Rene Theophile Hyacinthe Laënnec (178|-I826): The Man Behind the Stethoscope 雷内·西奥菲尔·风信子·莱恩内克 （178|-I826）：听诊器背后的人
Ariel Roguin, MD, PhD Ariel Roguin，医学博士，博士
Abstract 抽象
Rene Theophile Hyacinthe Laënnec (178I-I826) was a French physician who, in I8I6, 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. Rene Theophile Hyacinthe Laënnec （178I-I826） 是一位法国医生，他在 I8I6 发明了听诊器。使用这种新仪器，他研究了心脏和肺部发出的声音，并确定他的诊断得到了尸检期间观察结果的支持。Laënnec 后来出版了第一部关于使用听体声音的开创性著作 De L'auscultation Mediate（论介质听诊）。Laënnec 被认为是临床听诊之父，他撰写了对支气管扩张和肝硬化的第一篇描述，并从他发明的声音中对肺炎、支气管扩张、胸膜炎、肺气肿、气胸、肺结核和其他肺部疾病等肺部疾病进行了分类。Laënnec 完善了胸部体格检查的艺术，并引入了许多至今仍在使用的临床术语。
Ariel Roguin, MD, PhD Ariel Roguin，医学博士，博士
Department of Cardiology 心脏内科
Rambam Medical Center Rambam 医疗中心
B. Rappaport - Faculty of Medicine Technion - Israel Institute of Technology Haifa 31096 Israel B. Rappaport - 以色列理工学院 - 以色列理工学院 海法 31096 以色列
Tel: 972-50-206-320। 电话： 972-50-206-320।
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Email: aroguin@technion.ac.i 电子邮件： aroguin@technion.ac.i
Received: March 28, 2006 收稿日期： 2006-03-28
Revised: July I, 2006 修订日期：2006 年 7 月 1 日
Accepted: July 7, 2006 录用日期： 2006-07-07
The stethoscope may be the one instrument common to all doctors. The word stethoscope comes from the Greek words stethos, meaning chest, and skopein, meaning to explore. This instrument may even supersede the caduceus as the symbol of medicine - no other symbol so strongly identifies a doctor than a stethoscope dangling around the neck like a talisman. The story of how this remarkable invention came to be and the life of its inventor are described. 听诊器可能是所有医生共有的一种工具。听诊器这个词来自希腊语 stethos，意思是胸部，和 skopein，意思是探索。这种仪器甚至可能取代 caduceus 成为医学的象征——没有其他符号比像护身符一样挂在脖子上的听诊器更强烈地识别医生。描述了这项非凡发明如何诞生的故事及其发明者的生平。
In September 1816, during a cool morning, while walking in the courtyard of the Le Louvre Palace in Paris, Dr. Rene Theophile Hyacinthe Laënnec, a 35-year-old French physician, observed two children sending signals to each other using a long piece of solid wood and a pin. With an ear to one end, the child received an amplified sound of the pin scratching the opposite end of the wood. Later that year, Laënnec was called to a young woman with “general symptoms of a diseased heart.” ^(1,2){ }^{1,2} Both application of his hand to the chest and percussion offered little diagnostic assistance. Laënnec was reluctant to start immediate auscultation (placing the doctor’s ear on the patient’s chest) because of the age, sex and plumpness of the patient. In this moment of embarrassment, Laënnec recalled his observation of the children’s wood borne signaling. It was this observation that inspired Laënnec’s invention of the stethoscope. ^(3){ }^{3} He described the invention as follows (translated from French by John Forbes, 1834): 1816 年 9 月，在一个凉爽的早晨，35 岁的法国医生 Rene Theophile Hyacinthe Laënnec 医生在巴黎卢浮宫的庭院里散步时，观察到两个孩子使用一块长实木和一根针互相发送信号。这个孩子的耳朵朝向一端，收到了针子刮擦木头另一端的放大声音。那年晚些时候，Laënnec 被叫到一位患有“心脏疾病的一般症状”的年轻女子那里。他的手放在胸部和叩诊 ^(1,2){ }^{1,2} 都几乎没有什么帮助。Laënnec 不愿意立即开始听诊（将医生的耳朵放在病人的胸部），因为病人的年龄、性别和丰满程度。在这个尴尬的时刻，Laënnec 回忆起他对孩子们的木头信号的观察。正是这一观察激发了 Laënnec 发明听诊器的灵感。 ^(3){ }^{3} 他这样描述这项发明（由约翰·福布斯 （John Forbes） 翻译自法文，1834 年）：
I recalled a well known acoustic phenomenon: if you place your ear against one end of a wood beam the scratch of a pin at the other end is distinctly audible. It occurred to me that this physical property might serve a useful purpose in the case I was 我想起了一个众所周知的声学现象：如果你把耳朵靠在木梁的一端，另一端的销钉的划痕可以清楚地听到。我突然想到，这种物理特性在我所处的情况下可能有用
Figure 1. Laënnec’s stethoscope: 1) instrument assembled; 2) and 3) two portions of the instrument in longitudinal section; 4) detachable chest piece; 5) ear piece unscrewed; 6) transverse section. Photo courtesy of the US National Library of Medicine. 图 1.Laënnec 听诊器：1） 组装好的仪器;2） 和 3） 仪器的纵向部分;4） 可拆卸的胸件;5） 拧下耳件;6） 横截面。照片由美国国家医学图书馆提供。
dealing with. I then tightly rolled a sheet of paper, one end of which I placed over the precordium (chest) and my ear to the other. I was surprised and elated to be able to hear the beating of her heart with far greater clearness than I ever had with direct application of my ear. I immediately saw that this might become an indispensable method for studying, not only the beating of the heart, but all movements able of producing sound in the chest cavity. ^(1,4,5){ }^{1,4,5} 处理。 然后我紧紧地卷起一张纸，将纸的一端放在心前区（胸部）上，将耳朵放在另一端。我感到惊讶和欣喜，因为我能够听到她心脏的跳动，比我直接用耳朵听到的要清晰得多。我立即意识到，这可能成为一种不可或缺的方法，不仅是心脏的跳动，而且是所有能够在胸腔中产生声音的运动。 ^(1,4,5){ }^{1,4,5}
Laënnec discovered that heart sounds could be heard more clearly and loudly using mediate auscultation rather than immediate auscultation. Laënnec spent the next 3 years testing various types of materials to make tubes, perfecting his design and listening to the chest findings of patients with pneumonia. ^(5-7){ }^{5-7} After careful experimenting, Laënnec decided upon a hollow tube of wood, 3.5 cm in diameter and 25 cm long, which was the forerunner of the modern stethoscope. His instrument was fitted with a plug when used to listen to the heart and to make it portable, was made in parts that could be disassembled (figure 1). Laënnec 发现，使用介耳听诊而不是立即听诊可以更清晰、更响亮地听到心音。Laënnec 在接下来的 3 年里测试了各种类型的材料来制作管子，完善了他的设计并听取了肺炎患者的胸部检查结果。 ^(5-7){ }^{5-7} 经过仔细的实验，Laënnec 决定使用直径 3.5 厘米、长 25 厘米的空心木管，这是现代听诊器的前身。他的仪器在用于听诊心脏时装有插头并使其便于携带，由可以拆卸的部件制成（图 1）。
Laënnec investigated the sounds made by the heart and lungs with his invention and found that his diagnoses were supported by observations made in autopsies. In 1819, he published the first seminal work on the use of listening to body sounds entitled "De l’auscultation médiate ou Traité du Laënnec 利用他的发明研究了心脏和肺部发出的声音，发现他的诊断得到了尸检观察结果的支持。1819 年，他发表了第一部关于使用听体音的开创性著作，题为“De l'auscultation médiate ou Traité du
Diagnostic des Maladies des Poumon et du Coeur"8 (figure 2) at 38 years of age. Diagnostic des Maladies des Poumon et du Coeur“8（图 2），38 岁。
Laënnec’s wooden tube was the first true stethoscope. Wooden stethoscopes were used until the latter half of the 19^("th ")19^{\text {th }} century, when rubber tubing was developed. Since the introduction of the stethoscope in 1819, several modifications have been introduced, such as the binaural, the diaphragm, and the combined bell and diaphragm (with dual or triple heads). Further developments include teaching, electronic and differential ( 2 chest pieces) stethoscopes. The main advancements in the evolution of the stethoscope are detailed in table 1. Laënnec 的木管是第一个真正的听诊器。木制听诊器一直使用到本 19^("th ")19^{\text {th }} 世纪下半叶，当时橡胶管被开发出来。自 1819 年问世听诊器以来，已经引入了一些修改，例如双耳、隔膜以及组合的钟形和隔膜（双头或三头）。进一步的发展包括教学、电子和差分（2 个胸件）听诊器。表 1 详细介绍了听诊器发展的主要进展。
Life and Medical Career 生活和医疗生涯
Rene Theophile Hyacinthe Laënnec (figure 3) was born at Quimper in Brittany, France on February 17, 1781. He was 5 years old when his mother succumbed to tuberculosis. His father, a lawyer, was unable to care for him and thus, he went to live with his grand-uncle, the Abbé Laënnec. As a child, Laënnec’s health was not good; he suffered from lassitude and occasional periods of pyrexia and was also thought to be asthmatic. He found consolation in music and spent his spare time playing the flute and writing poetry. Throughout his professional career in Paris, Rene Theophile Hyacinthe Laënnec（图 3）于 1781 年 2 月 17 日出生于法国布列塔尼的坎佩尔。他 5 岁时，他的母亲死于肺结核。他的父亲是一名律师，无法照顾他，因此，他去和他的叔叔 Abbé Laënnec 住在一起。小时候，Laënnec 的健康状况不佳;他患有疲倦和偶尔的发热期，还被认为患有哮喘。他在音乐中找到了安慰，并将业余时间用于吹笛和写诗。在他在巴黎的整个职业生涯中，
Figure 2. Cover of De l’Auscultation Médiate ou Traité du Diagnostic des Maladies des Poumons et du Cœur (On Mediate Auscultation or Treatise on the Diagnosis of the Diseases of the Lungs and Heart) published in Paris in 1819. Photo courtesy of Historical Collections & Services, Claude Moore Health Sciences Library, University of Virginia. 图 2.1819 年在巴黎出版的 De l'Auscultation Médiate ou Traité du Diagnostic des Maladies des Poumons et du Cœur（《关于肺和心脏疾病诊断的中介听诊或论文》）的封面。照片由弗吉尼亚大学克劳德·摩尔健康科学图书馆的历史收藏和服务提供。
during exacerbations of his respiratory symptoms, he would steal to the countryside of Brittany for its rejuvenating fresh air. Laënnec was well educated in the classics and became well versed in Greek and Latin. ^(1){ }^{1} 当他的呼吸道症状恶化时，他会偷偷到布列塔尼的乡村去呼吸新鲜空气。Laënnec 受过良好的古典教育，精通希腊语和拉丁语。 ^(1){ }^{1}
At the age of 12 he proceeded to Nantes where his uncle, Dr. Guillaume François Laënnec (1748-1822), was Dean of the faculty of medicine at the university. Despite the turbulent times of the French Revolution, Laënnec was successful in his studies, learned English and German thoroughly and obtained a number of prizes. Laënnec was inspired by his uncle to pursue a career in medicine. In 1795, at age 14, Laënnec was already helping to care for the sick and the wounded at the Hôtel Dieu in Nantes. By the age of 18, he was serving in the Military Hospital in Nantes with the rank of third class surgeon and shortly thereafter he moved to the Hospice de la Fraternité becoming, at a young age, acquainted with clinical work, surgical dressing and treatment of patients. ^(1){ }^{1} 12 岁时，他前往南特，他的叔叔纪尧姆·弗朗索瓦·莱内克博士（1748-1822 年）是该大学医学院的院长。尽管法国大革命的动荡时期，Laënnec 在学业上取得了成功，彻底学习了英语和德语，并获得了许多奖项。Laënnec 受到叔叔的启发，开始从事医学事业。1795 年，14 岁的 Laënnec 已经在南特的 Hôtel Dieu 帮助照顾病人和伤员。到 18 岁时，他在南特的军事医院以三等外科医生的军衔服役，此后不久，他搬到了兄弟会临终关怀医院，在年轻时就熟悉了临床工作、外科敷料和病人的治疗。 ^(1){ }^{1}
Laënnec began his medical studies in Nantes under his uncle’s direction and was appointed surgeon at the Hôtel Dieu in Nantes in June 1799 at the age of 18. In 1800, Laënnec went to Paris and entered the École Pratique in Paris studying dissection in Guillaume Dupuytren’s (1777-1835) laboratory at which macroscopic pathology in surgery and the concept of disease and its comparison with anatomical conditions were introduced. Among the terms coined there are Dupuytren’s contracture, a thickening of the palmar fascia causing the ring and little fingers to bend into the palm so that they cannot be extended; Dupuytren’s abscess, an abscess of the right iliac fossa; and Dupuytren’s bandaging, a metal splint bandaging for fixation of fractured bone in various positions. Laënnec was fortunate to also study with such famous teachers as Laënnec 在叔叔的指导下在南特开始了他的医学研究，并于 1799 年 6 月被任命为南特 Hôtel Dieu 的外科医生，当时他 18 岁。1800 年，Laënnec 前往巴黎，进入巴黎实践学院，在纪尧姆·杜普伊特伦 （1777-1835） 的实验室学习解剖，在那里介绍了手术中的宏观病理学和疾病的概念及其与解剖条件的比较。创造的术语包括掌腱膜挛缩症，掌筋膜增厚导致无名指和小指弯曲到手掌中，因此无法伸展;掌腱膜脓肿，右髂窝脓肿;和 Dupuytren 的绷带，一种金属夹板绷带，用于将骨折的骨头固定在各种位置。Laënnec 有幸也师从了
Gaspard Laurent Bayle (1774-1816), Marie Francois Xavier Bichat (1771-1802), Jean-Jacques Leroux de Tillets (1749-1832) and Nicolas Corvisart des Marest (1755-1821), Napoleon’s life physician. 加斯帕·洛朗·贝勒 （1774-1816）、玛丽·弗朗索瓦·泽维尔·比沙特 （1771-1802）、让-雅克·勒鲁·德·蒂莱茨 （1749-1832） 和拿破仑的终身医生尼古拉斯·科维萨尔·德·马雷斯特 （1755-1821）。
Within a year of entering École Pratique, Laënnec obtained the first prizes in both medicine and surgery at the medical school. The following year, in June 1802, he published his first paper and while still a student, published a number of papers on such notable topics as peritonitis, amenorrhea and liver disease. ^(1)He{ }^{1} \mathrm{He} also served as editor of the Journal de Médecine. 在进入 École Pratique 的一年内，Laënnec 在医学院获得了医学和外科的一等奖。次年，即 1802 年 6 月，他发表了他的第一篇论文，并在学生时代发表了许多关于腹膜炎、闭经和肝病等著名主题的论文。 ^(1)He{ }^{1} \mathrm{He} 还担任过 Journal de Médecine 的编辑。
As his reputation increased, he began to give private instruction in morbid anatomy to supplement his income. Although suffering from asthma, he worked hard and announced his classification of anatomical lesions into encephaloid and cirrhous types. He also found that the tubercle lesion could be present in all organs of the body and was identical with that which had previously been thought to be limited to the lungs. He did not, however, realize that the condition was infectious. In 1804, Laënnec graduated in medicine with a thesis entitled, “Propositions sur la doctrine d’Hippocrate, relativement á la médecine practique.” In July 1804, he became an associate of the Société de l’École de Médecine. 随着他的名声越来越大，他开始提供病态解剖学的私人指导以补充他的收入。虽然患有哮喘，但他努力工作并宣布将解剖病变分为脑状和肝硬化类型。他还发现结节病变可以存在于身体的所有器官中，并且与以前被认为仅限于肺部的病变相同。然而，他并没有意识到这种情况具有传染性。1804 年，Laënnec 从医学专业毕业，论文题为“Propositions sur la doctrine d'Hippocrate， relativement á la médecine practique”。1804 年 7 月，他成为 Société de l'École de Médecine 的合伙人。
Family troubles, the death of his uncle from tuberculosis, and financial difficulties coupled with his break with Dupuytren disturbed the continuity of Laënnec’s work and caused his health to fail. He recovered by going to Brittany and on his return to Paris, became an editor-shareholder of the Journal de Médecine. Although his private practice increased, Laënnec was disappointed in not being appointed as a senior physician at any of Paris’ major hospitals. On his own 家庭问题、叔叔死于肺结核、经济困难以及他与 Dupuytren 的决裂，打乱了 Laënnec 工作的连续性，导致他的健康状况恶化。他去了布列塔尼康复，回到巴黎后，成为 Journal de Médecine 的编辑兼股东。尽管他的私人诊所增加了，但 Laënnec 对没有被任命为巴黎任何一家主要医院的高级医生感到失望。靠自己
Table 1. The evolution of the stethoscope. 表 1.听诊器的演变。
Date 日期
Inventor 发明家
Improvement 起色
1816
Laënnec
Rolled paper cone, later a wooden tube 卷起的纸锥，后来是木管
1828
Priorry Priorry （优先）
漏斗形钟形、更轻的杆和更薄的听筒，密封性更好
Funnel shaped bell, a lightened stem, and thinner
earpiece for a better seal
Funnel shaped bell, a lightened stem, and thinner
earpiece for a better seal| Funnel shaped bell, a lightened stem, and thinner |
| :--- |
| earpiece for a better seal |
1843
Williams 威廉姆斯
The first binaural stethoscope, using lead pipes for earpieces 第一台双耳听诊器，使用铅管作为听筒
1851
Marsh 沼泽
Sammann 萨曼
1855
Bianchi 白
Binaural stethoscope with flexible tubing 带软管的双耳听诊器
Binaural stethoscope with flexible tubing| Binaural stethoscope with flexible tubing |
| :--- |
1894
Rappaport, Sprague and Groom stethoscope with a rigid diaphragm, known as a "phonendoscope" Rappaport、Sprague 和 Groom 听诊器带有刚性隔膜，称为“声内镜”
Date Inventor Improvement
1816 Laënnec Rolled paper cone, later a wooden tube
1828 Priorry "Funnel shaped bell, a lightened stem, and thinner
earpiece for a better seal"
1843 Williams The first binaural stethoscope, using lead pipes for earpieces
1851 Marsh Sammann
1855 Bianchi "Binaural stethoscope with flexible tubing"
1894 Rappaport, Sprague and Groom stethoscope with a rigid diaphragm, known as a "phonendoscope" | Date | Inventor | Improvement |
| :--- | :--- | :--- |
| 1816 | Laënnec | Rolled paper cone, later a wooden tube |
| 1828 | Priorry | Funnel shaped bell, a lightened stem, and thinner <br> earpiece for a better seal |
| 1843 | Williams | The first binaural stethoscope, using lead pipes for earpieces |
| 1851 | Marsh | Sammann |
| 1855 | Bianchi | Binaural stethoscope with flexible tubing |
| 1894 | Rappaport, Sprague and Groom stethoscope with a rigid diaphragm, known as a "phonendoscope" | |
