The man

with the

stethoscope

 

Barbara Millar's person of the week

 

It was a foot long, made of wood, around one and three-quarter inches thick with a bore five-sixteenths of an inch in diameter, and with one end hollowed out in the form of a funnel. It was similar to an ear trumpet but had been given the name 'stethoscope' (from stethos: chest and skopas: examination) by its French inventor, Rene Laennec, who pioneered the use of the acoustic medical device he had launched in 1816 in diagnosing various chest conditions.
     The French physician wrote about the use of the stethoscope in 'De L'Auscultation Mediate' in 1819, and this work was brought to the attention of an English-speaking audience in four editions between 1821 and 1834, by the eminent Scottish physician Sir John Forbes. Forbes admitted: 'It must be confessed that there is something even ludicrous in the picture of a grave physician formally listening through a long tube applied to the patient's thorax as if the disease within were a living being that could communicate its condition to ensue without'. Nevertheless, within a few years the use of the stethoscope, that most potent symbol of the medical profession for almost 200 years, was widespread throughout Europe and North America.
     John Forbes was born near Cullen, Banffshire, in 1787, the fourth son of tenant farmer Alexander Forbes and his wife Cicilia Wilkie. The family later moved nearer to the coast where Forbes learned to swim in the freezing waters of the North Sea. With his friend James Clark, also from a farming background, he walked to the local parish school in Fordyce, where they were taught English, French, German, Latin and Greek. Forbes then won a bursary to study at Aberdeen Grammar School at the age of 15, before going on to enrol for an arts degree at Aberdeen's Marischal College between 1803-1805, although there is no record of his having graduated.
     In his spare time – to further a developing interest in a possible future medical career – Forbes was apprenticed to two general practitioners in Banff, and then decided to enlist in the Royal Navy as a surgeon. He obtained the diploma of the Royal College of Surgeons in 1806, sufficient to gain entry into the Royal Navy as a temporary assistant surgeon, his naval career coinciding with the latter part of the Napoleonic Wars. He was confirmed in the rank of full surgeon in 1809 and saw action against the French in the Caribbean and the North Sea, during which time his knowledge of French proved most useful, as he was able to act as an interpreter.
    
At the end of the war Forbes was put on half pay and returned to civilian life, enrolling that same year – as a 29-year-old mature student – at the medical school in Edinburgh, and obtaining his MD in 1817 on the same day as his old school-friend James Clark. During his studies Forbes had also attended lectures in geology given by Professor Robert Jamieson, professor of natural history at the university and an early tutor of Charles Darwin. When Jamieson was asked to recommend an Edinburgh physician with an interest in geology to take up a post at a medical practice in Penzance, Cornwall, he suggested Forbes, who moved to the south-west of England in 1817, where he became physician to the Penzance public dispensary as well working as general medical practice.
     His friend James Clark, who had been working in Rome (see SR archive: 10 February 2011), brought back an early model of Laennec's stethoscope from Paris in 1818. Clark was a great enthusiast of this new device, despite it being relatively unknown and rather unpopular, and he persuaded Forbes to translate Laennec's teachings on stethoscopy into English. His first translation, 'A treatise on diseases of the chest', published in 1821, was a great success. This was followed in 1824 by 'Original cases with dissections and observations illustrating the use of the stethoscope and percussion in diagnoses of diseases of the chest', in which Forbes, by now working in Chichester, described 39 patients who had been treated by him. This book included the first English translation of Leopold Auenbrugger's technique of percussion of the chest wall. Austrian physician Auenbrugger had originally invented percussion as a diagnostic technique – this was brought to the attention of Laennec, who, in following it up, discovered auscultation (listening to the internal sounds of the body using a stethoscope).
     While in Cornwall, Forbes contributed papers to the Royal Geological Society of Cornwall, one of his papers drawing attention to the health of the Cornish tin and copper miners, and including studies of their working conditions and the stethoscopic signs of pulmonary tuberculosis. He gave talks to the Penwith Agricultural Society on local natural history and climate and also found time to become the first honorary librarian of the Penzance public library, which he had helped to found in 1818. In 1820 he married Eliza Mary Burgh.
     Two years later the couple moved to Chichester where their only child, Alexander Clark Forbes, was born in 1824. Forbes named his son after his good friend James Clark and Clark returned the favour, naming his only son John Forbes Clark. Forbes was involved with starting the Chichester Mechanics' Institute in 1825, for the promotion of science, literature and the arts, and a few years later he was instrumental in establishing a natural history museum at the new Chichester Infirmary, which later became the Chichester District Museum.
     His book on 'original cases' was very favourably reviewed. The Lancet complimented the author on his 'outstanding work' and it was also highly recommended as being very helpful in the study of chest diseases. Dr Robin Agnew, the author of two books on Sir John Forbes, says: 'There was no doubt Forbes' book filled the gap that existed in the medical world for a reliable textbook on stethoscopy, and his work helped him to win over the sceptics in his profession. Indeed, Forbes himself had been one of the original doubters'.
    
For the next 14 years, Forbes combined private medical practice with hospital work at the Infirmary. A potential rival, Dr John Conolly, also a graduate of Edinburgh, departed to pursue a career elsewhere. But the two remained friends and, in collaboration with a third Edinburgh graduate, Alexander Tweedie, launched a 'Cyclopaedia of Practical Medicine'. This was Forbes' first foray into medical journalism, a career which was to occupy him for the next 15 years. In addition to submitting his own articles to 'Cyclopaedia', he was also its main editor. It became a popular forum for the best medical writers in Britain and was sold for a handsome profit in 1835.
     The following year Forbes and Conolly started a new publication: the British and Foreign Medical Review, a quarterly journal of practical medicine. They shared the editorship until 1839, after which Forbes did it alone. The review was read widely in Britain and America and helped to promote modern methods of diagnosis and treatment, thus enhancing the reputation of British medicine.
     In 1840 Forbes made a risky decision. He decided to resign as senior physician at Chichester Infirmary and to sell his lucrative practice, in order to move to London, to supervise his medical quarterly more closely and to establish himself in private medicine in the capital. He was once again helped by James Clark, who had been physician to the young Queen Victoria. In 1841 Forbes was made court physician to Prince Albert and the Royal household and the continued success of the British and Foreign Medical Review helped him build up his consultant practice in London.
     Over the next few years Forbes flirted briefly with subjects such as animal magnetism, based on the ideas of the Austrian physician Franz Mesmer, and with phrenology and homeopathy. He was also firmly of the opinion that drugs were often prescribed prematurely and in too large amounts, without waiting to see whether a 'wait and see' approach – letting nature take its course – might be more efficacious. He was appointed as one of the first two consulting physicians at the Brompton Hospital for Consumption and Diseases of the Chest in 1846 but resigned from medical practice two years later, intent on pursuing other interests, including the theatre (he treated actors without charge), the Royal Literary Fund (a benevolent fund to help British authors in financial straits) and the temperance movement, of which he was a fervent supporter.
     His wife, who had long suffered ill health, died in 1851. Two years later he was knighted by Queen Victoria. He wrote books of his walking holidays in Switzerland, Germany and the Tyrol, and was a prolific letter writer, corresponding with Sir Robert Peel and Sir Walter Scott as well as with Florence Nightingale, a near neighbour. The two never met – Florence was ill with what may have been chronic brucellosis – but they exchanged copies of each other's books with expressions of mutual respect and admiration.
     In 1859, after a series of strokes, Forbes retired with his brother Alexander to the home of his son in Whitchurch-on-Thames, where he died just before his 74th birthday in November 1861 – 150 years ago. Forbes expert Robin Agnew says that, although as a physician he was not a great innovator, he still deserves to be remembered 'as an outstanding medical journalist, a humane doctor, a diligent scholar and, above all, as the translator of Laennec'. Dr Agnew adds: 'His achievements as a pioneer stethoscopist and medical journalist deserve to survive into the 21st century'.

 

Barbara Millar is a trustee of the Institute of Contemporary Scotland