World of Health on René Théophile Hyacinthe Laennec
René Théophile Hyacinthe Laennec, known as the father of modern knowledge of pulmonary disease, is considered by many as one of the greatest clinicians of all time. He made a major contribution to medical science by introducing a method of diagnosing diseases called auscultation. Auscultation involves listening to and identifying various sounds made by different body structures. Laennec's specialty was chest diseases. Initially, his diagnostic method involved placing his ear to the chest of his patient. Ultimately, it led him to inventing the stethoscope, which he called the "chest examiner."
Although he is most famous for this work, he was the first person to describe the rare disease tuberculosis verrucosa cutis (tuberculosis of the skin), and gave cirrhosis its name from the Greek word kirrhos kirrhos, meaning tawny. The term "Laennec's cirrhosis" is still used to describe alcoholic liver cirrhosis. He was also a pioneer in matching postmortem (autopsy) findings with physical signs of disease.
Laennec was born in Brittany, France. His father was a lawyer and writer of poetry. His mother died when he was six years old and he went to live with his grand-uncle, the Abbé Laennec. At the age of 12, he went to Nantes where his uncle was a professor at the university. An excellent student, the young Laennec soon became fluent in English and German, won many academic prizes, and began studying medicine under his uncle's direction. In 1800, at the age of 19, he entered the university in Paris, gaining first prize in both medicine and surgery in less than a year. He became a student of medicine under the personal physician to Napoleon Bonaparte's (1769-1821), Jean-Nicolas Corvisart (1755-1821), who used percussion (tapping with the fingers) to diagnose chest disorders. Laennec improved upon this method by placing his ear directly on the patient's chest to identify and differentiate between healthy and unhealthy sounds of the heart and respiratory system.
By performing autopsies, he identified precise causes of unhealthy sounds, enabling him to better diagnose and treat future patients. He named dozens of different sounds, coining the terms rale, used to define any abnormal sound in the chest, and rhonchi which described a loud, low-pitched crackles during exhalation. These terms are still used by medical professionals.
In 1819, Laennec wrote his famous treatise, De l'auscultation médiate (On mediate auscultation), in which he described in unprecedented detail the sounds of chest disease and how he came to invent the chest examiner. This treatise, which laid the groundwork for modern pulmonary medicine, has been ranked in importance and insight with works of Hippocrates (c. 460-c. 377 B.C.) Laennec wrote "the most important part of an art is to be able to observe properly."
Ironically, his observation of children playing led to his inventing the stethoscope. He noticed children holding the end of a long piece of wood to their ears, listening to the tapping sounds made by a pin at the other end, the sound of which was transmitted through the wood. Laennec wrote about a young woman who came to him with symptoms of heart disease. Examination by percussion was ineffective "...on the account of the great degree of fatness...the other method (placing the ear to the chest) being rendered inadmissible by the age and sex of the patient." Recalling the children and the stick, he rolled several sheets of paper into a cylinder, placing one end on the woman's chest and the other to his ear. "I 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 the ear," he wrote.
Experimenting with materials of different types, densities, lengths, and thicknesses, he settled on a "...cylinder of wood, an inch and a half (3.8 cm) in diameter, and a foot (30.48 cm) long, perforated longitudinally by a bore three lines wide, and hollowed out into a funnel shape, to the depth of an inch and a half (3.8 cm) at one of its extremities." He then made his instrument available for purchase through the publishers of the treatise.
In 1822, Laennec succeeded Corvisart as chair of medicine at the Collège de France. Four years later, while studying tuberculosis (the contagious properties of which were not yet understood), he contracted the disease and died. Laennec was an intensely religious man and devout Catholic, well known for his charity to the poor, highly respected for his extreme kindness, beloved by students and colleagues. It is said that, near the end of his life, his primary goal was to "keep as far as possible from giving trouble to others."
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