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VIEWPOINTS 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.