Book Review

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

N Engl J Med 1998; 339:353-354July 30, 1998

Article

To See with a Better Eye: A life of R .T.H. Laennec
By Jacalyn Duffin. 453 pp. Princeton, N.J., Princeton University Press, 1998. $49.50. ISBN: 0-691-03708-6

This is an era of indifference to and poverty of skill in auscultation, which is unfortunate, since many of us trained in earlier days learned to relish the challenge, stimulus, and revelations that come from auscultation of the heart, lungs, great vessels, and torso. A new biography of Laennec, the father of auscultation, may therefore seem inappropriately timed. However, the advantage of good historical writing is that no time is inappropriate, and this book is indeed welcome.

René Théophile Hyacinthe Laennec was born in Brittany in 1781 into a family in modest circumstances. After the death of his mother when he was five years old, he was raised in Nantes in the home of an uncle, a doctor, who seems to have been a good surrogate parent. Laennec entered the French army as a third-class surgeon when he was only 14 and six years later moved to Paris, where he began his formal medical education. He received his medical degree at the age of 22. He was a pathologist of considerable talent, as well as a clinical practitioner. Laennec made the remarkable discovery of indirect auscultation, using at first a paper tube and later a wooden cylinder (Figure 1APhotograph of a Laennec Stethoscope and the Inscription on the Back of the Photograph (Courtesy of the Countway Library, Harvard Medical School). and Figure 1B), in 1817, and the first edition of his treatise on the subject was published in 1819. This report made his reputation, although his findings and their interpretation were attacked by a few, notably by his Parisian colleague, François-Joseph-Victor Broussais. Laennec returned to Brittany in 1819 and finally came back to Paris in 1821, where he combined teaching and a fashionable practice with further medical writing. He died in 1826.

The author has done a good job in assembling this solid biography. She has made excellent use of primary sources in France and has described Laennec's 45 years with attention to his hospital and private patients, his lecture notes, and his professional writing, as well as his correspondence. She points to his auscultatory findings in lung diseases, including pectoriloquy, and the chief limitations of his observations on heart sounds and murmurs. Although Laennec was famous for his primary role in auscultation, Duffin does not limit her discussion to this area but also writes extensively on his early interest in pathology and his final preoccupation with the composition and function of three components of the body: a solid, a liquid, and a vital principle. The book is well put together, with many excellent illustrations, extensive notes, and a large bibliography. The dust jacket is handsome. This book reaffirms Laennec's important place in medical history.

There are a few features of the biography that are less praiseworthy. One is the title. To See with a Better Eye, although catchy, is an awkward title for the biography of the father of auscultation. I would also have liked some better descriptions — for example, of the medical school in Paris, of Jean-Nicolas Corvisart des Marets, under whom Laennec studied, and of the Necker Hospital, where he worked. At times, like many biographers, the writer becomes so infatuated with her subject that she is unduly defensive and wordy. Finally, her style of writing is not characterized by simplicity and clarity — for example, “As in his formulation of pulmonary signs, the decision-making criteria he imposed on this ensemble of inductive evidence expressed an inkling of statistical probability, typifying one whose existence straddled the sensualist philosophy of the late eighteenth century and the dawn of positivist thought.” Yet these reservations are minor. This is a good biography and a valuable addition to the literature.

Oglesby Paul, M.D.
Harvard Medical School, Boston, MA 02115