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Before and After Laënnec

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Before and After Laënnec before and after laennec* By DOUGLAS GUTHRIE, M.D., F.R.C.S. to thi y to contribute Some time ago, when I rashly undertook under^ tuberculosis, I greatly a with the history of paper dealing * of sue a tas estimated the magnitude and the difficulty wled of time and a Given the necessary perseverence, e wr;tinp- of in medicine and an interest past even*f> historv general cu di y. , no Q of Medicine presents insuperable 1 History deman s a of a of medicine, however, branch is o mieht special a series o - is also a Of tuberculosis, quite e specialist. the be each in its aspect of subject. written, varying clinicians, e of and of the disease, the views pathologists o a the evolution of sanatorium treatment, development a vo ume, could each regulations concerning tuberculosis however, my igno it is not to select. personally, easy Speaking selection is poss ' narrowed the field from which considerably w ic may 1 can indicate a few of the signposts only principal into t e drawn more deeply guide those of you who feel , . past. to attention , is to direct SO?6. , The main object of this paper well worth reading, althoug works on tuberculosis which are still view on ? The latest generally regarded as out of date." any^subject may be or to be, themost he ought y said, the most correct view. Osier spoK ?ly'when necessarily are ic men of the past "it is a dry age when the great not be obsolete work. , . esteem." Old work need of tuberculosis two histories So far as I am aware, detailed only They?J are both of American origin. hav.c _ in recent years, c appeared Tuberculosis The Development of our Knowledge of by Clinical Pulmonary byLa^e Flick, ,925; and The Story of mdebted for those books I am largely^enulons Lawrason Brown, ,04.- To diffidence, am the information which, not without some before ? muc;t place you. ru e one inflexible ; In the of history there is writing so tha eac preserve a definite time-sense or chronology, be . -ru out recorded in its particular sequence. is the su jec One of the best methods of presenting QUest istory, ?ne striking or sensational event?in general teacher an empire, a dynasty ; in medical history, to all oth a school?and around this event group ^'"inorCa?historvhistory is Lister, and every events. In surgery, the dominant figure before of surgery is an account of events tuberculosis ? in th * What was the most definite landmark in Read at a meeting of the Tuberculosis Society of Scotland held Edinburgh ?n ioth May 1946. 689 700 DOUGLAS GUTHRIE Was it the discovery of the bacillus by Koch in 1882 ? Or was it the early attempt of Bodington, in 1840, to establish sanatorium treatment ? Laennec and His Achievement I wonder if you will agree with me when I suggest that a more significant event than any was the publication by Laennec, in 1819, of his classic work on Auscultation?Traite de VAuscultation Mediate. Laennec accomplished much during his short life. To-day, he is remembered as the inventor of the stethoscope, but that was only the first step in his great achievement, the tool which enabled him to explore a new field. His book is no mere description of the stetho- scope ; it describes what the stethoscope can do. It is one of the great medical classics. Reni Theophile Hyacinthe Laennec was born in 1781, at Quimper in Brittany, the son of a local lawyer. He had the misfortune to lose his mother when he was six years old, and as his father was a fickle and purposeless man, young Theophile, as he was called, was consigned, with his brother Michael, to the care of his uncle William, a physician at Nantes. Seven years later, when his father married again, Michael returned to Quimper, but Theophile remained, as he was determined to become a doctor like his uncle. Indeed, Laennec owed little to his father, and everything to his uncle. He studied in the Medical School of Nantes, and then in Paris. His health was feeble, he was often very poor, but he was fortunate in his teachers and fellow students. His chief friend was Gaspard Bayle, his senior by seven years, who exercised upon him that beneficial influence which so often passes from a senior student to a junior. Bayle himself is an important landmark in the history of tuberculosis. Before he died of tuberculosis at the age of 42, he had performed nine hundred post-mortem examinations in cases of that disease, many of which he had also investigated clinically. Almost certainly Bayle was a martyr to science. He corrected many errors ; he showed that early and advanced pulmonary tuberculosis were one disease and not a whole " " series of diseases, and he was the first to use the term miliary in describing small tuberculous lesions. Let us return, however, to the student life of Laennec. Another senior associate was Guillaume Dupuytren, who later won great fame as a surgeon ; a cynical and intolerant man, and it is not surprising that Laennec and he did not always agree. Laennec studied medicine at the Charite under Corvisart, of whom more will be said. Bichat was the brilliant teacher of morbid anatomy and when Bichat died of tuberculosis in 1802, at the age of 31, Laennec began to lecture on the subject and it was then that he discovered the sub-deltoid bursa, and proved that hydatid cysts were caused by a parasite. At this early stage of his career he busied himself in the study of Greek, the better to understand Hippocrates, and his thesis for which he received " his diploma in 1804 dealt with The Hippocratic Doctrine in relation 701 LAENNEC BEFORE AND AFTER to the Practice of Medicine." During on y worked writing papers ^^hSsJTonducdng^at the Necker strenuously, an c^-n and studying WOrk was rapidly increasing practice, ? ^ ^-s to which he was appointed he held Hospital ysic1^ g denham> '?"? ?" 1? en woman it su y to examining a stout young ^ is audible at one end o g just as the scratch of a pin sounds within even so mig the ear the other end, a note . Rolling placed against o serv of the . the thorax be conducted to the ear chest and one en " book into a tight roll he applied at he was P put his ear to the other, when to^gratifieddistinction, sounds with great c able to hear the heart hg constructed being ? use rolls o pap For a time he continued to known as the we a a wooden which answered very the cylinder ? eventually, " ? baton," the " cylinder,"'the was no ?er Yet Laennec to show stethoscope." x service was of work. H though that was a clever piece ^ to thig task the aid o what might be accomplished by ^ strange> he of his s devoted the remaining years murmUrs, wheezings, the chest whis 1 g ? unfamiliar sounds within and arranged, and all to be analysed and crackling-were ^ Heatings . arrange^ this was Laennec's accomphshmen in the great 1 > already miraculous that this wasted, hollow-cheeke ^ gnp of the disease he was so closely and w are described a in a to book within few years, produce ^ ^rst edition the stet classified all the sounds heard by ?scoP.' as is u auy regarded to read, an is dated It is a wag 1819. pleasure . the au o obliged a almost killed medical classic. But it ^ vvhere to is e ov to leave Paris and naturally he returned of of Bay he had a Kerlouarnec (the place ^ house, an Y Douarnenez. There, his health improved He and literally t rew 1821, he returned to Paris of Qne life> he what was knew that it kill him, but might e e an(j practised And so, argued, if others could be helped. was now o is at the second edition and laboured hard Francerrrance and with at the College of Physician at the Charite, Professor a^ ^ and teac er. a wide as reputation physician ^ that language " student . >> for the benefit of foreign ^ to rale," Latin, r the term , better than French, and he preferred patients, be so in e which meant death-rattle and might :0y Qnly two but: e ? He married Madame Argon in 1824, in obliged to In May 1 years of happy married life. of that year o 3 August and on the afternoon he retire to Brittany, 0 his wife that ami g he removed the rings from his fingers, exp 702 DOUGLAS GUTHRIE preferred that no one should have the trouble of doing this for him. Two hours later he died. The second edition of his book had been published just as he left Paris for the last time. It was translated into English by Sir John Forbes, a man of culture and a good linguist, who graduated at Edinburgh in 1807 and, after serving in the Navy for some years, conducted a large practice at Chichester and eventually became physician to Queen Victoria. There were four editions of his translation of Laennec's book, the last in 1834. A still better translation, though abridged, was published, with a Life of Laennec, by Sir Wm. Hale-White in 1923. Mention has been made of Laennec's teacher Corvisart, who was then at the height of his fame, soon to become a Baron, and physician to Napoleon, fean Nicholas Corvisart was a great teacher, though rather dictatorial in his methods.
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