Editing René Laennec (section)

==Invention of the stethoscope==
René Laennec wrote in the classic treatise ''De l'Auscultation Médiate'',<ref name=Laennec-1819/>
<blockquote>
In 1816, [he was] consulted by a young woman laboring under general symptoms of diseased heart, and in whose case percussion and the application of the hand were of little avail on account of the great degree of fatness. The other method just mentioned direct [[auscultation]] being rendered inadmissible by the age and sex of the patient, I happened to recollect a simple and well-known fact in acoustics, ... the great distinctness with which we hear the scratch of a pin at one end of a piece of wood on applying our ear to the other. Immediately, on this suggestion, I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised and pleased to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of my ear.
</blockquote>
Laennec had discovered that the new [[stethoscope]] was superior to the normally used method of placing the ear over the chest, particularly if the patient was overweight. A stethoscope also avoided the embarrassment of placing the ear against the chest of a woman.<ref name=Roguin-2006-09>{{cite journal |author=Roguin, A. |date=September 2006 |title=Rene Theophile Hyacinthe Laënnec (1781–1826): The man behind the stethoscope |journal=[[Clinical Medicine & Research]] |volume=4 |issue=3 |pages=230–235 |doi=10.3121/cmr.4.3.230 |pmc=1570491 |pmid=17048358}}</ref>

[[Image:Rene-Theophile-Hyacinthe Laennec Drawings stethoscope 1819.jpg|thumb|left|The first drawing of a [[stethoscope]] (1819)<ref name=Laennec-1819/>]]
[[Image:Stethoscope-2.png|thumb|right|A modern [[stethoscope]] ]]
Laennec is said to have seen school children playing with a long piece of solid wood in the days leading up to his innovation.<ref name=Scherer>
{{cite journal
 | last = Scherer | first = John R.
 | year = 2007
 | title = Before cardiac MRI: Rene Laennec (1781–1826) and the invention of the stethoscope
 | journal = [[Cardiology (journal)|Cardiology]]
 | volume = 14 | issue = 5 | pages = 518–519
 | pmid = 18651515
}}
</ref>
The children held their ear to one end of the stick while the opposite end was scratched with a pin, the stick transmitted and amplified the scratch. His skill as a flautist may also have inspired him. He built his first instrument as a 25&nbsp;cm by 2.5&nbsp;cm hollow wooden cylinder, which he later refined into three detachable parts. The refined design featured a funnel-shaped cavity to augment the sound, separable from the body of the stethoscope.<ref>{{cite book |last=Risse |first=Guenter |year=1999 |title=Mending Bodies, Saving Souls |location=Oxford, UK |publisher=Oxford University Press |url=https://archive.org/details/mendingbodiessav00riss |via=Internet Archive (archive.org) |url-access=limited |isbn=978-0-19-505523-8 |pages=[https://archive.org/details/mendingbodiessav00riss/page/n336 316]}}</ref>

His clinical work allowed him to follow chest patients from bedside to the autopsy table. He was therefore able to correlate sounds captured by his new instruments with specific pathological changes in the chest, in effect pioneering a new non-invasive diagnostic tool. [[Phthisis pulmonalis|Pulmonary phthisis]], for example, was one ailment he could more clearly identify using his knowledge of typical and atypical chest sounds.<ref name=Bynum-1994>{{cite book |last=Bynum |first=W.F. |date=27 May 1994 |title=Science and the Practice of Medicine in the Nineteenth Century |publisher=Cambridge University Press |isbn=978-052127205-6 |page=39}}</ref> Laennec was the first to classify and discuss the terms [[rales]], [[rhonchi]], [[crepitance]], and [[egophony]] – terms that doctors now use on a daily basis during physical exams and diagnoses.<ref name=Scherer/> Laënnec presented his findings and research on the stethoscope to the [[French Academy of Sciences]], and in 1819 he published his masterpiece ''On Mediate Auscultation''.<ref name=Laennec-1819>
{{cite book
 |first=René T.H. |last=Laennec
 |year=1819
 |title=De l'Auscultation Médiate, ou Traité du Diagnostic des Maladies des Poumon et du Coeur
 |trans-title=On Indirect Listening: A treatise on the diagnosis of lung and heart diseases
 |at=8
 |place=Paris, FR
 |publisher=Brosson & Chaudé
}} Two volumes.
</ref><ref name=Roguin-2006-09/><ref name=Laennec-Forbes-1835/><ref name=Forbes-1962/>

Laennec coined the phrase ''mediate [[auscultation]]'' (indirect listening), as opposed to the popular practice at the time of directly placing the ear on the chest ([[immediate auscultation]]). He named his instrument the [[stethoscope]], from the Greek words ''{{math|στήθος}}[stethos]'' (chest), and ''{{math|σκοπός}}[skopos]'' (examination).
[[File:Laennecs stethoscope, c 1820. (9660576833).jpg|thumbnail|One of the original stethoscopes belonging to Rene Theophile Laennec made of wood and brass]]
The stethoscope quickly gained popularity as ''De l'Auscultation Médiate''<ref name=Laennec-1819/> was translated and distributed across France, England, Italy, and Germany in the early 1820s.<ref name=Bynum-1994/> However, not all doctors readily embraced the new stethoscope. Although the ''[[New England Journal of Medicine]]'' reported the invention of the stethoscope two years later in 1821, as late as 1885, a professor of medicine stated, "He that hath ears to hear, let him use his ears and not a stethoscope." Even the founder of the [[American Heart Association]], L.A. Connor (1866–1950), carried a silk handkerchief with him to place on the wall of the chest for ear auscultation.<ref>{{cite journal |first=Harry |last=Bloch |year=1993 |title=Dr.&nbsp;Connor's technique |journal=[[Family Practice (journal)|Family Practice]] }}</ref>

Laennec often referred to the stethoscope as "the cylinder", and as he neared death only a few years later, he bequeathed his own stethoscope to his nephew, referring to it as "the greatest legacy of my life".

The modern [[binaural stethoscope|type, with two earpieces]], was invented in 1851 by [[Arthur Leared|A. Leared]]; in 1852 [[George Philip Cammann|G.P. Cammann]] perfected the design of the instrument for commercial production, which has become the current standard form.