René Théophile Hyacinthe Laënnec (1781-1826). Doscientos años del uso del estetoscopio. Una breve reseña / René Théophile Hyacinthe Laënnec (1781-1826). Two hundred years of the stethoscope. A brief overview

Se han cumplido doscientos años desde la publicación en la que se dio a conocer la aplicación clínica del estetoscopio. Esta fue realizada en 1819 por René Théophile Hyacinthe Laënnec. El Dr. Laënnec vivió su infancia en la efervescencia social de la Revolución francesa y estudió Medicina en París, donde se graduó en 1804. Su experiencia clínica en el Hospital Necker culminó con la invención del estetoscopio en 1816. Tres años después, la publicación de su obra maestra De l'auscultation médiate enfatizó un enfoque clínico-patológico más racional, en especial, para el entendimiento de las enfermedades cardiorrespiratorias. Sin duda, el Dr. Laënnec revolucionó la medicina al perfeccionar el arte de la semiología torácica, que permitió al médico transformar los sonidos que escuchaba en una imagen, la cual podía visualizar.Con ocasión del bicentenario de este trascendental hito de la medicina moderna, se recuerda su historia

Two hundred years have passed since the publication that revealed the clinical use of the stethoscope. René Théophile Hyacinthe Laënnec published it in 1819. Laënnec spent his childhood in the social effervescence of the French Revolution and studied medicine in Paris, where he graduated in 1804. His clinical experience at Necker Hospital peaked with the invention of the stethoscope in 1816. Three years later, he published his masterpiece De L'Auscultation Médiate, which underlined a more rational clinical-pathological approach, especially in the understanding of cardiopulmonary diseases. Undoubtedly, Laënnec revolutionized medicine by perfecting the art of thoracic semiology, which allowed him to translate the sounds he heard into an image that could be visualized.In the bicentennial of the invention of such fundamental milestone in modern medicine, the purpose of this article is to go over its history

[Searching the Roots of Erb's Auscultation Point]. / Auf den Spuren des Erb'schen Auskultationspunkts: Rätsel gelöst.

"Erb's point" is the fifth point of auscultation for the heart exam, located in the third intercostal space close to the sternum. It has sometimes been attributed to famous German neurologist Wilhelm Heinrich Erb (1840 - 1921), but without historical evidence. Erb's focus on neurology suggested that the auscultation point may have been confused with other points in the neck named after Erb. As Erb was a specialist for neurological manifestations of syphilis, we speculated that the heart murmur of aortic incompetence produced by syphilitic aortitis, best heard at Erb's point, linked Erb's name to the auscultation point. However, we eventually found a publication by an American physician who visited Erb's lectures in Heidelberg and reported that Erb explicitly introduced this "fifth point" in his case presentations in the late 1890 s. After all, Erb was chair of general medicine, with the first German chair of neurology only being established in 1919.

A Short History of Cardiac Inspection: A Quest "To See with a Better Eye".

Cardiac examination has evolved over centuries. The goal of cardiac evaluation, regardless the era, is to "see" inside the heart to diagnose congenital and acquired intra-cardiac structural and functional abnormalities. This article briefly reviews the history of cardiac examination and discusses contemporary best, evidence-based methods of cardiac inspection.

[Seeing sounds? The visualization of acoustic phenomena in heart diagnostics]. / Töne sehen? Zur Visualisierung Akustischer Phänomene in der Herzdiagnostik.

During the nineteenth century physiologists and clinicians developed several graphical recording systems for the mechanical registration of heart sounds. However, none of these replaced traditional methods of auscultation. The paper describes criticism of the aural sense as one of the driving forces behind the development of phonocardiography and analyses its variants from a technological and clinical perspective. Against the background of the physiological "method of curves," the parameters that prevented the implementation of phonocardiography against overwhelming odds are highlighted. Contemporaries denied specific evidence beyond auscultation. Many clinicians also feared that the art of auscultation was being undermined by the new, reproducible mechanical methods. The paper argues that phonocardiography was on the one hand regarded as impractical in clinical settings; on the other hand­and even more important­implicit practices, tacit knowledge and cultural models fostered skepticism against the new method. The argument of "self-evidence"­often connected to medical images, curves, graphs or tables­was not valid for the visualization of cardiac sounds in the opinion of the promoters of acoustic heart sound registration and its individual interpretation. Rather, the acts of subjective hearing and objectively reporting what was heard seemed "self-evident" for pathophysiological characteristics and the development of a diagnosis. Therefore, auscultation and phonocardiography coexisted with different emphases. While auscultation remained the method of choice for a bedside diagnosis, phonocardiography played its role in differential diagnostics or research settings.

Archibald Billing (1791-1881) MD FRCP FRS: bedside teaching at the London Hospital (1822).

After graduation at Trinity College Dublin in 1814 Archibald Billing, who was born in County Dublin, settled in London. His Dublin MD (1818) was incorporated at Oxford and he taught at the London Hospital where, when appointed Senior Physician in 1822, he introduced teaching at the patients' bedsides. He ceased to lecture in 1836 when he was invited to become a member of the Senate of the University of London. He published papers on a variety of clinical subjects but is remembered for First Principles of Medicine (1831) that went through six editions. His friends among the operatic artists included Niccolo Paganini, and The Science of Jems, Jewels, Coins and Medals (1867) was the work of a connoisseur. He lived in retirement for many years before he died at the age of 90 at 34 Park Lane, London, on 2 September 1881.

Aubrey Leatham and the introduction of cardiac pacing to the UK.

In the early 1950s, Dr Aubrey Leatham established a cardiac unit at St. George's Hospital, Hyde Park Corner, London. He developed and taught the essential clinical skill of cardiac auscultation. Under his guidance a clinical department for the care of cardiac patients was developed and coupled to physiological academic research. He was a pioneer in cardiac pacing and, in 1961, Harold Siddons, O'Neal Humphries, and Aubrey Leatham implanted the first 'indwelling' pacemaker in the UK in a 65-year-old man with repeated Stokes-Adams attacks due to complete heart block. The nickel-cadmium 'accumulator', which powered the pacemaker, had to be recharged once a week.

[Development of the stethoscope from Laennec to Cammann]. / Evolution du stéthoscope de Laennec à Cammann.

A history of Stethoscope from Laennec to Camman through Piorry, Nauche, Louis, Landouzy (father), Commins, Williams, Stokes, Billing and Depaul.

The decline of cardiac auscultation: 'the ball of the match point is poised on the net'.

A brief review of the history of cardiac auscultation confirms its decline. The intervention of healthcare institutions may avoid loss of medical culture and increased costs by adequate training of medical staff.

[François Joseph Double and auscultation]. / François Joseph Double et l'auscultation.

François-Joseph Double, co-founder of the Académie de Médecine, was one of those doctors who, right at the beginning of the nineteenth century, developped the accurate observation of the clinical signs of illness, which called earlier practice into question. This led him to study the unaided auscultation of respiratory and cardiac ailments. Shortly before Laennec's fundamental discovery of aided auscultation, Double was describing different sorts of sounds such as those which would later be called tubal breathing, and pulmonary rales or crackles; listening to the heart, he concentrated on problems of the beat, on unusual sounds but did not know how to link them to any specific ailment. The fact that his findings precede those of Laennec have not allowed him the recognition that his pioneering work deserves.

Rene Theophile Hyacinthe Laënnec (1781-1826): the man behind the stethoscope.

Rene Theophile Hyacinthe Laënnec (1781-1826) was a French physician who, in 1816, invented the stethoscope. Using this new instrument, he investigated the sounds made by the heart and lungs and determined that his diagnoses were supported by the observations made during autopsies. Laënnec later published the first seminal work on the use of listening to body sounds, De L'auscultation Mediate (On Mediate Auscultation). Laënnec is considered the father of clinical auscultation and wrote the first descriptions of bronchiectasis and cirrhosis and also classified pulmonary conditions such as pneumonia, bronchiectasis, pleurisy, emphysema, pneumothorax, phthisis and other lung diseases from the sounds he heard with his invention. Laënnec perfected the art of physical examination of the chest and introduced many clinical terms still used today.