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JAMA Revisited
August 6, 2019

Laënnec and the Stethoscope

Author Affiliations

August 9, 1919

JAMA. 1919;73(6):422- 423.

JAMA. 2019;322(5):472. doi:10.1001/jama.2018.15451

One hundred years ago—in 1819—Laënnec published his epoch-making work on auscultation. He was then 38 years old, and seven years later he died from pulmonary tuberculosis. It has been said that he cared more for his proficiency in horseback riding than for his fame, and that he “was but a breath of air, and he thought himself a Hercules. He transposed the facts, and the vigor of his mind he placed in his muscles. Innocent failings, imperceptible blots, especially on the brilliancy of those great and exemplary lives so full of glory because they are useful.”

Whatever his thoughts, if any, in regard to his fame may have been, he had no doubt in his mind as to the value of auscultation, and when he had recovered somewhat from his first breakdown, he did not hesitate, in 1822, to return to Paris from his home in Brittany, and to plunge again into the hardest kind of work, because he felt it a duty to extend further the knowledge of his new method, as it might be of use to mankind. For Laënnec is vastly more than merely the fortunate discoverer of the stethoscope: he himself demonstrated so completely its usefulness in diagnosis and treatment by clinical and anatomic observations of unrivaled accuracy and completeness as to leave comparatively little for others to add.… He devised a new method of observation and then wellnigh exhausted the field of investigation by that method, with results of the greatest practical value. Nor were Laënnec’s observations on the symptoms and lesions of disease primarily dependent on or initially incited by his happy discovery of mediate auscultation; for they had been carried on since his early student days, when he drew up the minute histories of 400 cases of disease, in large measure the basis of much of his future work, until he became chief physician in the Hospital Necker in 1816, and it was in the course of these clinico-anatomic studies that the idea of the stethoscope came to him….

Children playing about a long beam are said to have awakened in Laënnec the first germ of the thought of the stethoscope. One child would listen at one end of the beam while another tapped lightly the other end, the sound being transmitted through the solid beam. Again his own words tell the story best:

“In 1816 I was consulted by a young woman laboring under the general symptoms of diseased heart, and in whose case percussion and application of the hand were of little avail on account of the great degree of fatness…. I happened to recollect a simple and well-known fact in acoustics, and fancied it might be turned to some use on the present occasion. The fact I allude to is the great distinctness with which we hear the scratch of a pin at one end of a piece of wood, on applying our ear to the other. Immediately, on this suggestion, I rolled a quire of paper into a kind 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 had ever been able to do by the immediate application of the ear. From this moment I imagined that the circumstance might furnish means for enabling us to ascertain the character, not only of the action of the heart, but of every species of sound produced by the motion of all the thoracic viscera, and, consequently, for the exploration of the respiration, the voice, the rhonchus, and perhaps even the fluctuation of fluid extravasated in the pleura or the pericardium. With this conviction, I forthwith commenced at the Hospital Necker a series of observations from which I have been able to deduce a set of new signs of diseases of the chest, for the most part certain, simple and prominent, and calculated, perhaps, to render the diagnosis of the diseases of the lungs, heart and pleura as decided and circumstantial as the indications furnished to the surgeon by the introduction of the finger or sound, in the complaints wherein these are used.”

It is interesting to note that Laënnec speaks of Auenbrugger’s long neglected discovery of percussion as one of the most valuable in medicine, and emphasizes the value of the combination of percussion and auscultation.

To the medical student and young physician there should be a powerful inspiration and stimulus in the brief life of Laënnec. He was assiduous and systematic as a student, and began to make independent observations when barely 20, thus attaining a favorable distinction early. He lectured on pathologic anatomy, wrote critiques and reviews and took an active part in medical society work, presenting specimens and communications before he obtained his degree. Having graduated, he devoted himself to his practice and to his medical studies, in the course of which it became clear to him that to know disease we must know the underlying changes, and that this knowledge can be gained only by thorough, systematic, combined clinical and anatomic observations. And so he made his immortal discovery and continued his observations “with a degree of success, and a fertility of results, much more remarkable than the discovery itself.”

Section Editor: Jennifer Reiling, Assistant Editor.
Editor’s Note: JAMA Revisited is transcribed verbatim from articles published previously, unless otherwise noted.