(17 Feb 1781 - 13 Aug 1826)
Laennec And Auscultation
From Pathfinders in Medicine (1912)
CC by 4.0, credit: Wellcome Collection (source)
‘I present to the reader a new sign for the detection of diseases of the chest, which I have discovered. It consists in the percussion of the human thorax and the determination of the internal condition of this cavity by the varying resonance of the sounds thus produced. My discoveries in this subject are not committed to paper because of an itch for writing, nor an inordinate desire for theorizing. Seven years of observation have put the subject in order and have clarified it for myself and now I feel that it should be published.
‘I foresee very well that I shall encounter no little opposition to my views and I put my invention before the public with that anticipation. I realize, however, that envy and blame, and even hatred and calumny have never failed to come to men who have illuminated art or science by discoveries or have added to their perfection. I expect to have to submit to this danger myself, but I think that no one will be able to call any of my observations to account. I have written only what I have myself learned by personal observation over and over again, and what my senses have taught me during long hours of toil. I have never [p.220] permitted myself to add or subtract anything from my observations because of the seductions of preconceived theory.
‘I would not wish, however, that anyone should think that this method of diagnosis, which I suggest, has been developed to its utmost perfection. I confess with all candor that there are defects which conscientious observation will, I hope, amend with time. It is possible that there are even other important truths for the recognition of disease still hidden from this method of diagnosis. Some of these may prove of great usefulness for the differentiation, prognosis and cure of diseases of the chest.
‘This was the reason why in my personal experience, after I had succeeded in finding the signs in the chest and proceeded further to the investigation of their causes so far as my own observation could help me, I have always afterward had recourse to the commentaries of the most illustrious Baron Van Swieten, since I have considered that whatever can be desired by an observant man is sure to be found in his work. I have thus been able to spare you a long disquisition. I have found in his work a sure basis of knowledge on which my slight superstructure may be raised up to view.
‘I do not doubt, however, that I have accomplished a work which will earn the gratitude of all true devotees of the art of medicine, since I have succeeded in making clear certain things which shed not a little light on our knowledge of the obscure diseases of the chest, a subject hitherto very imperfectly understood.
‘I have omitted many things that seem doubtful because they are as yet not sufficiently elaborated. I shall endeavor, however, faithfully to devote myself to the further development of these points. Finally, it has not been my effort to write in any elegant diction. I have chosen a style in which I may be thoroly understood.’
It will be noticed that in this foreword Avenbrugger refers to his teacher, and thruout the monograph the name of Van Swieten is mentioned with the greatest respect. Van Swieten certainly had merits as a medical man: when he was called over from Holland, the Austrian throne had no heir; but Van Swieten drew the husband aside, gave him some private [p.221] instruction, with the result that Maria Theresa became pregnant sixteen times. Van Swieten spent most of his life writing eight huge volumes of commentaries on the aphorisms of his master Boerhaave, and tho some say that the commentaries are more valuable than the aphorisms, neither one nor the other is now read. Van Swieten wrote much on the diseases of the chest, but he did not mention percussion. The eminent doctor saw no use in tapping the thorax. He did not know that his pupil's finger had ushered in the era of modern diagnosis.
Gerhard Van Swieten's successor, the unpleasant Anton De Haen, left eighteen volumes behind him — including a treatise in defense of witchcraft. The historical student who digs among these paper ruins will find the author complaining that it is almost impossible to recognize thoracic diseases until it is too late to help the patient. The obstinate man did not see that in response to the physician's rapping, the door of thoracic knowledge opened.
But Avenbrugger had anticipated neglect, and he was too well-poised to permit himself to be embittered or become exasperated. He devoted himself to practice, made money, went to the opera in winter, cultivated a garden in summer, kissed his wife every day, and lived to celebrate his golden wedding.
While Avenbrugger was growing old in Vienna, a child was growing up in Brittany. He was sickly-born, the offspring of a tuberculous mother. One day, when the child was six years old, the neighbors came in and looked at him sympathetically, and the woman patted him kindly on the shoulders, for his mother was dead. His father was a lawyer, but the versatile advocate wrote poetry like Desforges-Maillard and was too busy in other respects to be bothered by a frail orphan. He brought the boy to his grand-uncle, an Abbé at Elliant.
The uncle saw that the child was obedient, and decided there would be another priest in the family. From him René Laennec received considerable misinformation which he never [p.222] forgot. The child was well-treated, and it seemed as if his existence would be eventless—he would quietly pass from his uncle's district to a parish of his own. For what can happen in Brittany? It is the land of the past, the province of the dead. In La Bretagne only the cock and the artist welcome the rising sun. To study a Breton peasant is like turning over a well-preserved half-animated fossil. His skull is thick enough to resist the advances of French civilization. He will not even speak French, but still whines out his barbarous patois, for he is convinced it is the language Adam and Eve spoke in paradise.
The Breton folk are as unchangeable as the Druidical dolmens and menhirs which litter their country. They are victims of the idée fixe; in politics and religion a new thought will never filter thru Brittany. In a thousand years, or in five thousand years, when the present theology disappears with its predecessors, the last Christian will be a Breton peasant.
The Bretons have never had any interest in the rest of the world, but outsiders have printed and painted the name of Brittany with praise. This is because Brittany is visited chiefly by clergymen who need a rest, and by artists in search of color. The former eulogize Brittany on account of the docility and piety of the inhabitants, and the artists are enchanted because the men wear long hair, broad-brimmed hats, blue blouses, large belts and baggy breeches of sail cloth, and because the women dress in white caps with wide lappets, and, instead of corsets, are arrayed in pretty spencers laced up in front of the waist which open above to allow for the swell of the bosom. When the Bretons begin to purchase their costume from Paris, we will hear no more of quaint and picturesque Brittany.
When René Laennec was nine years old, strange deeds were done: churchmen, including his uncle, were banished. Excited Frenchmen ran along the roadways, crying Liberté, Egalité, Fraternité, and pulling down the crucifixes: they had much work to do, for in Brittany wherever two roads meet, [p.223] there a crucifix is erected. What was happening? Was the world coming to an end? Ah, the world was being saved. It was the great and glorious French Revolution.
From the Reign of Terror issued an ocean of blood, but that scarlet stream watered the tree of liberty; in eternal letters it wrote the Rights of Man; it cast the oligarchs and the theocrats down; it exalted the disinherited of ages; it overthrew a royal carnival of crime hideous beyond belief; everywhere it uttered the glad tidings, Nous avons changé tout cela.
As might be expected the antiquated Bretons fought on the side of the old monarchy against the new republic. It did not matter to them that there was a law in France which gave the nobles permission to shoot at workmen on roofs, merely for the sport of seeing them tumble off. Probably the fact that an aristocrat was not expected to kill more than two toilers during a day's merriment—otherwise, labor would grow scarce,—made the honest Breton heart pulsate with devotion towards his merciful superiors. As an experiment it might be interesting to attempt to educate the cattle of Brittany—excluding the dullest beast of the field, la vraie Bretagne bretonnante.
After the Abbé's proscription, the boy was sent home to his father. ‘Mon Dieu,’ exclaimed that gentleman, and suddenly remembered that René had another uncle, a most honorable and distinguished man, Dr Laennec of the University of Nantes.
For ten years René remained under his guardianship, and here it was settled that he would follow in the footsteps of his medical relative. Then came the desire which in every period stirs all ambitious hearts that beat in provinces: to study in the capital. In the year 1800, at the age of nineteen, Laennec came to Paris.
Within the mesh of Parisian gaiety many a youthful student from the provinces has been lost, but René Laennec had come for the college curriculum, and the world of merriment had no meaning for him.
[p.224] Two years after his arrival in the French metropolis, Laennec attracted attention by a series of excellent articles which he contributed to the Journal of Medicine, a periodical which he eventually owned, but which at that time was edited by Corvisart, Leroux and Boyer.
Laennec was a favorite pupil of Corvisart, who had a mighty name in those days, for he was physician to the demigod who emerged from the wreck of the French Revolution. Napoleon had a cold in his chest, and was suspicious of the attendants who felt his pulse and looked at his tongue. He was told there was a doctor who diagnosed troubles in the chest by examining that part of the body. ‘Send him to me,’ said Napoleon. Corvisart came, and tapped the imperial thorax with his finger-tips. Thereupon Napoleon decided that Corvisart should have the honor of looking after his majesty's health. They grew so intimate that after the birth of the King of Rome Corvisart was audacious enough to lecture the world's chief phenomenon: ‘Sire, this prince must crown all your wishes! Recall your career: in less than ten years a simple officer of artillery, then captain, general of brigade, general-in-chief, first consul, emperor, spouse of an archduchess of Austria, father of a prince. Having reached so dizzy a height of fortune, rarely attained by any mortal, I beg of your majesty to stop! Fortune may turn; you may yet fall.
You speak like a peasant,’ answered Napoleon.
But we must not forget to ask: Where did Corvisart learn percussion? De Haen's successor was Maxmilian Stoll, who had the misfortune to marry the meanest woman on earth, but who was the most enlightened member of the Old Vienna School. Stoll praised Avenbrugger's work, and a pupil of Stoll, named Eyerel, wrote a treatise on percussion which came to Corvisart's notice. Later Corvisart came across Avenbrugger's Inventum Novum, and decided to translate it. ‘I know very well,’ wrote the generous Frenchman, ‘how little reputation is allotted to translators and commentators, and
[p.225] I might easily have elevated myself to the rank of an author, if I had elaborated anew the doctrine of Avenbrugger and published an independent work on percussion. In this way, however, I should have sacrificed the name of Avenbrugger to my own vanity, a thing which I am unwilling to do. It is he, and the beautiful invention which of right belongs to him, that I desire to recall to life.’
Before Corvisart, percussion was the possession of a handful; after Corvisart, percussion became common property. The torch which Avenbrugger kindled, Corvisart re-lit for all futurity. So we see that tho the torch of truth often flickers low, yet its immortal light is never wholly quenched. Floods of misunderstanding may roll over it, the weight of authority may threaten it, but thruout the long night it glimmers faithfully, waiting for the truth-seeker who will raise it aloft and bring morning to the intellectual world.
Besides Corvisart, Laennec's name is associated with that of Broussais, but in a very different manner. With Corvisart he came into loving contact; with Broussais he was in angry conflict. Laennec had no use for Broussais, and Broussais saw no good in Laennec. Broussais was a master of sarcasm, and Laennec was not backward in bandying scorn. No doubt Broussais was more talented in this respect, but then he had numerous and various hatreds, while Laennec could concentrate. When he spoke of Broussaisism his voice became acid, and his eyes shot sparks of indignation thru his tortoise-rimmed spectacles. What must have added special piquancy to the warfare between Broussais and Laennec was the circumstance that both were Bretons, and of all people in the world none are so chauvinistic as the folks that hail from Brittany.
Broussais was the medical theorist of the hour, and elaborated a complex system of ‘physiological medicine,’ but Corvisart and Laennec accepted only the Hippocratic watchword, Observation. Neither of the contestants was fair to the other, but it must be said that most of Broussais's theories are [p.226] now as obsolete as his hirudinomania, which was carried to such an extent that within a calendar year it became necessary to import forty-two million leeches into France. At one time there was hardly a French belly which had not given nourishment to these blood-suckers.
His theory of irritation as the cause of disease had great vogue in its time, and Oliver Wendell Holmes who heard Broussais in his latter days, told his Harvard students, ‘The way in which that knotty-featured, savage old man would bring out the word irritation—with rattling and rolling reduplication of the resonant letter r—might have taught a lesson in articulation to Salvini.’
In 1812, eight years after his graduation, Laennec was appointed physician to the Beaujon Hospital. Gifted and conscientious, willing to work to the point of exhaustion, Laennec became one of the most renowned pathologic anatomists of the nineteenth century. He was particularly interested in the diseases of the chest, and of course employed percussion as he learnt it from Corvisart, but no one yet knew that Laennec was to be Avenbrugger's spiritual heir.
The malady which Laennec studied above all others was tuberculosis, the insidious foe which killed the woman who gave him life. Day and night his thin hands grappled with the ancient enemy of the human race. Immemorial indeed, for who shall say in what distant epoch this subtle thief first gained access to the lungs of man? Who knows in what dark and nebulous time a primeval mother first listened in an agony of helplessness to the hacking cough of her infant? We are aghast at the mortality-tables of a sanguinary war, but on the white bed of consumption fall more victims than on the red field of battle.
At Necker Hospital, Paris, France, in 1816, Dr. Theophile Laennec devised hollow wooden cylinders for listening to sounds in patients’ chests. These early stethoscopes helped physicians to better understand diseases of the lungs.
(One of a series: A History of Medicine In Pictures, commissioned by Parke, Davis & Company. Artist Robert A. Thom, c.1960) (source)
In 1816 Laennec was transferred to the Necker Hospital. During this year a woman who was suffering from heart trouble consulted him. Laennec questioned her, but was puzzled how to proceed with the examination. There was no use in thumping her thorax, for the patient was too stout; [p.227]neither could he put his ear directly upon her breast, for she was still young. We may argue that physicians have privileges, but Laennec himself claims that immediate auscultation was inadmissible. In his dilemma he happened to recollect a fact in physics. Acting on the idea, he rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the patient's heart and the other to his own ear. This was the first stethoscope. Then René Laennec heard the language of pathology. A diseased heart appealed to him for aid. Injuries that for centuries had been inaudible, now found a voice. A sick organ murmured its tale of woe into the ear of a great and sympathetic physician. Auscultation, the crowning glory of physical diagnosis, came into existence.
In the guesses of philosophers like Democritus, who had nothing except the deductive method, we find foreshadowed nearly every principle of modern science, but the ancients knew practically nothing of auscultation. Even Hippocrates refers to the subject but once, and his observation is erroneous. He says in De Morbis, ‘You shall know by this that the chest contains water and not pus, if in applying the ear during a certain time on the side, you perceive a noise like that of boiling vinegar.’ Aretaeus too seems to have known and practiced a sort of auscultation, but otherwise medical antiquity had no ear.
In the seventeenth century the Englishman Robert Hooke stumbled upon the truth, but altho this versatile genius sowed seeds in twenty different fields, he never remained to harvest the crop. There is still enough unworked soil in Hooke to support discoveries for the next three centuries. ‘I have been able,’ wrote Hooke, ‘to hear very plainly the beating of a man's heart; and it is common to hear the motion of the wind to and fro in the guts and other small vessels; the stopping in the lungs is easily discovered by the wheezing, the stopping of the head by the humming and whistling noises, the slipping to and fro of the joints, in many cases by crackling and the like. [p.228] As to the working or motion of the parts one amongst another, methinks I could receive encouragement from hearing the hissing noise made by a corrosive menstruum in its operation, the noise of fire in dissolving.’
After his invention Laennec toiled like a fanatic. An undersized body did the work of twenty men. He improved his stethoscope, and with his instrument discovered many secrets in the wondrous box that holds the heart and lungs. He began also to write out his observations. As the industrious days went on there gathered on his desk a pile of manuscript which looked as if it weighed more than the author. At last he was ready to write the preface, which is somewhat reminiscent of Avenbrugger's foreword. ‘I may say,’ wrote Laennec, that no one who has made himself expert with this method will have occasion to say with Baglivi, Oh, how difficult it is to diagnose disease of the lungs! But our generation is not inquisitive as to what is being accomplished by its sons. Claims of new discoveries made by contemporaries are likely for the most part to be met by smiles and mocking remarks. It is always easier to condemn than to test by actual experience. It suffices for me if I can only feel sure that this method will commend itself to a few worthy and learned men who will make it of use to many patients. I shall consider it ample, yea, more than sufficient reward for my labor, if it should prove the means by which a single human being is snatched from untimely death.’
It was now ready for type. The manuscripts became proof-sheets, the proof-sheets became printed pages, and the printed pages became a book. Laennec's Treatise on Mediate Auscultation and the Use of the Stethoscope is universally recognized as an imperishable medical classic. But the author took no joy in his finished work. His life, his strength, his spirit, had gone into the making of his book. The book was vital with robust and fresh-blown power; the writer was weary, broken up and undone. Laennec lost interest in everything. Food was set before him, but he could not eat. A bed was [p.229] prepared for him, but he could not sleep. He breathed with difficulty, he suffered from muscular debility, the slightest exertion being followed by the greatest prostration, and often he fainted. A deep melancholy sat upon him: he was a picture of an overworked neurasthenic.
Laennec had just enough sanity in balance to know that he must escape from Paris and return to Brittany. So he left the crowded hospital-wards, and after a terrible journey, stood once more in his native town of Quimper. The sea-breeze came from the shores of the Bay of Douarnenez, and the hills and the forests were green. Laennec smelled the air fragrant with fresh butter. He saw the long-haired peasants stand knee-deep in fields of buckwheat; he heard the girls singing as they drove the cows home from pasture, and he felt that here he might recover. Nature was his physician, and she prescribed him daily doses of the earth and the sea and the sky. Abstaining from mental effort, he spent his time in the open air, riding horseback, angling in the stream, hunting the woods for foxes and partridges. The breath of a new life entered that wasted frame; color crept into those pallorless cheeks. ‘Anne, cook this pair of snipes,’ he said, as he put down his bag and rifle, ‘I'm as hungry as a bear.’ The household was in delight—René was getting well.
For two years Laennec lingered at Quimper. Quimper is the quintessence of Brittany—everything characteristic of the province has retreated and crystallized there. Quimper has not wound her clock for centuries, and the sands in her hourglass do not run. It is the same time now that it was when the Druid priests chanted their heathen hymns under the oaks, and if they returned they would see the monuments they erected still standing—but surmounted by a cross. In Quimper, on the cradle and the grave alike, falls the dust of a distant past.
Laennec loved Quimper — who ever heard of a Breton that did not relish the very dung-heaps of Brittany? Breton sailors have been known to pine so passionately for their [p.230] native land, that they died heart-broken upon the voyage. Laennec was sympathetic towards the peasantry, and was ever ready to use his medical skill in their behalf — and forget the fee. As a member of the Ultramontane Church, Laennec was a determined enemy of free institutions, autocracy was his ideal, democracy was a red spectre to him, but tho Laennec would not trust the common people to govern themselves, he was fond of them, for a man's theories do not fundamentally affect his character.
But with the return of health came the conviction that a physician's place is at the clinics and not on the mossy banks where at twilight the poet reclines. He thought of the endless invalids at Paris who were victims of improper diagnosis—he should be there with his stethoscope. It was time to exchange the gossamer ferns of the fields for the delicate gauze of the wards.
Laennec was again at Paris. During his absence his pupils had carried on his work, his book had gained him a reputation, and honors awaited him. Not only was he made Professor of Medicine in the College of France, not only did he receive the chair of Clinical Medicine at the Hospital La Charité, but he had the felicity to be appointed physician to the Duchess of Berri. We need not be surprised at his gratification, for the royalty-superstition, barbarous tho it be, seems inbred in the bones of man. Even so liberal a thinker as Huxley felt flattered when he was granted an interview with a fat and commonplace widow, who thru no merit of her own happened to be a queen. Goethe was a life-long sycophant at the court of Saxe-Weimar, and when the duke rode off to join the armies of the Allies who endeavored to replace Louis XVI on his bloody throne, the author of Faust—let the Muses blush—followed the duke.
But Laennec was more interested in the hospital than in the noblesse; essentially he was a physician, not a courtier. Again he forgot the limitations of flesh; his earnest spirit would not let him rest. Bayle had demonstrated that when [p.231] tubercles are present in the lungs, the patient has tuberculosis—but the doctor could not recognize the condition until the hectic fever set in and the pus was spat up. By auscultation, however, tuberculosis could be diagnosed in an early stage, and thus the labors of Laennec began to reduce the death-rate of the most prevalent of diseases. The impetus which Laennec gave to the study of thoracic troubles, was felt thruout the medical world. In this instance the triumvirate of the Irish School of Medicine especially distinguished themselves: Graves, by his fresh-air propaganda for tuberculosis; Stokes, by the book on the stethoscope that he wrote in his twenty-first year; and Corrigan, by his work on Permanent Patency of the Aortic Valves. To the Hospital La Charité came students from all nations to hear the lectures of the diminutive, narrow-chested man, who first raised a hopeful voice against the Great White Plague.
After the elapse of a few years it was necessary to prepare a second edition of his Treatise. ‘Second edition’ to the majority of authors means the correction of a few errors, the addition of a few notes, the insertion of the legend on the title-page, Revised and Greatly Enlarged, and an expression of gratitude in the preface that the second edition was needed. But to so conscientious an individual as Laennec, a second edition meant the re-writing of the entire book. To write a book with the sweat of your brain and your heart's blood is a serious thing; nature usually throws nervous prostration into the bargain. For a quarter of a century Lagrange worked on his Mécanique Analytique, but when the volume was finally printed, the author let it lay for over two years on his desk unopened. He was too tired. The efforts that Laennec expended upon the second issue of his magnum opus, together with the Herculean labors which this pigmy performed in the clinics, again wrecked his health on the altar of overwork. In this state his only remedy was Quimper. Once more he returned to his native town, and life and death struggled in his sunken chest.
[p.232] A party of travelers presented themselves at a house in Quimper, and knocked for admission.
‘What do you want?’ asked the man who came to the door.
‘We are weary of wandering; let us rest at your hearth.’
‘Pass on; the roads are full of vagabonds; who knows who you may be?’
‘Be hospitable, brother; the sky threatens; a storm is coming.’
‘If you hasten you will reach the next inn before the clouds burst.’
‘Listen,’ says the spokesman of the pretended travelers, ‘I deceived you when I asked for shelter. I come for another purpose. My young master desires the girl of this house. There was never a youth like him. He can plow as much in one day as three hired laborers; alone he can replace an overturned cart; he has wrestled with all the able-bodied men of the village, and has laid many champions on their backs; in his hand a stick is more powerful than a sword in the hand of a soldier.’
‘And this maiden,’ replies the other, ‘think you there are many as good as she? She is light and supple as the blossom-covered branches of the broom. She is a timid virgin, and when the dance begins, she holds in one hand the hand of her mother, and in the other that of a female friend. But she is not here; she has long left her father's house.’
‘You deceive me; the yew-tree is made for the church-yard, the rose for the garden, and young girls to grace the home of a husband. Do not throw us into despair! Lead hither by the hand her whom we desire, and we will place her at the wedding-feast near her bridegroom.’
‘It seems we must yield to you, friend. I will fetch her,' and going into the room he comes back with an old woman, and asks, ' Is this then the rose you are seeking?’
‘From the venerable appearance of this woman,’ replies the other, ‘I judge that she has well-fulfilled her task in this world, and that she has conferred happiness on him who has [p.233] loved her. But she has ended that which the other must now begin. She is not the woman I seek.’
The host returns again to the house, and leads forth a young married woman. ‘Here,’ he says, ‘is a young girl, beautiful as a star. Her cheeks are like roses; and her eyes are of crystal. One glance from them can render a heart sick for ever! This must be the fair one whom you want.’
‘Certainly this soft cheek and youthful freshness look like those of a maiden. But that finger, bearing the marks of rubbing—has it not often been rubbed with pap for an infant to suck?’
‘Nothing escapes your notice! Tell me, is this she whom you want?’ and he brings out a child.
‘That is exactly what she, whom I seek, was some years ago. Some day this pretty child will make a husband happy. But she must remain yet a long while on the espalier. The one whom I want waits for the gardener's basket to carry her to the table of the nuptial feast.’
‘Friend, it is enough,’ says the bride's spokesman, ‘You deserve her whom you seek.’
Together the two families enter the house. The bride and bridegroom clasp hands, all kneel in prayer, then repair to church, and return for the feast. At the head of the principal table, opposite each other, sit the happy couple, and between them is placed a gigantic dish of butter. Hundreds of peasants are present; they eat and drink and dance; they swallow a flock of ducks and chew-a herd of cows—they eat and drink and puke. They gulp down barrels of liquor till we marvel at the capacity of the human alimentary canal. They eat and drink and roll under the tables, every atom drunk.
At midnight, in the presence of the company, the bride is undressed and put into the oaken bed; the bridegroom jumps in beside her, walnuts and wine are passed to them, and the celebration continues. Gradually those guests who are not asleep begin to take their departure, and Quimper grows as quiet as usual—so quiet that in the silent night we can hear [p.234] a hacking cough. Laennec is perishing of tuberculosis. He passes away holding in his hand a cross. He dies modestly, forgetting that the stethoscope has done more for mankind than the crucifix.
Laennec's name remained the greatest in the history of tuberculosis until the epochal evening, two generations later, when Robert Koch read his paper, The Etiology of Tuberculosis, announcing that a short rod-shaped bacterium was the sole and only causative agent of the universal scourge. Suffering mankind now awaits him who will discover a remedy to destroy Dr Koch's bacillus. In high expectation Koch himself proclaimed that he had found a specific; but tuberculin is a stain—the only one—on the Hanoverian's bright escutcheon. The Jenner of tuberculosis has not yet arisen; when he comes, when he brings to the medical market the blessed drug that will materially help to transform consumptives into normal human beings, the historical student will join in the general rejoicing, but he will not forget how much the world owes to the previous labors of René Laennec.