by Melinda Henry, Mayo Medical School, and Jamie Newman, MD, FACP
Who more appropriate to discover percussion in the human form than a Viennese-trained physician? Josef Leopold Auenbrugger invented the technique of percussing the patient’s chest in 1754, just two years before Wolfgang Amadeus Mozart’s birth in 1756.
The son of an innkeeper, Auenbrugger is said to have tapped wine barrels in his father’s cellar as a boy to find out how full they were. Little would one expect that this percussive background would lead to a medical breakthrough. Later in life he became a composer and wrote an opera for Austrian Empress Marie Theresa.
Auenbrugger described the lung as sounding like a drum with a heavy cloth over it. When the lung is full, stated Auenbrugger, such as in the case of pneumonia, the sound is similar to tapping the fleshy part of the thigh. Auenbrugger practiced these techniques on cadavers. He injected fluid into the pleural cavity and created a science around when and where efforts should be made for its removal.
These observations were published in a small book, now considered a medical classic. Called Inventum Novum, the full English title is A New Discovery that Enables the Physician from the Percussion of the Human Thorax to Detect the Diseases Hidden Within the Chest (and hence, the shorter, more common title).
What is a great story—albeit true—without rejection and shame? His ideas rejected and forced to resign his commission in his current post, Auenbrugger showed understanding of human nature in the following statement: “I have not been unconscious of the dangers I must encounter, since it has always been the fate of those who have illustrated or improved the arts and sciences by their discovery, to be beset by envy, malice, hatred, detraction, and calumny.”
Auenbrugger’s work did eventually rise out of obscurity largely through the exposure of Jean Nicolas Corvisart, Napoleon’s favorite physician. Corvisart, who also influenced René-Théophile-Hyacinthe Laennec, inventor of the stethoscope, led a school of medicine that hoped to correlate the clinical exam to pathologic findings. Corvisart taught the method of percussion to his students and in 1808 translated and published the book with annotations—just a year before Auenbrugger’s death. Ironically, Auenbrugger may not have known about this translation that spread rapidly among the medical community.
To some the physical exam is defunct, supplanted by scans and lab. Two hundred and fifty years later, the technique of percussion is still a cornerstone of the art of the physical exam. Next time you percuss an ascitic abdomen or tap out the level of a pleural effusion, think back to Leopold Auenbrugger, his Inventum Novum, and the birth of the modern physical exam. TH
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