1866: Catologue of stethoscopes

Check out these stethoscopes from the a physician's catalog of S. May and Son from 1866. Keep in mind these are not actual size.:

Reference:

1. S. Maw and Son, Manufacturer of respiratory equipment, "A catalogue of surgeon's instruments, air and water beds, pillows, and cushions, bandages, trusses, elastic stockings, inhalers, galvanic apparatus, and other appliances used by the medical profession," 1866, London, 11 Aldersgate St., Buttler and Tanner, The Selwood Printing Works, page 127-8

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1854: M. Priory fine tunes stethoscope and percussion

Pierre Adolph Priory (1794-1879)

Joseph Auenbrugger, Jean Corvisart, and Rene Laennec introduced the medical community to chest percussion and auscultation.  Both techniques became valuable for helping physicians diagnose diseases of the chest, although both needed to be perfected.  

By the time of his death in 1826, Rene Laennec saw his invention of the stethoscope become accepted by his peers.  However, he would readily admit that his new tool was not yet perfected. He would spend many hours himself improving upon it, and when he died this task was left to his peers.

Pierre Adolph Piorry (often referred to as M. Priory due to his French origin) was born in 1794, served in the Napoleanic wars in Spain, and served at the Atarazanas Hospital in Spain where he was able to witness military surgery." (1, page 675)

In 1814 he returned to his medical practice in France, and, like Laennec, served as a student of Corvisart. He qualified as a physician in 1816, the same year Laennec invented his stethoscope.  (1, page 675)

This is a picture of the Priory binaural stethoscope complete with
the pleximeter(round, solid ivory disks on bottom second from left)
and fingerthimble ivory percussor (on botton right).  Picture from 1828.
Photo from http://www.antiquemed.com/binaural_stethoscope.htm

He had a gift as a teacher, and between 1817 and 1826 he delivered lectures on physiology and pathology.  In 1826 he was appointed physician to the Paris Hospital.  In 1837, after many years of attempting to do so, he became professor of medicine at Paris School of Medicine (l'Hospital de la Pitie, Paris).  He was 43.  (1, page 676)

He then took off where Laennec left off, working hard to fine tune the binaural stethoscope.  The product he ended up with would be the general design of most stethoscopes used for the rest of the 19th century.  He also worked to improve the technique of percussion.  His work in this area created excitement for the remainder of the century, although it would ultimately be for naught. (1, page 675)

A Classic Reprint Series of Priory's book
is proof his ideas are still sought after.
The first edition was published in 1826.

His stethoscope was trumpet shaped and made of wood, although it was shorter and thinner than Laennec's.  It came with a removable wood plug, ivory earpiece and chest piece, with the chest piece also serving as a pleximeter (described below).  This design was also much more pleasing to physicians, and was much easier to carry in their bags. (5)

In a 1979 Biography of Priory, Alex Sakula said of Priory:

Priory, enthused by Laennec's invention, developed an ambition to emulate the great master and to achieve fame in some similar fashion. Priory describes in his poem Dieu L'ame et Nature how he came to study percussion.  He prayed to God asking to be able to make some discovery like that of Laennec.  A few months later, he had slight pruritus and while scratching the skin over his chest he heard a sound.  He interposed a coin and scraped it and obtained a stronger sound, which varied according to the density and elasticity of the underlying organ." (1, page 577)

This is a picture of Priory's Pleximeter. (5, page 311)

Sakula said that the next day he began his work on percussion, and hoped that what Laennec had done for auscultation he could do for percussion.  On February 28, 1826, he "read a prize winning paper on his new method of percussion to the Academie Royale de Medecine.  Laennec (then very near his death) was one of those present." (1, page 577)

Scott Alison, in his 1861 book, "The physical examination of the

 chest," described the procedure of percussion as follows: 

 The pleximeter is to be placed in or over an intercostal space,

 or upon a flat surface, and fitted well with gentle pressure upon

 the body,and held by the thumb and forefinger of the left hand. 

It may be employed together with a hammer or with the fingers." 

A percussion hammer is sown here.  (5, page 311

In the paper, Sakula said, Priory described his new technique of doing percussion, which involved placing a small plate between the patient's skin and the percussing finger.  He called the plate a pleximeter from the Greek words to strike and to measure. (1, page 577)

This little gadget shows the extent that some physicians went to 

create the perfect pleximeter.  Scott Alison described it as:

"An instrument combining both a pleximeter and a hammer 

was contrived by Dr. Aldis some years ago. It consistsof a

 hammer moving on a fulcrum, and of a disc of cork which 

receives the blow of the hammer. The cork disc is placed 

upon the chest, and the hammer is raised by the finger to the

 required height. The higher the hammer is raised, the more force

 is obtained. The hammer falls by the operation of a spring.

 Great uniformity of blow is obtained by this instrument. 

This ingenious contrivance has obtained the name of 

echometer." (5, page 312)

As Laennec experimented with various materials while trying to perfect his stethoscope, Priory experimented with various materials while trying to perfect his pleximeter, said Priory, "but finally settled on a small ivory plate, 5 cm in diameter.  He also devised a combined stethoscope and pleximeter made of ivory and cedar wood." (1, page 577)

These are a few of the varieties of wooden binaural stethoscopes
in use by physicians as of 1861. (5, page 316)

After all the publicity that the stethoscope had garnished since Laennec introduced it in 1819, percussion had lost some of its luster.  Some probably believed the stethoscope would replace it completely.  (1, pages 576-577)

However, Sakula said:

"Piorry did not regard percussion as competing with auscultation, and taught that the two techniques were supplementary one to another." (1, page 577)

This is a flexible stethoscope.  In his 1861 book, Scott Alison said,
"In employing the flexible stethoscope, it is even more necessary
than in the case of the wooden instrument to observe that the object
end is well applied so as to close the tube.  If left partially open,
scarcely any sound is perceived. (5, page 321)

There were still many physicians who did not adapt his stethoscope and pleximeter.  Many who finally accepted his research on percussion came up with their own techniques for performing the procedure.  For instance, the preferred method became the use of the finger of one hand used as the pleximeter, and the finger of the other hand as the percussor.  Yet the principle is the same.  (1, page 577)

The Cyclopaedia of Practical medicine, edited in part by John Forbes, best concludes the accomplishments of Priory regarding percussion: (3, page 7)

M. Priory, a young Parisian physician, has the honor of having, if not invented, at least brought into a formal and matured shape, this new application of the discovery of Auenbrugger, and with practical results greater precision and importance than could have been anticipated. (3, page 7)

Dr. Sibson's pleximeter 

consists of a plate of 

ivory which receives

the blow, and of a brass

hammer or weight

working in a metal frame.

. The weight or hammer

is raised by the fingers;

these being removed, 

the weight or hammer 

falls upon the ivory plate

by the elasticity of an

indiarubber band connecting 

the weight or hammer 

with the ivory plate.

The hammer works

perpendicularly

to the plate. (5, page 313

Like many new tools invented or discovered to assist physicians do their jobs better, the Priory stethoscope and pleximeter were not accepted by all physicians.

Piorry remained a famous physician until his retirement at the age of 72 in 1866.  He died at age 85 in 1879.

Yet long before he passed from this world his hard work paid off.  By 1854 percussion had been fine tuned so that it was often performed not just over the chest, but over various organs of the body to help doctors diagnose any pathological disorders.

While there were various stethoscopes designed during the remainder of the 19th century after Priorry's death, most were adaptations of his design.  Examples include binaural stethoscopes made by Quain, Stokes, Arnold, Barclay, Elliotson, Dobell, Loomis, Burrow, Clark, Camman, and Furguson. (4, page 626)

These other stethoscopes were made of various materials, produced by various manufacturers, and were scattered through various publications.  Still, Priory's stethoscope remained the most popular design for the remainder of the century.

References:  

1. Sakula, Alex., "Pierre Adolphe Piorry (1794-1879): pioneer of percussion and pleximetry," October, 1979, Thorax ( 34(5): 575–581).  
2. "The Binaural Stethoscope," antiquemed.com, http://www.antiquemed.com/binaural_stethoscope.htm, information reviewed March 8, 2012
3. Forbes, John, Alexander Weedie, Conolly, editors, "The cyclopaedia of practical medicine," volume 1, London, 1833
4. 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
5. Alison, Somerville Scott, "The physical examination of the chest in pulmonary consumption and its intercurrent diseases," 1861, London, John Churchill

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1819: Laennec is first to describe lung sounds

After he invented the stethoscope in 1819, it was then next task of him to perform experiments with it.  As he was the first to auscultate with this device, he would also be the first to describe lung sounds.

He noted first normal lung sounds, although he did not refer to them as clear as we do today.  He also noted an array of adventitious noises in the lungs among those who were not healthy, and for this he needed a name.  He said:

For want of a better or more generic term I use the word rhonchus* to express all the sounds, besides those of health, which the act of respiration gives rise to, from the passage of the air through fluids in the bronchi or lungs, or by its transmission through any of the air passages partially contracted. (1, page 55)

M. Andrus said Laennec chose the term rhonchus because...

...It was desirable that some name might be found for this phenomenon which would prove generally acceptable to British physicians.  In the former edition of this translation, the nearest English synonym, rattle, was used, but this word has been adapted by few.  The original French term rale appears to be most generally employed in this country, but there are several objections to its use. (1, page 55)

Today, the term rhonchi is used to describe the sound of air moving through secretions, and the term wheeze is used to describe the sound of air moving through air passages partially contracted.  Rhonchi is generally heard as a coarse sound, is continuous, and is often times confused as a wheeze.

Laennec avoided this confusion simply by calling all continuous sounds rhonchi. Today, many medical caregivers avoid the confusion by calling all continuous lung sounds a wheeze.  So there really is not much difference here other than the term used.

While we generally describe the various lung sounds as clear, diminished, rhonchi, wheeze and crackles, Laennec basically described five types of rhonchi, as follows (modern term I think he is referring to is in parenthesis): (1, pages 55-62)

1. Moist crepitous rhonchus, or crepitation:, similar to the sound of blowing into a dried bladder, or the sound made by rubbing between the finger and thumb a piece of hair, or the noise of boiling butter.  This is a sign of the early stage of peripneumony and edema of the lungs and pulmonary apoplexy (crackles)
2. Mucous rhonchus, or guggling: Formed by the passages of air through sputa in the bronchi, and sounds like bubbles, or blowing through a pipe into soapy waters. The sound of the bubbles can be described as middling, small, large, or very large, and is a sign of peripneumony or suffocative catarrh in old people near death (the death rattle) or those dying of phthisis, or hemoptysis, or phthisis, or diseases of the heart, or tuberculosis excavations, and may be regarded as an evil omen (tracheal Rhonchi, large airways, or upper airway rhonchi, and may be audible, as in a death rattle)
3. Dry sonorous rhonchus, or snoring: Crackling rhonchus; Flat grave sound, sometimes extremely loud, sounding like a person snoring, and may be diagnostic of pulmonary fistula, or dilated bronchi, and may be caused by temporary inflammation or contraction of the bronchi (rhonchi or sonorous wheeze, )
4. Dry sibilous rhonchus, or whistling: Prolonged whistle flat or sharp, dull or loud, and may sound like the chirping of birds, and may be caused by thick secretions obstructing the airway or local contraction of the smaller bronchi (wheeze)
5. Dry crepitous rhonchus, with large bubles or crackling: The sound of air entering lungs that had been dried, or air cells or vesicles (alveoli) that had been unevenly dilated, may make noise similar to that produced when blowing into a dried bladder.  May be indicative of emphysema  (fine inspiratory crackles heard upon the opening of previously collapsed alveoli) (1, pages 55-62, 98)

Andral said he would differentiate the rhonchi based on whether the cause was in the air cells (alveoli), the air passages (bronchi) or some morbid excavations formed in the substance of the lungs (secretions). He would break the sounds down this way: (2, page 55)

• Vesicular Rhonchi: Originating from the vesicles or air cells (alveoli)
• Bronchial Rhonchi: Originating from the bronchial tubves
• Cavernous rhonchi: Originating from morbid excavations

He further noted that lung sounds are either humid or dry.  (2, page 55)

He would then break them down this way: (2, pages 55-56)

1. Humid vesicular rhonchus: Moist crepitous rhonchus, Rale crepitant of Laennec (coarse crackles or rhales)
2. Dry vesicular rhonchus: Dry crepitous rhonchus, rale crepitant  (fine inspiratory crackles)
3. Humid bronchial rhonchus: Mucous rhonchus (Rhonchi)
4. Dry bronchial rhonchus: Sibilous rhonchi, rale sibilant (wheeze)
5. Humid cavernous rhonchus: May be caused by abscess or gangrene of the lungs or the later stages of tubercle or phthisis, and may sound like mucous rhonchus or guggling, and is usually over a small spot (as in just over the area affected, and is usually heard with deep inspiration or while coughing)
6. Dry cavernous rhonchus: described because it is possible, not that it has ever been described by any author (2, page 55-56)

Andral said that little was added to the description of rhonchus between the time of the first edition of his book in 1819 and the 4th edition in 1838.  He noted that a flaw in Laennec's description of the various lung sounds was that he did not mention at what point during the respiratory phase the sounds were heard. (2, page 62)

Andral said this was an important thing left out, because some sounds are heard only on inspiration, or only on expiration, and sometimes both.  So he added the following:

• Crepitous rhonchi or vesicular rhonchi: heard only on inspiration because it is a noise produced by the air vesicles cracking open
• Humid Bronchial rhoncus: heard during inspiration and expiration, and mostly during expiration because it is the sound of air moving through secretions, and the secretions are there at all stages of respiration
• Sibilous and sonorous rhonchi, or dry bronchial rhonchus: Heard oftener during expiration more so than inspiration
• Mucous rhonchus: Heard during both inspiration or expiration

So you can see that little has changed regarding the description of lung sounds other than the terms used.  The terms often varied from one author to the next, and this is true even to this day.

References:

1. Laennec, Rene, "Mediate Auscultation," translated by John Forbes, Notes by professor Andral, 4th edition, 1838, New York, Samuel S. and William Wood
2. Andras, author of the notes in the book, "Mediate Auscultation, by Rene Laennec," ibid 

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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.  

Conclusion:

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.

References:

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,"  http://antiquemed.com/, 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

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