- To See with a Better Eye: A Life of R. T. H. Laennec
Jacalyn Duffin has given us the definitive Laennec, for many years to come. Her sources are abundant: more than seven hundred case histories, more than one thousand letters, lecture notes, annotated manuscripts, and more. She makes elegant use of Laennec’s biography as a frame for his medical work, thus enhancing the drama of an existence lived in counterpoint to the official political history of France during the Great Revolution and Empire. Royalist, practicing Catholic, and member, since 1803, of the secret reactionary Congrégation, Laennec found himself relegated to the fringes of official medicine. His brilliant success in his examinations made him confidently expect a professorship; but in 1808 he withdrew to a life of research and private practice, caring for a clerical and aristocratic clientele.
Under the Bourbon Restoration Laennec’s life changed—and the pace of Duffin’s prose noticeably quickens. The year 1816 brought an appointment at Necker Hospital, and by 1822 he was a member of the Academy of Medicine and of the Collège de France, owing to royal intervention. That year he played a [End Page 510] prominent part in the notorious cleansing of the Medical Faculty where eleven distinguished professors who had served the Revolution or Napoleon were peremptorily dismissed. His popularity declined under the July Monarchy: his eulogy in the Academy of Medicine was not read until 1839, thirteen years after his death.
Laennec’s career began at age thirty-five, in 1816, with his invention of the stethoscope. News of the instrument spread quickly and students now flocked to the bedside of his patients. He at first explored heart sounds, but he soon auscultated his patients’ lungs, and quickly learned to associate a specific sound with the underlying lesion and disease. Postmortem examination regularly confirmed his diagnosis in the living patient. Duffin makes a convincing argument that Laennec became far more than a pathological anatomist. Of great help was his accidental exposure to “pectoriloquy” in the summer of 1817: a patient spoke instead of breathing quietly while he was auscultating her, and he was startled by the volume and clarity of her voice as heard through the chest wall. Soon the combination of percussion and auscultation in pneumonia led him to discern sounds that allowed a differentiation among three stages of this disease, and thus “a physiological progression that could now be defined in the living patient” (p. 133). He came to focus increasingly on functional disturbances.
On 23 February 1818 Laennec gave a detailed presentation on auscultation to the Academy of Sciences. The following year he published the first edition of his Treatise on Mediate Auscultation. Duffin argues that this book “introduced a diagnostic method that endorsed and consolidated the new way of thinking about disease” (p. 152). A detailed comparison between the first edition of the Treatise and the second edition of 1826 allows her to present a meticulously documented analysis of Laennec’s clinical research and conclusions.
Part 3 of Duffin’s work focuses on Laennec’s lessons at the Collège de France, an “unpublished book” in which he attempted a synthesis of his medical philosophy. It is startling to learn that he now believed that lesions could occur not only in the solid or liquid components of the body but also in the “vital principle” in human beings. Laennec’s nephew and executor was so uncomfortable with what Duffin calls “perceived vitalism” that he refused to honor his uncle’s wish to see the Collège de France lessons published. Thus we have hitherto known only the inventor of the stethoscope; this learned book presents a much more complex and interesting scientist and thinker.
Duffin completes her book with five appendices, a long primary and secondary bibliography, forty-five illustrations, and twenty-three tables. It is a handsome volume to be read with pleasure and profit.