René Laennec

René Théophile Hyacinthe Laënnec (Quimper, Brittany, France, February 17, 1781-Douarnenez, France, August 13, 1826) was a French physician, inventor of the stethoscope. In 1816, due to the modesty that the doctor felt when bringing his ear closer to the chest of the patients and also due to the difficulty in perceiving noises in overweight patients, he created a cylinder 30 cm long, the origin of the instrument.

Early Years

Laennec was born in Quimper (Brittany). His mother died of tuberculosis when he was five years old and he went to live with his great-uncle the Abbé Laennec (a priest). As a child, Laennec fell ill with lassitude and repeated instances of pyrexia. Laennec was also thought to have asthma.At the age of twelve he moved to Nantes, where his uncle, Guillaime-François Laennec, worked at the medical school of the University of Nantes.

His father (a lawyer) later discouraged him from continuing as a doctor and René then had a period of time where he took long walks in the countryside, danced, studied Greek and wrote poetry. However, in 1799 he returned to study. Laennec studied medicine at the University of Paris under several famous physicians, including Guillaume Dupuytren and Jean-Nicolas Corvisart. There he was trained to use sound as a diagnostic aid. Corvisart advocated the reintroduction of percussion during the French Revolution.

Medical career and contributions

In 1816 Laënnec was appointed chief physician of the Necker Hospital. He was professor of medicine at the College of France between 1822 and 1826, succeeding Jean-Nicolas Corvisart, a famous cardiologist and private physician to Napoleon Bonaparte.

Three are Laënnec's main contributions to medicine:

• Invention of the stethoscope (or fonendoscope) and description of its use for diagnosis.
• Delimitation of semi-logic pictures of heart and lung diseases, for diagnosis of such diseases from symptoms.
• The description of numerous anatomical-pathological lesions.

At that time, immediate auscultation was practiced by placing the ear directly against the chest. Frequently, the doctor interposed a silk scarf to avoid direct contact with the patient. The procedure had several drawbacks, among them, the difficulty in perceiving noises in obese patients, and the violation of the modesty of women. It is said that Laënnec was inspired by some children playing with a tree branch, seeing that one of them scratched the wood while another applied his ear to hear the amplified sound.

In 1819, his two voluminous volumes "De l'auscultation médiate ou traité de diagnostic des maladies des poumons et du coeur fondé principalement sur ce nouveau moyen d'exploration' 34; ("Of auscultation mediated or treated on diagnosis of diseases of the lungs and heart based mainly on this new means of exploration"). He had been painstakingly delineating the semiological pictures of multiple illnesses, noting the sounds heard through his stethoscope and relating them to autopsy results for patients who had died.

There are numerous lesions that he characterized in his excellent descriptions, including: bronchiectasis, pulmonary emphysema, pulmonary edema and infarction, lobar pneumonia, pulmonary gangrene, pneumothorax, pleurisy, pulmonary tuberculosis, and tuberculous involvement of other organs, including the the meninges. He was more than half a century ahead of time in recognizing that the tubercles and the gelatinous and cheesy exudate corresponded to the same disease and not to two different ones as was believed at the time. He had realized, without using a microscope, that one shape could be transformed into another. The dualistic belief, supported by Rudolf Virchow, was to persist until the discovery in 1882 of the tuberculosis bacillus by Robert Koch.

The name Laennec is associated with a form of liver cirrhosis (Laennec liver cirrhosis or alcoholic cirrhosis). Curiously, this is not because he has made a contribution on the subject, but simply because of a footnote proposing the name cirrhosis (from the Greek kirrós, "yellow") for the yellowish, indurated, granular liver found at autopsy in a case of pulmonary emphysema.

In 1826, the year of his death, the second edition of his work appeared with the simple title of Traité d'auscultation mediate (Treatise on Mediate Auscultation). In it, he tells how the tuberculosis contagion accident occurred: twenty years ago, examining some tubercular vertebrae, the saw had eroded the index finger of his left hand. He describes in detail how the injury that appeared after the accident developed and how it was treated.

Some posts

De l’auscultation médiate.... Stéthoscope, poumons

• Propositions sur la doctrine d'Hippocrate, relativement à la médecine pratique, présentées et soutenues à l'École de médecine de Paris, le 22 prairial an XII (medical thesis, 1804)
• De l'Auscultation médiate, ou Traité du diagnostic des maladies des poumons et du cœur, fondé principalement sur ce nouveau moyen d'exploration 2 v. 1819) v. 1 2
• Traité inédit sur l'anatomie pathologique, ou Exposition des altérations visible qu'éprouve le corps humain dans l'état de maladie (1884)
• La Guerre des Vénètes: poème épique héroï-comique (1931)

Literature

• Emmanuel Lallour. Laënnec, notice historique. A. de Kerangal, Quimper 1868.
• Ariel Roguin. Rene Theophile Hyacinthe Laënnec (1781–1826): The Man Behind the Stethoscope. In: Clinical Medicine & Research. v. 4, No. 3, September 2006, ISSN 1539-4182 p. 230–235, PMID 17048358, doi 10.3121/cmr.4.3.230.
• John R. Schererer. Before cardiac MRI: Rene Laennec (1781–1826) and the invention of the stethoscope. In: Cardiology Journal. v. 14, No. 5, 2007, ISSN 1897-5593 p. 518–519, PMID 1865151515.