Wednesday, June 29, 2016

1818: Rostan claims asthma is cardiac, not nervous

Leon Louis Rostan (1790-1866) 
Writing as early as 1818, Professor Leon Louis Rostan said that he did not believe in nervous asthma. In fact, he went as far to conclude in his writings that asthma was not even so much asthma but was nothing more than cardiac asthma.

Mr. Rostan was the son of a wealthy family and received a good education.                        

A brief biography of Mr. Rostan was given by Harris L. Coulter.  He wrote:
He studied at Paris and graduated in 1812.  By 1814 he became (Philippe) Pinel's deputy at the Salpetriere where for eight months he administered a 2000-bed ward for Napoleon's army returning from Russia.  Four years later he was appointed physician at the same hospital where for the next fifteen years he gave heavily attended courses in "organicism."  A Zurich student noted in 1831 that Rostan's clinic was the most enlightening of all, being the only one given at the sickbed. (6, page 526)(also see 7)
As with many other physicians who studied asthma, he himself had the disease, suffering at one time a severe attack.  Perhaps this is what enticed him to study asthma during his tenure at Salpetriere.  (7)

After studying asthma in elderly women for many years at Salpetriere, and then performing autopsies on them once they passed away, he determined that what they actually had was heart disease, or what he called cardiac asthma. He published the results of his findings in a paper called "Is the asthma of old people a nervous affection?"  (3 pages 56-57)(5, pages 152-153)

The following are a couple examples of what he found (3, page 57):
  • 61 years old idiot who suffered from periodic paroxysms of great oppression of breathing... a large aneurism of the left ventricle of the heart, and ossification of the parts surrounding the bronchiae, were the appearances observed after death.  3, page 57)
  • A 74 year old woman, who had been asthmatic for 18 years: upon opening the body, he found an active aneurism of the left ventricle, with ossification of the aorta.  (3, page 57)
According to George Gregory, in his "Treaties on the theory and practice of physic, Rostan noted possible causes of asthma were "morbid alteration in the organs of respiration and circulation, producing an accumulation of blood in the lungs."  Examples include: (4, page 214)
  • Thickening of the left ventricle of the heart
  • Enlargement of the left ventricle
  • Ossification (hardening) of the valves of the left ventricle
  • Ossification of the valves of the aorta
  • Thickening of the parieties of the aorta
  • Adhesions between the lungs and the pleura
  • Effusions of serum into the cavity of the chest
  • The bronchia inflamed and filled with mucus
  • The lungs converted to a substance resembling liver (4, page 214)
J.B. Berkart, in his book "On Asthma: It's pathology and Treatment," said Rostan always found some pathological explanation for dyspnea.  He said:
Rostan,  more especially, urged that in the numerous instances of it which had come under his notice he had always found pathological changes sufficient to account for the dyspnoea; and saw, therefore, no reason to assign this to a derangement of the nervous system. He appears, however, to have employed the term asthma in a manner too vague to give weight to his objections. So that the demonstration of the symptomatic nature of the disease in his own cases does not necessarily apply to all others. (1, page 22)
While some of the patients at Hospice de la Salpetriere were diagnosed with asthma, Rostan said "he never saw a case of purely nervous asthma." That all the cases that "commenced as nervous affections" were discovered to have some form of organic disease.  (3, page 57)

Armand Trousseau, in a 1858 lecture at Hotel Dieu, said the following of Rostan:
If my honorable colleague, Prof. Rostan, admits to-day the existence of purely nervous asthma, he has not always admitted it. There was a time when he did not believe in this peculiar neurosis of the respiratory organs, and he regarded it as being symptomatic of affections of the heart.  Influenced by the recollection of the laborious investigations which he had made on this subject in the case of the asthma of old men, while he was a physician of the Salpetriere, M. Rostan recognized no difference between asthma and dyspnoea. (2, page 517)
Trousseau, however, said he disagreed with Dr. Rostan.  He said:
To him, these two words (dyspnea and asthma) were synonymous; to me, this is far from being the case. Asthma is, in my eyes, a special, complete malady; it is a manifestation, a particular form of a general condition, having very different local expressions, manifesting itself sometimes by attacks of dyspnoea, of oppressed breathing, constituting asthma, but able, also, to exhibit itself in attacks of articular gout, or gout in a more diffused form, in attacks of gravel, or rheumatism... It is not the difficulty of breathing which constitutes asthma; for it would be necessary in this case to call by this name the dyspnoea which is symptomatic of diseases of the heart, or great vessels, the violent distress which goes to the verge of suffocation in patients suffering from oedema of the glottis, or children taken with croup. Now there is no one who would not shun such a confusion. Between dyspnoea and asthma the difference is immense. If asthmabe a dyspnoea of special form and character, every attack of dyspnoea is not asthma. (2, page 517)
Other physicians, however, agreed with Rostan that asthma was not nervous, including Beau, Crozant, Budd, and Louis.  (1, 30-31,

Berkart said Beau and his pupil Crozant, instead of believing asthma was nervous or spasmotic, thought it was a disease of...
...chronic bronchial catarrh, accompanied with very viscid secretion.  Such sputa, they maintain, are capable of obstructing the bronchi, and of thus producing the dyspnoeal attacks, as well as the sonorous sibilant rhonchi -- their 'rales vibrants' (sound of mucus moving through narrowed air passages).  With the displacement of the mucous plug into a larger bronchus, or on its expulsion by means of a fit of coughing, the dyspnea ceases, and with it also the rales disappear. This form of bronchitis, in their opinion, due partly to an idiosyncrasy of the patient, partly to exciting causes, which greatly vary in different individuals."  (1, page 30-32) (8, page 52)
However, Berkart said Beau's opinion was not well supported, mainly because the nervous theory of asthma "was so well rooted to be readily abandoned upon the mere denial of its foundation. Beau omitted to offer any proof that a bronchial spasm was impossible or improbable" (1, page 31)

Of Budd, Berkart said he believed asthma was a tonic spasm of the diagram or glottis  (1, page 34-35)  Of Louis, Berkart said he believed "emphysema was a disease of gradual and insidious development, it therefore seemed to them highly probable that the asthmatic paroxysm were merely its precursory symptom."  (1, page 32)

Rostan's theory arose from the fact he studied older men and women with dyspnea, and determined the cause was not asthma but heart failure (cardiac asthma).   So most of Rostan's cases probably weren't even asthma to start with, but cases of heart failure.

Regardless of the views of Rostan, Beau, Constant, Budd and Louis, the nervous theory of asthma won the era.  It would remain a main asthma theory until it was disproved in the 1950s.

  1. Berkart, J.B., "On asthma: its pathology and treatment," 1878, London, J. & A. Churchill
  2. Trousseau, Armand, "Lectures on Asthma: Lecture III, Examination of the opinions of the profession of this disease," delivered at Hotel Dieu and translated from the Gazette de Hospiaux on Sept. 16th, 1858, for the Boston Medical and Surgical Journal, published in the Medical and Surgical Journal, 1859, edited by W.W. Morton, page 517
  3. "Historical sketch of the progress of medical science, from January to July, inclusive, 1819," The London Medical and Physical Journal, Volume XLII, no. 245, July 1819, J. Souter, pages 56-57
  4. Gregory, George, S. Colhoun, "Treaties on the theory and practice of physic, with notes and additions adapted to the practice of physic in the University of Maryland, ," volume 2, 1826, Philadelphia, J.H. Cunningham
  5. Wood, John, "On some effects of inflammation of the membranous lining of the larynx; with suggestions relative to the operation of bronchotomy and incidental remarks on spasm and wounds of the throat," pages 138-157,  Volume XVII, London, 1832, Published by the Royal Medical Chirurgical Society of London,
  6. Coulter, Harris L., "Divided history of the schism in medical thought," volume II, 1977, Berkeley, California, North Atlantic Books
  7. Rostan, Leon Louis, ",, accessed 12/30/13
  8. Fox, Wilson, writer, Sidney Coupland, editor,"A treaties on the diseases of the lungs and pleura," London, 1891, J. & A. Churchill
RT Cave Facebook Page
RT Cave on Twitter
Print Friendly and PDF

Monday, June 27, 2016

1816: Laennec invents the stethoscope

Figure 1 --Rene Laennec (1781-1826).  Along with
crediting an old kid's game with giving him the idea of
creating his first stethoscope, he was also skilled with
the flute.  His memory and his musical skill  helped him
come up with the ingenious plan of rolling up paper into
a hollow tube.  He then used this to listen to lung sounds.
He later modestly chimed that he was amazed the device
wasn't invented years ago.  Hippocrates was known for
performing auscultation by placing his ear upon his
patient's chest.  A simple stethoscope would have
greatly benefited the ancient physician. (4, page xxiii)
Before the 19th century the only way for a physician to auscultate (hear) heart and lung sounds was to place his ear upon his patent's chest.  This would change thanks to a brilliant invention by French Physician Rene Laennec.

A procedure called Immediate Auscultation was probably used by priest/physicians in ancient Egypt, although it was first described for the medical community around 400 B.C. by Hippocrates.

Laennec quotes Hippocrates from De Morbis:
auYou shall know by this that the chest contains water and not pus, if in applying the ear during a certain time on the side, you perceive a noise like that of boiling vinegar. (4, pages 28-29) 
Immediate auscultation, or placing an ear directly on the chest of the patient, was never further investigated by the successors of Hippocrates, and therefore never became standard practice.  (4, page 29)

Not helping matters was the fact that most people did not take regular baths, and sick people were sometimes hot and wet from sweat.  Laennec said that it was flat out disgusting. (4, pages 29)

Also not helping matters was the fact that it was not gentlemanly to do this to a lady, and that fat tissue muffles sound.

When he was 38-years-old on a hot and humid day in 1816, Rene Theophile Hyacinthe Laennec was posed with all of these problems, yet the need to auscultate his patient's heart and lung sounds was essential.

He came up with an ingenious plan that helped him assess his patient, yet which also helped him improve the assessment skills for all physicians.

Who was Rene Laenec? 

Laennec was born on February 17, 1781, to to an an "advocate of the provincial courts, and held some appointments under government, in his native country (France)... Fortunately his son was heir of the more solid parts of his genius; without his wit, but without his volatility.  (1, page xix)

At an early age he was put under the care of his uncle, a clergy man in charge of the parish of Eliam, in the vicinity of Quimper.  However, after the French Revolution broke out his care was transferred to another uncle, Dr. Laennec of Nanates. (1, page xix)
Dr. Laennec was a man of highest respectability both as to talent and conduct, and directed the studies of his nephew with the interest and affection of a parent. The young scholar did credit to his friends and teachers; having obtained considerable distinction from his fellows at the chief school of the department of the Lower Loire, wither he had been sent by his uncle. Having completed his preparatory studies at this seminary, his thoughts naturally turned towards physic as a profession. He willingly engaged himself as the pupil of his uncle, and entered upon the study of his future profession with the zeal inherent in his character, and with success indicative of his subsequent eminence. Besides the instructions derived from his uncle, who was at that time senior physician of the hospital, and afterwards Professor of Medicine and Materia Medica at Nantes, he attended the courses of anatomy given by the surgeons of the same establishment, and is said, even at this early age, to have shown a decided predilection for morbid anatomy and clinical observation.(1, page xix)
Figure 2 --
Shown here:  Matthew Baille (1761-1823)
While under the tutelage of Corvisant,
Laennec became good friends with
Matthew Baillie.  Ironically, both were
famous for their studies of diseases of
the lungs, and both were diagnosed with
consumption,and eventually died of this disease.  
In 1800 he attended the medical school of La Charite, which was where he came to tutelage of a well respected and well known physician by the name of Jean Nicolas Corvisant.  He also became good friends at this school with Matthew Baillie, who himself would go on to gain great fame as a physician.  (1, page x)

He had actually gained recognition earlier in his career, for while in school he wrote a history of medicine, and, in the year 1802 at the age of 21, published articles that were well received by his fellow physicians.  (1, page x)

He opened a clinic in and began seeing patients.  In 1816 he was appointed chief physician to the Necker Hospital.  It was here where he was presented with the opportunity whereby he came up with an ingenious plan that changed medical diagnosis forever.  (1, page xxiii)

What was Laennec's ingenious plan? 

So on a hot and humid day in 1816, a 36-year-old physician by the name of Rene Laennec came up with an ingenious plan.

According to Kendall F. Haven in his book "One hundred greatest inventions of all time," Laennec was a "well established doctor and diagnostician of chest and abdominal disorders when he was asked by a fellow physician to assess an obese young woman with breathing difficulties." (2, page 96)

Not that it matters, but, for the record, the patient's name was Marie-Melanie Basset, and she was only 40.

Haven said:
Laenec's normal technique was to have the woman partially disrobe so he could place his ear against a hanker chief over her chest.  He'd listen to lung sounds over five spots:  the underside of each arm, each side of upper back, and upper breast bone. 
Figure 3 --
Gabriel Andral (1797-1876)
He was a French pathologist at the
University of Paris.  He is best known
for his work on blood chemistry.
Andral wrote the comments in
the margins of the 1838 edition
of Laennec's book.
Yet when he did this on this Marie, he heard nothing.  So he tried percussion, a method of tapping on the chest to check for dull or resonant sounds that might indicate certain diseases. Yet this method proved useless as well.

Thinking off the cuff, Haven said, he "grabbed 24 sheets of paper, rolled them tightly into a bundle, and secured them in shape with paste glue. He applied one end of this paste roll against the young woman's chest, and the other to his ear." (2, page 97)

Leanecc was "delighted" to learn he could hear the woman's heart and lung sounds better this way than with the unaided ear against her chest.  He was so excited at how simple a device could make this job so much easier that he set out to do a series of experiments to find metals and tubes that would aid his ear in hearing heart and lung sounds.  (2, page 96)

He actually wanted to name the device le cylindre claiming it was frivolous to name such a device.  However, his colleagues thought it should have a name, and they came up with some of their own. Yet once he decided he didn't like any of these names, he decided to call it a stethoscope.  Stethe coming from the Greek term for chest, and scope coming from the Latin term for aim.  (2, page 97)

His stethoscope was actually a monaural stethoscope, meaning that it had only one ear piece.  You can see a picture of his monaural stethoscope in figure 4.

How did Laennec come up with his idea?

In his book "A treaties on the diseases of the chest, and on mediate auscultation," Laennec recollected a little kid's game, and it was this that gave him an idea.

He wrote:
In 1816, I was consulted by a young woman laboring under general symptoms of diseased heart, and in whose case percussion and the application of the hand were of little avail on account of the great degree of fatness. The other method just mentioned (auscultating with an ear to the chest) 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 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. (4, page 6)
Figure 4 -- Laennec's Monaural Stethoscope (1820).  It was an inch
and a half in diameter and a foot long, perforated longitudinally
by a bore three lines wide, and hollowed out into a funnel shape
at one end to the depth of an inch and a half. A plug of wood
was fitted into this hollowed extremity with a perforation through
it of the same diameter as that of the rest of the tube. The plug
was used in auscultating heart sounds, and discarded in
 stethoscopes made at a later date. It was made in two sections
for convenience of carrying. (6, page 626)  Perhaps it
 provided some solace to Laennec that he was diagnosed with
consumption using a stethoscope similar to this. Photo Copyright
Science Museum/ Science and SocietyPicture Library
So he thereby discovered that his invention was better for hearing sounds inside the human body than the ear alone.

What was the first stethoscope like? 

Laennec described his first stethoscope in his book Mediate Auscultation:
The first instrument which I used was a cylinder of paper, formed of three quires, compactly rolled together, and kept in shape by paste. The longitudinal aperture which is always left in the centre of paper thus rolled, led accidentally in my hands to an important discovery. (4, page 7)
He  also set off on a quest to study and perform experiments using the device, and he fine tuned it until he came up with a better product.  He trialed a variety of materials, lengths, and sizes of aperture, until he came up with the product he thought was idea.

He said:
In consequence of these various experiments I now employ a cylinder of wood, an inch and a half in diameter, and a foot long, perforated longitudinally by a bore three lines wide, and hollowed out into a funnel-shape, to the depth of an inch and a half at one of its extremities. It is divided into two portions, partly for the convenience of carriage, and partly to permit its being used of half the usual length. The instrument in this form—that is, with the funnel-shaped extremity,—is used in exploring the respiration and rhonchus: when applied to the exploration of the heart and the voice, it is converted into a simple tube, with thick sides, by inserting into its excavated extremity a stopper or plug traversed by a small aperture, and accurately adjusted to. the excavation. (See figure 2)  (10, page 7)
What other experiments did Laennec perform with his stethoscope?

While his binaural stethoscope made it easy for him to hear the various sounds inside the chest, he soon realized that he had a rare opportunity to advance upon what was already known about diseases of the chest.

This in mind, he used his new tool to study diseases of the chest, matching what he observed what he observed while his patients were alive with what he found on autopsy after death.  He said:
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 (the sound of air flowing through diseased air passages), and perhaps even the fluctuation of fluid extravasated (leaked) in the pleura (sack around the lungs) or the pericardium (sack around the heart). (4, page 6)
Figure 3 -- Laennec listens to man with tuberculosis*
He took upon this opportunity to study diseases of the chest at the Necker Hospital where he also received patients at his clinic.  He therefore bravely came into close contact with some of the sickest and contagious people in France at the time, which can be seen in figure 3.  It was this type of dedication to his work whereby he contacted the disease that ended up ending his life.

How was the stethoscope accepted by Laennec's peers? 

Despite how useful he found this new tool in diagnosing and researching diseases of the chest, it was initially rejected by his peers in the medical community.
"What a ridiculous idea," his colleagues would say.  "We doctors are called upon for our brilliant medical minds.  To say we should carry some frivolous tool around with us is absolutely ridiculous and below us." 
This is a plate of the parts of the Laennec's stethoscope
as it appeared in the first edition of his book in 1819.
(4, pages 783) 
Another doctor wrote, "He that hath ears to hear, let him use his ears and not a stethoscope."

This was yet another example of a dogmatic and proud medical profession refusing to accept anything new or different. For thousands of years physicians rejected any scientific idea that opposed Galen's superstitions, and now they flat out rejected a tool that would allow them to do their jobs better.

Perhaps under the encouragement of Corvisart, Laennec published a book reporting what both he and Corvisart had learned about the diseases of the chest by using their new discoveries: chest percussion, vocal fremitus, and the stethoscope.

The book was published in 1819 and titled "De Auscultation Mediate, ou Traitt du Diagnostic des Maladies despoumons ct du Cceur, fonde principalement sur ce nouveau moyen. (A treaties on the diseases of the chest, and on mediate auscultation)" 

The book was well received, and, in 1821, it was translated into English by John Forbes (whose book was referenced in writing this post).

Slowly over the next few years his hard work payed off.  So even though he only lived six years after his discovery, he was able to see its acceptance before he passed away in 1826.

Perhaps there was no better evidence as to his tool's usefulness than by his own perseverance in studying the various diseases of the chest, a quest which may have ultimately cost him his life.  

Figure 4 -- Painting of Laennec using his stethoscope on a boy.
This picture was taken from a painting by Robert Thom,
copyrighted in 1960.  

Laennec married in 1824 and had two children. However, he was only able to enjoy his young family for a short time.

He continued to work arduously at his clinic, both seeing physicians and performing research.

He also worked hard in perfecting the book he became famous for, releasing the second edition in 1826.  Subsequent editions were then published by John Forbes.

In the process of accomplishing this, along with his other duties as a physician and researcher, he became so exhausted that he was forced to give up his work and return to the home he was born in. Although some say he was simply tired from being ridiculed by his colleagues.

Either way, he was ultimately diagnosed with phthsis pulmonalis, which is the Latin form of consumption, or tuberculosis.  Ironically, he was diagnosed with the very same tool he invented.  Perhaps this was consolation, proof that the passion of his life's work was finally accepted.

He passed away on August 13, 1826,

In the ensuing years his invention adjusted by others, and eventually a stethoscope with two ear pieces (binaural) was invented. In 1852 George Camman fine tuned the stethoscope so it was similar to the models we use today.

  1. Forbes, John, The life of the author, translator of "A treaties on the diseases of the chest, and on mediate auscultation," a book written by Rene Theophile Hyacinthe Laennec, 1838, New York, Philadelphia, Samuel S., pages xix-xxiii
  2. Haven, Kendall F, "One hundred greatest inventions of all time," 2006, U.S., Greenwood Publishing Group, Inc., pages 96-98
  3. "Now I hear:  The history of the stethoscope,", 1998-2011, accessed 12/28/13
  4. Laennec, Rene Theophile Hyacinthe, "A treaties on the diseases of the chest, and on mediate auscultation," translated by John Forbes, notes by Dr. M. Andral, 4th edition, 1838, New York, Philadelphia, Samuel S. and William Wood, Thomas Cowperthwaite and Company
  5.  Barchers,Suzanne, "I've Discovered Sound," Brainworks, 2009, Leopard, page 9
  6. Camman, Donald M, "Historical Sketch: Stethoscopes," A Reference Handbook for Medical Sciences, edited by Albert Henry Buck, by various writers, volume VI, 1888, New York, William Wood and Company, 626-628
RT Cave on Twitter
Print Friendly and PDF

Friday, June 24, 2016

1813: Asthma remedy of Peter Smith, Root and Herb Doctor

Father and Doctor Peter Smith (1753-1818) was the son of a physician, he was born in Whales, and he was educated as a physician at Princeton, mainly under the direction of his father.  He was a Puritan, and he was among the many who settled in the territory of the Ohio Valley.  He preached the word of God, and he also healed with his botanic remedies. (3, page 354)

He referred to himself as "Peter Smith, the Indian Herb Doctor" mainly because he preferred to heal with herbs and roots.  In this way, he became well known among the Ohio Valley as "Peter Smith, the Indian Herb Doctor. (3, page 354)

He was not your typical root and herb doctor (botanic physician), one who was looking for a quick way to fame and money.  Near the end of his life he published a book that was filled with botanic remedies and was similar to Samuel Thomson's book "New Guide to Health; or Botanic Family Physician."  (3, page 354).

Father (Dr.) Smith's book was published in 1813, and titled "The Indian Doctor's Dispensatory: Being Father Smith's Advice Respecting Disease and Their Cure" (2, page 136)

It is known as the first materia medica published in the west. (3, page 354)

Among the medical recipes in this book Peter Smith provides us with his botanic remedy for asthma:
Take Sena, pulverized; sulpher, and spermaceti, of each one ounce, two ounces cream of tartar, half an ounce anniseed, pulverised; rub them together in a mortar: take a teaspoon in molasses, going to bed, two or three nights at a time, I have found enough for to relieve me. It is a moderate purge, and a little debilitating. (1, page 82)
Also good for asthma is Chalybeate Oxymel:
Take two ounces of Columbo root, one drachm of Virginia Snake Root, twenty ten penny nails, and one quart of good Vinegar, put them together in an iron pot; simmer it a little over a fire; then let it stand forty eight hours; then boil it down to a pint; strain and wring out the liquor, and return it into the pot;then add one pound of sugar and a gill of spirits; simmer it down on coals to the consistence of molasses, and bottle it up for use.
The common uses for a grown person may be a teaspoon, morning, noon, and night, when the stomach is empty, about ten minutes before meals; but begin with less, and increase the dose, as you find the stomach can bear it.
The intention of the medicin is to recruit the blood, and strengthen the system.  It may be taken a week, and then miss a week; and then take it again, and so at intervals renew the course, more or less, until the patient is quite well and strong.  (1, page 60-61)
So, would you try one of Dr. Smith's remedies?  If you lived in the American west during this era, chances are you might have.

  1. Smith, Peter, "The Indian Doctor's Dispensatiry: Being Father Smith's Advice Respecting Disease and Their Cure 1812," print 1901, Reprint 2005, Kessinger Publishing's Rare Reprints, see pages 60, 61, 82, and the introductory "Biography of Dr. Peter Smith."
  2. Rothstein, William G., "American Physicians in the Nineteenth Century: From Sects to Science," 1992, Baltimore, John Hopkins University Press
  3. Prince, Benjamin F, editor, "A Standard History of Springfield and Clark County, Ohio," volume I, 1922, Chicago and New York, The American Historical Society, 
RT Cave Facebook Page
RT Cave on Twitter
Print Friendly and PDF

Wednesday, June 22, 2016

1819: Laennec remedies for consumption

Consumption was the most common disease seen by physicians during the 19th century.  Rene Laennec, in his 1819 book "Mediate Auscultation," gives us a list of common remedies during his time.

He said bleeding was a common remedy for consumption, although he believed it was neither a cure nor a preventative for the disease, and doing so only results in a "useless loss of strength."  (2, pages 387-388)

However, Laennec did support the application of leeches in the upper part of the thighs. (2, pages 387-388)

He described the use of issues and cautery by the ancients.  He said:
Hippocrates directed four eschars with a red hot iron below the axilla, on the breast or back.  Celsus recommends six -- one beneath the chin, one on the throat, one under each nipple, and one at the lower angle of each scapula.  (2, page 388)
However, Laennec said he...
...repeated the application of the searing iron as many as twelve or fifteen times.  It is, however, only a very small number of patients that will submit to a mode of treatment so horribly painful. Small moxas, of only a line in diameter, applied two or three at a time, and repeatedly, have appeared to me more useful than the searing iron; as under their employment I have sometimes se'en a very striking suspension of all the symptoms. At all events, I have now almost entirely renounced the use of the actual cautery. Measures so painful ought not to be had recourse to, unless they are found by experience to hold out a reasonable hope of success. For this reason, I now restrict myself to the application of the caustic potass, in the places above mentioned, so as to form eschars of eight or ten lines in diameter; and I do not even insist upon this, if the patient is very averse to it. (2, pages 388-389)
To promote expectoration, he recommends: (2, pages 389-390)
  • Lime-water
  • The natural and artificial sulphureous lime-water
  • Natural and artificial sulphureous
  • Hydrochlorate of lime
  • Preparations of mercury
  • Hydrochlorate of barytes
  • Preparations of antimony (2, pages 389-390)

To cause the cicatrizing of the internal ulcers, a physician might try: (2, page 390)

  • Plants of an anticorbutic and aromatic kind
  • Purgatives
  • Balsamics, particularly the balsams of Tolu, Peru, and Mecca
  • Terpentine
  • Camphor
  • Sulphur dissolved in volatile oils
  • Vapors from decoctions of plants of an emollient, aromatic, narcotic, or balsamic kind
  • The fumes of different kinds of resins burned on a hot iron or a brazier, particularly of myrrh, benzoin, and petrolium tar
  • The air of cow houses
  • The air produced by the sublimation of zinc, lead, sulphur, etc. 
  • Inspiration of gases such as oxygen, hydrogen, 
  • Etc. (2, page 390-391) 
All of these above were generally thought to provide benefit to the consumptive by one physician or another since the days of Hippocrates.  Laennec said:
I shall content myself with merely enumerating several others, the inefficacy of which has been sufficiently demonstrated. Of this kind are— mercurial salivation; emetics frequently repeated, or continued for a long period in doses sufficient to excite nausea merely; acorns, roasted or raw; charcoal; different kinds of mushrooms, and among others, the boletus suaveolens and the agaricus pifratus and deliciosus ;red cabbage; crabs, oysters, and other shell-fish; frogs; vipers; chocolate; the conserve and sugar of roses in large doses; wine and spirits; sudorifics; electricity; millepedes; opium; cicuta; wolfsbane; cinchona; the seeds of the phellandrium aquaticum; the preparations of lead; hydrocyanic acid; the swing, formerly recommended by Themison (apud Csel: Aurel.) and revived by the moderns, &c. &c.
For those whose consumption was not curable, he offered various palliative treatments.

Emollient drinks, and alimentary matters of a mucilaginous nature, have been always in use,—such as milk, (woman's, ass's, cow's, goat's, mare's,) saloop, sago, gum, Iceland moss, potato-starch, arrow-root, barley, rice, sugar, and the infusions of inert mucilaginous plants, properly sweetened. When the cough is dry, and the expectoration difficult, also when there is a want of sleep, opium in small doses, or any other narcotic extract, is added with advantage. The hydrocyanic acid also sometimes succeeds very well in relieving the cough and even the dyspnoea; but its effects are less certain than those of opium. Antimonials, although at different times much cried up, have never appeared to me of great efficacy, even in aiding expectoration. The diarrhoea must be also treated by mucilaginous drinks, and the milder preparations of opium. However, when it depends on the presence of tuberculous ulcers in the intestines, as it almost always does, we can only hope at best to suspend its violence; and we cannot always even effect this. The acetate of lead appears sometimes to moderate this symptom; but it is much more efficacious in lessening the perspirations: indeed it is almost the only means we can oppose to these. Dyspnoea must be combated by the preparations of opium and other narcotic plants. The hydrocyanic acid and musk are also sometimes beneficial in this respect. I speak not here of pulmonary congestions, whether terminating in inflammation, haemorrhage, or serous effusion. I shall merely remark, that, in these cases, we must not take away more blood than is absolutely necessary to relieve the symptoms, since bleedings, either too copious or too frequent, have an evident effect in accelerating the progress of the disease. (1, page 395)
However, while all of these could be trialed by a physician, the one remedy he found to be most useful was that of relocation.  He said this was a trend the English recently picked up, and which he found to be quite effective, particularly relocation to the seaside, or a voyage at sea.   (1, pages 243-394)

  1. Ramadge, Francis Hopkins, "The Curability of Consumption: the reprint of a series of papers, presenting its most prominent and important practical points in the diagnosis, prognosis, and treatment of the disease," 1850, London, Printed by W. Clowes and Sons
RT Cave Facebook Page
RT Cave on Twitter
Print Friendly and PDF

1815: Parry Shares his wisdom of asthma

Dr. Caleb Hillier Parry, in his 1815 book "Elements of Pathology and Therapeutics," gives us an excellent idea of what physicians knew about asthma at that time.  Through his thoughts relayed through this book we gather answers to all our questions on the subject.  

1.  What leads to a fit of asthma?  In patients who are subject to spasmodic asthma, fits of that disorder often begin with a violent coryza, in which the eyes become red and watery, and all the symptoms of a cold in the head are observable. After a few days, or sometimes even only hours, these symptoms suffer some degree ofalleviation, and the malady proceeds to the bronchia, occasioning all the well-known signs of spasmodic asthma. What, then, is this state in the bronchia, but an affection of the mucous membrane of those cells, exactly similar to that which had previously existed in the same membrane in the nose?  (1, page 196)

2.  Is asthma spasmotic in nature? It may, however, be said, that asthma is a spasmodic affection, depending on causes acting on the mind, etc, and returning at regular periods. (1, page 197)

3.  What are the exciting causes of asthma? The disease called spasmodic asthma is brought on by almost every thing which increases the action of the heart, and which stimulates and fills the vessels of the mucous membrane itself. Thus it is produced by intense heat, by lightness of air, by exercise, by full meals, by stimulating drinks, and by certain effluvia, as those of hay, whether new or old, of sealing wax, and other burning substances, and of ipecacoanha, while powdering, or even sometimes when a paper or bottle of it is opened in the same room with the patient. Of the operation of all these causes I have seen several examples; and similar cases might doubtless be found in the writings or experience of other medical men.   (1, pages 197-198)

4.  What specifically is asthma? These facts are convincing proofs of such a preternatural fulness of the vessels of the mucous membrane of the bronchia, as to impede free inspiration, and to produce all the symptoms of spasmodic asthma. (1, page 198)

5.  How is asthma relieved?  Asthma is relieved by gently open bowels, by heavy air, by inhaling that which is cold, and by cooling drinks. It diminishes, as soon as mucous secretion begins to take place; and is more speedily and effectually relieved by spitting of blood. (1, page 198)

6.  Is asthma nervous? We see the absurdity of assuming asthma to be a nervous disease, produced by a spasmodic constriction of tubes, in the parietes of which no muscular fibres have ever been demonstrated, and no equivalent power of producing such an effect has ever been proved. (1, page 200)

7.  What exactly occurs during an asthma attack? Spasmodic asthma is rarely accompanied with much preternatural heat, though the pulse is sometimes quick. The oppression of breathing consists of a general sense of constriction rather than pain, which resists inspiration, and which the patient in vain attempts to overcome, by employing all the muscles which assist in elevating the ribs, and therefore expanding the thorax. It is, however, apposite to remark, that, in patients in whom the disease is habitual, it sometimes runs into the state of bronchitis, and has all the marks of an acute affection of that kind. (1, pages 200-201)

8.  Can the cure of other ailments cause asthma? Fits of spasmodic asthma are not uncommon after the cessation of gouty paroxysms! I have often seen various thoracic affections, as pulmonary consumption, asthma, inflammation of the heart, or hydrothorax, arise from the spontaneous or artificial cure of ulcers, perpetual blisters, or fistula? (1, page 383, 386)

9.  Can asthma kill? A gentleman, formerly affected with frequent fits of epilepsy, ceased to suffer them on the appearance of gout, which often recurred, and a paroxysm of which was immediately followed by a sudden attack of spasmodic asthma, which, in twenty minutes, proved fatal.

10.  Can other ailments lead to a cure of asthma? That kind of chronic bronchitis, which is often called asthma humidum, is frequently relieved by the coming on of oedema in the lower extremities. I have also known dyspnoea and cough, of long standing, entirely cease on the appearance of ascites.

Bottom line:  Parry believed that asthma was essentially inflammation of the air passages of the lungs that lead to spasms of these passages.  In other words, he was a proponent of the bronchitic theory of asthma. 

RT Cave Facebook Page
RT Cave on Twitter
Print Friendly and PDF

Monday, June 20, 2016

1815: Parry supports bronchitic theory of asthma

Caleb Hillier Parry (1755-1822)
Much like the great London physician William Heberden, Dr. Caleb Hillier Parry of Bath was known for taking copious nots. Perhaps he used these notes when describing asthma in his 1815 book "Elements of Pathology," (1, page 372)

He was born in Bath in 1755 and received his general education at the academy of Warrington, and his medical and philosophical education at the schools of Edinburgh and London.  (2, page 372)

William Heberden was the first to describe Angina Pectoris in a speech he gave to the Royal College of Chest Physicians in 1768.  In 1772 his speech was published in The Transactions of the Royal College.  While he described the symptoms of chest pain accurately, Heberden did not know chest pain was caused by a diseased heart.

A few years later, in 1786 a friend of his by the name of Edward Jenner, the same man who earlier had discovered the world's first vaccination, said that angina pectoris was caused by "ossification," or hardening of the coronary arteries, or the arteries that deliver blood to the heart.  In a letter to Dr. Heberden, he said that without the right amount of blood, the heart could not perform its function of pumping blood through the vessels of the body.  (2, page 372)(3, pages 37-38)

Jenner shared his knowledge on the subject with his friend Dr. Parry.  Parry, in turn, communicated what Jenner learned about the subject, plus some insights of his own, with the medical community through his 1797 book "An Inquiry into the Symptoms and Causes  of Syncopy Anginosa, Commonly Called Angina Pectoris."  (2, page 372)(3, page 37)

This work was well received by the medical community. It was through this book that Caleb Parry became the first person to suggest that the way we live, and the foods we put into our bodies, may lead to disease, particularly angina pectoris. He suggested regular exercise and the avoidance of fresh meat.  (2, page 372)(3, page 38)

While "Angina Pectoris" was well received, his most famous work by far was "The Elements of Pathology," which, according to The Gentleman's Magazine:
This exhibits a great system of original and unexampled depth of observation, accuracy of conclusion, and abundance of fact and illustration; it may truly be considered as an almost unparalleled example of great originality and capacity.
It was in this book that he shared, among other things, his knowledge on the subject of asthma.
In patients who are subject to spasmodic asthma, fits of that disorder often begin with a violent coryza, in which the eyes become red and watery, and all the symptoms of a cold in the head are observable. After a few days, or sometimes even only hours, these symptoms suffer some degree of alleviation, and the malady proceeds to the bronchia, occasioning all the well-known signs of spasmodic asthma. What, then, is this state in the bronchia, but an affection of the mucous membrane of those cells, exactly similar to that which had previously existed in the same membrane in the nose? (4, page 196)
It may, however, be said, that asthma is a spasmodic affection, depending on causes acting on the mind, &c. and returning at regular periods. (4, page 197)A
A little over a century later, Orville Brown summed up Parry's view of asthma this way:
Parry suggests that engorgement of the mucous membrane of the bronchi produced such tumidity of it as to mechanically interfere with the passage of the air. (4, page 32)
In other words, like Robert Bree, Parry was a supporter of the bronchitic theory of asthma.  He was a great physician and medical philosopher until he was afflicted by a case of palsy 1816. He died in 1822.

Further Reading:
  • 1815: Dr. Parry shares his wisdom of asthma (5/3/16)
  1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 3rd edition, 1821, Philadelphia and London, W.B. Saunders Company
  2. Urban, Sylvanus, "Dr. Caleb Hillier Parry," The Gentleman's Magazine and Historical Chronical, from January to June, 1822, volume XCII, London, printed by John Nichols, pages 372-373
  3. Roberts, Barbara H., "Treating and Beating Heart Disease: A Consumers Guide to Cardiac Medicines," 2009, Jones and Bartlett Publishers, chapter two: "Treating Angina Pectoris," 
  4. Parry, Caleb Hillier, "Elements of Pathology and Therapeutics; being the outlines of a work intended to ascertain the nature, causes, and most efficacious modes of prevention and cure, of the greater number of the diseases incidental to the human frame," Volume I: General Pathology, 1715, London, Printed by Richard Cruttwell
  5. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company

RT Cave Facebook Page
RT Cave on Twitter
Print Friendly and PDF

Friday, June 17, 2016

1811: Frank insists asthma is periodic

Johan (John) Peter Frank (1745-1821)
During the last half of the 18th century, a time when nosological systems were being framed, most physicians confused asthma with other causes of dyspnea and angina (chest pain).  One physician who did not do this was Dr. Johan (John) Peter Frank, said Joseph Bergson in 1851.  

According to, Frank was born in Germany in 1745, and died in Vienna in 1821.  He studied at Heidelberg and Strasbourg. He became physician at Rastadt in 1769, professor at Göttingen (the school made famous by Haller) in 1784, and professor at Privia in 1785.  He held a couple other jobs before opening a practice at Vienna in 1811. (5)

Being that the second half of the 18th century was dedicated to nosology, or classifying diseases, Frank joined in on this quest, becoming known for is systematising of everything known about public health at that time.  He was among the first physicians to endorse the international regulation of health problems, according to   He likewise "endorsed the notion of 'medical police,' whereby one of the duties of the state was to protect the health of its citizens."(5)

He is often referred to as the founder, or father, of public health.  Along with being a physician, he also spent time as a teacher of physiology, pathology, forensic medicine, and public health. (6, pages 81-82)

His most significant book was System einer vollstandigen medicinischen Polizey published in 1784, and it was his systematisation of public health wisdom, and it made him quite famous.  In fact, is was due to this work that he was offered his jobs at both Rastadt and Göttingen. (6, pages 81-82)

As part of his writings he took some time to note what he thought about asthma. He wrote, via a review by G.H. Hill, the following in Latin: 
"Asthma non habetur solum pro respiratione anxia cum sibilo et stertore, sed exposcit, ut simul periodice recurrat, libera prebeat intervalla et nullius alterius evidentis morbi sit symptoms." (1, pages 374-375)
By running that quote through Google Translate, we get the following:
"Asthma is not the only breathing with a hiss and stertore anxious, but insisted that they periodically return provides free intervals and no other obvious disease is a symptom."
He basically said that asthma is not just a disease of wheezing and noisy breathing, but is a disease that occurs periodically.  When it does occur there are no obvious symptoms of disease, meaning there are no apparent scars or organic lesions on the body or lungs.

Dr. G. Lingen, in 1839, quotes him as saying:
"In asthmate, ut nominant, puerili, glandulas bronchioles, praeter sanitatis modum, turgidas, maxime verothymum insigniter tumefactum invenerunt anatomici: ita quidem ut totam fere anterioris pectoris regionem ille occupaverit, &c." (2, page 208)
Running this through Google Translate we get:
"In the asthma, to name, childish, glands of bronchioles, in addition to health manner of it, turgid, but especially the thyme and remarkably swollen with pride and they found a anatomists, even so, indeed, as he had taken possession of almost the whole of the anterior region of the breast, & c." 
He basdically said asthma results in swelling and congestion of the air passages of the lungs.

He also referred to asthma as "asthma thymicum," or spasm of the glottis.  It was periodic, and occurred frequently in children.  He, therefore, was probably referring to croup, or dyspnea caused by swelling of the vocal cords. He is essentially describing croup in children. (2, page 208) (3, page 202)

Frank wrote a book called De curandis hominum morbis epitome: praelectionibus academicis dicata, or "The curing of diseases, summarize, academic lectures devoted to the clinical," in 1811.

  1. Gill, M. H., "Review and Bibliographic Notices: "On the spasmotic asthma of adults," by Joseph Bergson, published Gill's book, "The Dublin Quarterly Journal of Medical Science," volume X, August and November, 1850, Dublin, Hodges and Smith, pages 373-388
  2. Lingen, G., "A Case of Asthma Thymicum Koppi, or Laryngismus Stridulus Anglorum, Crowing or Croup Like Inspiration," in the book "Miscallanies of Homeopathy," edited by an association of homeopathic physicians, 1839, Philadelphia, L. J. Kinderlen, pages 207-210
  3. Stokes, William, "A Treaties on the Diagnosis and Treatment of the Chest," 1837, Philadelphia, A. Waldie
  4. Rush, Benjamin, "Letters of Benjamin Rush," in this book Rush describes who Mr. Frank was and what he thought about asthma
  5. Johan Peter Frank,,, accessed 1/19/14
  6. Sigerist, Henry E., translator and author of the introduction, "The People's Misery: Mother of Diseases, An Address Delivered in 1790 by Johann Peter Frank,, accessed on 1/18/14
RT Cave Facebook Page
RT Cave on Twitter
Print Friendly and PDF

Wednesday, June 15, 2016

1808: Corvisart re-introduces chest percussion to medicine

Jean Nicolas Corvisart (1755-1821) was the
mentor and teacher of two men who would go
on to gain fame studying diseases of the chest:
 Matthew Baillie and Rene Laennec.
Another pupil of his was Marie-Francois-
Xavier Bichat, the founder of biology. 
Joseph Avenbrugger introduced the medical community to chest percussion in 1761, although his idea was flat out rejected by many and rarely used by those who learned of it.  It would be another 53 years before his idea would be accepted, and it would take the efforts of a famous physician by the name of Jean Nicolas Corvisart des Merets (1755-1821). 

J.F. Halls Dally, in a 1941 article, said Corvisart was born February 15, 1755, to Pierre Corvisart, an advocate and attorney to the Parliament of Paris. For part of his childhood he lived with an uncle who was a priest at Vimille.  He then started college at Sainte-Barbe at the age of 12, where he was a "mediocre pupil who favored of outdoor sports. (1, page 239)

Of Corvisart's childhood education, Dally said: 
He is said to have left the college almost as ignorant as when he went in, with no reputation but that of an incorrigible idler. Thus the childhood of Corvisart gave no promise of his brilliant future. (1, page 239)
Later on he started as a law student, but after spending time at medical clinics of Paris he became interested in medicine. He became particularly interested in the speeches of Dr. Anthony Petit, a professor of anatomy and medicine. It was this reason "the young Corvisart recognized the profession for which he was designed. He longed to study the animal economy, and for this purpose he determined to be a physician," said Baron Cuvier in his 1830 memoir of Corvisart. (2, page 81) (1, page 23)

Surreptitiously, as he didn't want his father to be disappointed, he attended the lectures of the most famous physicians of the day, including Petit and Pierre Joseph Desault, said Cuvier. His father ultimately found out and approved of his transfer to the medical profession. (2, page 81)

Dally said he paid his way through medical school by becoming a male nurse at at Hotel Dieu, the oldest hospital in Paris.  It was here he became greatly influenced by the surgeon Pierre Joseph Desault, chief surgeon of the Hotel Dieu. Corvisart observed diseases with him and and examined bodies.  He also delivered his own lectures on anatomy and physiology, and these were well received.  He soon became well liked by his fellow students and physicians. (1, page 239)(2, page 81)

He was offered a job as physician at Necker, although he declined this position because all who held it had to wear a particular wig that had been handed down for decades.  Other clinics had given up this tradition, but it was still alive at Necker.  When he was offered a choice of taking the job and wearing the wig, or keeping his hair, he said he'd prefer to keep his hair.  This was a minor set back, however, because other opportunities awaited him. (1, page 240)(2, page 81)

It's interesting to note that while medicine in other areas of Europe had moved forward by leaps and bounds, Cuvier said medicine in France remained much as it was in the middle ages when the Faculty of Paris was formed. He said:
Besides, there were no public lectures at the beds of the sick. In order to see a few patients, the students accompanied the elder physicians in their visits; afterwords, when these physicians were unwell, or too much busied with practice, they acted for them, and thus they continued, till at length they, too, slowly attained their professional rank. (2, page 81)
Desbois de Rochfort (1750-1786)
In 1788 he became elected as physician at Necker hospital. His predecessor was Desbois de Rochfort, (Rochfort had passed away) chief physician at Le Charite, who was the...
...real creator of clinical medicine in France.  The pupil thus succeeded the master, and the glory of the master gained added lustre. Corvisart took over the clinical teaching and from that moment his reputation, already established among his colleagues and students, began to spread outside the confines of the hospital." (1, page 240)(2, page 81)
However, unlike his predecessors, he believed it was best to diagnose diseases by their signs and symptoms and pathological anatomy, as opposed to guessing what might be found on autopsy.  (1, page 240)

Then things change for the worse in France. Although the end result would benefit the medical profession of France.  Dally said:
In 1793 the Reign of Terror began.  The medical schools were shut, anyone could call himself a doctor and treat the sick.  Medical education was three centuries behind the times. But out of the Revolution grew modern medical education.  In the new schools of Paris laboratories were instituted for scientific study; students were taught at the bedside in hospital after the manner of Sydenham.  And it was Corvisart -- formerly rejected because he wore no wig, who taught, who for he had now become the leading professor in France. He acquired the natural history of disease by collecting observations, and when possible, following the example of Morgagni, he noted from dissection and from autopsy the changes in the body that caused symptoms of disease.  His chief lectures were given at the Necker hospital, and subsequently over a term of fifteen years at Cochin Hospital." (1, page 240)
Corvisart, whose reputation increased daily, lived in close contact with the most illustrious men of the time.  In 1795, on the criterion of the first school of medicine in Paris, he was unanimously elected to fill the Chair of Clinical Medicine, for the first time included as part of public education in France. Two years later, in 1797, he was made Professor of Medicine at the College de France. (1, page 240-241) 
While Corvisart was professor of medicine at the Charite Hospital in Paris, he studied the works of Auenbrugger and found the technique of percussion useful in diagnosing his own patients.

He championed for percussion when he re-published Abenbrugger's booklet about percussion Inventum Novum in 1808.  While he didn't have to, he humbly gave credit for the discovery of percussion to Avenbrugger.

He wrote:
"I could have raised myself to the rank of an author by remodeling the work of Auenbrugger and publishing a work on percussion.  But by that I would sacrifice the name of Auenbrugger to my own vanity; that I do not wish to do: it belongs to him, it is his beautiful and rightful discovery which I wish to bring to life." (1, page 242-243)
While Corvisant supported Avenbrugger's general technique, he adjusted it slightly so that "he used the palmar surface of the extended and approximated fingers," said Alex Sakula. (6, page 576)

Corvisart used the technique to help diagnose patients with tuberculosis and other diseases of the chest.  Based on the sounds emitted he would be able to tell how large or small the tubercles inside a patient were, along with their locations. (3)

Corvisart and his students -- one of whom was Rene Laennec -- were believed to be the only physicians in the world who used percussion. Perhaps this was because Corvisart was among the few physicians who studied Auenbrugger's work.

The use of percussion was among the diagnostic techniques used by Corvisart.  He used percussion, took a pulse, listened to the patients lung sounds by placing his ear on his patient's chest, watched the patient's breathing, felt for a temperature, observed sputum and perspiration, color of the patient's skin, changes in the voice, etc.  (2, page 81)

This was the new medical diagnostic practice that had already engulfed the medical profession throughout much of Europe, all but for the exception of chest percussion and, maybe also, vocal fremitis (vibration felt by the hand on the chest when a person speaks.  Different diseases would produce different sounds, according to the Free Dictionary by Farlex).

The Catholic Encyclopedia notes that Corvisant may have been the first to describe the technique of vocal fremitis, which is where a hand is placed over the patient's chest, and the patient is asked to make a sound, such as "a" or "e."  The physician then notes the vibratjions (fremitis) felt as the person made these sounds. Corvisart found this to be another very useful procedure in diagnosing diseases of the chest.  (5)

So, in this way, Corvisart was able to add to the list of diagnostic tools used by European physicians of his era.  By using these tools, Corvisart, and based on his studies of bodies, was able to match changes on the outside of the body with changes that might be occurring inside the body.  He was, therefore, able to use observation and science to diagnose.

In this way, he was able to use observation and science to diagnose patient, as opposed to using theory and just guessing.  Perhaps it was this that most impressed the emperor of France.

Napoleon Bonaparte was a famous military leader and
emperor of France. In these days, the best,
and perhaps only, means of adapting new ideas
was to earn the respect of the ruling party.

The technique of chest percussion may not even have been adapted by the medical profession at all if not for Emperor Napolean Bonaparte (1769-1821) selecting Corvisart as his own personal physician.  (4)

Dally said Corvisart was recommended as physician to Bonaparte because he was impressed that Corvisart used a scientific technique instead of simply guessing what was wrong, as other physicians of his era did.

Some speculate it was Boneparte who convinced Corvisart to write his first book, a treaties on diseases of the heart. This work was significant to our history of asthma because it was among the essential steps needed for future physicians to pluck cardiac disorders that caused dyspnea out from under the umbrella term asthma. (1, page 243)

Of this, Dally said:
It is said that cardiology as such did not exist prior to Corvisart's work. He really created cardiac symptomatology, and established differential diagnosis between cardiac and pulmonary disease, as well as between functional and organic heart disease." (1, page 243)
Corvisart later wrote his commentaries on Auenbrugger, which was also well received by his peers. (1, page 241)(2, page 82)

Thanks to the writings of Corvisart, and later Rene Laennec, Auenbrugger's discovery would become readily accepted shortly after his death in 1807, and Auenbrugger would eventually go down as one of the great minds in medical history.

Auenbrugger did, however, live "just long enough to witness the beginning of a proper recognition of his discovery," said Dally. (1, page 243)

Of course Corvisart himself would also go down as one of the great minds in medical history, not just because he re-introduced chest percussion to medicine, but because was a great physician overall who left an indelible impression on the medical profession.

He developed apoplexy (stoke symptoms) that took away his ability to perform his job, but not his mind.  He then suffered a cardiac arrest on September 18, 1821. He left behind no family, although he left much to his family of physicians.  (2, page 82)

Further reading:
  1. Laennec, the inventor of the stethoscope
  2. Auenbrugger introduced chest percussion to medical profession
  1. Dally, J.F. Halls, "Life and times of Jean Nicolas Corvisart (1755-1821)," Proc R Soc Med., March, 1941, 34 (5), pages 239-246
  2. Baron, Cuvier, "Biographical Memoir of M. Corvisart," Literary Port Folia, Thursday, March 18, 1830, No. 11, Philadelphia, pages 81-82
  3. "The Catholic Encyclopedia, "Leopold Auenbrugger,"
  4. Williams, Henry Smith, "The Century's Progress in Scientific Medicine," Harper's Magazine, 1899, page 3
  5. "The Catholic Encyclopedia, "Leopold Auenbrugger,"
  6. Sakula, Alex., "Pierre Adolphe Piorry (1794-1879): pioneer of percussion and pleximetry," October, 1979, Thorax ( 34(5): 575–581).  
RT Cave Facebook Page
RT Cave on Twitter
Print Friendly and PDF