To See with a Better Eye

To See with a Better Eye: A Life of R. T. H. Laennec

JACALYN DUFFIN
Copyright Date: 1998
Pages: 472
https://www.jstor.org/stable/j.ctt7zvjqm
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    To See with a Better Eye
    Book Description:

    René Théophile Hyacinthe Laennec (1781-1826) is best known for his invention of the stethoscope, one of medicine's most powerful symbols. Histories, novels, and films have cloaked his life in hagiography and legend. Jacalyn Duffin's fascinating new biography relies on a vastly expanded foundation of primary source material, including thousands of pages of handwritten patient records, lecture notes, unpublished essays, and letters. She situates Laennec, the scientist and teacher, within the broader social and intellectual currents of post-Revolutionary France. Her work uncovers a complex character who participated actively in the dramatic changes of his time.

    Laennec's famousTreatise on Mediate Auscultationwas his only published book, but two lesser known works were left in manuscript: an early treatise on pathological anatomy and a later set of lectures on disease. The three parts of Duffin's biography correspond to these books. First, she examines Laennec's student research on the emerging science of pathological anatomy, the background for his major achievement. Second, she uses his clinical records to trace the discovery and development of "mediate auscultation" (listening through an instrument, or mediator, to sounds within the human body). The stethoscope allowed clinicians to "see" the organic alterations inside their living patients' bodies. Finally, she explores the impact of auscultation on diagnostic practice and on concepts of disease. Analyzed here for the first time in their entirety, Laennec's Collége de France lectures reveal his criticism of over-enthusiastic extrapolations of his own method at the expense of the patient's story.

    Originally published in 1998.

    ThePrinceton Legacy Libraryuses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

    eISBN: 978-1-4008-6467-6
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-viii)
  2. Table of Contents
    (pp. ix-x)
  3. LIST OF ILLUSTRATIONS
    (pp. xi-xii)
  4. LIST OF TABLES
    (pp. xiii-xiv)
  5. ACKNOWLEDGMENTS
    (pp. xv-2)
  6. INTRODUCTION
    (pp. 3-8)

    The life of R. T. H. Laennec (1781–1826) spanned the French Revolution, the first Empire, and the Restoration. Through sickness, war, and poverty, he studied medicine, practiced his Catholic faith even when it was banned, tended his patients, dissected their cadavers, and taught his students. A prominent clinician, he waged a bitter polemic with one of the most popular doctors in Paris, conducted physiological experiments, and wrote three books on pathology, diagnosis, and disease, only the second of which was published. In his spare moments, he cultivated letters, played music, hunted, hiked, and danced. He also developed the technique...

  7. PART ONE: PATHOLOGY:: ANATOMY, PHYSIOLOGY, AND THE BODY POLITIC
    • CHAPTER ONE Youth and Revolution
      (pp. 11-23)

      The early life of R. T. H. Laennec, like that of most French people of the late eighteenth century, was marked by war, suffering, illness, and loss, but his trauma was alleviated by optimism and the frivolity of youth. Motherless at five, sent to the army at fourteen, seriously ill at seventeen, he was a dedicated student, talented in music, and not a little vain. The dramatic political changes of the Revolution, First Empire, and Restoration marked him deeply and influenced the course of his career. The romantic story of his life has been told many times; twentieth-century biographers—myself...

    • CHAPTER TWO Student in the Paris School
      (pp. 24-53)

      Laennec’s destination was the seven-year-old medical school in Paris, where he would spend three years as a student and many more as a devoted alumnus. He already had gathered clinical experience in Brittany, but his exposure to professional leaders in the capital sharpened his learning and honed his skills as a participant in a newly created medical culture. There he was influenced intellectually and spiritually, and he became known as a brilliant but single-minded young man with an aptitude for the new science of pathological anatomy and a penchant for preserving the past.

      In December 1794, the medical school of...

    • CHAPTER THREE Research and Academic Aspirations
      (pp. 54-76)

      Laennec would remain dependent on his father’s less than generous largesse for four more years, and his confident expectation of a position in the Paris school would not be filled for more than a decade. His student awards and his publications were impressive, but they could not overcome the requirements of political acceptability. Academic security would come only after 1815 and the Restoration, through the connections he had established in his youth. In the months immediately following his thesis defense, he could not imagine the long wait that lay ahead.

      This chapter traces Laennec’s early career as an independent researcher...

    • CHAPTER FOUR Clinical Practice, Clinical Physiology
      (pp. 77-101)

      Over the course of his career, Laennec worked in private practice, in public hospitals, in teaching clinics, and as a volunteer in both urban and rural environments. As a result, most of the contemporary “styles” of medical practice, as described by Jacques Léonard, from the country doctor to thegrand patron,can be found in the career of this one physician.¹ His own health was precarious, but he discovered the restorative benefits of regular exercise, physical rest, and psychic diversion. Personal illness and the stories of his patients reminded him that pathological anatomy could not explain all diseases. These experiences...

    • CHAPTER FIVE The Restoration: Politics, Hospitals, and Patients
      (pp. 102-118)

      Laennec was thrilled by the return of the king and the promise of peace and prosperity. During 1814 and 1815, he sent a string of breathless letters to his cousin Christophe reporting in rhapsodic terms on the final “short reign of him who has reigned too long,” and on the approach of Wellington, the military actions of medical students, Napoleon’s One Hundred Days, and the return of the king “who alone can bring peace and good order.”¹ The stubborn opposition of another cousin failed to sway his views and he became a contributor to royalist propaganda. The Restoration had a...

  8. PART TWO: AUSCULTATION
    • CHAPTER SIX The Discovery
      (pp. 121-150)

      Rarely does a discovery occur in an instantaneous flash, although accounts by inventors often make it seem that way. A discovery is a complex process. It can follow a long prehistory and emerges—sometimes quite slowly—within a receptive milieu that holds at least an inkling of what might constitute a useful application. It cannot be a product of chance alone, although it may profit from accidental circumstance. Most moments of discovery pass undocumented, and the stories are constructed retrospectively by the discoverers or their associates. Despite the best of intentions, post hoc accounts are never innocent; they are written...

    • CHAPTER SEVEN The Treatise on Mediate Auscultation: The Lungs
      (pp. 151-173)

      As he had intended, Laennec’s book on auscultation was understood as a contribution to pathological anatomy as soon as it was published. Less evident however, both then and now, was the author’s additional intention that auscultation should also be accepted as a contribution to physiology. In this chapter and the next, we will leave the thread of Laennec’s life to analyze the ideas in his most important publication. I will review the status of his treatise as a contribution to pathology and the attendant shift in disease concepts, especially as they pertain to the chest. Without refuting the general view...

    • CHAPTER EIGHT The Treatise on Mediate Auscultation: The Heart and Clinical Reasoning
      (pp. 174-206)

      Laennec’s medical successors and historians have criticized his research on the heart in different ways, all mostly inadequate and ranging from open ridicule to bemused indulgence. Words, like “wrong,” “inferior,” or “less excellent,” have been applied to his cardiac semiology and he has been accused of leaving the study of heart disease in a hopeless “snarl.”¹ Sometimes, the fact that he ever listened to the heart at all has been treated as pardon for his “mistakes,” but usually his cardiac research is neglected in favor of his more “successful” work on diseases of the lungs. What was the error? His...

  9. PART THREE: DISEASE
    • CHAPTER NINE Reception and Impact of Auscultation: Reviews, Diagnoses, and Broussais
      (pp. 209-239)

      Laennec’s treatise received immediate attention at home and abroad. Auscultation and the conceptual changes it subtended had a prompt impact on diagnosis and on the conceptualization of disease—an impact that was soon felt in the medical literature and at all levels of hospital practice, including record keeping. Most observers recognized the work as a contribution to pathological anatomy and to the detection of organic lesions. Laennec’s ideas about physiology and etiology, however, had little resonance for his contemporaries, and they were largely ignored, except by his rival Broussais, who accused him of plagiarism. From his retreat in Brittany, Laennec...

    • CHAPTER TEN Return to Paris: Elite Practice and Professor in the Clinic
      (pp. 240-258)

      By mid-November 1821, Laennec was back in Paris. He intended to accept the accolades that he had long believed were his due, and he would rebut his critics, especially Broussais. The stethoscope was already known throughout Europe, and its detractors were growing scarce, but he needed to reestablish his authority over the presumptuous young investigators like Collin and Andral who had challenged the expertise of the inventor. From his room at the Hotel du Bon Lafontaine, he returned to the clinical service at the Necker hospital and served an illustrious private clientele. The death of Corvisart two months earlier had...

    • CHAPTER ELEVEN At the Collège de France: The Second Unpublished Book
      (pp. 259-285)

      In the quarter century that elapsed from Laennec’s first writings to his last, the focus of his interest shifted from pathological anatomy to disease. One reason for the change had been his clinical practice; a second, was his intervening research on auscultation. The stethoscope endorsed an anatomical approach to disease, but it also enhanced his appreciation of the physiological aspects of illness that defied explanation by dissection. A third reason was the corresponding change in the subjects he taught: as a student, he had concentrated on the new science of pathological anatomy, but as Professor at the College de France,...

    • CHAPTER TWELVE Between the Quick and the Dead: Pathology, Physiology, and Clinical Medicine
      (pp. 286-304)

      In the mid- to late nineteenth century, as George Weisz has clearly shown, French physicians and historians were eager to promote Laennec’s contributions to pathological anatomy as a way of enhancing the scientific and nationalistic claims for the discipline.¹ That special emphasis increased, and during the century after his death, French pathologists had published portions of his treatise on pathological anatomy.² By 1963, Foucault joined a long line of French writers who had classified the treatise on auscultation as a work of pathological anatomy, and auscultation has received considerable attention by historians of the discipline.³ For historians of physiology, however,...

  10. APPENDIX A A Note on Sources: Scientific Papers and Correspondence
    (pp. 305-310)
  11. APPENDIX B Laennec’s Finances
    (pp. 311-313)
  12. APPENDIX C Patients in the Two Editions of the Traité de l’auscultation
    (pp. 314-323)
  13. APPENDIX D Laennec’s Network: A Glossary of Frequently Cited Names
    (pp. 324-327)
  14. LIST OF ABBREVIATIONS
    (pp. 329-332)
  15. NOTES
    (pp. 333-396)
  16. BIBLIOGRAPHY OF R. T. H. LAENNEC: Publications, Reviews, and Other Professional Activities
    (pp. 397-406)
  17. BIBLIOGRAPHY
    (pp. 407-436)
  18. INDEX
    (pp. 437-453)
  19. Back Matter
    (pp. 454-454)