Great inventions don't always have to be complicated, rather it is often the application of a simple device or technique to a new area that pays dividends. In 1816 that device was René Laennec's ear and the area he was about to apply it to was the heaving bosom of a young lady.

Before you think this column has simply descended into filth perhaps I should explain. René-Théophile-Hyacinthe Laennec was perhaps the finest doctor of his day. Following his mother's death from tuberculosis when he was only five years old, he had expressed an interest in being a medical man and, aged just twelve, he was sent off to begin his studies with his uncle Guillaime-François Laennec who taught at the medical faculty of Nantes University. By 1799 Laennec was studying in Paris under the greatest doctors of the day, including Baron Guillaume Dupuytren, famed for treating Napoleon Bonaparte's haemorrhoids, and Jean-Nicolas Corvisart des Marest.

In Paris Laennec was introduced to the classical forms of clinical examination - inspection, auscultation and palpitation. For those of us without a medical training that's - look at the patient, listen to the patient and then give them a poke. To this suite, Corvisart, in his study of heart disease, had added percussion - a technique involving tapping the patient's body to determine what lies beneath. This method had originally been developed as a quick and easy way of telling if a beer barrel was full or empty but had brilliantly been applied to diagnosing chest diseases by Josef Leopold Auenbrugger in 1761. Like lots of brilliant ideas (and I don't need to tell engineers this) Auenbrugger's had been largely ignored at the time but Corvisart in Paris and Joseph Škoda (uncle of the early Czech motor magnate) in Vienna were rapidly re-introducing the idea.

These four techniques were now on the brink of becoming the basis of modern diagnosis but for one problem. Looking at a patient was fine, as was poking them and giving them the odd tap, but the problem that dared not speak its name was listening to their chest - auscultation. The usual method of doing this was simply for the doctor to place his ear on the patient chests to listen to their heart. This was fine it is was a man, but what if it were a woman? And what if it were a young woman? And what if it were a young woman who was frankly on the large side and possessed of a somewhat imposing cleavage?

This was the very problem that faced René Laennec in 1816 as he stood in his consulting room, looking down on his latest patient, for looking was all that he could do. The woman had presented with heart disease, certainly exacerbated of not caused by her great size. He had thought about percussion and palpitation but ruefully noted that:

"the application of the hand were of little avail on account of the great degree of fatness.

All that remained was auscultation but that was out of the question as diving into the young lady's cleavage was considered a little forward, even when done by a medical man. There was also not guarantee that Laennec could navigate his way through the mounds of flesh to find the heartbeat.

Fortunately it was at this point that Laennec had his moment of genius. He remembered an old school game in which children put one end of a long, hollow stick to their ear while a child at other end scratched it very lightly with a pin. Despite the pin being so far away and the scratching so tiny, it sounded incredibly loud and nearby in the child's ear as the tube transmitted and amplified the sound. These were the sort of games children played in the days before Grand Theft Auto.

This gave Laennec his idea:

"Immediately, on this suggestion, I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised and pleased to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of my ear."

He had invented the stethoscope and medicine would never be the same again. Of course the device needed some improvement and by 1819 he had produced the first drawings of 'The Cylinder' as he called it - a wooden tube with an ear piece at one end. It wasn't exactly the modern binaural stethoscope whose invention would have to wait until 1851, but it was the start of a revolution.

Armed with a now complete diagnosis suite he went on to name the diseases cirrhosis and melanoma before returning to the disease that killed his mother, tuberculosis. Studying such a disease meant being frequently exposed to it and the always sickly Laennec took more risks that most. In 1826 his nephew, Mériadec Laennec, used his uncle's 'cylinder' to diagnose the disease in Laennec himself. He died on 13th August that same year, aged only 45. On his deathbed he bequeathed his stethoscope to his nephew, referring to it as "the greatest legacy of my life."

hi

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