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To see with a better eye: a life of R T H Laennec

M. Nicolson

Published 1999 in Medicina e historia

ABSTRACT

The debunking tendencies of modern historiography notwithstanding, historians of medicine still find it difficult to resist depicting the invention of the stethoscope as a defining moment. Laennec's cylinder stands for the apotheosis of the clinico-anatomical programme of the Paris School, for the "disappearance of the sick man", and as the starting point of the long and triumphant march of medical technology. That the idea of mediate auscultation first suggested itself within a consultative encounter, that it sprang from the problematics of male professional proximity to the female body, renders the story of the invention interesting to "behaviourists" (in Erwin Ackerknecht's sense), to historians of the body, and to those who do "medical history from below", as we all have to nowadays. The life, work and legacy of Rene Theophile Hyacinthe Laennec, Catholic, Royalist and Breton, a legend in his own lecture-notes (and in thousands of subsequent ones), has something for everyone indeed. It is remarkable, therefore, that Laennec has not had a full biographical treatment for forty years. Whatever the reason, it cannot have been lack of resources. Much manuscript material survives and, in Brittany, the collection of Laennec memorabilia seems to have the status of a cottage industry. Professor Duffin has laboured long in the various archives to provide us with what is a very full and scholarly biographical study. Duffin's account of stethoscopy is not overall, a radically revisionist one. She is content to endorse the pivotal importance of her subject's innovation. "Doctors' stories", as she puts it, "were forever changed by Laennec's invention". The stethoscope allowed pathological anatomy to function as a conceptual model in the clinical sphere; auscultation revolutionized how disease processes were constructed, and how doctors and patients related to each other during the diagnostic encounter. These may be broadly familiar arguments but much of the historical detail that Duffin presents in their articulation is both new and very pertinent. Much of the strength of To see with a better eve derives from the author's painstaking exploration of less familiar aspects of Laennec's work and writings. An outstanding example is her detailed account of the lectures Laennec gave as a professor of the College de France, following his return to Paris in 1821. The text of only one of these has been published but manuscript versions of a further 162 survive. Duffin skilfully exploits this wealth of material to provide a rounded picture of the mature Laennec, presenting his developed views as a clinician and as a theorist, and responding to contemporary criticism of his work, notably of course that of F J V Broussais. As well as being very enlightening with respect to Laennec, this discussion might be regarded as another step in the historiographic rehabilitation of Broussais. Duffin authoritatively delineates the role Broussais's critical polemic played in shaping the second edition of L'Auscultation mediate. She also intriguingly notes that Broussais, his sustained attacks upon Laennec notwithstanding, acknowledged that, in certain respects, he shared a common perspective with the inventor of the stethoscope. Perhaps the most noteworthy aspect of this communality was that both men, unlike the vast majority of their Parisian peers, had reservations as to the extent to which pathological anatomy could provide a proper foundation for clinical medicine. Laennec's attitude to pathological anatomy is perhaps the point at which Duffin most bracingly challenges received historiographical assumptions. Certainly the stethoscope made a conceptual link between the morgue and the ward. Lesions which previously had been seen

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