In a monthly column for PBS NewsHour, Dr. Howard Markel revisits moments that changed the course of modern medicine, like the invention of the stethoscope. Photo By BSIP/UIG via Getty Images.
Long before Hippocrates (ca. 460-380 B.C.) taught his disciples the importance of listening to breath sounds, references to it appeared in the Ebers papyrus (ca. 1500 B.C.) and the Hindu Vedas (ca. 1500-1200 B.C).
But it was not until the early 19th century that physicians began to systematically explore the precise clinical meanings of both breath and heart sounds by correlating data gathered during patient examinations with what was ultimately discovered on the autopsy table.
René Théophile Hyacinthe Laënnec
This was the period when Paris reigned as the international center for all things medical. Drawing from a system of hospitals affording limitless access to what was then referred to as “clinical material,” the Paris medical school boasted a talented faculty that represented the vanguard of medicine.
One of the brightest stars in this firmament was the man credited with creating the stethoscope, René Théophile Hyacinthe Laënnec (1781-1826). Before he assumed the position of chief of service at the teeming Necker Hospital in 1816, Laënnec became adept at a technique called percussion, which involves striking the chest with one’s fingertips in search of pathologic processes.
Yet neither percussion nor the time-honored technique of listening to breath sounds by placing an ear against a patient’s chest satisfied Laënnec’s demand for diagnostic precision.
He was especially critical of physicians’ inability to hear muffled sounds emerging from the chest of an obese person, and he balked at what he described as the “disgusting” hygiene of his patients, many of whom were unwashed or lice-ridden.
Laënnec examines a consumptive patient with a stethoscope in front of his students at the Necker Hospital.
One day in the fall of 1816, Laënnec was scheduled to examine a young woman who had been “laboring under general symptoms of diseased heart.”
He was running late, according to the most charming version of the tale, and so took a shortcut through the courtyard of the Louvre, where a group of laughing children playing atop a pile of old timber caught his attention.
A pair of youngsters toying with a long, narrow wooden beam especially entranced Laënnec. While one child held the beam to his ear, the other tapped nails against the opposite end; all had a jolly good time transmitting sound.
Whether or not this instructive event ever occurred, Laënnec would later record that his invention was inspired by the science of acoustics and, in particular, the fact that sound is “conveyed through certain solid bodies, as when we hear the scratch of a pin at one end of a piece of wood, on applying our ear to the other.”
Upon entering his patient’s room, Laënnec asked for a quire of paper and rolled it into a cylinder. Placing it against the patient’s chest, the doctor was amazed to find how well he could “perceive the action of the heart in a manner much more clear and distinct than [he had] ever been able to do by the immediate application of the ear.”
Between 1816 and 1819, Laënnec experimented with a series of hollow tubes that he fashioned out of cedar or ebony, arriving at a model approximately 1 foot in length and 1.5 inches in diameter, with a 1/4-inch central channel. He would name his invention the stethoscope, derived from the Greek stethos, meaning chest, and skopein, meaning to observe.
In the mid-1950s, Jackie Chambers listens to Selma Perry’s heartbeat at the Smithsonian Institute through a replica of Laënnec’s third model stethoscope. Photo by Orlando via Getty Images.
A superb flautist who often used music to console himself during his own long and ultimately losing battle against tuberculosis, Laënnec pursued his studies with a vigor that belied the frailty of his frame.
He became the first physician to distinguish reliably among bronchiectasis, emphysema, pneumothorax, lung abscess, hemorrhagic pleurisy, and pulmonary infarcts. He also opened the door to our modern understanding of cardiac maladies by describing their associated heart sounds and various murmurs.
On Aug. 19, 1819, when Laënnec’s magnum opus on the stethoscope, De l’Auscultation Médiate, was published, the two-volume book caused hardly a stir in the medical world — even at the price of 13 francs, with a stethoscope thrown in for an extra 3 francs.
By the late 1820s, however, the book had been reprinted and translated into other languages and had managed to triumph over poor publicity and distribution. This success, combined with the gradual acceptance of the stethoscope by practicing physicians, allowed Laënnec to revolutionize clinical medicine.
Dr. Howard Markel writes a monthly column for the PBS NewsHour website, highlighting the anniversary of a momentous event that continues to shape modern medicine. He is the director of the Center for the History of Medicine and the George E. Wantz Distinguished Professor of the History of Medicine at the University of Michigan.
He is the author or editor of 10 books, including “Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892,” “When Germs Travel: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed” and “An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine.”
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