Antall József szerk.: Orvostörténeti közlemények 97-99. (Budapest, 1982)
TANULMÁNYOK - Birtalan Győző: Laennec és Skoda, a belgyógyászati diagnosztika klasszikusai (angol nyelven)
is led to the often neglected edemas of congestive origine, in general to the symptoms of latent cardiac insufficiency. He proves that in such cases antiflogistic procedures are out of place. He states that it is a great mistake to give identical treatment to all that is anatomically identical. Naturally he was fully aware of the scarce curing competence of his age. But he could never remain insensible to the sufferings of his patients and treated them as best he could. He shared Celsus' opinion: "Melius est anceps experiri auxilium, quam nullum". Laennec's merits as it is commonly known proved to be lasting in internal nosology and diagnostics. His following important statement sums up the starting point for his researches: "La nature est astreinte à des règles constantes, dans la destruction comme dans la construction des êtres". 5 This phrasing can be evaluated as a demand of clinical medicine for deterministically building natural sciences. Absorbed in this conviction, Laennec tried to retrive and describe the characteristic anatomic manifestations of destructive processes in the organism by the means of his in most part original semiology. A special stimulus was added to the realization of this generous enterprise by the use of the new method of investigation, stethoscopic auscultation. The euphoria of finding the new diagnostic tool kept alive and justified the enormous collecting and analyzing work. Although Skoda was right to say later that the indirect instrumental examination, compared to the long practised direct auscultation, was not a novelty in principle, merely a technical improvement. Yet, it was the persistent and complete retrieval of the possibilities inherent in the method introduced by Laennec that led to the great achievement contained in the "Traité de l'auscultation médiate" publishing in 1819. The most important factor in the success and long lasting impact of the work must have been undoubtedly the author's enormous clinical intelligence and factual knowledge. We have reason to suppose that if not Laennec but a physician of lesser ability had been the first to propagate the method of stethoscopy this fact would not have meant so much directly to internal medicine. Laennec, however, when introducing his method, the special values of which he tended to overestimate sometimes, also described a series of very important thoracic diseases and his clinico-pathologic analyses were of a level never achieved before. We can mention for among these new or newly interpreted clinical pictures those of emphysema, pneumothorax, pulmonary infarction, hydrothorax, different forms of pneumonia, pleurisy, changes due to pulmonary tuberculosis, pericarditis. It is also worth mentioning that Laennec when trating the possibilities of indirect auscultation, makes a digression to its use in veterinary medicine. He accounts of his experience when the stethoscope helped to communicate with deaf-mutes. He pointed out repeatedly that auscultation is no rival to percussion but they complement each other. He has a manifold approach to his subject. He starts partly from outlined, traditional nosological entries (e. g. "peri pneumonia", pleuritis, pericarditis, etc.), partly from important syndromes of different pathomechanism (e. g. hydrothorax, asthma, heart dilatation and hypertrophy) as well as from symptom analyses (e. g. different forms of rattlings "râles", pulse and heart sounds). He supports his material with detailed clinical and pathological data of the related cases. Autopsy reports, of course, not only exemplify the exposed subjects but registrate other findings as well. Thus among the organic deform 5 Laennec, R. Th. : Traité inédit sur Tanatomie pathologique ou exposition des altérations visibles qu'éprouver le corps humain dans Tétat de maladie par Laennec. V. Cornil, Paris, 1884, p. 52
