1819

Laennec publishes his Treatise on Mediate Auscultation: “The stethoscope made it possible to reveal physical changes before the patient died. Disease no longer had to be defined by subjective symptoms felt and described by the patient; it could now be defined and classified as a physical change detected objectively by the doctor, sometimes even without the patient’s knowledge. As a result, concepts of disease could be reformulated to incorporate anatomical observations. The stethoscope had finally ruptured the epistemological barrier that had prevented the seemingly useful pathological anatomy from finding applications in the clinical setting” (Duffin, 152). “Finally, it was possible for physicians to prove that a person was physically sick without feeling sick. With the stethoscope, the doctor could detect a lesion before the patient had suffered any symptoms. Even people who felt completely well could no longer be certain that they were. Reiser compared Laennec’s invention to Gutenberg’s as the instrument that turned the focus of medicine from sick people to disease. Physicians became the custodians of knowledge that had previously belonged only to their patients. Laennec is their hero” (Duffin, 302-03;also 298-99; Reiser, 25-29). “The elevation of the auscultatory sound to a level of concrete reality occurred only because of the close demonstrable correspondence between the sound and the visible lesion disclosed at autopsy. Successful auscultation required the physician to transform the sound he heard into a picture he could visualize. One metaphor that recurred regularly in the medical literature between 1820 and 1850 was ‘seeing’ disease by listening through the stethoscope. . . . Auscultatory sounds could be demonstrated in the laboratory ‘with all the precision attainable in some of the higher branches of physics.’ . . . The existence of physical principles, which explained the mechanisms of the sounds produced by the body’s organs, bore witness to the superiority claimed for auscultatory signs. Physicians venerated such evidence. It brought them close to a dream of that period: to be able to base medical practice on scientific law” (Reiser, 30, 31).