Everything about Ren Laennec totally explained
René-Théophile-Hyacinthe Laennec (
February 17,
1781-
August 13,
1826) was a French
physician and inventor of the
stethoscope. Dr. Laennec was born in
Quimper, Brittany and studied medicine at the
Hôpital de la Charité,
Paris qualifying in
1804. He invented the
stethoscope in
1816, while working at the
Hôpital Necker.
The Stethoscope
Laennec is the author of the classic treatise
De auscultation's Mediate (On Mediate Auscultation), published in August, 1819. This refers to his idea of using an instrument, or mediator, to hear sounds within the body. (The complete title of this book, often referred to as the 'Treatise' is
De l’Auscultation Médiate ou Traité du Diagnostic des Maladies des Poumons et du Coeur (On Mediate Auscultation or Treatise on the Diagnosis of the Diseases of the Lungs and Heart).
- Preface from De auscultations médiate
"In 1816 I was consulted by a young woman labouring 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 [directauscultation] 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 wasn't 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'd ever been able to do by the immediate application of my ear."
The origin of this idea occurred when Laennec saw some young children playing near the Louvre listening to the ends of a long piece of wood that transmitted the sounds of pin scratches. The next day, he rolled up a piece of paper, tied it with a string, and listened to his patients' chests with it. Laennec was a carpenter and then built a 25 cm by 2.5 cm hollow wooden cylinder which he also used to listen to the chest sounds of his patients. He later modified this cylinder to have detachable parts. He noted the various sounds that he heard and then correlated them to the anatomical findings at their autopsies. He also used a solid piece of wood to 'listen' to heart sounds. In February of 1818, he presented his findings in a talk at the Academie de Medecin, later publishing his findings in 1819 (above).
Laennec may have been motivated by several factors in his invention of the stethoscope: he'd discovered that it was a better way to transmit sounds from the chest as opposed to the method in vogue at the time of placing his ear over the chest, especially if the patient was overweight; using a stethoscope avoided the embarrassment of placing his ear against the chest of a woman, as noted in the story above; Laennec was also a student of the newly popular art of percussion in making diagnoses, but this had limitations as noted above if the patient was overweight. (This art of percussion had been emphasized by Laennec's teacher, Corvisart, who in turn popularized the method first described by the Austrian physician
Leopold Auenbrugger in 1761 in his work
Invent um Novum.)
This new method of auscultation wasn't readily accepted by some doctors, who preferred the usual method of listening directly to the chest with one's ear (
immediate auscultation). 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.
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He also named this instrument for mediate auscultation the
stethoscope, which is derived from the Greek (
stethos meaning chest). Laennec often referred to the stethoscope as "the cylinder," and as he neared death, he bequeathed his own stethoscope to his nephew, referring to it as "the greatest legacy of my life."
The
binaural stethoscope, which has two
ear pieces, was
invented by the
American George Cammann in
1852.
Medical Contributions
This book,
De l'Auscultation Mediate, was a landmark in the knowledge of chest diseases. Laennec classified and discussed the terms
rales,
rhonchi,
crepitance, and
egophony - terms that doctors use on a daily basis during physical exams and diagnoses.
Other medical contributions were his descriptions 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. (See below:
Laennec's cirrhosis)
He originated 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 (
mela,
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 made many important contributions about
tuberculosis.
Perhaps equally as important a contribution to medicine was his reawakening of the spirit of objective scientific observation. When he published his text in 1819, he included this motto in Greek, "the most important part of an art is to be able to observe properly." His text was held in very high regard by many doctors as a gold standard for the practice of medicine. Professor Benjamin Ward Richardson stated in
Disciples of Aesculapius that "the true student of medicine reads Laennec's treatise on mediate auscultation and the use of the stethoscope once in two years at least as long as he's in practice. It ranks with the original work of Vesalius, Harvey and Hippocrates."
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Of interest is the fact that very little was known of the actual physiology of the heart when Laennec wrote his treatise. He did describe two heart sounds, but erroneously thought that the first heart sound was due to ventricular
systole and the second heart sound was due to atrial systole.
Eponyms
Cirrhosis of the
liver is occasionally still called
Laennec's cirrhosis, as Laennec was one of the first to recognise this problem as a disease entity. He also has other medical eponyms associated with his name:
Laennec's cirrhosis refers to the appearance of regenerated liver, comprising small lobules separated by a fine, fibrous tissue;
Laennec's thrombus is an antenatal thrombus in the heart; and
Laennec's pearls refer to sputum produced by asthmatics.
Hamman's murmur, which is also known as
Laënnec-Hamman symptom or
Laënnec-Müller-von Bergmann-Hamman symptom, or
Hamman's crunch is a crunching sound heard over the precordiun due to spontanneous mediastinal emphysema.
Biography
There are many interesting facts about Laennec's life.
- He developed his interest in medicine from observing his uncle, Gauillaime-Francois Laennec, practice as a doctor in Nantes, France.
René Laennec was a practicing surgeon in Nantes during the French Revolution.
Laennec studied medicine in Paris under several famous physicians, including Dupuytren (of Dupuytren's Contracture fame) and Nicolas Corvisart des Marest (1755–1821), who was Napoléon's physician.
His father 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 medicine.
Laennec's book finally brought him the fame and social position that he sought. He obtained a chair at the Collège de France in 1822 and became a professor of medicine in 1823.
His final appointments were that of Head of the Medical Clinic at the Hôpital de la Charité and Professor at the Collège de France.
One of the 4 medical schools of the Université Claude Bernard Lyon 1 is named after him.
Ironically, Laennec suffered from asthma and tuberculosis. Tuberculosis had been the cause of death of his mother when he was a child, had killed his cousin, and then lead to his own death in 1824, a short time after he'd achieved such professional respect and fame. His nephew, Mériadec Laennec listened to his uncle's chest and heard the fateful sounds of tuberculosis. He had used his uncle's stethoscope to make this diagnosis. René Laennec then returned to Brittany from Paris and wrote his will, bequeathing his stethoscope to his nephew.
Before his death, he wrote:
"I know that I've risked my life, but the book I'm going to publish will be, I hope, useful enough to be of more value than the life of a man."
A Man of Faith
On a more personal side, Laennec was a very kind man. Being a Breton, he was a very devout Catholic. Some refer to his charity towards the poor as being proverbial. He was beloved by his colleagues and his students, being especially thoughtful to his English speaking students.
Laennec’s landmarks in Paris
On the exterior wall of the “Hôpital Necker - Enfants Malades”, where Laennec developed “mediate auscultation” with the stethoscope, near the entrance of the hospital in 149, Rue de Sèvres, there's a marble memorial tablet with a graved portrait of Laennec and this inscription: "Dans cet hôpital Laennec découvrit l'auscultation. 1781-1826". Some of the oldest buildings of the hospital can be seen on the same front of this large and modern medical area.
Image:Laennec memorial, Necker Hospital, Paris 1.jpg|The entrance in Rue de Sevres
Image:Hopital_Necker_Laennec_stethoscope_2.jpg|Laennec’s memorial tablet
Image:Laennec memorial, Necker Hospital, Paris 3.jpg|One of the old buildings of the hospital
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