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Women Gave Birth to the Stethoscope:
Laennec’s Introduction of the Art
of Auscultation of the Lung
Haragopal Thadepalli
Geriatrics/Gerontology Division, Charles R. Drew University of Medicine and Science, and School of Medicine, University of California, Los Angeles
There is a key question in the story of
Laennec that must be asked: why did he
use a tube to auscultate the lung?
René-Théophile-Hyacinthe Laennec
(1781–1826) was born in Brittany, France.
He not only invented the stethoscope, he
was also the first to describe the alcoholic
cirrhosis of the liver known as “Laennec
cirrhosis.”
Laennec learned direct auscultation of
the heart (i.e., applying the ear directly to
the patient’s chest wall to listen for sounds
from the organ) while studying under
Corvisart (1755–1821), the personal physician to Emperor Napoleon Bonaparte.
Laennec stated, “I had been in the habit
of using this method for a long time, in
obscure cases, and where it was practicable—which lead me to the discovery of
one much better” [1]. The “much better”
method that Laennec referred to is that of
Dr. Leopold Avenbrugger (1722–1809),
who developed percussion of the chest
wall for the diagnosis of heart and lung
diseases. Laennec stated:
Received 12 March 2002; electronically published 31 July
2002.
Reprints or correspondence: Dr. Haragopal Thadepalli,
Geriatrics/Gerontology Division, Charles R. Drew University
of Medicine and Science, 1731 E. 120th St., Los Angeles,
CA 90059 ([email protected]).
Clinical Infectious Diseases 2002; 35:587–8
2002 by the Infectious Diseases Society of America. All
rights reserved.
1058-4838/2002/3505-0013$15.00
In 1816, I was consulted by a young
woman laboring under general
symptoms of diseased heart, and in
whose case percussion and the application of the hand were of little
avail on account of the great degree
of fatness. The other method application of ear just mentioned being rendered inadmissible by the
age and sex of the patient, I happen to recollect a simple and wellknown fact in acoustics, and fancied
at the same time, that it might be
turned to some use on the present
occasion. I rolled a quire of paper
into a sort of cylinder and applied
one end of it to the region of the
heart and the other to my ear, and
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 have ever been able to
do by the immediate application of
the ear. I shall now describe the instrument to all others. It consists
simply of a cylinder of wood. …
This instrument I commonly designate simply the cylinder, sometimes the Stethoscope. [1]
“The employment of this new method
must not make us forget that of Avenbrugger” [1].
Laennec’s interpretation of the findings of auscultation (deciphering the lung
sounds to detect underlying pathologic
characteristics of the lung) is a forgotten
art. Just for kicks, let me mention some
very descriptive words that he introduced
into the art of auscultation of the lung [2].
Pectoriloquy.
Vibrations produced
by the sound of a voice through chest wall
with a cavity of the lung.
Bronchophony. The sound of a voice
heard from the roots of the lung. The
sound is best heard between the scapula
and the vertebral column (usually heard
in cases of dense lobar pneumonia).
Aegophony. A sound that is a blend
of bronchophony and pectoriloquy (heard
in cases of massive pleural effusion).
Rhonchus. A sound produced by
passage of air through fluids in the
bronchus.
Crepitations. A sound like salt in a
vessel exposed to heat (associated with wet
lung).
Sonorous rhonchus. A sound like a
loud snore of a person or the cooing of a
wood pigeon (associated with bronchial
fistula or dilated bronchus).
Amphoric resonance.
A musical
metallic tinkling attributed to a fistulous
opening into a cavity partly filled with
fluid; also known as bourdonnement
amphorique.
Rub. Laennec called this the sound
of the friction of ascent and descent (e.g.,
pleural rub).
In practice, Laennec continued to use
the direct auscultation method whenever
he examined men with a thin chest wall.
Auscultation of the Lung • CID 2002:35 (1 September) • 587
For all women and obese men, he used
indirect auscultation (i.e., use of a stethoscope). Thus, I describe this episode
jokingly: “women gave birth to the
stethoscope.”
In the picture on the cover of the 15
January 2002 issue of Clinical Infectious
Diseases, you can see Laennec examining
an extremely thin man by direct auscul-
588 • CID 2002:35 (1 September) • Thadepalli
tation while holding the stethoscope in his
left hand.
Laennec paid dearly for all his efforts
to describe the auscultation method. He
became very sick and stayed on and off at
his birthplace, Brittany, and he died of
consumption, also known as phthisis [3].
Louis Pasteur and Robert Koch were not
yet around to call it “tuberculosis.”
References
1. Laennec RTH. A treatise on the diseases of the
chest. John Forbes, trans. London: TG Underwood, 1821.
2. May LA. Classic description of physical signs
in medicine. New York: Dubar Science
Publications, 1977:11–25.
3. Sigerist HE. The great doctors. New York: WW
North and Company, 1933:283–90.