1816

Laennec discovers mediate auscultation with a paper horn; begins stethoscopic research early in 1817, with “pectoriloquy” [literally, “the chest speaks”] his first breakthrough (exaggerated intensity of voice through chest wall associated with cavity in underlying lung and hence with pulmonary phthisis [Duffin, 134-138]); received medical and popular attention in mid-1817 in consultation for dying Mme de Staël; presented to Académie des Sciences in Feb, 1818 (Duffin, 124-127).1819: “egophony” [from Greek, aïgon, after the bleating voice of a goat] = distinctive nasal quality of voice heard through chest wall overlying fluid in thoracic space (assoc. with pleural effusion) (145-147). 1824: “Bronchophony” = “imperfect” pectoriloquy; louder than usual sound of patient’s voice through chest but only the airways (bronchi), not the whole chest, that “spoke” (assoc. with bronchiectasis and pneumonia) (163-66). “ . . . even a trained musical ear would struggle to discern stethoscopic crackles and fizzes that . . . sound more like twentieth-century musique concrète or artificially synthesized sounds than anything remotely considered ‘music’ during the nineteenth century. . . . Laennec’s Treatise is a fascinating exercise in awakening and expressing whole new realms of sonic awareness and timbre. Though he developed a new vocabulary to describe ‘unmusical’ sounds with greater precision, at many points the shaping force of previous musical and sonic experiences seemed to guide his choices” (Pesic, 23). Laennec drew on sounds from his Parisian milieu to characterize chest sounds: a râle had as most common meaning the death-rattle from the hospital ward; microacoustic death-rattles: as dying breaths rattled through fluid-filled lungs, those in earlier stages of pulmonary disease might emit micro-rattles from their fluid-compromised lungs (Pesic, 24). His hospital practice consisted of lower-class craftsmen and workers (esp. metal-workers), so he described a characteristic “metallic tinkling through the stethoscope by evoking an eerily diminutive craft-scene, hearing ‘a noise perfectly like a blow struck on metal, glass, or porcelain, which one strikes lightly with a nail or on which one drops a grain of sand’” (25). Austin Flint in 1850-52 made auscultation understandable to Americans by, inter alia, suggesting variations in pitch made it easier for students to distinguish various sounds  “Flint’s Law” on the correlation of pitch, resonance and consolidation of the lungs (= part of lung filling with liquid and swelling/hardening) (D. Smith, 139)