LAENNEC, RENÉ

LAENNEC, RENÉ (1781–1826), French physician.

Born in Quimper, Brittany, on 17 February 1781, René Théophile Hyacinthe Laennec was the eldest child of three. Their mother died in 1786 and their father, a magistrate and poet, was incapable of caring for his family. Laennec and his brother went to live with their uncle, Guillaume Laennec, a physician at Nantes. As an adolescent, Laennec began the study of medicine under the tutelage of his uncle. The Revolution disrupted his home and education, leaving a deep impression on his spiritual and political views. He thereafter opposed the atheism and republicanism of the new intelligentsia, and later joined the Congrégation, a clandestine group of Catholics. In 1801, he began his studies at the newly reopened medical school in Paris, where he studied with Jean Noël Hallé and Baron Jean-Nicolas Corvisart des Marets, physician to Napoleon Bonaparte. Corvisart had developed Leopold Auenbrugger's examination technique of percussion, which involved tapping on the chest to determine the state of the organs inside. Corvisart correlated sounds emanating from the chests of living patients with later findings at autopsy, and after twenty years of experimentation published a treatise on heart disease (1806) and an amplified translation of Auenbrugger's work (1808).

A witness to Corvisart's research, Laennec excelled in the new science of pathological anatomy. Conducted by dissection of cadavers, abnormal (or pathological) anatomy was increasingly thought to be of importance to medicine; however, its utility at the bedside, before the patient died, was obscure. Laennec taught private courses and penned a treatise on the subject. He wrote and edited scientific articles for Corvisart's Journal de Médecine; his special interests were parasitology, ancient medicine, music, and Greek, Latin, and Breton languages. Laennec's 1804 thesis was an original interpretation of Hippocratic passages that reconciled the father of medicine with the new anatomoclinical ideals.

At his graduation in 1804, Laennec won several prizes and hoped to join the Paris faculty, but he was repeatedly passed over for academic jobs, probably because of his political and religious conservatism. He entered clinical practice in Paris in order to sustain his research in pathological anatomy and provide for his family. Clerics, Bretons, and returning émigrés made up his clientele, which included Cardinal Joseph Fesch, François-René de Chateaubriand, Hughes-Félicité-Robert de Lamennais, and Victor Cousin.

Following the restoration of the French throne, Laennec was rewarded for his long-standing royalism with a position at Necker Hospital. This 1816 appointment coincided closely with his discovery of mediate auscultation, the idea that breath and voice sounds from the chest could be heard more clearly with the aid of a mediator. This led to the invention for which he is most famous, the stethoscope, the name derived from the Greek words for chest and exploration. The device was initially a rolled paper notebook that he later replaced with a wooden cylinder. Like his teacher Corvisart, Laennec correlated the sounds heard in his hospital patients with the morbid findings at their autopsies. This research resulted in a new vocabulary of the organic changes that occurred inside a patient's body before death, and helped to make abnormal anatomy useful in the clinical setting. The new method was described in Laennec's treatise, De l'auscultation mediate (On mediate auscultation), which appeared in 1819. In 1821, British physician John Forbes published a partial translation in English, and within five years auscultation was widely practiced in Europe and North America. A second edition appeared in 1826 and was translated into English by Forbes the following year.

In 1822, Laennec took up the chair of clinical medicine at the Collège de France, and he also accepted a position as court physician to the duchesse Marie-Caroline de Berry. In 1823 he succeeded his teacher Corvisart as physician at the Hôpital de la Charité in Paris. In his teaching, Laennec often criticized a too-rigid application of anatomy to bedside medicine, and he emphasized the importance of psychic well-being to bodily health. For some critics, this stance was baffling, as the inventor appeared to reject the significance of his own achievements. Laennec's stethoscope had increased the relevance of pathological anatomy to bedside medicine. It also encouraged a reconceptualization of diseases as products of organic change rather than clusters of subjective symptoms. As a result, auscultation supported a paradigm shift in medical epistemology—not only for chest diseases, but for all diseases: from patient based diagnosis based on descriptions of symptoms to physician-based diagnosis based on the status of body organs. The stethoscope has been credited with the triumph of anatomical medicine, but it also has been described as the first instrument of medical technology to distance and diminish the role of the patient in his or her own illness experience.

Laennec lived to see his stethoscope widely accepted in Europe and America. Laboring through bouts of tuberculosis, he completed the second edition of his treatise in spring 1826, and immediately embarked on the arduous journey to his home in Brittany, where he died just a few weeks later on 13 August.

See alsoDisease; Science and Technology; Tuberculosis.

bibliography

Duffin, Jacalyn. To See with a Better Eye: A Life of R. T. H. Laennec. Princeton, N.J., 1998.

Laennec, R. T. H. De l'auscultation médiate, ou traitédu diagnostique des maladies des poumons et du coeur. 2 vols. Paris, 1819. 2nd ed., Paris, 1826. Translated as A Treatise of Diseases of the Chest and on Mediate Auscultation by John Forbes. London, 1827.

Jacalyn Duffin