2.81 on 1 February 1981. Downloaded from Thorax, 1981, 36, 81-90 R T H Laennec 1781-1826 His life and work: a bicentenary appreciation ALEX SAKULA From Redhill General Hospital, Redhill, Surrey ABSTRACT Rene Theophile Hyacinthe Laennec was born on 17 February 1781 in Quimper and spent much of his youth in Nantes, where his uncle Guillaume was Dean of the Faculty of Medicine. He was considerably influenced by his uncle and went to study medicine in Paris where he qualified in 1804. Among his teachers were Corvisart and Bayle who stimulated his interest in the clinical diagnosis of diseases of the chest and especially tuberculosis, from which Laennec himself suffered. His clinical experience and morbid anatomical dissections at the Necker Hospital culminated in his invention of the stethoscope (1816) and the writing of his masterpiece De l'Auscultation Mediate (1819) which may be regarded as the pioneer treatise from which modern chest medicine has evolved. Despite his great success in Paris, Laennec always retained a great love for his native Brittany. When his health finally broke down, he returned to his home Kerlouarnec, near Quimper, and died there on 13 August 1826, aged 45 years. On the occasion of the bicentenary of his birth we pay homage to the memory of this great French physician. "People will not look forward to posterity who never look backward to their ancestors." Edmund Burke: Reflections on the Revolution http://thorax.bmj.com/ in France Two hundred years have elapsed since the birth of the great French physician, Rene Th6ophile Hyacinthe Laennec, who, by his invention of the stethoscope, bequeathed to us the first tool to aid clinical diagnosis, as well as providing the symbol by which, more than any other, the physician is at present recognised. Moreover, in his great on October 2, 2021 by guest. Protected copyright. treatise, De l'A uscultation Mediate, Laennec's rational clinico-pathological approach may be said to have laid the foundations of modern clinical medicine and especially our understand- ing of cardiorespiratory disease. Birth and early years in Quimper Laonnec (fig 1) was born on 17 February 1781 at 2 rue du Quai, Quimper, in Southern Brittany, France. Quimper, at the junction of the rivers Odet and Steir, is the capital of the county of Cornouaille, in the departement of Finisterre. It was, and is, a charming old walled city, with its Address for reprint requests: Dr A Sakula, Redhill General Fig 1 RTH Laennec. From coloured engraving, Hospital, Earlswood Common. Redhill, Surrey RHI 6LA. reproduced by courtesy of the Wellcome Trustees. 81 Thorax: first published as 10.1136/thx.36.2.81 on 1 February 1981. Downloaded from 82 Alex Sakula narrow streets and twin-spired cathedral of St father, and in 1801 he set out for Paris by Corentin. Laennec came of good Breton stock- carriage, although he walked the last 200 miles his father, Theophile Marie Laennec, became an to the capital! Admiralty judge at Quimperle, and his mother Michelle (nee Guesdon) came from a well- Paris School of Medicine connected Quimper family. The name Laennec most probably derived from the Breton "Lennek", On arrival in Paris, Laennec lived in the Latin meaning reader or scholar. Laennec was baptised Quarter with his brother Michaud (who was Rene after his godfather (his grandfather), reading Law), and began his medical studies Hyacinthe after his godmother (sister of his god- at the lcole de Mddecine. The Paris school of father), and Thdophile (after his father). He was medicine, no doubt stimulated by the revolution- the eldest of three children. A younger brother ary spirit of the times, had become the chief Michaud was born in 1782 and a sister Marie- centre of clinical research in France, and prob- Anne in 1785. In 1785, Laennec's mother died at ably in Europe, and Laennec came under the the confinement of her fourth child, who died influence of great teachers. He was a pupil of shortly after birth. His father, a gay but somewhat Guillaume Dupuytren (1777-1835) at the Ecole feckless character, was left a widower with the Pratique, dissected under Xavier Bichat (1771- three young children-Laennec then aged 5 years 1802), and at the Salp6triere and Charitd hospi- -with whom he could not cope. The children tals he was taught by the great Jean Nicolas stayed at first with an uncle Michel Jean Corvisart (1755-1821) and Gaspard Laurent Bayle Laennec, a nearby rector, for one year, but it was (1774-1816). Bayle was at that time seven years then arranged for the two boys to be sent to older than Laennec, but the two men soon be- Nantes to be cared for by another uncle, came great friends. Guillaume Francois Laennec (1748-1822), who Laennec was now the typical impecunious was the Dean of the Medical Faculty in the medical student, very industrious, with the ambi- University of Nantes. tion to qualify and return to country practice in Brittany. As a student, he was already publish- Nantes and Uncle Guillaume ing papers on peritonitis, the liver capsule, ame- norrhoea, and so on. He obtained the first Laennec was aged 7 years when he and his prize in medicine in 1803, and in 1804, aged 23, http://thorax.bmj.com/ brother Michaud sailed to Nantes in 1788. They he qualified MD with a thesis entitled Proposi- stayed with their uncle Guillaume in his apart- tions sur la doctrine d'Hippocrate relativement ment in Place de Bouffai. France was then in a la medecine pratique, based on a study of the the throes of the Revolution, and 1793 saw the master's writings in the original Greek. Terror in Nantes. The red-painted guillotine Afteir qualification, Laennec was engaged in stood in the Place de Bouffai, and the young hospital practice in Paris, but also spent a con- Laennec must have witnessed from his window siderable time lecturing, which he did in Latin, the gruesome execution scenes. Laennec was a and writing many papers, for example, on angina. lively ginger-haired lad, proficient at his studies, He worked on a book on pathological anatomy on October 2, 2021 by guest. Protected copyright. learning Latin, Greek, and English, and showing which was never published, coedited the Journal a talent for writing poetry. He was fond of play- de Medecine, and contributed to the Dictionaire ing the flute, was keen on dancing, and as a des Sciences Me'dicales. His reputation as a sound hobby developed a skill in whittling. physician soon spread, and among his patients He admired his uncle Guillaume, whose exam- (many of whom were Bretons living in Paris) ple influenced Laennec's choice of medicine as a there numbered famous contemporary figures, career. In 1795, aged 14, Laennec was already such as Madame Chateaubriand, Madame de helping in the care of the sick and wounded in Stael, and Cardinal Flesch (uncle of Napoleon the H6tel Dieu in Nantes, and by 1799 he was Bonaparte). serving in the Military Hospital in Nantes, with the rank of third class surgeon. The worst exces- Laennec's health ses of the Revolution were now subsiding, and Laennec was keen to proceed to Paris to continue In late eighteenth and early nineteenth century his medical studies. Unfortunately, he received Europe, tuberculosis was rife, accounting for little support from his father, who had remarried one in four deaths ("Captain of the men of in 1795, but with uncle Guillaume's encourage- death") and its infectious nature was not appre- ment he at last obtained a small stipend from his ciated. Laennec's mother was already consump- Thorax: first published as 10.1136/thx.36.2.81 on 1 February 1981. Downloaded from R T H Laennec 1781-1826 83 tive when she married, and her death at the age of 32 was no doubt contributed to by tubercu- losis. His uncle Michel Jean with whom he lived for one year before going to Nantes died from the disease. His younger brother Michaud, who was very close to him in his youth and also lived with him as a student in Paris, suffered from tuberculosis and died in 1810, aged 28. Laennec himself developed respiratory symp- toms ("asthma") around 1796, aged 15. By the time he qualified in 1803 he was very ill with phthisis. His long hours of medical work, coupled with further exposure to large numbers of tuber- culous patients as well as necropsies on those dying of the disease, led to further deterioration of his health. Laennec was small, only 5' 3" in height, and he became thinner and wizened in appearance as his tuberculosis became more established. In 1814 after a spell of intense work at the Salpd- triere and the Hotel Dieu, which was full of sick and wounded soldiers from the Napoleonic campaigns, Laennec's health broke down and he was forced to take a prolonged rest in Brittany. Laennec's teacher Bichat died of tuberculosis in 1802, aged 31, and his great friend Bayle died Fig 2 Kerlouarnec. View of rear of house. of the disease in 1816, aged 42. in the midst of the dead and the dying. This Laennec's love of Brittany is the best thing in the world for a doctor, but http://thorax.bmj.com/ when it lasts too long it becomes a bore." As a lad, Laennec came to love his native Another letter written from Paris to a friend Brittany countryside and coast. There was, at in country practice in 1817 contained the that time, a resurgence of interest in the Breton following: heritage and culture ("Celtomania") and Laennec "I rise at half past seven or even eight o'clock was an enthuasiastic follower of this movement.