LAENNEC, MARTYR TO SCIENCE.
On August 13, 1826, there died at Quimper in Brittany at the early age of forty-five, one of the greatest physicians of all time. His name, René Theodore Laennec, was destined to be forever associated with one of the most fruitful advances in medicine that has ever been made, and one which practically introduced the modern era of scientific diagnosis. At the present time the most interesting phase of medical development is concerned with the early recognition and the prevention of tuberculosis. To Laennec more than to any other is due all the data which enable the physician of the twentieth century to make the diagnosis of tuberculosis with assurance, and to treat it with more confidence than before, and so prevent its spread as far as that is possible.
The history of pulmonary consumption in its most modern phase is centred around the names of three men, Laennec, Villemin, and Koch. To Laennec will forever belong the honor of having fixed definitely the clinical picture of the disease, and of having separated it by means of auscultation and his pathological studies from all similar affections of the lungs. Villemin showed that it was an infectious disease, absolutely specific in character, and capable of transmission by inoculation from man to the animal. To Koch the world owes the knowledge of the exact cause of the disease and consequently of the practical method for preventing its spread. The isolation of the bacillus of tuberculosis is the great triumph of the end of the nineteenth century, as the separation of the disease from all others by Laennec was the triumph of the beginning of that century. There is [{136}] still room for a fourth name in the list, that of the man who will discover a specific remedy for the disease. It is to be hoped that his coming will not be long delayed.
The estimation in which Laennec was held by the most distinguished among his contemporaries, may be very well appreciated from the opinions expressed with regard to him and his work by the best-known Irish and English clinical observers of the period. Dr. William Stokes, who was himself, as we shall see, one of the most important contributors to our clinical knowledge of diseases of the heart and lungs in the nineteenth century, said with regard to the great French clinician whom he considered his master:
"Time has shown that the introduction of auscultation and its subsidiary physical signs has been one of the greatest boons ever conferred by the genius of man on the world.
"A new era in medicine has been marked by a new science, depending on the immutable laws of physical phenomena, and, like the discoveries founded on such a basis, simple in its application and easily understood--a gift of science to a favored son; one by which the ear is converted into the eye, the hidden recesses of visceral disease open to view; a new guide to the treatment, and a new help to the ready detection, prevention and cure of the most widely spread diseases which affect mankind."
Dr. Addison, who is best known by the disease which since his original description has been called by his name, was no less enthusiastic in praise of Laennec's work. He said:
"Were I to affirm that Laennec contributed more toward the advancement of the medical art than any other single individual, either of ancient or of modern times, I should probably be advancing a proposition which, in the estimation of many, is neither extravagant nor unjust. His work, [{137}] De l'Auscultation Mediate, will ever remain a monument of genius, industry, modesty and truth. It is a work in perusing which every succeeding page only tends to increase our admiration of the man, to captivate our attention, and to command our confidence. We are led insensibly to the bedside of his patients; we are startled by the originality of his system; we can hardly persuade ourselves that any means so simple can accomplish so much, can overcome and reduce to order the chaotic confusion of thoracic pathology; and hesitate not in the end to acknowledge our unqualified wonder at the triumphant confirmation of all he professed to accomplish."
These tributes to Laennec, however, from men who were his contemporaries across the channel, have been more than equalled by distinguished physicians on both sides of the Atlantic at the end of the nineteenth and the beginning of the twentieth century. While we might hesitate to accept the opinions of those who had been so close to him at the beginning of the new era of physical diagnosis, there can be no doubt now, after the lapse of three-quarters of a century, of what Laennec's influence really was, and the tributes of the twentieth century place him among the few great geniuses to whom scientific medicine owes its most important advance.
At the annual meeting of the State Medical Society of New York held in Albany at the end of January, 1903, the president of the society, Doctor Henry L. Elsner, of Syracuse, in his annual address devoted some paragraphs to a panegyric of Laennec. He wished to call attention to what had been accomplished for scientific medicine at the beginning of the last century by a simple observant practitioner. In the course of his references to Laennec and his work he said:
"It is by no means to be considered an accident that, [{138}] among the greatest advances in medicine made during the century just closed, the introduction of pathological anatomy and auscultation into the practice of medicine at the bedside were both effected by the same clear mind, Laennec. He is one of the greatest physicians of all time."
He then quoted the opinion of a distinguished English clinician, Professor T. Clifford Allbutt, who is well known, especially for his knowledge of the history of medicine. Professor Allbutt is the Regius Professor of Physic (a term about equivalent to our practice of medicine) of Cambridge University, England, and was invited to this country some years ago as the representative of English medicine to deliver the Lane lectures in San Francisco. During his stay in this country he delivered a lecture at Johns Hopkins University on "Medicine in the Nineteenth Century," in which he said, "Laennec gives me the impression of being one of the greatest physicians in history; one who deserves to stand by the side of Hippocrates and Galen, Harvey and Sydenham. Without the advances of pathology Laennec's work could not have been done; it was a revelation of the anatomy of the internal organs during the life of the patient."
René Theodore Hyacinthe Laennec, who is thus conceded by twentieth century medicine a place among the world's greatest medical discoverers, was born February 17, 1781, at Quimper in Bretagne, that rocky province at the north of France which has been the sturdy nursing mother of so many pure Celtic Frenchmen who have so mightily influenced the thought not only of their own country but of all the world. The names of such Bretons as Renan and Lamennais have a universal reputation and the province was even more distinguished for its scientists.
There was published [Footnote 2] a few years ago in France a detailed [{139}] history of Breton physicians. This work sketches the lives of the physicians of Breton birth from the sixteenth to the twentieth century. Only those of the nineteenth century concern us, but the list even for this single century includes such distinguished names as Broussais, whose ideas in physiology dominated medicine for nearly the whole of the first half of the nineteenth century; Jobert, the famous French surgeon whose reputation was world-wide; Alphonse Guerin, another distinguished surgeon, whose work in the protection of wounds in some respects anticipated that of Lister; Chassaignac, to whose inventive genius surgery owes new means of preventing hemorrhage and purulent infection, and who introduced the great principle of surgical drainage; finally Maisonneuve, almost a contemporary, whose name is a household word to the surgeons of the present generation; without mentioning for the moment the subject of this sketch, Laennec, the greatest of them all. Six greater men never came from one province in the same limited space of time.
[Footnote 2: Les Médecins Bretons par Dr. Jules Roger. Paris, J. B. Baillière, 1900.]
Bretagne, "the land of granite covered with oaks" as the Bretons love to call it, may well be proud of its illustrious sons in the century just past. Taken altogether they form a striking example of how much the world owes to the children of the countryside who, born far from the hurrying bustle of city life, do not have their energies sapped before the proper time for their display comes. These Bretagne physicians, illustrious discoverers and ever faithful workers, are at the same time a generous tribute to the influence of the simple, honest sincerity of well-meaning parents whose religious faith was the well-spring of humble, model lives that formed a striking example for their descendants. The foundations of many a great reputation were laid in the simple village homes, far from the turmoil and the excitement of the fuller [{140}] life of great cities. The Bretons are but further examples of the fact that for genuine success in life the most precious preparation is residence in the country in childhood and adolescent years. The country districts of Normandy, the province lying just next to Bretagne, have furnished even more than their share of the Paris successes of the century, and have seen the Norman country boys the leaders of thought at the capital.
Laennec's father was a man of culture and intelligence, who, though a lawyer, devoted himself more to literature than his case books. His poetry is said to recall one of his better known compatriots, Deforges-Maillard. Laennec was but six years old when his mother died. His father seems to have felt himself too much preoccupied with his own work to assume the education of his son, and so the boy Laennec was placed under the guardianship of his grand-uncle, the Abbé Laennec, and lived with him for some years in the parish house at Elliant.
A relative writing of Laennec after his death says that the boy had the good fortune to be thus happily started on his path in life by a hand that was at once firm and sure. The training given him at this time was calculated to initiate him in the best possible way into those habits of application that made it possible for him to make great discoveries in after life. The boy was delicate besides, and the house of the good old rector-uncle was an excellent place for him, because of its large and airy rooms and the thoroughly hygienic condition in which it was kept. Household hygiene was not as common in those days as in our own and child mortality was higher, but the delicate boy thrived under the favorable conditions.
Besides the parish house was situated in the midst of a beautiful country. The perfectly regular and rather serious [{141}] life of the place was singularly well adapted to develop gradually and with due progression the precious faculties of a young, active mind and observant intelligence. This development was accomplished besides without any excitement or worry and without any of the violent contrasts or precocious disillusions of city life.
The boy passed some four or five years with his grand-uncle the priest and then went to finish his studies with a brother of his father, Dr. Laennec, a physician who has left a deservedly honored name. At this time Dr. Laennec was a member of the Faculty of Medicine at the University of Nantes. The growing lad seems to have been wonderfully successful in his studies, and a number of prizes gained at school show how deeply he was interested in his work. During this time he learned English and German and became really ready to begin the study of the higher sciences. Besides working at his academic studies, Laennec paid some attention to his uncle in his professional work, and by careful observation laid the foundation of his medical studies. His character as an observer, rather than a student of books, showed itself very early. He devoted himself to the clinical investigation of cases in the military hospital and was especially interested in the study of anatomy.
In 1800, at the age of nineteen, he went to Paris. It was typical of the man and his careful, thoroughness all through life that the first impulse when he found himself free to work for himself, was to try to make up for what he considered defects in his elementary studies. It must not be forgotten that the ten years of Laennec's life, from his tenth to his twentieth year, came in the stormy time of the French Revolution, and that school regularity was very much disturbed. His first care then was to take up the study of Latin again. He learned to read and write the language with elegance and [{142}] purity. Later on, occasionally, he delivered his clinical lectures, especially when foreigners were present, in Latin. We shall have the occasion to see before the end of this article, with what easy grace he learned to use it from some passages of the preface of his book written in that language.
He did not allow his accessory studies, however, to interfere with his application to his professional work. He was one of those rare men who knew how to rest his mind by turning it from one occupation to another. When scarcely more than a year in Paris, Laennec secured the two first prizes for medicine and surgery in the medical department of the University of Paris. In 1804 he wrote two medical theses, one of them in Latin, the other in French. The subject of both was Hippocrates, the great Greek father of medicine, whom Laennec admired very much and whose method of clinical observation was to prove the key-note of the success of Laennec's own medical career.
At this time the Paris school of medicine had two great rival teachers. One of them was Corvisart, who endeavored to keep up the traditions of Hippocrates and taught especially the necessity for careful observation of disease. The other was Pinel, famous in our time mainly for having stricken the manacles from the insane in the asylums of Paris, but who was known to his contemporaries as a great exponent of what may be called "Philosophic Medicine." Corvisart taught principally practical medicine at the bedside; Pinel mainly the theory of medicine by the analysis of diseased conditions and their probable origin.
Needless to say, Laennec's sympathies were all with Corvisart. He became a favorite pupil of this great master, who did so much for scientific medicine by introducing the method of percussion, invented nearly half a century before by Auenbrugger, but forgotten and neglected, so that it [{143}] would surely have been lost but for the distinguished Frenchman's rehabilitation of its practice. Corvisart was a man of great influence. He had caught Napoleon's eye. The great Emperor of the French had the knack for choosing men worthy of the confidence he wished to place in them. His unerring judgment in this matter led him to select Corvisart as his personal physician at a moment when his selection was of the greatest service to practical medicine, for no one was doing better scientific work at the time, and this quasi-court position at once gave Corvisart's ideas a vogue they would not otherwise have had.
Corvisart's most notable characteristic was a sympathetic encouragement of the work of others, especially in what concerned actual bedside observation. Laennec was at once put in most favorable circumstances, then, for his favorite occupation of studying the actualities of disease on the living patient and at the autopsy. For nearly ten years he devoted himself almost exclusively to the care and study of hospital patients. In 1812 he was made physician to the Beaujon Hospital, Paris. Four years later he was transferred to the Necker Hospital, where he was destined to bring his great researches to a successful issue. To the Necker Hospital, before long, students from all over the world flocked to his clinical lectures, to keep themselves in touch with the great discoveries the youthful master was making. In spite of rather delicate health Laennec fulfilled his duties of physician and professor with scrupulous exactitude and with a self-sacrificing devotion that was, unfortunately, to prove detrimental to his health before very long.
One of his contemporaries says of him:
"Laennec was almost an ideal teacher. He talked very easily and his lesson was always arranged with logical method, clearness and simplicity. He disdained utterly [{144}] all the artifices of oratory. He knew, however, how to give his lectures a charm of their own. It was as if he were holding a conversation with those who heard him and they were interested every moment of the time that he talked, so full were his lectures of practical instruction."
Another of his contemporaries says, naïvely: "At the end of the lesson we did not applaud, because it was not the custom. Very few, however, who heard him once, failed to promise themselves the pleasure of assisting at others of his lectures."
The work on which Laennec's fame depended and the discovery with which his name, in the words of our great American diagnostician, Austin Flint, the elder, will live to the end of time was concerned with the practice of auscultation. This is the method of listening to the sounds produced in the chest when air is inspired and expired in health and disease, and also to the sound produced by the heart and its valves in health and disease. Nearly two centuries ago, in 1705, an old medical writer quoted by Walshe, in his "Treatise on the Disease of the Lungs and Heart" said very quaintly but very shrewdly: "Who knows but that one may discover the works performed in the several offices and shops of a man's body by the sounds they make and thereby discover what instrument or engine is out of order!"
It was just this that Laennec did. He solved the riddle of the sounds within the human workshop, to continue the quaint old figure, and pointed out which were the results of health and which of disease. Not only this, but he showed the difference between the sounds produced in health and disease by those different engines, the lungs and the heart. The way in which he was led to devote his attention originally to the subject of auscultation is described by Laennec himself with a simplicity and directness so charmingly characteristic [{145}] of the man, of his thoroughly Christian modesty, of his solicitude for even the slightest susceptibility of others and of his prompt inventive readiness, that none of his biographers has been able to resist the temptation to quote his own words with regard to the interesting incident, and so we feel that we must give them here.
He says:
"In 1816 I was consulted by a young person who was laboring under the general symptoms of a diseased heart. In her case percussion and the application of the hand (what modern doctors call palpation) were of little service because of a considerable degree of stoutness. The other method, that namely of listening to the sounds within the chest by the direct application of the ear to the chest wall, being rendered inadmissible by the age and sex of the patient, I happened to recollect a simple and well-known fact in acoustics and fancied it might be turned to some use on the present occasion. The fact I allude to is 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 the occurrence of this idea 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. 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.
"From this moment I imagined that the circumstance might furnish means for enabling us to ascertain the character not only of the action of the heart, but of every species of sound produced by the motion of all the thoracic viscera, and consequently for the exploration of the respiration, the voice, the râles and perhaps even the fluctuation of fluid effused in the pleura or pericardium. With this conviction I forthwith [{146}] commenced at the Necker Hospital a series of observations from which I have been able to deduce a set of new signs of the diseases of the chest. These are for the most part certain, simple and prominent, and calculated perhaps, to render the diagnosis of the diseases of the lungs, heart and pleura as decided and circumstantial as the indications furnished to the surgeons by the finger or sound, in the complaints wherein these are of use."
This is the unassuming way in which Laennec announces his great discovery. He did not in modern fashion immediately cry "Eureka!" and announce the far-reaching importance of his method of diagnosis. For two years he devoted himself to the patient study of the application of his method and the appreciation of its possibilities and its limitations. Then he presented a simple memoir to the French Academy of Sciences on the subject. A committee of three, then distinguished members of the Academy, Doctors Portal, Pelletan and Percy were named to investigate the new discovery.
It is rather interesting to notice, though almost needless to say, that the names of these men would be now absolutely unremembered in medical history but for the fortuitous circumstance that made them Laennec's investigators. Such is too often the ephemeralness of contemporary reputation. Fortunately for the committee, they reported favorably upon Laennec's discoveries. It is not always true of new and really great advances in medicine that they are received with proper appreciation upon their first announcement. Even Harvey said of his discovery of the circulation of the blood that he expected no one of any reputation in his own generation to accept it. It is not very surprising to find then in the matter of the Laennec investigators that there is a cautious reserve in their report, showing that they were not too ready [{147}] to commit themselves to a decided opinion on the importance of the new discovery, nor to any irretrievable commendation.
The important part of the discovery was supposed to consist in the use of the wooden cylinder which Laennec came to employ instead of the roll of paper originally used. This wooden cylinder, now familiar to us under the excellent name invented for it by Laennec himself is the modern single stethoscope. This instrument is of great service. The really important part of Laennec's work, however, was not the invention of the stethoscope, but the exact observation of the changes of the breath sounds that could be noted with it in various forms of chest diseases.
Laennec succeeded in pointing out how each one of the various diseases of the heart and lungs might be recognized from every other. Before his time, most of the diseases of the lungs, if accompanied with any tendency to fever particularly, were called lung fever. He showed the difference between bronchitis and pneumonia, pneumonia and pleurisy, and the various forms of tuberculosis and even the rarer pathological conditions of the lung, such as cancer, or the more familiar conditions usually not associated with fever, emphysema, and some of the forms of retraction.
With regard to heart disease, it was before Laennec's discovery almost a sealed chapter in practical medicine. It was known that people died from heart disease often and, not infrequently, without much warning. The possibility that heart conditions could be separated one from another, and that some of them could be proved to be comparatively harmless, some of them liable to cause lingering illness, while others were surely associated with the probability of sudden fatal termination, was scarcely dreamed of. It is to Laennec's introduction of auscultation that modern medicine owes all its exacter knowledge of heart lesions and their [{148}] significance. He himself did not solve all the mysteries of sound here as he did in the lungs; indeed, he made some mistakes that render him more sympathetic because they bring him down to the level of our humanity. He did make important discoveries with regard to heart disease, and his method of diagnosis during his own life was, in the hands of the Irish school of medicine, to prove the key to the problems of disease he failed to unlock.
Almost at once Laennec's method of auscultation attracted widespread attention. From Germany, from Italy, from England, even from the United States, in those days when our medical men had so few opportunities to go abroad, medical students and physicians went to Paris to study the method under the direction of the master himself and to learn from him his admirable technique of auscultation. Those who came found that the main thing to be seen was the patient observation given to every case and Laennec's admirably complete examination of each condition. The services to diagnosis rendered by the method were worthy of the enthusiasm it aroused. Only the work of Pasteur has attracted corresponding attention during the nineteenth century. Physicians practice auscultation so much as a matter of course now that it is hard to understand what an extreme novelty it was in 1820, and how much it added to the confidence of practitioners in their diagnosis of chest diseases.
Bouilland said, with an enthusiasm that does not go beyond literal truth, "A sense was lacking in medicine and I would say, if I dared, that Laennec the creator, by a sort of divine delegation of a new sense, supplied the long-felt want. The sense which medicine lacked was hearing. Sight and touch had already been developed in the service of medical diagnosis. Hearing was more important than the other two senses, and in giving it to scientific medicine Laennec disclosed a new [{149}] world of knowledge destined to complete the rising science of diagnosis."
Henri Roger said: "Laennec in placing his ear on the chest of his patient heard for the first time in the history of human disease the cry of suffering organs. First of all, he learned to know the variations in their cries and the expressive modulations of the air-carrying tubes and the orifices of the heart that indicate the points where all is not well. He was the first to understand and to make others realize the significance of this pathological language, which, until then, had been misunderstood or, rather, scarcely listened to. Henceforth, the practitioner of medicine, endowed with one sense more than before and with his power of investigation materially increased, could read for himself the alterations hidden in the depths of the organism. His ear opened to the mind a new world in medical science."
The freely expressed opinions of distinguished German, English and American physicians show that these enthusiastic praises from his French compatriots are well deserved by Laennec for the beautifully simple, yet wonderfully fecund method that he placed before the medical profession in all its completeness.
The first employment of the stethoscope by rolling up sheets of paper is of itself a sign of his readiness of invention. He made his own stethoscopes by hand and liked to spend his leisure time fashioning them carefully and even ornately. One of the stethoscopes certainly used by him and probably made by himself is to be seen at the Museum of the College of Physicians of Philadelphia.
After three years of study and patient investigation of the use of auscultation in pulmonary and cardiac diagnosis, Laennec wrote his book on the subject. This is an immortal work--a true classic in its complete treatment of the subject. [{150}] We have had thousands of books written on the subject since Laennec's time, and yet no physician could do better at the present moment than study Laennec's two comparatively small volumes to learn the art of physical diagnosis.
It is a characteristic of genius to give a completeness to work that endows it with an enduring independent vitality. Almost innumerable disciples follow in the footsteps of a teacher, and each thinks that he adds something to the fulness of the revelation made by the master. At the end of a century the fourth generation finds that scarcely anything has been added and that the master's work alone stands out, not merely as the great central fact of the new theory or doctrine, but as the absolute vital entity to which the other supposed discoveries are only adventitious and not entirely indispensable accessories.
Dr. Austin Flint, the elder, admittedly one of the greatest diagnosticians in pulmonary and heart diseases that we have ever had in America, said on this subject: "Suffice it to say here that, although during the forty years that have elapsed since the publication of Laennec's works the application of physical exploration has been considerably extended and rendered more complete in many of its details, the fundamental truths presented by the discoverer of auscultation not only remain as a basis of the new science, but for a large portion of the existing superstructure. Let the student become familiar with all that is now known on this subject, and he will then read the writings of Laennec with amazement that there remained so little to be altered or added."
Laennec's unremitting devotion to his hospital work finally impaired his health. He was never robust and strangers who came to Paris and saw him for the first time wondered that he should be able to stand the labor he required of himself. The portraits of him give a good impression of [{151}] his ascetic delicacy; they convey besides a certain wistfulness, the look of one close to human suffering, and unable to do all that he would wish to relieve it. Long before his discovery of the mysteries of auscultation, he had accomplished results that of themselves, and without his subsequent master discovery, would have given him an enduring name in medical literature. Laennec's genius enabled him to make a really great discovery, but Laennec's talent, the principal part of which was an inexhaustible faculty for untiring labor, an infinite capacity for taking pains with all that he did, enabled him to make a number of smaller discoveries any one of which would have given a great reputation to a lesser man.
Some idea of the amount of work that he did in preparing himself for the observations that were to result in his discovery may be gathered from details of his earlier career. During the first three years of his attendance at La Charité Hospital in Paris he drew up a minute history of nearly four hundred cases of disease. As early as 1805 he read a paper on hydatid cysts. These cysts were formerly thought to be hollow tumors formed within the tissues themselves somewhat as other cystic tumors are formed. Laennec showed conclusively that their origin was entirely due to certain worms that had become parasites in human beings. The cysts instead of being tumors were really one stage of the worm's existence, and had an organization and an independent existence of their own. He gave an exact description of them and even showed that there were several types of the parasite, and described the different changes that various forms produced in the human tissues. This study of the hydatid parasites remains a remarkable contribution to medicine down even to our own day.
During these early years Laennec devoted himself particularly to the study of pathology. Like all the men who [{152}] have made great discoveries in medicine he understood that all true medical advance must be founded on actual observation of the changes caused by disease in the tissues, and that this knowledge can only be obtained in the autopsy room. For years he devoted himself to the faithful study of the tissues of patients dead from various forms of disease. He wrote as the result of this work a treatise on peritonitis that was a distinct advance over anything known before his time and which, in the words of Benjamin Ward Richardson, "as a pathological study was shrewdly in anticipation of the later work of one who became his most formidable rival, the famous Broussais."
From the peritoneum his attention was attracted to the liver. As early as 1804 he wrote a description of the membranes of the liver. Pathological changes in the liver continued to occupy his attention for some time, and it is to him we owe the name cirrhosis of the liver, as a term for the changes which are produced by alcohol in this gland. Alcoholic cirrhosis is often spoken of as Laennec's cirrhosis of the liver, and he was the first to point out the significance of the changes in the organ, their etiology and the reason for the symptoms that usually accompany this condition. This work alone would have been sufficient to have made Laennec's name a permanent fixture in medical literature.
During the early years of Laennec's career at Paris, the French Anatomical Society was founded and Laennec became a prominent member of it. Corvisart, who was the moving spirit in the society, was at this time--the early years of the nineteenth century--doing his great teaching at the medical school of the University of Paris. He was Laennec's master, and was at the height of his glory. It was a constant source of surprise to his students to note how well the master's diagnosis agreed with postmortem findings. This is, after [{153}] all, the only true criterion of scientific diagnosis. It is not surprising that the strict application of this practical method of control of medical theory soon gave rise to a series of distinct advances in medical knowledge of the greatest importance.
Discussions of cases were frequent and Laennec took a prominent part in them. His knowledge of medicine was broadening in this great field of practice, and he was chosen as one of the contributors to the Dictionnaire des Sciences Médicales. His articles for this work contained much original matter of great value and suggestive views of notable importance. Laennec was the first to give a description of carcinoma encephaloides and certain especially malignant forms of cancers. He showed the distinction between pigmented spots of benignant character and those that were due to malignant disease.
"After all, however," says Benjamin Ward Richardson, "the grand reputation of Laennec must rest on his one immortal work. It is not too much to say that any man of good intelligence could have written the other memoirs. No one less than Laennec could have written the 'Treatise on Mediate Auscultation and the Use of the Stethoscope.' The true student of medicine, who never wears out, reads this original work of Laennec once in two years at least, so long as he is in practice and takes a living interest in the subject of which it treats. It ranks equally with the original works of Vesalius, Harvey and Bichat and as a section of medical literature is quite equal to any section of Hippocrates." [Footnote 3]
[Footnote 3: The full title of this work of Laennec's is "De l'auscultation médiate ou traité du diagnostic des maladies des poumons et du coeur par R. T. H. Laennec." Its modest motto is the Greek sentence:
(The most important part of an art is to be able to observe properly.) The book was published in Paris by J. A. Brosson et J. S. Chandé, rue Pierre-Sarrazin, No. 9, 1819.]
Some quotations from the Latin preface to the book will serve to show that Laennec appreciated the value of the discovery he had made for the diagnosis of chest diseases, yet that he did not expect it to be taken up enthusiastically at once, and in his modest way he adds that he shall be satisfied if it should serve to save but one human being from suffering and death. [Footnote 4]
[Footnote 4: "Imo neminem hanc methodum expertum deinceps cum Baglivio dicturum esse spero: O quantum difficile est diagnoscere morbos pulmonum."
"Nostra enim aetas incuriosa quoque suorum (the italics are Laennec's own); et si quid novi ab homine coaevo in medio ponitur, risu ut plurimum ineptisque cavillationibus excipiunt; quippe facilius est aspernari quam experiri."
"Hoc mihi satis est quod bonis doctisque viris nonnullis acceptam aegrotisque multis utilem, hanc methodum fore confidere possim; hominem unum ereptum orco dulce dignumque meae atque etiam majoris operae pretium praemium fore existimem."
"I may say that no one who has made himself expert with this method will after this have occasion to say with Baglivi, Oh! how difficult it is to diagnose disease of the lungs."
"For our generation is not inquisitive as to what is being accomplished by its sons. Claims of new discoveries made by contemporaries are likely for the most part to be met by smiles and mocking remarks. It is always easier to condemn than to test by actual experience."
"It suffices for me if I can only feel sure that this method will commend itself to a few worthy and learned men who will make it of use to many patients. I shall consider it ample, yea, more than sufficient reward for my labor, if it should prove the means by which a single human being is snatched from untimely death.">[
Unfortunately, as we have said, Laennec's untiring devotion for nearly twenty years to medical investigation caused his health to give way. It is painful to think that in the full tide of the success of his great labors, when the value of his work was only just beginning to be properly appreciated and when he had attained a position which would satisfy even lofty ambitions, his nerves gave way and he had many [{155}] of the typical melancholic symptoms that disturb the modern neurasthenic. Fortunately, his habits of life, always extremely abstemious, and his liking for outdoor sports had been a safeguard for him. He retired to the country and for nearly two years spent most of his time in the open air.
It was not long before surcease from intellectual labor and indulgence in field sport restored him to health and to activity. He foresaw, however, that to go back to the city and to his scientific work would almost surely lead to another breakdown. One of his biographers states that it was the great regard which he had for his family and the powerful influence of his religious principles which alone had sufficient weight to make him leave his retreat in the country. After an absence of two years, he returned to Paris and once more took up his hospital duties.
Soon after his return he received the appointment of physician to the Duchesse de Berri. One of the main objections to this position in Laennec's mind seems to have been the necessity for occasionally wearing court dress with a sword and regalia. Ordinarily he went dressed very plainly, and it was noted that, when men of much less authority and much less practice used their own carriages, he usually took a hired cab. His position at court gave him enough influence to bring about the proper recognition of his merit as a teacher. At this time his lectures on auscultation, though he held no regular professorship, were crowded by students from all nations. The year after his return to Paris he was appointed Professor of Medicine in the College of France, and afterward of clinical medicine at the Hospital La Charité where he had made his own studies as a medical student.
About this time he was offered a position of importance as a member of the Royal Council of Public Instruction. This he refused, however, because it would deprive him of [{156}] some of the precious time that he wished to devote to the further investigation of important subjects in clinical medicine and especially to the elaboration of his method of auscultation.
One of the most striking features of Laennec's character was his absolute placidity and lack of personal ambition. His life was passed in the most complete calm. He devoted himself to his work, and had the supreme joy of duty accomplished, seeming to look for no other enjoyment in life. Those who knew him best said that they had never seen him angry or even impatient. In the midst of his discussion with Broussais, it might have been expected that there would occasionally have been some flashes of impatience, for the great protagonist of medical theory was a man of satiric character, and his supposedly scientific discussion was stained by some very bitter personalities. In spite of all Broussais' sarcasm, Laennec remained absolutely unmoved. Occasionally his friends saw a smile at some of Broussais' emphatic asseverations, but Laennec simply continued at his work, and looked straight ahead, convinced that what he was doing was for the cause of truth, and the truth would finally prevail.
He was known for the kindness of his disposition, and his readiness to help his friends whenever it was possible. He was never known to injure anyone, and a certain quiet elevation of spirit preserved him from all conceit. One of his most intimate Breton friends, Kergaradec, said, "I have never heard Laennec express by a single word, or even by the slightest insinuation, anything that might seem to indicate pride in what he had accomplished or that might provoke a listener to say something in praise of him." The friends he made were bound to him with hoops of steel. They were not many, for he had not the time to waste on many friends. He was too devoted to his work, and too [{157}] deeply interested in the great problem whose solution he foresaw meant so much for the good of humanity, to have much time for anything but his studies and his patients.
With regard to Laennec's personal character, his most recent biographer Dr. Henri Saintignon, has said: [Footnote 5]
[Footnote 5: Laennec, Sa vie et son oeuvre. Par Dr. Henri Saintignon. Paris, J. B. Baillière et Fils, 1904.]
"I have shown in the course of this life just what was the character of Laennec and his intellectual and moral qualities, so that it will not be necessary for me to dwell at length on this subject, in concluding. His great piety, which had never been abandoned from his earliest infancy, was his main guide during all his life. Without ostentation, yet without any weakness, absolutely ignoring human respect, he obeyed with utter simplicity the prescriptions of his faith. While he did not conceal his convictions when during the first empire they might have proved a source of lessened esteem, or positive prejudice, he made no noise about them when under the Restoration they might have proved the means of advancement and of fortune. He had not in the slightest degree what is so often objected to, in devoted persons, namely, the love of making proselytes. The words of Prof. Desgenettes might very well have been applied to him: as he did not believe himself to have any mission to lead others to his opinions, he limited himself to preaching by example. The reproach of being rabidly clerical or propagandist, which was urged against him, when he first became a member of the faculty of medicine, was absolutely unjustified. Laennec never occupied himself with politics nor with religion in public. As a physician he devoted himself exclusively to his profession, receiving at his clinic all those who desired to follow his teaching, whatever might be their opinions or their beliefs."
It was not long, however, before Laennec's many labors in Paris began to tell on his health once more. His practice after his return to health and his attachment to the court became large and lucrative. It is characteristic of the man and his ways that he frequently refused, owing to lack of time, to go to see wealthy patients, from whom he would have received large fees, but it is said that he never refused to go to see a poor patient. His hospital patients always received the most solicitous attention, and his time was almost entirely at their disposal. It was not long before Laennec himself, who had taught modern physicians so much about the diagnosis of pulmonary diseases, began evidently to suffer from pulmonary disease himself. There seems no doubt now that almost constant association with tuberculous patients in an overworked subject inclined naturally to be of underweight, and therefore especially susceptible, led to the contraction of the disease.
After about four years in Paris, a dry, hard cough developed insidiously, gradually increased in annoyance, and finally grew so serious as to demand a return once more to his native Bretagne. He lost flesh, became subject to intermittent attacks of fever and suffered from some pleuritic and pulmonic pains. For some time after his return to his native air he improved. He was treated by the usual method employed at the time whenever fever accompanied any ailment. Venesection was the main part of what was then called the antiphlogistic treatment. It is needless to say he did not improve. He was suffering from exhausting disease and the treatment became really an accessory to further exhaustion.
At last there could be no longer any doubt that the end was approaching. The old curé of the village came often to visit him, and brought him all the consolations of religion. [{159}] With his sincere Christian faith and firm conviction, it was not hard for Laennec to find the moral force and the calm necessary to secure an easy death. Finally one day, on August 13th, his wife saw him take off his fingers one after another the rings he wore, and place them softly upon the table. When she asked him why he did so, he replied, "It will not be long now before someone else would have to do this service for me, and I do not wish that they should have the trouble." Even in death he was thinking of others rather than of himself, and he was calmly facing the inevitable, thoroughly prepared for it. Two hours afterward, at five o'clock in the afternoon, without there having been at any time the slightest loss of consciousness, Laennec passed away.
How faithfully his family had watched over him, and how simple was the feeling of Christian confidence in all of them, may very well be gathered from the letter of his cousin Ambrose to Laennec's brother Meriadec in Paris.
"My dear Meriadec:--Poor Renè is no more. His life was passed in the midst of labor and of benevolence. While he had all the virtues of the true Christian, and a wisdom far beyond what was usually granted to men, they have not sufficed to obtain for him the grace of a longer life. Somehow it was ordained that this glory and ornament of our family was not to remain with us. What a sad reflection it is on our restless eagerness in this life, and on the vanity of our hopes, that a genius like this must perish just when it was about to receive the fruit of its labors! He leaves to us a name, a name difficult to sustain and the example of virtues that it will not be easy to imitate. Let us hope that he will watch over us in the future as he has done in the past, and that he will still continue to aid us after his death. Although I have been prepared for this sad event, I could not suspect how much grief I was to experience in losing my [{160}] second master, my friend from earliest infancy, and him whom I had become accustomed to consider as my eldest brother. I must confess that for some years now we have all had to pay dear for the short intervals of happiness that it has pleased heaven to accord to us."
Laennec's burial took place in the cemetery of Ploare. The attendance at the funeral was very large. Practically the entire population of the countryside came to mourn for the benefactor that they loved so much. He had made friends even among the simplest of the country people and knew most of them by name. After his return to the country, he had improved somewhat in appearance, and the neighbors had been very glad to express their feelings of gratitude for his apparent improvement in health. Undoubtedly not a little of this state of better spirits was due to the fact that he liked Brittany and the peasants of the neighborhood so well, and always felt so much at home among them.
He was mild and agreeable in his manners, and of a quiet and even temper. His conversation was lively and full of quiet humor, and his friends often said that they never came away from a conversation with him without having learned something. Toward the end of his life, when his great reputation caused him to be honored by medical men from all over the world, and when his reputation made him the lion of the hour, he lost none of his natural affability and kindness of heart. He was remarkable, especially, for his great kindness and courtesy to foreigners, and he is said to have taken special care to make himself understood by English-speaking medical visitors.
It must be confessed that he was somewhat less popular with his contemporaries who did not belong to his immediate circle of friends and students. One of the reasons for this was his genius, which no generation seems ready to [{161}] acknowledge in any of its members. Another reason was his continued misunderstanding with Broussais. Broussais was the medical theorist of the hour, and medical theories have always been popular, while medical observation has had to wait for due recognition. There were undoubtedly good points in Broussais' theories that Laennec failed to appreciate. This is the only blot on a perfect career, taking it all in all, whether as man or as physician. It can easily be understood with what impatience Laennec, entirely devoted himself to observation, would take up the study of what he considered mere theory, and it is easy to forgive him his lack of appreciation.
Benjamin Ward Richardson says: "It was a common saying regarding Laennec by his compeers that, while he was without a rival in diagnosis, he was not a good practitioner; which means that he was not a good practitioner, according to their ideas of practice, heroic and fearful. To us, Laennec would now be a practitioner very heroic; so much so, that I doubt if any medical man living would, for the life of him, take some of his prescriptions. But in his own time, when so little was known of the great system of natural cure, he would be easily out of court. It was amply sufficient against him that he had a glimmering of the truth as to the existence of a considerable run of cases of organic disease, for which the so-called practice of remedial cure by drugs, bloodlettings and other heroic plans, could do no good but was likely to do grievous harm." We are reminded of Morgagni's refusal to permit bloodletting in his own case, though he practised it himself on others. Like Laennec, Morgagni seems to have doubted the efficacy of bloodletting at a time when unfortunately all medical men were agreed that it was the sovereign remedy.
If Laennec was not popular with his immediate [{162}] contemporaries, succeeding generations have more than made up for the seeming neglect. Less than twenty-five years after his death, Austin Flint, here in America, hailed him as one of the five or six greatest medical men of all times. Forty years after his death, Professor Chauffard, himself one of the distinguished medical men of the nineteenth century, said:
"Without exaggeration we can call the glory which has come to French medicine because of the great discovery of auscultation a national honor. It must be conceded that for a long time before Laennec, the great man of medicine, those to whom medical science owed its ground-breaking work did not belong to France. Harvey, Haller and Morgagni had made the investigations on which are founded the circulation of the blood, experimental physiology, and pathological anatomy, in other lands than ours. It almost seemed that we were lacking in the fecund possibilities of daring and successful initiative. Auscultation, however, as it came to us perfect from the hands of Laennec, has given us a striking revenge for any objections foreigners might make to our apathy. This discovery has rendered the scientific medicine of the world our tributary for all time. It was an immortal creation, and its effects will never fail to be felt. More than this, it will never be merely an historical reminiscence, because of the fact that it guided men aright, but it will in its actuality remain as an aid and diagnostic auxiliary. Auscultation will not disappear but with medical science itself, and with this stage of our civilization which guides, directs and enlightens it."
Laennec was known for his simple Bretagne faith, for his humble piety, and for uniformly consistent devotion to the Catholic Church, of which he was so faithful a member. His charity was well known, and while his purse was very ready to assist the needy, he did not hesitate to give to the [{163}] poor what was so much more precious to him, and it may be said to the world also, than money--his time. After his death, and only then, the extent of his charity became known.
Dr. Austin Flint said of him: "Laennec's life affords an instance among many others disproving the vulgar error that the pursuits of science are unfavorable to religious faith. He lived and died a firm believer in the truths of Christianity. He was a truly moral and a sincerely religious man."
Of his death, his contemporary, Bayle, who is one of his biographers, and who had been his friend from early youth, said:
"His death was that of a true Christian, supported by the hope of a better life, prepared by the constant practice of virtue; he saw his end approach with composure and resignation. His religious principles, imbibed with his earliest knowledge, were strengthened by the conviction of his maturer reason. He took no pains to conceal his religious sentiments when they were disadvantageous to his worldly interests, and he made no display of them when their avowal might have contributed to favor and advancement." Surely in these few lines is sketched a picture of ideal Christian manhood. There are those who think it wonderful to find it in a man of genius as great as Laennec. It should not be surprising, however, for surely genius can bow in acknowledgment to its Creator.
Shortly after the death of Pasteur it was well said that two of the greatest medical scientists of the nineteenth century have given to the physicians of France a magnificent, encouraging and comforting example. It is almost needless to say these two were Laennec and Pasteur, and their example is not for France alone, but for the whole medical world. They were living nineteenth century answers to the advocates of free thought, who would say that religious belief and [{164}] especially Catholic faith make men sterile in the realm of scientific thought.
No better ending to this sketch of Laennec's life seems possible than the conclusion of Dr. Flint's address to his students in New Orleans, already so often quoted from. It has about it the ring of the true metal of sincere Christian manhood and unselfish devotion to a humanitarian profession:
"The career of the distinguished man whose biography has been our theme on this occasion is preeminently worthy of admiration. In his character were beautifully blended the finest intellectual and moral qualities of our nature. With mental powers of the highest order were combined simplicity, modesty, purity and disinterestedness in such measure that we feel he was a man to be loved not less than admired. His zeal and industry in scientific pursuits were based on the love of truth for its own sake and a desire to be useful to his fellow-men. To these motives to exertion much of his success is to be attributed. Mere intellectual ability and acquirements do not qualify either to make or to appreciate important scientific discoveries. The mind must rise above the obstructions of self-love, jealousy and selfish aims. Hence it is that most of those who have attained to true eminence in the various paths of scientific research have been distinguished for excellencies of the heart as well as of the head. The example of Laennec is worthy of our imitation. His superior natural gifts we can only admire, but we can imitate the industry without which his genius would have been fruitless. Let us show our reverence to the memory of Laennec by endeavoring to follow humbly in his footsteps." Quod faustum vertat!