Josef Leopold Auenbrugger

Listening to the sounds of the body was a irevolutionary advance in the physicians' ability to make a diagnosis. The Austrian physician Auenbrugger invented the method of auscultating the patient's chest in 1754, while the Frenchman Laënnec invented the stethoscope in 1816. However, they were both preceded by the Italian physician Giovanni Maria Lances (1654-1720), who first described percussion of the chest bone.

The Austrian physician Josef Leopold Auenbrugger was the son of a wealthy innkeeper who died when Leopold was quite young. He received his medical education at the University of Vienna, where one of his teachers was Gerhard van Swieten (1700-1772), who, through a series of reforms had made the medical faculty one of the leading in Europe. He graduated on November 18, 1752.

Auenbrugger was so strongly influenced by his teacher that he dedicated one of his books to van Swieten. It was a book published in 1776 in which Auenbrugger suggests camphor as a treatment for a special form of mania.

From 1751 to 1758 Auenbrugger worked as assistant physician at the Spanish military Hospital, but did not receive a salary until 1755. Because of his work in the hospital, Empress Maria Theresia in 1757 ordered the Faculty of Medicine to admit him as a member without charging him any fees. From 1758 to 1762 he was chief physician at the Spanish Hospital, obtaining experience in diagnosis of chest diseases. After leaving the Spanish Hospital Auenbrugger became one of Vienna’s most distinguished physicians.

It was in 1754, while he was still working as a volunteer in the hospital, Auenbrugger conceived the method of percussion of the chest in order to be able to judge the condition of the underlying organs on the basis of the sound. In 1781 Auenbrugger wrote the libretto for the comic opera Der Rauchfangkehrer by Antonio Salieri (1750-1825), and was undoubtedly aided in developing his diagnostical technique by his musical knowledge, which enabled him to perceive differences in tone when the chest was tapped. For seven years he had observed the changes in tone caused by diseases of the lungs or the heart in patients at the Spanish Hospital, checking and controlling his findings by dissections of corpses and by experiments. He attempted to prove his theories of sound muffling using barrels, which he filled up to various levels, and tapping on bodies he had filled with liquids. As a boy he had tapped the wine barrels in his father’s cellar to find how full they were.

Auenbrugger published his discovery in Vienna in 1861 in a book entitled A New Discovery that Enables the Physician from the Percussion of the Human Thorax to Detect the Diseases Hidden Within the Chest.
In it he describes which sounds are characteristic in different diseases of the chest. If one taps the fingertips on a healthy chest wall, one will perceive a sound like that of a drum. Diseases of the chest cavity change the normal tone of the tapping to sinus altior (high or tympanic sound), a sonus obscurior (indistict sound), or a sonus carnis percussae (dull sound). This small book is today reckoned as one of the greatest of classics in medical literature.

Half a year later he published a book on lung diseases in the workers of the stone quarries.

Although his discovery was extremely important and today is still a basic diagnostic method, it received little attention in the medical world. Maximilian Stoll (1742-1788), then director of the medical clinic at the Spanish Hospital in Vienna, tried the new method and praised it in one of his books

Still, Auenbrugger’s epoch-making invention hardly reached beyond the city of Vienna in the 18th century. The book was reviewed in several journals, the first mention probably being that of Oliver Goldsmith in the London Public Ledger for August 27, 1861. In 1762 Albrecht von Haller (1708-1777) drew attention to ”this important work” in his lengthy review in the Göttingische Anzeigen von Gelehrten Sachen. Neither this nor a translation into French in 1770 by Rozière de la Chassagne drew much attention. The first Vienna physician to take Auenbrugger's invention seriously was the anatomist Johann Ludwig Gasser (1723-1765), who tested Auenbrugger's percussion on corpses and confirmed its value. Unfortunately, Gasser died before he was able to publish his results. This was done by Michael Julius Ganter in 1764.

More influential than these positive references, however, was the opinion of Rudolph Augustin Vogel (1724-1774), who could not find anything new in the Inventum novum. He claimed to recognize in it only the successio Hippocratis.

Van Swieten and Anton de Haen (1704-1776), the chief of the Vienna Clinic, never mentioned Auenbrugger’s percussion, not even when discussing diseases of the chest, but Maximilian Stoll, de Haen’s successor, described it in his publications and systematically taught it at the bedside. The spread of Auenbrugger’s technique was interrupted by Stoll’s premature death; his successors Jakob von Reinlein (1744-1816) and Johann Peter Frank (1745-1821) did nothing to carry on his work.

Nevertheless, percussion was used as a diagnostic tool before 1800. Heinrich Callisen (1740-1824), a surgeon in Copenhagen, reported several observations obtained by percussion in his System der Wundarzneikunst (1788); and the Paris surgeon Raphael Bienvenu Sabatier (1732-1811) used it to advantage for the diagnosis of epyema. Percussion was practiced and taught at several German universities, including Halle, Wittenberg, Würzburg, and Rostock.

The man who was to make Auenbrugger’s technique world known was Jean-Nicolas Corvisart des Marest, Napoleon’s favourite physician. Reading one of Stoll’s books he had found a reference to Auenbrugger’s discovery, investigated the method for several years and soon taught it to his students. Corvisart translated Auenbrugger’s treatise from Latin, and published it with annotations in 1808, the year before Auenbrugger’s death.

That made the difference. Corvisart’s fame and his excellent translation made the news of the great discovery spread rapidly in the medical world. Although Auenbrugger alone deserves the credit for inventing auscultation as an investigative method, what made it popular was the invention of the stethoscope by René Théophile Hyacinthe Laënnec (1781-1826) in 1816. The stethoscope is strictly not necessary, as one can hear equally well by resting the head to the patient's chest. At the time, however, women were not too happy to have their doctor that close to their breast. The times they are a 'changing.

A suprising work from Auenbrugger is a book on "The quiet madness, or the suicidal drive as a real disease", published in 1783.

On November 12, 1783, Auenbrugger was knighted for his contributions to medicine by the emperor Joseph II. From then his full name was Joseph Leopold Auenbrugger, Edler von Auenbrugg.

• Inventum novum ex percussione thoracis humani ut signo abstrusos interni pectoris morbos detegendi.
  (A New Discovery that Enables the Physician from the Percussion of the Human Thorax to Detect the Diseases Hidden Within the Chest).
  Vindobonae, J. T. Trattner, 1761, 1763, 1775.
  First German translation in Vienna, 1843. First French translation by Rozière de la Chassagne:
  
• Manuel des pulmoniques, ou traité complet des maladies de la poitrine. On y a joint une nouvelle méthode de rennoitre ces mêmes maladies par la percussion du thorax, traduite du Latin.
  2 parts in one volume. Paris, Humaire, 1770. 319 pages. French annotated translation by Jean-Nicolas Corvisart:
  
• La nouvelle méthode pour reconnaître les maladies internes de poitrine par la percussion de cette cavité. Paris, 1808. English translation by John Forbes:
  
• On percussion of the chest; being a translation of Auenbrugger’s original treatise entitled Inventum novum ex percussione thoracis humani et signo abstrusos interni pectoris morbos detegendi. In: "Original Cases With Dissections and Observations . . . Selected from Auenbrugger, Corvisart, Laennec and Others." London, 1824.
  
  Inventum novum was reprinted in:
  F. A. Willius and T. E. Keys, Cardiac Classics, St. Louis, Missouri, 1941, pp. 193-213.
  C. N. B. Camac, Classics of Medicine and Surgery, New York 1959, pp. 120-147.
  It also appears, with an introduction by Henry E. Sigerist, in Bulletin of the History of Medicine, Baltimore, 1936, 4: 373-403.
  Fascimile reprint by Max Neuburger (Vienna-Leipzig, 1922) includes the original edition, and translations into English, French and German. Other works by Auenbrugger:
  
• Experimentum nascens de remedio specifico sub signo specifico in mania virorum. 1776.
  Suggesting camphor as a treatment for a special form of mania.
• Von der stillen Wuth oder dem Triebe zum Selbstmorde als einer wirklichen Krankheit, mit Original-Beobachtungen und Anmerkungen. Dessau, 1783.
• Heilart der epidemischen Ruhr. 1783. Other important works on auscultation/percussion:
• J. N. Corvisart des Marest:
  Essai sur les maladies et les lésions organiques du coeur et des gros vaisseaux.
  Paris, Migneret, 1806. English translation, 1812; reproduced 1962.
• R. T. H. Laënnec:
  De l'auscultation médiate, ou traité du diagnostic des maladies des poumons et du coeur, fondé principalement sur ce nouveau moyen d’exploration.
  2 volumes. Paris 1819; 1826; 1831 by Mériadec Laënnec; 3 volumes 1836.
  German translation, 1822; 1823.
  Also by Friedrich Ludwig Meissner (1796-1860) under the title of Abhandlung von den Krankheiten der Lungen und des Herzens und der mittelbaren Auscultation als eines Mittels zu ihrer Erkennung, Leipzig, 1832. On Auenbrugger and his work:
• P. James Bishop:
  A List of Papers, etc., on Leopold Auenbrugger (1722-1809) and the History of Percussion.
  Medical History, 1961, 5: 192-196. A bibliography listing all important works pertinent to the subject with short critical remarks that facilitate orientation.
• H. L. Blumgart:
  Leopold Auenbrugger. His "Inventum norvum" – 1761.
  Circulation, Dallas, Texas, 1961, 24: 1-4.
• C. Costa:
  Sobre la vicisitud creadora – Auenbrugger y Morgagni frente a frente.
  Anales chilenos de historia de la medicina, 1936, 5: 63-223.
• Charles Coury:
  Auenbrugger, Corvisart et les origines de la percussion.
  In J. N. Corvisart, Nouvelle méthode pour reconnaître les maladies internes de poitrine par la percussion de cette cavité, par Auenbrugger. Paris, 1868, pp. 109-160.
• M. Jantsch:
  200 Jahre "Inventum novum".
  Wiener medizinische Wochenschrift, 1961, 111: 199-202.
• R. G. Rate:
  Leopold Auenbrugger and the "Inventum novum."
  Journal of the Kansas Medical Society, 1966, 67: 30-33.
• J. J. Smith:
  The "Inventum novum" of Joseph Leopold Auenbrugger.
  Bulletin of the New York Academy of Medicine, 1962, 38: 691-701.