Two hundred years ago, it was a French doctor who developed the first version of this now essential medical device, in part to preserve the utmost decorum during his examination of his female patients. It is rather remarkable that his inspiration came from watching a group of schoolchildren at play, as well as his own abilities as a flautist. The stethoscopes produced during the Regency were made of wood and looked nothing like those in use today, but they served much the same crucial purpose for doctors that they do in modern times.
The singular story of the development of the stethoscope . . .
René-Théophile-Hyacinthe Laënnec was born into a Catholic family in February of 1781, in the town of Quimper, which is situated on the coast of Brittany. His mother suffered from tuberculosis, but it is believed she died in childbirth when he was just five years old. His father, a lawyer, did not feel equal to the task of caring for his three young children, a daughter and two sons. Known within the family as Théo, the young boy was initially sent to his grand-uncle, the Abbé Michel Laënnec. However, within a couple of years, the Catholic Abbé decided it was in his best interests to leave Revolutionary France and he decided to move to England.
Young Théo was then sent to live with his uncle, Guillaume, and his kindly wife, who lived in Nantes. In that household, he was reunited with his younger brother, Michaud. When their father showed no signs of remarrying or wishing to take custody of the boys, they were adopted by their uncle. The boys then became brothers to their younger cousin, Christophe, and the birth of two more boys enlarged the family in the years that followed. The lively boys all delighted in the company of their beloved dog, Mirza, and an elderly parakeet named Jacquot. Though life was sometimes difficult for Catholics in Revolutionary France, for the most part, the Laënnec family had a loving and happy home. All of the boys studied at the local school, where Théo shone academically from a young age. He studied the classics and natural history, wrote poetry and learned to play the flute.
Despite his increasing interest in natural history, Théo also developed a growing interest in the medical arts, since his uncle, Guillaume Laënnec, was a well-respected doctor in the town of Nantes. Théo had begun to work at the L’ Hôtel-Dieu, the hospital at which his uncle was the director. In the mid-1790s, when Théo expressed his intent to formally study medicine, his father, who had recently married a wealthy widow, objected, at least in part because he had begun to resent his brother’s influence over the boy. He wrote to his eldest son that he was not to consider a career in medicine since he had plans for the boy to go into commerce. However, over the years, experience had shown that the elder Laënnec was frequently given to flights of fancy which were often vague and not grounded in reality. In the summer of 1797, Théo walked from Nantes to Quimper, to visit his father and his new wife. His stepmother was kind and welcoming, though she made it clear she considered medicine "a profession for fools." But the young man was determined and over the course of the visit, Théo was able to gain grudging approval from his father to pursue his medical studies.
One of the casualties of the French Revolution was the university system. The Convention of Paris had abolished all universities, claiming that they were breeding grounds for privilege and superstition. During the Revolution, The Directory never managed to organize a new university system to replace that which had been abolished. Fortunately for Théo Laënnec and a number of other young men, several of the teachers from the old medical school in Brittany had begun to offer private courses on foundational medical subjects. Théo was a diligent and apt student, but he did not neglect his other interests. He continued his natural history studies, wrote poetry and regularly played his flute. Between 1798 and 1799, he wrote a series of lyrical rhymes to a young lady named Nisa. Nothing more is known about the relationship, or the young lady, except that she died in her twenties.
By 1801, Théo Laënnec had learned everything he could from his uncle and his teachers in Nantes. His uncle arranged for him to go Paris for further study in the field of medicine, though the young man had to walk all the way to the capital. He was fortunate to be enrolled at the Collège de France. One of his most important teachers was Jean-Nicolas Corvisart-Desmarets, who had become an expert in disorders of the heart and the circulatory system. Though Laënnec did not like Corvisart, whom he found pretentious and socially ambitious, he kept his own counsel and set himself to learn all he could. In 1804, the year in which Laënnec qualified as a doctor, Corvisart was appointed personal physician to Emperor Napoleon Bonaparte.
Through the eighteenth century, doctors seldom carried out any type of physical examination of their patients. Instead, each patient would describe their symptoms to their doctor, who would then make a diagnosis based on that information. In fact, since there was no physical interaction with the patient, many people wrote letters to their doctors describing their symptoms, and would get a diagnosis and/or any prescriptions by return post. However, by the turn of the nineteenth century, most doctors had come to prefer some kind of physical examination of their patients before making a diagnosis. And, by this time, there were more diagnostic techniques available to doctors than there had ever been. One of those techniques was auscultation.
Auscultation, that is, the practice of listening to the internal sounds made by a living body, in order to diagnose various illnesses and ailments, dates back at least to Ancient Egypt. The term itself was coined by Laënnec. He based it on the Latin verb auscultare, which means "to listen." Physicians had long employed the sounds made by various internal organs, including the heart, the blood vessels, the lungs, the stomach and the bowels, to aid them in determining the causes of a number of maladies suffered by their patients. But their only means by which to hear those important internal sounds was to place their ear directly against the chest of their patient. However, this method was problematic, as it could be difficult to clearly hear specific sounds in patients who were obese or exceptionally muscular.
But even more problematic for the practice of auscultation was the need for such close physical contact with a patient. Many patients, particularly females, felt the practice violated their modesty. Many doctors found the practice repugnant when they had to examine patients who neglected their personal hygiene. To mitigate these issues, most doctors placed a large handkerchief over the chest of the patient under examination before attempting to place an ear to their chest. But even the use of a handkerchief was not modest enough for some female patients and they refused to submit to any form of auscultation. In addition, a number of experienced doctors felt that the cloth of the handkerchief masked the clarity of the internal sounds they needed to hear. Such interference made diagnosis of a number of internal ailments very difficult.
In 1816, Dr. Théo Laënnec was appointed to the staff of the Necker Hospital in Paris. One day in the late fall, a young woman was brought to see him, showing symptoms of what he suspected was a heart disorder. He knew that listening to her heart would be one of his most crucial diagnostic methods. But she was quite young and rather plump, with ample breasts. Dr. Laënnec felt it would be completely indecorous for him to examine her using immediate auscultation, that is, placing his ear to her chest. But in the previous weeks, he had been toying with an alternate method which might provide him with a clearer sound, while eliminating the need to press his ear to the young lady’s chest.
A month or so before the examination of this young woman took place, Dr. Laënnec had been walking through the gardens of the Louvre Palace when he saw a group of schoolchildren playing. They took turns as one of them pressed his ear to a hollow stick, while listening to the sounds another was making by scratching on the wooden tube with a pin. As a flute player, Dr. Laënnec was well aware that sound could be transmitted via various materials. Looking about his office, Dr. Laënnec spied a quire of paper on his desk. He picked up the sheaf of paper and rolled it into a tube. Laënnec then applied one end of the tube to the young lady’s chest, and held his ear to the other. He was very pleased to discover that he was able to hear the sounds of her heart much more clearly than he ever had before.
Laënnec knew that paper was not the ideal medium by which to transmit sound, nor would a roll of paper hold up to constant use. He came to the conclusion that a tube of wood would be the best conductor of sound, and he set about making this new medical diagnostic instrument. His first attempt was to make a simple wooden tube, but over time he considered other ways to improve the sound the instrument could deliver. His ideas centered on the standard hearing trumpet of the day as a model for his new device, Laënnec then made a wooden tube to which he attached a funnel-like piece at one end and a plug with a small hole at one end to more fully focus the sound. Dr. Laënnec decided to call his new device a "stethoscope," from the Latin stetho, meaning chest, and scope, meaning to explore.
Initially, there were a number of doctors who belittled Laënnec’s stethoscope, because they did not understand the properties of sound or how it could deliver better results than immediate (unaided) auscultation. However, a small group of his close medical colleagues did choose to use this new medical device and were pleased with the results. In 1818, Dr. Laënnec presented his research on the use of the stethoscope to the Academy of Sciences in Paris. The following year, he published his most important work, De l’auscultation médiate ou Traité du Diagnostic des Maladies des Poumon et du Coeur. (From mediated auscultation or Treaty of the Diagnosis of Lung and Heart Diseases). It was in this publication that he coined the term "mediate auscultation" for listening to internal body sounds using an aid, like a stethoscope. Within the year, his work was acknowledge in most medical circles to be one of the greatest advancements in the understanding and diagnosis of diseases of the chest. Before the Regency came to a close, the stethoscope was in use by many doctors across the Continent and the British Isles.
Sadly, Dr. Laënnec died of tuberculosis in August of 1826. The diagnosis of his final illness was made with his most important invention, the stethoscope. The instrument he invented was a rigid wooden tube and could only deliver monaural sound. The design remained nearly unchanged though most of the nineteenth century. But as the twentieth century dawned, a number of changes began to be made to the stethoscope to provide stereo sound, that is, sound to both ears. A set of flexible tubes was added which made the device much easier to use, and able to deliver even better sound. With those successive changes, the stethoscope invented during the Regency has evolved into the iconic medical instrument of today.
Dear Regency Authors, by late 1816, with Napoleon safely on St. Helena, France once again open to travel. A wide range of people, including the British, were taking advantage of the opportunity. Therefore, it is not beyond the realm of possibility that either Dr. Laënnec and/or his stethoscope could make an appearance in a story set at that time or later. Will a doctor in your story object to the use of the device, because it is new and unfamiliar, or because it was invented by a Frenchman? Or, will the life of one of your characters be saved because their physician owned a stethoscope and knows how to use it? Then again, if your story is set before 1816, might you choose to incorporate early methods of immediate (unaided) auscultation when a physician examines one of your characters. What might result from such an examination if the doctor’s actions are considered indelicate by the patient or members of her family?