This month, we highlight a book from the early 19th-century French physician who created the most iconic symbol of healthcare providers around the world. Assessing the condition of a patient in 1816, René Laënnec (1781–1826), rolled up a piece of paper to create a crude cone and proceeded to listen to the patient’s chest sounds. Thus was born the stethoscope (from the Greek, stethos:chest and skopé:examination).
Along with the stethoscope, he advanced the understanding of peritonitis and coined the term “cirrhosis” to describe the liver’s tawny appearance. He was the first to lecture on melanoma, describing its spread to the lungs and naming it “melanose.”
In 1819, he published De l’auscultation médiate, ou Traité du diagnostic des maladies des poumons et du coeur [On mediate auscultation, or a treatise on the diagnosis of diseases of the lungs and heart], a landmark work that identified a range of chest sounds—rales, rhonchi, crepitance, egophony—and distinguished between normal and pathological breath sounds. His work transformed the physical exam from an art of intuition into a science of precision.
After some early opposition to his invention, De l’auscultation médiate and the stethoscope would take off, quickly spreading throughout Europe and the U.S.
Laënnec’s early life was shaped by loss and frailty. At just five years old, he lost his mother to tuberculosis—a disease that would haunt both his family and his future. After the death of his mother, Laënnec’s father sent him to live with his uncle, Dr. Guillaume-François Laënnec, the dean of the medical faculty at the University of Nantes. Despite chronic illness—likely asthma—and frequent fevers, young Laënnec was intellectually gifted and artistically inclined.
While at Nantes, he studied music, carved wooden instruments, and wrote poetry. By age 14, he was already assisting in patient care at the Hôtel-Dieu in Nantes, and by age 18, he was a third-class surgeon at the city’s military hospital.
Encouraged by his uncle and undeterred by his father’s objections to pursuing medicine as a career, Laënnec studied medicine in Paris. There, he trained under some of the era’s most celebrated physicians, including Jean-Nicolas Corvisart-Desmarets, Xavier Bichat, and Guillaume Dupuytren.
Already somewhat frail from his chronic illness, Laënnec further declined after beginning his practice. Medical school and his research had exposed him to numerous tuberculotic patients and cadavers. By 1814, his poor health forced him to return to Brittany to recover in the quiet countryside.
In 1816, Laënnec returned to Paris to take over as the chief of Necker Hospital. It was there that he continued his research into chest diseases and was inspired to create the stethoscope. Prior to his invention, the standard practice for attempting to observe chest sounds was direct auscultation—placing an ear directly on the chest of the patient.
Laënnec appreciated the information that could be assessed through direct auscultation, but not the discomfort and embarrassment it caused both the patient and the physician. It also had its limitations. Laënnec was growing frustrated when inspiration struck. His musical training, woodcarving, and (perhaps apocryphally) recalling a children’s game where someone scratches one end of a tube, sending sounds to another child listening at the other end, combined to create a vision of a listening tube applied to the patient’s chest.
Putting his idea into practice, he quickly rolled up some paper, creating an approximation of a cone. He placed one end of the cone on the patient’s chest and the other to his ear. Voila! A symphony of chest sounds. The musically inclined Laënnec eventually carved a wooden tube with a fluted opening on one end and an earpiece on the other.
As his health continued to fail, in 1824, Laënnec’s nephew examined him, listening to his chest with a stethoscope, and diagnosed him with tuberculosis. In the summer of 1826, Laënnec fell into a coma and died on August 13. His now-famous stethoscope he bequeathed to his nephew.
As mentioned, De l’auscultation médiate is a two-volume set. Our copy is in great shape. Both volumes are covered in blue and black marbled paper, and the fore-edge has a lovely dark blue and black speckling. Although the paper isn’t of the highest quality, it has held up well, with only minor foxing and staining. Not surprisingly, the four folded illustrations in the back of volume one have taken the most abuse and are in the roughest shape (although still sturdy and usable).
LAËNNEC, RENÉ (1781–1826). De l’auscultation médiate, ou Traité du diagnostic des maladies des poumons et du coeur. Printed in Paris by J.-A. Brosson et J.-S. Chaudé, 1819. 23 cm tall.
Contact the John Martin Rare Book Room Curator Damien Ihrig at damien-ihrig@uiowa.edu or 319-335-9154 to see these books in-person or virtually.
