Hardcover
-
PICK UP IN STORECheck Availability at Nearby Stores
Available within 2 business hours
Related collections and offers
Overview
Laennec's famous Treatise on Mediate Auscultation was 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.
The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover 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.
Product Details
| ISBN-13: | 9780691635644 |
|---|---|
| Publisher: | Princeton University Press |
| Publication date: | 04/19/2016 |
| Series: | Princeton Legacy Library , #376 |
| Pages: | 474 |
| Product dimensions: | 6.10(w) x 9.30(h) x 1.20(d) |
Read an Excerpt
To See with a Better Eye
A Life of R. T. H. Laennec
By Jacalyn Duffin
PRINCETON UNIVERSITY PRESS
Copyright © 1998 Princeton University PressAll rights reserved.
ISBN: 978-0-691-03708-0
CHAPTER 1
Youth and Revolution
I often feel a touch of melancholy when I think that these times, so stormy for the State, have been for me the happiest of my life.
—Laennec to his father, 4 September 1798
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 included—are indebted to Alfred Rouxeau, the Breton physiology professor whose hagiographic account was based on a thousand family letters that he located and transcribed (see Appendix A).
Laennec was born on 17 February 1781 at the inland port of Quimper near the western tip of Brittany. He was the first child of Théophile-Marie Laennec (1747–1836) and Michelle-Gabrielle-Félicité Guesdon (1754–1786), who became parents ten months after their marriage. Both families had respectable roots in the regions of Finistere: the child's paternal grandfather and great-grandfathers on both sides had been mayors of Quimper. Maternal grandparents claimed distant relationship to the writer Elie Freron (1718–1776) and the poet Francois de Malherbe (1555–1628); the father's ancestors included several generations of lawyers.
The Laennec family lived at the mother's birthplace, which they shared with her father until his death on 10 October 1781 (fig. 1.1). Their home stood on the quay overlooking the confluence of the Steir and Odet Rivers opposite a park; it was demolished in the twentieth century. The old man left the house to his daughter and his position as bailiff in the municipal bureaucracy to her husband.
Laennec's father, Théophile-Marie, was the eldest of the five children born to lawyer Michel Laennec (1714–1782) who lived at the manor of Kerlouarnec (Place of the Foxes) near Douarnenez twenty kilometers northwest of Quimper. Like his father, Théophile-Marie became a lawyer, and in 1781 he held positions as king's counselor and officer of the Admiralty of Quimper. By the 1790s he was unhappily situated as a magistrate in the civil court at the town of Quimperlé. Intelligent, but unreliable, selfish, and sometimes deceitful, he thought that he belonged in Paris and that he deserved the indulgence of others to help him pursue his destiny. His passions were plotting, rhyming, gossip, and writing prose. The unsettled times and his capricious nature resulted in ever-precarious employment, and he contracted many debts. For four years after his father died on 31 October 1782, Théophile-Marie prevented his three living siblings from receiving any benefit from the estate. The beautiful property of Kerlouarnec he kept for himself, but it slid into the serious decline from which his physician son would later try to retrieve it. Laennec père seems to have blown with whatever political breeze passed his way hoping with each change to find a comfortable niche in the new order. In the Terror, he tried to ingratiate himself with the revolutionary tribunals; once it became possible to restore confiscated fortunes, he became the champion of émigrés; in the early Empire, he published an ode to Napoleon; and he cheered with his son at the return of the King in 1814.
Little is known of the infancy of the Laennec children. A brother, Michel (Michaud), was born 14 July 1782, and a sister, Marie-Anne, in 1785. A single reference to a nourrice (wet nurse) in one of the father's letters led Rouxeau to conclude that the future doctor, always called Théophile by his family, spent a year away from the home in the care of a Breton-speaking wet nurse. Laennec's mother died on 15 November 1786, two days after giving birth to a baby girl whose first breath had also been her last. Most historians have attributed the mother's death to tuberculosis, and some have blamed her for unwittingly infecting her famous son, but the evidence pointing to the mother's tuberculosis is slim: she died young, as did her brothers and her sons; and her physician brother-in-law once described her as "frail." More likely, she succumbed to childbed fever or another complication resulting from her delivery two days before. Rouxeau refused to accept the tuberculosis hypothesis for the mother's death, because of Laennec's much later surprise at learning of phthisis (tuberculosis) in his family.
The widowed Théophile-Marie was considered incapable of caring for his three living children. The little girl was taken by his wife's sister, Madame de la Potterie, and in January 1787, the two boys were sent to live with the father's youngest brother, abbé Michel Laennec (1750–1801), doctor of the Sorbonne and priest of the small parish of Elliant, sixteen kilometers east of Quimper. There they began their studies and learned catechism, but at the end of a year, the abbé left to become canon at the larger community of Tréguier on the north coast of Brittany. By March 1788, the children were sent back to their father in Quimper. The priest-uncle and the father both appealed to their middle brother, Guillaume-François Laennec (1748–1822), physician at Nantes. Guillaume found the request "bizarre," but he agreed to care for the "orphans." Rouxeau tells us that the litde boys sailed into the port of Nantes on 15 May 1788. France was on the verge of its long and bloody Revolution, and more than nine years would pass before either child saw his father again.
Guillaume Laennec became a second father to his nephews (fig. 1.2). Born at Kerlouarnec, he had left Finistère to study medicine in Paris, Montpellier, and London. While in Paris from 1769 to 1772, Guillaume frequented the home of Elie Fréron, writer and critic of Voltaire, and he was an eager student of the private anatomy lessons of the surgeons Raphael Bienvenu Sabatier (1732–1811) and Antoine Petit (1722–1794). But he had difficulty paying for the expensive Parisian cadavers, which could not be obtained from the cemeteries as they had been in Brittany. In 1773, he completed his degree in Montpellier where he followed the classes of Paul-Joseph Barthez (1734–1806). After a few months in London, he practiced first in Quimper, then as a temporary medical officer in the navy at Brest, before settling on marriage and a career in Nantes.
A well-documented family legend testifies to the legalistic fighting spirit of this medical descendant of a long line of jurists. Upon his engagement to the youthful Désirée de Gennes de Matignon in 1781, Guillaume was required by his future father-in-law to leave Quimper for a larger town befitting his bride from Rennes, the capital of Brittany. Guillaume thought it wise to avoid the city of his in-laws and instead chose Nantes where six of twelve doctors had recently died. Despite the apparent need for doctors, jealous physicians in the medical faculty had influenced municipal authorities to deny privileges to Guillaume and his fellow Montpellier graduate, surgeon Pierre-François Blin (1756–1834); the newcomers could undertake thirty-nine months of supplemental training, write five examinations, and pay twenty-four hundred livres in fees. At first Guillaume complied and passed three of the five examinations, but he became impatient following his marriage in July 1783, and tried to renegotiate the terms of his situation. After four unsuccessful attempts at finding a compromise, he adopted the creative strategy of suing the University. Representing himself and relying on a 1707 law, he argued for more than two years through nine hearings in the parliament at Rennes and finally won his case and that of Blin in 1785.
Guillaume's success galvanized the attention of his fellow citizens; a few months later the faculties of law, letters, and theology (but not medicine) elected him Procureur général of the University. In that capacity, he brought six new doctors to Nantes and, three years later, controlled seven of eleven votes in the medical faculty. In March 1788, he was elected Rector of the University. Guillaume was not a man to inspire feelings of indifference; either he was loved or he was hated. More denunciations and bitterly won triumphs lay ahead.
The young Laennec and his brother arrived in Nantes shortly after Guillaume's election as Rector. They joined their cousin, four-year-old Christophe, but Guillaume's family soon grew to include three more sons and a daughter. The earliest known autograph of the future doctor is his nine-year old signature on the baptismal record of his cousin, Ambroise, born in February 1790. The Laennecs of Nantes lived in a grand building in the Place Bouffay, near a (now vanished) branch of the Loire. Several servants worked under the watchful and economically shrewd eye of Guillaume's mother-in-law, Madame de Gennes, who had moved from Rennes after her husband's death. She was said to have been more fond of young Théophile than she was of any of her own grandchildren. Well into his late adolescence, the boy entrusted her and her daughter with the management of his meager resources and his wardrobe.
Nantes suffered greatly during the Revolution. Guillaume Laennec was relatively comfortable, but his old enemies and the political instability compelled him to be vigilant. The privileges of a physician and an administrator were suspect, contact with aristocracy was dangerous, and connection to a priest could be fatal. In contrast to his older brother, Guillaume's political sympathies were more closely guarded, and his religious sentiments leaned toward the skeptical, although he once described himself "a bit Jansenist." Years earlier at the festivities surrounding the marriage of the Dauphin (soon to be Louis XVI) to fourteen-year-old Marie Antoinette, he had been dismayed to witness the trampling of dozens of Parisians; to his father, Guillaume deplored the unnecessary, royal extravagance and complained that the money spent on fireworks could have funded several courses in obstetrics. Guillaume may have welcomed the democratization of some structures following the meetings of the Estates General, but he was cynical about the benefits of the Convention. In the 1790s, he was named to several regional committees, only to resign or be removed. Papers testify to his willingness to provide certificates that would exempt fellow citizens from extreme privation or restore their lost property; others describe him as a "demagogue" and enemy of the Revolution.
Shortly after the execution of Louis XVI on 21 January 1793, a counterrevolutionary war exploded in the Vendee, southeast of Brittany. The uprising was the result of dissatisfaction with the economic situation and had been triggered by reaction to a massive conscription effort for the wars with the Rhineland, the Netherlands, and Austria. The counterrevolutionaries, or Chouans, were a mixture of peasants, Catholics, royalists, and smugglers, with backing from foreign opportunists. The Terror in Brittany was dominated by an effort to put down these uprisings. Instability and outright violence continued at intervals with more or less vigor until mid-1800.
In March 1793, a guillotine was erected in Place Bouffay in front of the Laennec home, and over the following three months, some fifty people were executed. An enthusiastic crowd was expected to fill the windows overlooking the square. To spare his family from this gruesome obligation, Guillaume Laennec moved to a newer dwelling a short distance away in Place de l'Egalité (now Place Royale) at the end of June 1793. Earlier that same year, when the property of the clergy was confiscated, he had acquired the large country house at Petit Port north of town on the border of the bucolic valley of the Cens. There the children could seek refuge for longer periods of time when the wars were quiescent.
In October 1793, Jean-Baptiste Carrier (1756–1794) was sent to quell the uprisings in the west as the representative on mission of the Convention government. He emptied the prisons, rounded up "brigands," encouraged pillaging and the rape of women and children, and ruthlessly shot or guillotined hundreds. For a quicker and less costly method of execution, he drowned countless, bound prisoners in a series of noyades, which entailed scuttling crowded barges in the Loire. Guillaume's son, Christophe, recalled a frightening night when Carrier came to the family home for food and drink and was angered when Madame de Gennes voiced her opposition to his agenda. As punishment, her physician son-in-law was sentenced to six weeks of hospital arrest at the Hôtel Dieu (renamed the Temple de l'Humanité). According to other sources, Guillaume's "arrest" may have had nothing to do with his mother-in-law's indiscretion and he was confined to the hospital with five other doctors because of the overwhelming medical need. By early February 1794, Carrier had been recalled. The mortality under his three-month reign of terror in Nantes is unknown, but the carnage is considered to have been the highest in France with estimates ranging from four to twenty thousand deaths.
In late 1794, Guillaume Laennec traveled to Paris as an accuser of Carrier. The trial focused on the unauthorized executions and his responsibility for deaths of children and women, some of whom had been pregnant. In his deposition, Guillaume described Carrier's "republican marriages": a boy and a girl—or an old man and an old woman—were stripped, tied together, and thrown in the river. He wrote to his wife of the arrest of the "monster" and his trial: "Nantes has her revenge!" Carrier was executed on 16 December 1794. While in the capital, Guillaume lobbied successfully for a commission as a military physician and for support of the fragile botanical garden, which had been the mainstay of hospital remedies until the troubles caused it to be expropriated and neglected. Two years later he appealed for the right to reestablish formal medical training in Nantes, but the faculty would not be resurrected until 1808.
Throughout these turbulent times, the nephews attended school: first in the preparatory courses of the Institution Tardivel; then at the Collège de l'Oratoire. Schools and their curricula were reorganized as a result of the revolutionary mistrust of the priest instructors; however, "religion" persisted as a subject, joined with logique morale and "development of the rights of man." The earliest surviving record of Laennec's schooling is from the summer of 1792, when he was listed as one of seventeen students in the quatrième class. The boys appear to have excelled in their studies of rhetoric, ancient languages, Latin, natural history, drawing, literature, mathematics, physics, and chemistry. In their spare hours, they played games and music and learned to swim and hunt with their younger cousins. Théophile enjoyed additional lessons in flute, drawing, and dance, and he kept a rock collection, which his uncle referred to as his personal "quarry," relating it to the boy's initial desire to study engineering. At the age of seventeen, after visiting a political café, Laennec revealed himself to be a supporter of the Republic, fascinated by the effect of the government's suppression of newspapers, which, he said, had left "a profound and deep chagrin that enveloped all the thoughts [of journalists and their friends] and even penetrated their discourse." And he pondered the irony of his situation: "I often feel a touch of melancholy when I think that these times, so stormy for the State, have been for me the happiest of my life."
(Continues...)
Excerpted from To See with a Better Eye by Jacalyn Duffin. Copyright © 1998 Princeton University Press. Excerpted by permission of PRINCETON UNIVERSITY PRESS.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
LIST OF ILLUSTRATIONS LIST OF TABLES ACKNOWLEDGMENTS INTRODUCTION PART ONE: PATHOLOGY: ANATOMY, PHYSIOLOGY, AND THE BODY POLITIC CHAPTER ONE Youth and Revolution CHAPTER TWO Student in the Paris School CHAPTER THREE Research and Academic Aspirations CHAPTER FOUR Clinical Practice, Clinical Physiology CHAPTER FIVE The Restoration: Politics, Hospitals, and Patients PART TWO: AUSCULTATION CHAPTER SIX The Discovery CHAPTER SEVEN The Treatise on Mediate Auscultation: The Lungs CHAPTER EIGHT The Treatise on Mediate Auscultation: The Heart and Clinical Reasoning PART THREE: DISEASE CHAPTER NINE Reception and Impact of Auscultation: Reviews, Diagnoses, and Broussais CHAPTER TEN Return to Paris: Elite Practice and Professor in the Clinic CHAPTER ELEVEN At the College de France: The Second Unpublished Book CHAPTER TWELVE Between the Quick and the Dead: Pathology, Physiology, and Clinical Medicine APPENDIX A A Note on Sources: Scientific Papers and Correspondence APPENDIX B Laennec's Finances APPENDIX C Patients in the Two Editions of the Traite de Pauscultation APPENDIX D Laennec's Network: A Glossary of Frequently Cited Names APPENDIX E The Family of R. T. H. Laennec LIST OF ABBREVIATIONS NOTES BIBLIOGRAPHY OF R. T. H. LAENNEC: PUBLICATIONS, REVIEWS, AND OTHER PROFESSIONAL ACTIVITIES BIBLIOGRAPHY INDEX