Corvisart’s comments constitute a large and important part of the book last mentioned, and virtually make of it an original work by Corvisart. Auenbrugger’s original treatise was published in 1763 and was then, according to Dezeimeris, entirely forgotten, notwithstanding the fact that in 1770 it was translated into French by Rozière de la Chassagne. Auenbrugger was the first physician who recognized the fact that, by percussion of the walls of the chest, a diagnosis may be made of some of the diseases affecting the organs contained therein. Corvisart practiced Auenbrugger’s percussion method during a period of twenty years and was in the habit of demonstrating it to the numerous students who attended his courses in clinical medicine. It was this long experience in the practice of percussion that enabled him to extend, correct and modify the method as it was set forth in Auenbrugger’s little treatise. If he had not done this and had not published the results in his French translation (of 1808), Auenbrugger would not have won the credit for his glorious discovery. The delicately considerate manner in which Corvisart engineered the whole scheme throws a flood of light upon the noble character of Napoleon’s First Physician.
CHAPTER XIX
LAËNNEC AND THE INVENTION OF THE MODERN METHOD OF AUSCULTATION; PAUL-JOSEPH BARTHEZ
René Théophile Hyacinthe Laënnec (1781–1826) was born at Quimper in Brittany, France. I am not able to furnish any details concerning his early history. His subsequent career as a physician, however, and especially his writings, show very clearly that he must have received a very careful and thorough education. Previous to 1816 auscultation of the chest was carried out in the same manner as it was in the time of Hippocrates,—that is, by applying the examiner’s ear, either directly or through an interposed piece of linen, to the surface of the skin overlying the particular part which he was desirous of examining.
In 1816 I was consulted [writes Laënnec] by a young woman who presented certain general symptoms that pointed to the existence of some disease of the heart, and in whom, by reason of her embonpoint, simple palpation and percussion could scarcely be expected to furnish satisfactory information in regard to the nature of the disorder. The age and sex of the patient not permitting me to make such an examination as I have just mentioned I was compelled to adopt some other measure; and I then recalled to mind the acoustic phenomenon with which everybody is familiar, to-wit: if the ear be applied to one end of a wooden beam it will perceive with perfect distinctness the sound made by the scratching of a pin’s point on the opposite end of the beam. From this circumstance I inferred that in the present case I might advantageously utilize the principle underlying this phenomenon. Accordingly I rolled up into a cylinder-shaped, stiff-walled tube several sheets of writing-paper, and, resting one end of the cylinder on the skin of the precordial region, I applied my ear to the other end of the tube. I found to my surprise and pleasure that I was now able to hear the pulsations of the heart much more distinctly than I had ever before heard them when I applied my ear directly to the chest-wall.
This first experience made such a deep impression on the mind of Laënnec that he promptly instituted a series of experiments which had for their object (1) the determination of the form of instrument that would best answer the desired purpose, and (2) the discovery of the various cardiac and pulmonary conditions that might advantageously be studied by the use of this instrument. Such were the first steps taken in one of the most useful medical discoveries of which we have any record. Auscultation, the importance of which had been dimly foreseen by Hippocrates the Great, became now for the first time, in the early part of the nineteenth century, one of the most effective aids to the physician in ascertaining the true nature and extent of certain diseases located in the cavity of the chest, in watching their progress, and in regulating their treatment in accordance with the physical conditions revealed by the aid of the method. The history of medicine has few more important events to record than this discovery made by Laënnec, one of France’s greatest physicians.
As a result of the experiments to which I have just referred there was soon substituted for the crude thin-walled paper cylinder a solid column of light wood, hollowed out centrally throughout its length by a narrow tubular channel. To this new instrument the name “stethoscope” was given. It would require too great an amount of space to give here the full and very explicit instructions supplied by Laënnec regarding the manner in which this instrument is to be employed in actual practice; and, furthermore, they are to be found in the best modern textbooks which deal with diseases of the chest.
LAËNNEC
(Copied from an old French print in the possession of the New York Academy of Medicine.)