Makers of Modern Medicine

by James J. Walsh

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.