On August 13, 1826, there died at Quimper in Brittany at the early age
of forty-five, one of the greatest physicians of all time. His name,
Rene Theodore Laennec, was destined to be forever associated with one
of the most fruitful advances in medicine that has ever been made, and
one which practically introduced the modern era of scientific
diagnosis. At the present time the most interesting phase of medical
development is concerned with the early recognition and the prevention
of tuberculosis. To Laennec more than to any other is due all the data
which enable the physician of the twentieth century to make the
diagnosis of tuberculosis with assurance, and to treat it with more
confidence than before, and so prevent its spread as far as that is
possible.
The history of pulmonary consumption in its most modern phase is
centred around the names of three men, Laennec, Villemin, and Koch. To
Laennec will forever belong the honor of having fixed definitely the
clinical picture of the disease, and of having separated it by means
of auscultation and his pathological studies from all similar
affections of the lungs. Villemin showed that it was an infectious
disease, absolutely specific in character, and capable of transmission
by inoculation from man to the animal. To Koch the world owes the
knowledge of the exact cause of the disease and consequently of the
practical method for preventing its spread. The isolation of the
bacillus of tuberculosis is the great triumph of the end of the
nineteenth century, as the separation of the disease from all others
by Laennec was the triumph of the beginning of that century. There is
{136} still room for a fourth name in the list, that of the man who
will discover a specific remedy for the disease. It is to be hoped
that his coming will not be long delayed.
The estimation in which Laennec was held by the most distinguished
among his contemporaries, may be very well appreciated from the
opinions expressed with regard to him and his work by the best-known
Irish and English clinical observers of the period. Dr. William
Stokes, who was himself, as we shall see, one of the most important
contributors to our clinical knowledge of diseases of the heart and
lungs in the nineteenth century, said with regard to the great French
clinician whom he considered his master:
"Time has shown that the introduction of auscultation and its
subsidiary physical signs has been one of the greatest boons ever
conferred by the genius of man on the world.
"A new era in medicine has been marked by a new science, depending
on the immutable laws of physical phenomena, and, like the
discoveries founded on such a basis, simple in its application and
easily understood--a gift of science to a favored son; one by which
the ear is converted into the eye, the hidden recesses of visceral
disease open to view; a new guide to the treatment, and a new help
to the ready detection, prevention and cure of the most widely
spread diseases which affect mankind."
Dr. Addison, who is best known by the disease which since his original
description has been called by his name, was no less enthusiastic in
praise of Laennec's work. He said:
"Were I to affirm that Laennec contributed more toward the
advancement of the medical art than any other single individual,
either of ancient or of modern times, I should probably be advancing
a proposition which, in the estimation of many, is neither
extravagant nor unjust. His work, {137} _De l'Auscultation Mediate_,
will ever remain a monument of genius, industry, modesty and truth.
It is a work in perusing which every succeeding page only tends to
increase our admiration of the man, to captivate our attention, and
to command our confidence. We are led insensibly to the bedside of
his patients; we are startled by the originality of his system; we
can hardly persuade ourselves that any means so simple can
accomplish so much, can overcome and reduce to order the chaotic
confusion of thoracic pathology; and hesitate not in the end to
acknowledge our unqualified wonder at the triumphant confirmation of
all he professed to accomplish."
These tributes to Laennec, however, from men who were his
contemporaries across the channel, have been more than equalled by
distinguished physicians on both sides of the Atlantic at the end of
the nineteenth and the beginning of the twentieth century. While we
might hesitate to accept the opinions of those who had been so close
to him at the beginning of the new era of physical diagnosis, there
can be no doubt now, after the lapse of three-quarters of a century,
of what Laennec's influence really was, and the tributes of the
twentieth century place him among the few great geniuses to whom
scientific medicine owes its most important advance.
At the annual meeting of the State Medical Society of New York held in
Albany at the end of January, 1903, the president of the society,
Doctor Henry L. Elsner, of Syracuse, in his annual address devoted
some paragraphs to a panegyric of Laennec. He wished to call attention
to what had been accomplished for scientific medicine at the beginning
of the last century by a simple observant practitioner. In the course
of his references to Laennec and his work he said:
"It is by no means to be considered an accident that, {138} among
the greatest advances in medicine made during the century just
closed, the introduction of pathological anatomy and auscultation
into the practice of medicine at the bedside were both effected by
the same clear mind, Laennec. He is one of the greatest physicians
of all time."
He then quoted the opinion of a distinguished English clinician,
Professor T. Clifford Allbutt, who is well known, especially for his
knowledge of the history of medicine. Professor Allbutt is the Regius
Professor of Physic (a term about equivalent to our practice of
medicine) of Cambridge University, England, and was invited to this
country some years ago as the representative of English medicine to
deliver the Lane lectures in San Francisco. During his stay in this
country he delivered a lecture at Johns Hopkins University on
"Medicine in the Nineteenth Century," in which he said, "Laennec gives
me the impression of being one of the greatest physicians in history;
one who deserves to stand by the side of Hippocrates and Galen, Harvey
and Sydenham. Without the advances of pathology Laennec's work could
not have been done; it was a revelation of the anatomy of the internal
organs during the life of the patient."
Rene Theodore Hyacinthe Laennec, who is thus conceded by twentieth
century medicine a place among the world's greatest medical
discoverers, was born February 17, 1781, at Quimper in Bretagne, that
rocky province at the north of France which has been the sturdy
nursing mother of so many pure Celtic Frenchmen who have so mightily
influenced the thought not only of their own country but of all the
world. The names of such Bretons as Renan and Lamennais have a
universal reputation and the province was even more distinguished for
its scientists.
There was published [Footnote 2] a few years ago in France a detailed
{139} history of Breton physicians. This work sketches the lives of
the physicians of Breton birth from the sixteenth to the twentieth
century. Only those of the nineteenth century concern us, but the list
even for this single century includes such distinguished names as
Broussais, whose ideas in physiology dominated medicine for nearly
the whole of the first half of the nineteenth century; Jobert, the
famous French surgeon whose reputation was world-wide; Alphonse
Guerin, another distinguished surgeon, whose work in the protection of
wounds in some respects anticipated that of Lister; Chassaignac, to
whose inventive genius surgery owes new means of preventing hemorrhage
and purulent infection, and who introduced the great principle of
surgical drainage; finally Maisonneuve, almost a contemporary, whose
name is a household word to the surgeons of the present generation;
without mentioning for the moment the subject of this sketch, Laennec,
the greatest of them all. Six greater men never came from one province
in the same limited space of time.
[Footnote 2: Les Medecins Bretons par Dr. Jules Roger. Paris, J. B.
Bailliere, 1900.]
Bretagne, "the land of granite covered with oaks" as the Bretons love
to call it, may well be proud of its illustrious sons in the century
just past. Taken altogether they form a striking example of how much
the world owes to the children of the countryside who, born far from
the hurrying bustle of city life, do not have their energies sapped
before the proper time for their display comes. These Bretagne
physicians, illustrious discoverers and ever faithful workers, are at
the same time a generous tribute to the influence of the simple,
honest sincerity of well-meaning parents whose religious faith was the
well-spring of humble, model lives that formed a striking example for
their descendants. The foundations of many a great reputation were
laid in the simple village homes, far from the turmoil and the
excitement of the fuller {140} life of great cities. The Bretons are
but further examples of the fact that for genuine success in life the
most precious preparation is residence in the country in childhood and
adolescent years. The country districts of Normandy, the province
lying just next to Bretagne, have furnished even more than their share
of the Paris successes of the century, and have seen the Norman
country boys the leaders of thought at the capital.
Laennec's father was a man of culture and intelligence, who, though a
lawyer, devoted himself more to literature than his case books. His
poetry is said to recall one of his better known compatriots,
Deforges-Maillard. Laennec was but six years old when his mother died.
His father seems to have felt himself too much preoccupied with his
own work to assume the education of his son, and so the boy Laennec
was placed under the guardianship of his grand-uncle, the Abbe
Laennec, and lived with him for some years in the parish house at
Elliant.
A relative writing of Laennec after his death says that the boy had
the good fortune to be thus happily started on his path in life by a
hand that was at once firm and sure. The training given him at this
time was calculated to initiate him in the best possible way into
those habits of application that made it possible for him to make
great discoveries in after life. The boy was delicate besides, and the
house of the good old rector-uncle was an excellent place for him,
because of its large and airy rooms and the thoroughly hygienic
condition in which it was kept. Household hygiene was not as common in
those days as in our own and child mortality was higher, but the
delicate boy thrived under the favorable conditions.
Besides the parish house was situated in the midst of a beautiful
country. The perfectly regular and rather serious {141} life of the
place was singularly well adapted to develop gradually and with due
progression the precious faculties of a young, active mind and
observant intelligence. This development was accomplished besides
without any excitement or worry and without any of the violent
contrasts or precocious disillusions of city life.
The boy passed some four or five years with his grand-uncle the priest
and then went to finish his studies with a brother of his father, Dr.
Laennec, a physician who has left a deservedly honored name. At this
time Dr. Laennec was a member of the Faculty of Medicine at the
University of Nantes. The growing lad seems to have been wonderfully
successful in his studies, and a number of prizes gained at school
show how deeply he was interested in his work. During this time he
learned English and German and became really ready to begin the study
of the higher sciences. Besides working at his academic studies,
Laennec paid some attention to his uncle in his professional work, and
by careful observation laid the foundation of his medical studies. His
character as an observer, rather than a student of books, showed
itself very early. He devoted himself to the clinical investigation of
cases in the military hospital and was especially interested in the
study of anatomy.
In 1800, at the age of nineteen, he went to Paris. It was typical of
the man and his careful, thoroughness all through life that the first
impulse when he found himself free to work for himself, was to try to
make up for what he considered defects in his elementary studies. It
must not be forgotten that the ten years of Laennec's life, from his
tenth to his twentieth year, came in the stormy time of the French
Revolution, and that school regularity was very much disturbed. His
first care then was to take up the study of Latin again. He learned to
read and write the language with elegance and {142} purity. Later on,
occasionally, he delivered his clinical lectures, especially when
foreigners were present, in Latin. We shall have the occasion to see
before the end of this article, with what easy grace he learned to use
it from some passages of the preface of his book written in that
language.
He did not allow his accessory studies, however, to interfere with his
application to his professional work. He was one of those rare men who
knew how to rest his mind by turning it from one occupation to
another. When scarcely more than a year in Paris, Laennec secured the
two first prizes for medicine and surgery in the medical department of
the University of Paris. In 1804 he wrote two medical theses, one of
them in Latin, the other in French. The subject of both was
Hippocrates, the great Greek father of medicine, whom Laennec admired
very much and whose method of clinical observation was to prove the
key-note of the success of Laennec's own medical career.
At this time the Paris school of medicine had two great rival
teachers. One of them was Corvisart, who endeavored to keep up the
traditions of Hippocrates and taught especially the necessity for
careful observation of disease. The other was Pinel, famous in our
time mainly for having stricken the manacles from the insane in the
asylums of Paris, but who was known to his contemporaries as a great
exponent of what may be called "Philosophic Medicine." Corvisart
taught principally practical medicine at the bedside; Pinel mainly the
theory of medicine by the analysis of diseased conditions and their
probable origin.
Needless to say, Laennec's sympathies were all with Corvisart. He
became a favorite pupil of this great master, who did so much for
scientific medicine by introducing the method of percussion, invented
nearly half a century before by Auenbrugger, but forgotten and
neglected, so that it {143} would surely have been lost but for the
distinguished Frenchman's rehabilitation of its practice. Corvisart
was a man of great influence. He had caught Napoleon's eye. The great
Emperor of the French had the knack for choosing men worthy of the
confidence he wished to place in them. His unerring judgment in this
matter led him to select Corvisart as his personal physician at a
moment when his selection was of the greatest service to practical
medicine, for no one was doing better scientific work at the time, and
this quasi-court position at once gave Corvisart's ideas a vogue they
would not otherwise have had.
Corvisart's most notable characteristic was a sympathetic
encouragement of the work of others, especially in what concerned
actual bedside observation. Laennec was at once put in most favorable
circumstances, then, for his favorite occupation of studying the
actualities of disease on the living patient and at the autopsy. For
nearly ten years he devoted himself almost exclusively to the care and
study of hospital patients. In 1812 he was made physician to the
Beaujon Hospital, Paris. Four years later he was transferred to the
Necker Hospital, where he was destined to bring his great researches
to a successful issue. To the Necker Hospital, before long, students
from all over the world flocked to his clinical lectures, to keep
themselves in touch with the great discoveries the youthful master was
making. In spite of rather delicate health Laennec fulfilled his
duties of physician and professor with scrupulous exactitude and with
a self-sacrificing devotion that was, unfortunately, to prove
detrimental to his health before very long.
One of his contemporaries says of him:
"Laennec was almost an ideal teacher. He talked very easily and his
lesson was always arranged with logical method, clearness and
simplicity. He disdained utterly {144} all the artifices of oratory.
He knew, however, how to give his lectures a charm of their own. It
was as if he were holding a conversation with those who heard him
and they were interested every moment of the time that he talked, so
full were his lectures of practical instruction."
Another of his contemporaries says, naively: "At the end of the lesson
we did not applaud, because it was not the custom. Very few, however,
who heard him once, failed to promise themselves the pleasure of
assisting at others of his lectures."
The work on which Laennec's fame depended and the discovery with which
his name, in the words of our great American diagnostician, Austin
Flint, the elder, will live to the end of time was concerned with the
practice of auscultation. This is the method of listening to the
sounds produced in the chest when air is inspired and expired in
health and disease, and also to the sound produced by the heart and
its valves in health and disease. Nearly two centuries ago, in 1705,
an old medical writer quoted by Walshe, in his "Treatise on the
Disease of the Lungs and Heart" said very quaintly but very shrewdly:
"Who knows but that one may discover the works performed in the
several offices and shops of a man's body by the sounds they make and
thereby discover what instrument or engine is out of order!"
It was just this that Laennec did. He solved the riddle of the sounds
within the human workshop, to continue the quaint old figure, and
pointed out which were the results of health and which of disease. Not
only this, but he showed the difference between the sounds produced in
health and disease by those different engines, the lungs and the
heart. The way in which he was led to devote his attention originally
to the subject of auscultation is described by Laennec himself with a
simplicity and directness so charmingly characteristic {145} of the
man, of his thoroughly Christian modesty, of his solicitude for even
the slightest susceptibility of others and of his prompt inventive
readiness, that none of his biographers has been able to resist the
temptation to quote his own words with regard to the interesting
incident, and so we feel that we must give them here.
He says:
"In 1816 I was consulted by a young person who was laboring under
the general symptoms of a diseased heart. In her case percussion and
the application of the hand (what modern doctors call palpation)
were of little service because of a considerable degree of
stoutness. The other method, that namely of listening to the sounds
within the chest by the direct application of the ear to the chest
wall, being rendered inadmissible by the age and sex of the patient,
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 the occurrence of this idea 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. I 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 _rales_ and perhaps
even the fluctuation of fluid effused in the pleura or pericardium.
With this conviction I forthwith {146} commenced at the Necker
Hospital a series of observations from which I have been able to
deduce a set of new signs of the diseases of the chest. These are
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 surgeons by the finger or sound, in the complaints
wherein these are of use."
This is the unassuming way in which Laennec announces his great
discovery. He did not in modern fashion immediately cry "Eureka!" and
announce the far-reaching importance of his method of diagnosis. For
two years he devoted himself to the patient study of the application
of his method and the appreciation of its possibilities and its
limitations. Then he presented a simple memoir to the French Academy
of Sciences on the subject. A committee of three, then distinguished
members of the Academy, Doctors Portal, Pelletan and Percy were named
to investigate the new discovery.
It is rather interesting to notice, though almost needless to say,
that the names of these men would be now absolutely unremembered in
medical history but for the fortuitous circumstance that made them
Laennec's investigators. Such is too often the ephemeralness of
contemporary reputation. Fortunately for the committee, they reported
favorably upon Laennec's discoveries. It is not always true of new and
really great advances in medicine that they are received with proper
appreciation upon their first announcement. Even Harvey said of his
discovery of the circulation of the blood that he expected no one of
any reputation in his own generation to accept it. It is not very
surprising to find then in the matter of the Laennec investigators
that there is a cautious reserve in their report, showing that they
were not too ready {147} to commit themselves to a decided opinion on
the importance of the new discovery, nor to any irretrievable
commendation.
The important part of the discovery was supposed to consist in the use
of the wooden cylinder which Laennec came to employ instead of the
roll of paper originally used. This wooden cylinder, now familiar to
us under the excellent name invented for it by Laennec himself is the
modern single stethoscope. This instrument is of great service. The
really important part of Laennec's work, however, was not the
invention of the stethoscope, but the exact observation of the changes
of the breath sounds that could be noted with it in various forms of
chest diseases.
Laennec succeeded in pointing out how each one of the various diseases
of the heart and lungs might be recognized from every other. Before
his time, most of the diseases of the lungs, if accompanied with any
tendency to fever particularly, were called lung fever. He showed the
difference between bronchitis and pneumonia, pneumonia and pleurisy,
and the various forms of tuberculosis and even the rarer pathological
conditions of the lung, such as cancer, or the more familiar
conditions usually not associated with fever, emphysema, and some of
the forms of retraction.
With regard to heart disease, it was before Laennec's discovery almost
a sealed chapter in practical medicine. It was known that people died
from heart disease often and, not infrequently, without much warning.
The possibility that heart conditions could be separated one from
another, and that some of them could be proved to be comparatively
harmless, some of them liable to cause lingering illness, while others
were surely associated with the probability of sudden fatal
termination, was scarcely dreamed of. It is to Laennec's introduction
of auscultation that modern medicine owes all its exacter knowledge of
heart lesions and their {148} significance. He himself did not solve
all the mysteries of sound here as he did in the lungs; indeed, he
made some mistakes that render him more sympathetic because they bring
him down to the level of our humanity. He did make important
discoveries with regard to heart disease, and his method of diagnosis
during his own life was, in the hands of the Irish school of medicine,
to prove the key to the problems of disease he failed to unlock.
Almost at once Laennec's method of auscultation attracted widespread
attention. From Germany, from Italy, from England, even from the
United States, in those days when our medical men had so few
opportunities to go abroad, medical students and physicians went to
Paris to study the method under the direction of the master himself
and to learn from him his admirable technique of auscultation. Those
who came found that the main thing to be seen was the patient
observation given to every case and Laennec's admirably complete
examination of each condition. The services to diagnosis rendered by
the method were worthy of the enthusiasm it aroused. Only the work of
Pasteur has attracted corresponding attention during the nineteenth
century. Physicians practice auscultation so much as a matter of
course now that it is hard to understand what an extreme novelty it
was in 1820, and how much it added to the confidence of practitioners
in their diagnosis of chest diseases.
Bouilland said, with an enthusiasm that does not go beyond literal
truth, "A sense was lacking in medicine and I would say, if I dared,
that Laennec the creator, by a sort of divine delegation of a new
sense, supplied the long-felt want. The sense which medicine lacked
was hearing. Sight and touch had already been developed in the service
of medical diagnosis. Hearing was more important than the other two
senses, and in giving it to scientific medicine Laennec disclosed a
new {149} world of knowledge destined to complete the rising science
of diagnosis."
Henri Roger said: "Laennec in placing his ear on the chest of his
patient heard for the first time in the history of human disease the
cry of suffering organs. First of all, he learned to know the
variations in their cries and the expressive modulations of the
air-carrying tubes and the orifices of the heart that indicate the
points where all is not well. He was the first to understand and to
make others realize the significance of this pathological language,
which, until then, had been misunderstood or, rather, scarcely
listened to. Henceforth, the practitioner of medicine, endowed with
one sense more than before and with his power of investigation
materially increased, could read for himself the alterations hidden in
the depths of the organism. His ear opened to the mind a new world in
medical science."
The freely expressed opinions of distinguished German, English and
American physicians show that these enthusiastic praises from his
French compatriots are well deserved by Laennec for the beautifully
simple, yet wonderfully fecund method that he placed before the
medical profession in all its completeness.
The first employment of the stethoscope by rolling up sheets of paper
is of itself a sign of his readiness of invention. He made his own
stethoscopes by hand and liked to spend his leisure time fashioning
them carefully and even ornately. One of the stethoscopes certainly
used by him and probably made by himself is to be seen at the Museum
of the College of Physicians of Philadelphia.
After three years of study and patient investigation of the use of
auscultation in pulmonary and cardiac diagnosis, Laennec wrote his
book on the subject. This is an immortal work--a true classic in its
complete treatment of the subject. {150} We have had thousands of
books written on the subject since Laennec's time, and yet no
physician could do better at the present moment than study Laennec's
two comparatively small volumes to learn the art of physical
diagnosis.
It is a characteristic of genius to give a completeness to work that
endows it with an enduring independent vitality. Almost innumerable
disciples follow in the footsteps of a teacher, and each thinks that
he adds something to the fulness of the revelation made by the master.
At the end of a century the fourth generation finds that scarcely
anything has been added and that the master's work alone stands out,
not merely as the great central fact of the new theory or doctrine,
but as the absolute vital entity to which the other supposed
discoveries are only adventitious and not entirely indispensable
accessories.
Dr. Austin Flint, the elder, admittedly one of the greatest
diagnosticians in pulmonary and heart diseases that we have ever had
in America, said on this subject: "Suffice it to say here that,
although during the forty years that have elapsed since the
publication of Laennec's works the application of physical exploration
has been considerably extended and rendered more complete in many of
its details, the fundamental truths presented by the discoverer of
auscultation not only remain as a basis of the new science, but for a
large portion of the existing superstructure. Let the student become
familiar with all that is now known on this subject, and he will then
read the writings of Laennec with amazement that there remained so
little to be altered or added."
Laennec's unremitting devotion to his hospital work finally impaired
his health. He was never robust and strangers who came to Paris and
saw him for the first time wondered that he should be able to stand
the labor he required of himself. The portraits of him give a good
impression of {151} his ascetic delicacy; they convey besides a
certain wistfulness, the look of one close to human suffering, and
unable to do all that he would wish to relieve it. Long before his
discovery of the mysteries of auscultation, he had accomplished
results that of themselves, and without his subsequent master
discovery, would have given him an enduring name in medical
literature. Laennec's genius enabled him to make a really great
discovery, but Laennec's talent, the principal part of which was an
inexhaustible faculty for untiring labor, an infinite capacity for
taking pains with all that he did, enabled him to make a number of
smaller discoveries any one of which would have given a great
reputation to a lesser man.
Some idea of the amount of work that he did in preparing himself for
the observations that were to result in his discovery may be gathered
from details of his earlier career. During the first three years of
his attendance at La Charite Hospital in Paris he drew up a minute
history of nearly four hundred cases of disease. As early as 1805 he
read a paper on hydatid cysts. These cysts were formerly thought to be
hollow tumors formed within the tissues themselves somewhat as other
cystic tumors are formed. Laennec showed conclusively that their
origin was entirely due to certain worms that had become parasites in
human beings. The cysts instead of being tumors were really one stage
of the worm's existence, and had an organization and an independent
existence of their own. He gave an exact description of them and even
showed that there were several types of the parasite, and described
the different changes that various forms produced in the human
tissues. This study of the hydatid parasites remains a remarkable
contribution to medicine down even to our own day.
During these early years Laennec devoted himself particularly to the
study of pathology. Like all the men who {152} have made great
discoveries in medicine he understood that all true medical advance
must be founded on actual observation of the changes caused by disease
in the tissues, and that this knowledge can only be obtained in the
autopsy room. For years he devoted himself to the faithful study of
the tissues of patients dead from various forms of disease. He wrote
as the result of this work a treatise on peritonitis that was a
distinct advance over anything known before his time and which, in the
words of Benjamin Ward Richardson, "as a pathological study was
shrewdly in anticipation of the later work of one who became his most
formidable rival, the famous Broussais."
From the peritoneum his attention was attracted to the liver. As early
as 1804 he wrote a description of the membranes of the liver.
Pathological changes in the liver continued to occupy his attention
for some time, and it is to him we owe the name cirrhosis of the
liver, as a term for the changes which are produced by alcohol in this
gland. Alcoholic cirrhosis is often spoken of as Laennec's cirrhosis
of the liver, and he was the first to point out the significance of
the changes in the organ, their etiology and the reason for the
symptoms that usually accompany this condition. This work alone would
have been sufficient to have made Laennec's name a permanent fixture
in medical literature.
During the early years of Laennec's career at Paris, the French
Anatomical Society was founded and Laennec became a prominent member
of it. Corvisart, who was the moving spirit in the society, was at
this time--the early years of the nineteenth century--doing his great
teaching at the medical school of the University of Paris. He was
Laennec's master, and was at the height of his glory. It was a
constant source of surprise to his students to note how well the
master's diagnosis agreed with postmortem findings. This is, after
{153} all, the only true criterion of scientific diagnosis. It is not
surprising that the strict application of this practical method of
control of medical theory soon gave rise to a series of distinct
advances in medical knowledge of the greatest importance.
Discussions of cases were frequent and Laennec took a prominent part
in them. His knowledge of medicine was broadening in this great field
of practice, and he was chosen as one of the contributors to the
_Dictionnaire des Sciences Medicales_. His articles for this work
contained much original matter of great value and suggestive views of
notable importance. Laennec was the first to give a description of
carcinoma encephaloides and certain especially malignant forms of
cancers. He showed the distinction between pigmented spots of
benignant character and those that were due to malignant disease.
"After all, however," says Benjamin Ward Richardson, "the grand
reputation of Laennec must rest on his one immortal work. It is not
too much to say that any man of good intelligence could have written
the other memoirs. No one less than Laennec could have written the
'Treatise on Mediate Auscultation and the Use of the Stethoscope.' The
true student of medicine, who never wears out, reads this original
work of Laennec once in two years at least, so long as he is in
practice and takes a living interest in the subject of which it
treats. It ranks equally with the original works of Vesalius, Harvey
and Bichat and as a section of medical literature is quite equal to
any section of Hippocrates." [Footnote 3]
[Footnote 3: The full title of this work of Laennec's is "De
l'auscultation mediate ou traite du diagnostic des maladies des
poumons et du coeur par R. T. H. Laennec." Its modest motto is the
Greek sentence: [Greek Text], (The most important part of an art is
to be able to observe properly.) The book was published in Paris by
J. A. Brosson et J. S. Chande, rue Pierre-Sarrazin, No. 9, 1819.]
{154}
Some quotations from the Latin preface to the book will serve to show
that Laennec appreciated the value of the discovery he had made for
the diagnosis of chest diseases, yet that he did not expect it to be
taken up enthusiastically at once, and in his modest way he adds that
he shall be satisfied if it should serve to save but one human being
from suffering and death. [Footnote 4]
[Footnote 4: "Imo neminem hanc methodum expertum deinceps cum
Baglivio dicturum esse spero: O quantum difficile est diagnoscere
morbos pulmonum."
"Nostra enim _aetas incuriosa_ quoque _suorum_ (the italics are
Laennec's own); et si quid novi ab homine coaevo in medio ponitur,
risu ut plurimum ineptisque cavillationibus excipiunt; quippe
facilius est aspernari quam experiri."
"Hoc mihi satis est quod bonis doctisque viris nonnullis acceptam
aegrotisque multis utilem, hanc methodum fore confidere possim;
hominem unum ereptum orco dulce dignumque meae atque etiam majoris
operae pretium praemium fore existimem."
"I may say that no one who has made himself expert with this method
will after this have occasion to say with Baglivi, Oh! how difficult
it is to diagnose disease of the lungs."
"For our generation is not inquisitive as to what is being
accomplished by its sons. Claims of new discoveries made by
contemporaries are likely for the most part to be met by smiles and
mocking remarks. It is always easier to condemn than to test by
actual experience."
"It suffices for me if I can only feel sure that this method will
commend itself to a few worthy and learned men who will make it of
use to many patients. I shall consider it ample, yea, more than
sufficient reward for my labor, if it should prove the means by
which a single human being is snatched from untimely death."]
Unfortunately, as we have said, Laennec's untiring devotion for nearly
twenty years to medical investigation caused his health to give way.
It is painful to think that in the full tide of the success of his
great labors, when the value of his work was only just beginning to be
properly appreciated and when he had attained a position which would
satisfy even lofty ambitions, his nerves gave way and he had many
{155} of the typical melancholic symptoms that disturb the modern
neurasthenic. Fortunately, his habits of life, always extremely
abstemious, and his liking for outdoor sports had been a safeguard for
him. He retired to the country and for nearly two years spent most of
his time in the open air.
It was not long before surcease from intellectual labor and indulgence
in field sport restored him to health and to activity. He foresaw,
however, that to go back to the city and to his scientific work would
almost surely lead to another breakdown. One of his biographers states
that it was the great regard which he had for his family and the
powerful influence of his religious principles which alone had
sufficient weight to make him leave his retreat in the country. After
an absence of two years, he returned to Paris and once more took up
his hospital duties.
Soon after his return he received the appointment of physician to the
Duchesse de Berri. One of the main objections to this position in
Laennec's mind seems to have been the necessity for occasionally
wearing court dress with a sword and regalia. Ordinarily he went
dressed very plainly, and it was noted that, when men of much less
authority and much less practice used their own carriages, he usually
took a hired cab. His position at court gave him enough influence to
bring about the proper recognition of his merit as a teacher. At this
time his lectures on auscultation, though he held no regular
professorship, were crowded by students from all nations. The year
after his return to Paris he was appointed Professor of Medicine in
the College of France, and afterward of clinical medicine at the
Hospital La Charite where he had made his own studies as a medical
student.
About this time he was offered a position of importance as a member of
the Royal Council of Public Instruction. This he refused, however,
because it would deprive him of {156} some of the precious time that
he wished to devote to the further investigation of important subjects
in clinical medicine and especially to the elaboration of his method
of auscultation.
One of the most striking features of Laennec's character was his
absolute placidity and lack of personal ambition. His life was passed
in the most complete calm. He devoted himself to his work, and had the
supreme joy of duty accomplished, seeming to look for no other
enjoyment in life. Those who knew him best said that they had never
seen him angry or even impatient. In the midst of his discussion with
Broussais, it might have been expected that there would occasionally
have been some flashes of impatience, for the great protagonist of
medical theory was a man of satiric character, and his supposedly
scientific discussion was stained by some very bitter personalities.
In spite of all Broussais' sarcasm, Laennec remained absolutely
unmoved. Occasionally his friends saw a smile at some of Broussais'
emphatic asseverations, but Laennec simply continued at his work, and
looked straight ahead, convinced that what he was doing was for the
cause of truth, and the truth would finally prevail.
He was known for the kindness of his disposition, and his readiness to
help his friends whenever it was possible. He was never known to
injure anyone, and a certain quiet elevation of spirit preserved him
from all conceit. One of his most intimate Breton friends, Kergaradec,
said, "I have never heard Laennec express by a single word, or even by
the slightest insinuation, anything that might seem to indicate pride
in what he had accomplished or that might provoke a listener to say
something in praise of him." The friends he made were bound to him
with hoops of steel. They were not many, for he had not the time to
waste on many friends. He was too devoted to his work, and too {157}
deeply interested in the great problem whose solution he foresaw meant
so much for the good of humanity, to have much time for anything but
his studies and his patients.
With regard to Laennec's personal character, his most recent
biographer Dr. Henri Saintignon, has said: [Footnote 5]
[Footnote 5: Laennec, Sa vie et son oeuvre. Par Dr. Henri
Saintignon. Paris, J. B. Bailliere et Fils, 1904.]
"I have shown in the course of this life just what was the character
of Laennec and his intellectual and moral qualities, so that it will
not be necessary for me to dwell at length on this subject, in
concluding. His great piety, which had never been abandoned from his
earliest infancy, was his main guide during all his life. Without
ostentation, yet without any weakness, absolutely ignoring human
respect, he obeyed with utter simplicity the prescriptions of his
faith. While he did not conceal his convictions when during the
first empire they might have proved a source of lessened esteem, or
positive prejudice, he made no noise about them when under the
Restoration they might have proved the means of advancement and of
fortune. He had not in the slightest degree what is so often
objected to, in devoted persons, namely, the love of making
proselytes. The words of Prof. Desgenettes might very well have been
applied to him: as he did not believe himself to have any mission to
lead others to his opinions, he limited himself to preaching by
example. The reproach of being rabidly clerical or propagandist,
which was urged against him, when he first became a member of the
faculty of medicine, was absolutely unjustified. Laennec never
occupied himself with politics nor with religion in public. As a
physician he devoted himself exclusively to his profession,
receiving at his clinic all those who desired to follow his
teaching, whatever might be their opinions or their beliefs."
{158}
It was not long, however, before Laennec's many labors in Paris began
to tell on his health once more. His practice after his return to
health and his attachment to the court became large and lucrative. It
is characteristic of the man and his ways that he frequently refused,
owing to lack of time, to go to see wealthy patients, from whom he
would have received large fees, but it is said that he never refused
to go to see a poor patient. His hospital patients always received the
most solicitous attention, and his time was almost entirely at their
disposal. It was not long before Laennec himself, who had taught
modern physicians so much about the diagnosis of pulmonary diseases,
began evidently to suffer from pulmonary disease himself. There seems
no doubt now that almost constant association with tuberculous
patients in an overworked subject inclined naturally to be of
underweight, and therefore especially susceptible, led to the
contraction of the disease.
After about four years in Paris, a dry, hard cough developed
insidiously, gradually increased in annoyance, and finally grew so
serious as to demand a return once more to his native Bretagne. He
lost flesh, became subject to intermittent attacks of fever and
suffered from some pleuritic and pulmonic pains. For some time after
his return to his native air he improved. He was treated by the usual
method employed at the time whenever fever accompanied any ailment.
Venesection was the main part of what was then called the
antiphlogistic treatment. It is needless to say he did not improve. He
was suffering from exhausting disease and the treatment became really
an accessory to further exhaustion.
At last there could be no longer any doubt that the end was
approaching. The old cure of the village came often to visit him, and
brought him all the consolations of religion. {159} With his sincere
Christian faith and firm conviction, it was not hard for Laennec to
find the moral force and the calm necessary to secure an easy death.
Finally one day, on August 13th, his wife saw him take off his fingers
one after another the rings he wore, and place them softly upon the
table. When she asked him why he did so, he replied, "It will not be
long now before someone else would have to do this service for me, and
I do not wish that they should have the trouble." Even in death he was
thinking of others rather than of himself, and he was calmly facing
the inevitable, thoroughly prepared for it. Two hours afterward, at
five o'clock in the afternoon, without there having been at any time
the slightest loss of consciousness, Laennec passed away.
How faithfully his family had watched over him, and how simple was the
feeling of Christian confidence in all of them, may very well be
gathered from the letter of his cousin Ambrose to Laennec's brother
Meriadec in Paris.
"My dear Meriadec:--Poor Rene is no more. His life was passed in the
midst of labor and of benevolence. While he had all the virtues of
the true Christian, and a wisdom far beyond what was usually granted
to men, they have not sufficed to obtain for him the grace of a
longer life. Somehow it was ordained that this glory and ornament of
our family was not to remain with us. What a sad reflection it is on
our restless eagerness in this life, and on the vanity of our hopes,
that a genius like this must perish just when it was about to
receive the fruit of its labors! He leaves to us a name, a name
difficult to sustain and the example of virtues that it will not be
easy to imitate. Let us hope that he will watch over us in the
future as he has done in the past, and that he will still continue
to aid us after his death. Although I have been prepared for this
sad event, I could not suspect how much grief I was to experience in
losing my {160} second master, my friend from earliest infancy, and
him whom I had become accustomed to consider as my eldest brother. I
must confess that for some years now we have all had to pay dear for
the short intervals of happiness that it has pleased heaven to
accord to us."
Laennec's burial took place in the cemetery of Ploare. The attendance
at the funeral was very large. Practically the entire population of
the countryside came to mourn for the benefactor that they loved so
much. He had made friends even among the simplest of the country
people and knew most of them by name. After his return to the country,
he had improved somewhat in appearance, and the neighbors had been
very glad to express their feelings of gratitude for his apparent
improvement in health. Undoubtedly not a little of this state of
better spirits was due to the fact that he liked Brittany and the
peasants of the neighborhood so well, and always felt so much at home
among them.
He was mild and agreeable in his manners, and of a quiet and even
temper. His conversation was lively and full of quiet humor, and his
friends often said that they never came away from a conversation with
him without having learned something. Toward the end of his life, when
his great reputation caused him to be honored by medical men from all
over the world, and when his reputation made him the lion of the hour,
he lost none of his natural affability and kindness of heart. He was
remarkable, especially, for his great kindness and courtesy to
foreigners, and he is said to have taken special care to make himself
understood by English-speaking medical visitors.
It must be confessed that he was somewhat less popular with his
contemporaries who did not belong to his immediate circle of friends
and students. One of the reasons for this was his genius, which no
generation seems ready to {161} acknowledge in any of its members.
Another reason was his continued misunderstanding with Broussais.
Broussais was the medical theorist of the hour, and medical theories
have always been popular, while medical observation has had to wait
for due recognition. There were undoubtedly good points in Broussais'
theories that Laennec failed to appreciate. This is the only blot on a
perfect career, taking it all in all, whether as man or as physician.
It can easily be understood with what impatience Laennec, entirely
devoted himself to observation, would take up the study of what he
considered mere theory, and it is easy to forgive him his lack of
appreciation.
Benjamin Ward Richardson says: "It was a common saying regarding
Laennec by his compeers that, while he was without a rival in
diagnosis, he was not a good practitioner; which means that he was not
a good practitioner, according to their ideas of practice, heroic and
fearful. To us, Laennec would now be a practitioner very heroic; so
much so, that I doubt if any medical man living would, for the life of
him, take some of his prescriptions. But in his own time, when so
little was known of the great system of natural cure, he would be
easily out of court. It was amply sufficient against him that he had a
glimmering of the truth as to the existence of a considerable run of
cases of organic disease, for which the so-called practice of remedial
cure by drugs, bloodlettings and other heroic plans, could do no good
but was likely to do grievous harm." We are reminded of Morgagni's
refusal to permit bloodletting in his own case, though he practised it
himself on others. Like Laennec, Morgagni seems to have doubted the
efficacy of bloodletting at a time when unfortunately all medical men
were agreed that it was the sovereign remedy.
If Laennec was not popular with his immediate {162} contemporaries,
succeeding generations have more than made up for the seeming neglect.
Less than twenty-five years after his death, Austin Flint, here in
America, hailed him as one of the five or six greatest medical men of
all times. Forty years after his death, Professor Chauffard, himself
one of the distinguished medical men of the nineteenth century, said:
"Without exaggeration we can call the glory which has come to French
medicine because of the great discovery of auscultation a national
honor. It must be conceded that for a long time before Laennec, the
great man of medicine, those to whom medical science owed its
ground-breaking work did not belong to France. Harvey, Haller and
Morgagni had made the investigations on which are founded the
circulation of the blood, experimental physiology, and pathological
anatomy, in other lands than ours. It almost seemed that we were
lacking in the fecund possibilities of daring and successful
initiative. Auscultation, however, as it came to us perfect from the
hands of Laennec, has given us a striking revenge for any objections
foreigners might make to our apathy. This discovery has rendered the
scientific medicine of the world our tributary for all time. It was an
immortal creation, and its effects will never fail to be felt. More
than this, it will never be merely an historical reminiscence,
because of the fact that it guided men aright, but it will in its
actuality remain as an aid and diagnostic auxiliary. Auscultation
will not disappear but with medical science itself, and with this
stage of our civilization which guides, directs and enlightens it."
Laennec was known for his simple Bretagne faith, for his humble piety,
and for uniformly consistent devotion to the Catholic Church, of which
he was so faithful a member. His charity was well known, and while his
purse was very ready to assist the needy, he did not hesitate to give
to the {163} poor what was so much more precious to him, and it may be
said to the world also, than money--his time. After his death, and
only then, the extent of his charity became known.
Dr. Austin Flint said of him: "Laennec's life affords an instance
among many others disproving the vulgar error that the pursuits of
science are unfavorable to religious faith. He lived and died a firm
believer in the truths of Christianity. He was a truly moral and a
sincerely religious man."
Of his death, his contemporary, Bayle, who is one of his biographers,
and who had been his friend from early youth, said:
"His death was that of a true Christian, supported by the hope of a
better life, prepared by the constant practice of virtue; he saw his
end approach with composure and resignation. His religious principles,
imbibed with his earliest knowledge, were strengthened by the
conviction of his maturer reason. He took no pains to conceal his
religious sentiments when they were disadvantageous to his worldly
interests, and he made no display of them when their avowal might have
contributed to favor and advancement." Surely in these few lines is
sketched a picture of ideal Christian manhood. There are those who
think it wonderful to find it in a man of genius as great as Laennec.
It should not be surprising, however, for surely genius can bow in
acknowledgment to its Creator.
Shortly after the death of Pasteur it was well said that two of the
greatest medical scientists of the nineteenth century have given to
the physicians of France a magnificent, encouraging and comforting
example. It is almost needless to say these two were Laennec and
Pasteur, and their example is not for France alone, but for the whole
medical world. They were living nineteenth century answers to the
advocates of free thought, who would say that religious belief and
{164} especially Catholic faith make men sterile in the realm of
scientific thought.
No better ending to this sketch of Laennec's life seems possible than
the conclusion of Dr. Flint's address to his students in New Orleans,
already so often quoted from. It has about it the ring of the true
metal of sincere Christian manhood and unselfish devotion to a
humanitarian profession:
"The career of the distinguished man whose biography has been our
theme on this occasion is preeminently worthy of admiration. In his
character were beautifully blended the finest intellectual and moral
qualities of our nature. With mental powers of the highest order
were combined simplicity, modesty, purity and disinterestedness in
such measure that we feel he was a man to be loved not less than
admired. His zeal and industry in scientific pursuits were based on
the love of truth for its own sake and a desire to be useful to his
fellow-men. To these motives to exertion much of his success is to
be attributed. Mere intellectual ability and acquirements do not
qualify either to make or to appreciate important scientific
discoveries. The mind must rise above the obstructions of self-love,
jealousy and selfish aims. Hence it is that most of those who have
attained to true eminence in the various paths of scientific
research have been distinguished for excellencies of the heart as
well as of the head. The example of Laennec is worthy of our
imitation. His superior natural gifts we can only admire, but we can
imitate the industry without which his genius would have been
fruitless. Let us show our reverence to the memory of Laennec by
endeavoring to follow humbly in his footsteps." _Quod faustum
vertat!_
{165}