René Laennec’s stethoscope gave doctors a new way to listen to patients – hearing their bodies, but perhaps not their voices. As Google produces a Doodle celebrating the inventor Vanessa Heggie looks at this crucial change in the relationship between doctors and their patients

It’s easy to romanticise the story of René Laennec: in 1816 the dashing doctor, faced with a young female patient with heart disease, is unable to lay his head on her breasts because of his sense of decency, and so rolls up a paper tube, creating the first version of what would become the stethoscope. Although some doctors resisted this new technology, it eventually became the iconic symbol of the doctor, used in millions of unimaginative stock photographs everywhere.

But Laennec’s invention was not just inspired by a young woman whose ‘fatness’ meant that the usual investigation – feeling the heartbeat with the hand – did not work. It came from something even more dramatic: the French Revolution. And since every drama deserves a twist ending, what was supposed to ensure liberty, equality and decent healthcare to free citizens, also changed the balance of power between patients and doctors.

Revolutionary Medicine

As I mentioned in a recent post, the French Revolution in the late eighteenth century included a total shake up of French systems of healthcare. The Royal schools of medicine, the church-run hospitals, were not acceptable to the new regime. A new system had to be introduced – although the most extreme liberals argued that no government had the right to dictate who could and could not be a doctor, and the most extreme utopians claimed that perfect societies had no disease, so there was no need for a healthcare system anyway.

The more pragmatic members of the Revolution argued that the new healthcare scheme had to be egalitarian and democratic: consequently it was based on the training not of the elite physicians (doctors), but on the manual labour of surgeons. It was going to focus on personal experience, not on trusting the word of ‘authorities’. So, for example, ward walking became crucial – you wouldn’t take your teacher’s word, you’d shadow them at work, see what treatments they gave to patients, what diagnoses they made, and the next day you’d come back and see if the patient had improved. If the patient died, you’d be there at the autopsy to hear the reason why the intervention failed.

The only way to get this intense experience of diseases and their treatments was in a hospital – where hundreds, sometimes thousands of patients could be gathered, and could be treated for free on condition that they agreed to be teaching objects, and be autopsied after their deaths. Laennec trained and worked in several hospitals of this kind, including the Saltpêtrière Hospital, and the Necker Hospital.

Facebook Twitter Pinterest A more traditional encounter between doctor and patient; he listens to her and gently takes her pulse. The lower status surgeon sits at her feet ready to make a physical intervention. Matthijs Naiveu ca. 1700 Photograph: Wellcome Library, London/Wellcome Library, London. Wellcome Images

Listen to the disease, not the patient

This is the kind of medical training we expect today, so it can be hard to see what’s revolutionary about it; but it was a huge break from the education and practice of eighteenth century doctors. Traditionally, doctors had a book-based university education, and provided a very different kind of medical treatment, which considered the patient as a whole and prescribed complex ‘regimens’ of treatment – exercise, diet, drugs, bleeds and so on – individually tailored to each unique patient. In this encounter, a pulse might be taken, or the urine examined, but the most important diagnostic tool was the ear: listening to the patient tell you about themselves and their symptoms. This was so important that in the eighteenth century it was commonplace to diagnose people by letter, rather than in person.

Gentlemen did not generally touch their patients; if one needed to be bled or cut, a surgeon could do the job instead. But Laennec was trained in the revolutionary French style, where surgical approaches were as important as any other form of medicine. Instead of a holistic whole, patients were bits and pieces, organs and tissues, parts and lumps that could be cut out, examined, listened to. They could be broken down into parts, and diseases localized to those parts, rather than being a ‘general imbalance’ of the whole.



The point of the stethoscope was to let doctors hear with their own ears the noises of the body, and from that deduce what was happening inside. The only way to prove that they were right was through an autopsy. Laennec, famously, autopsied every patient he could in order to prove that the diagnosis he’d made in life was backed up by the nodules, lumps, liquid in the lungs, and so on, he found in death.

The shift away from trusting the authority of books also shifted trust away from patients - at least, away from their voice, and instead to the visible, audible symptoms in their living (and dead) bodies. While the eighteenth century doctor would rely on the patient to describe their symptoms, the nineteenth century doctor would find out for themselves – looking, listening, tapping and rapping, even shaking the body to find out what was going on inside.



This new kind of medicine did not meet with universal approval; the French hospitals were criticized as places where disease was studied, so patients were treated as ‘subjects’ to be prodded, poked and dissected. On the other hand, would-be doctors from all over Europe, and the USA, flocked to Paris in the early nineteenth century to get this innovative, exciting training, which seemed to be discovering all sorts of new things about disease. Laennec’s stethoscope is a symbol of authority in more ways than one: a symbol of egalitarian, democratic, experience-based authority; a symbol of the shift of power between patient and physician.