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Where Laennec was a true pioneer was in correlating clinical signs with pathology. In the first edition of his treatise on mediate auscultation (1819) he analysed the physical signs of percussion and auscultation and substantiated them with their pathologo-anatomical relevance; and, in the second (1823) he provided a complete description of pathology, diagnosis and treatment. Writing about three early Welsh followers of Laennec (March 2004 JRSM1), Dr Morris acknowledges that Williams, Davies and Lucas were among many foreigners who came under the French doctor's influence. In England these included Heberden, Fothergill and the ‘great men’ of Guy's Hospital—Richard Bright, Thomas Addison and Thomas Hodgkin—who fostered the attitudes that were to make Britain a leader in clinical medicine. Reference must also be made to the Irish connection—John Cheyne, Abraham Colles, Robert Adams and John Corrigan from the great Dublin School, and the two leaders Robert Graves and William Stokes. Laennec's teaching had an immediate impact in Britain by the influential work of such physicians. Graves and Stokes, both graduates of Edinburgh and subsequently professors in Dublin, collaborated in a new system of clinical instruction. Stokes in 1825 published a small treatise on the stethoscope inspired by Laennec.2
The modern practice of a complete clinical examination derives from nineteenth century methods such as auscultation and percussion. In today's world of imaging techniques and other technologies, it is a challenge for teachers to decide which of the old techniques are worthy of preservation.