THE MONAURAL STETHOSCOPE

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Assessing the sounds of the human body was reported in the ancient medical literature. Amongst the earliest known medical manuscripts are the medical papyruses of ancient Egypt dating to the seventeenth century B.C., which referred to audible signs of disease within the body. Hippocrates, the Father of Medicine, advocated for the search of philosophical and practical instruments to improve medicine in 350 B.C. He discussed a procedure for shaking a patient by the shoulders (succussion) and listening for sounds evoked by the chest. Hippocrates also used the method of applying the ear directly to the chest and found it useful in order to detect the accumulation of fluid within the chest. In the sixteenth century, the renown surgeon Ambroise Pare noted that "if there is matter or other humors in the thorax, one can hear a noise like that of a half filled gurgling bottle." The distinguished scientist William Harvey, in his 1616 lecture on the structure and function of the heart, described the heart's motion as "two clacks of a water-bellows to rayse water" and noted that "with each movement of the heart, when there is delivery of a quantity of blood from the veins or arteries, a pulse takes place and can be heard within the chest." The French physician Jean-Nicolas Corvisart, who is considered the founder of French clinical medicine, was accustomed to placing his ear over the cardiac region of the chest to listen to the heart. Bayle and Double, who like Laennec were students of Corvisart, used the unaided ear to listen to the heart of their patients. Double suggested the regular use of this technique in his treatise on Semiologie published in early 1817, prior to the publication of Laennec's treatise on auscultation. He wrote "the ear should be brought against the thoracic wall" in order to appreciate the noises inside. Nevertheless, the evolution from listening with the unaided ear (immediate auscultation) to the aided ear (mediate auscultation) awaited Laennec's invention of the stethoscope.

Immediate Auscultation

An engraving of a physician examining a patient by "immediate" ausculatation, in which the doctor placed his ear on the chest of the patient to hear the sounds made by the lungs during breathing.The print shows a group of phiscians, medical students and nurses observing the physician performing his exam. The print is entitled "A Visit to the Hospital" by the artist Luis Jimenez Aranda. It was copyrighted in 1894, and originally displayed at the Chicago World's Fair in 1893.


RENE LAENNEC: INVENTOR OF THE STETHOSCOPE

The stethoscope was conceived in 1816 when a young French physician named Rene Theophile Hyacinthe Laennec was examining a young female patient. Laennec was embarrassed to place his ear to her chest (Immediate Auscultation), which was the method of auscultation used by physicians at that time. He remembered a trick he learned as a child that sound travels through solids and thus he rolled up 24 sheets of paper, placed one end to his ear and the other end to the woman's chest. He was delighted to discover that the sounds were not only conveyed through the paper cone, but they were also loud and clear. The onset of Laennec's stethoscope research began in 1817 at the Necker hospital. The first published oberservation documenting auscultation using the stethoscope (Mediate Auscultation) was in March 8, 1817, when Laennec noted examining a 40 year old chambermaid, Marie-Melanie Basset. Laennec's research activities about mediate ausculatation were first brought to public attention with his consultation in June of 1817 for Mme de Stael, who was the daughter of the Neckers and an author who criticized the rise of Napoleon's empire. Her personal physician described Laennec's consultation: "Another well known doctor [Laennec], using a horn of paper, which he placed with one end on a part of the thorax and the other in his ear, believed he diagnosed a hydothorax, an could even hear a sort of undulation. One can well understand that I considered this method of investigating the interior of the chest to be very strange, and I did not share his opinion, in spite of the regard I might have for him."

Laennec began his study of medicine under his uncle who was a professor of the faculty of medicine in Nantes. Eventully he entered the Paris University where he studied medicine under Jean-Nicolas Corvisat, who was a proponent of immediate ausculatation and percussion. He was a devout Catholic and his charity to the poor was proverbial, taking him to the Hospital Necker after his studies to care for the sick and poor.  It was at the Hopital Necker that Laennec invented the stethosopce. His clinical work allowed him to correlate auscultation and post-mortem findings thus defining disgnoses of diseases of the chest. On February 23, 1818, Dr. Laennec presented his findings in his Memoire sur L'Ausculatation to the Academy of Medicine in Paris, later publishing his comprehensive treatise De L'Auscuatation Mediate of his work in 1819. In 1823, Laennec was appointed professor of clinical medicine at Paris University resigning from Necker hospital to preside over his former mentor Corvisat's clinique interne at the Charite hospital. A few years later just prior to his death he bequeathed his own stehoscope to his nephew, Dr. Meriadac Laennec, referring to it as the "greatest legacy of my life." It is said that Meriadac diagnosed Laennec as having tuberculosis using his stethosocpe. In his lecture on Laennec in 1883, the preeminent American authority on ausculataion, Dr. Austin Flint said "Laennec's life affords a striking incidence among others disproving the vulgar erorr that the pursuit of science is unfavorable to religious faith."

                                                                                                                                                                                                                                                                                                            
R.T.H. Laennec                 

The faience buste shown in the middle photo was created by Georges Robin, HB-Henriot Quimper, in 1926 for the centennial of the death of Docteur Laennec. This reissue white enamel monochrome from the original mold has a height of 12.6 inches and is number 15 of a limited series of 100 pieces. The buste was based on the the oil portrait on the left of Rene Theophile Hyacinthe Laennec by Paul Dubois, circa 1854. This posthumous portrait was comissioned by the Medical Faculty of the Universite Paris Descartes and painted from the only full length portrait of Dr. Laennec shown in the photographic print on the right by Alexandre Dubois, a struggling artist who painted Laennec as payment for his medical services in 1812. The original portrait did not dispaly Laennec's stethoscope and the family had the artist add the stethsocpoe to his portrait in 1825 after the invention of the instrument by Dr. Laennec in 1816. Note Laennec's stethoscope shown in the lower left hand corner of both portraits. The 1854 Paul Dubois painting changed Laennec's garb from the 1812 Alexandre Dubois original portrait, perhaps because the Faculty of Mediciane wanted to show Laennec in a traditional faculty robe. In the 1854 portrait, Laennec is now wearing an academic robe with a matching hat on the table instead of a lamp, as well as two matching books on the table instead of the large book dispalyed in the original version. Laennec's treatise on asculatation was publised in two volumes.
                   ( Photo on the left courtesy of Museum of the History of Medicine,
Paris University Descartes and on the right from the Wellcome Museum, London)                

                           
                                                      
Laennec preferred to have his instrument simply called "Le Cylindre," as he thought naming such a fundamental instrument was unnecessary. He became remorse at the names it was being given by his colleagues and decided that if it should be called anything, it should be "Stethoscope," which is derived from the Greek words for 'I see' and 'the chest.' Laennec was a skileed wood turner and set up a small shop in his home with a wood-turning lathe and stocked different types of wood. He created a stethoscope from a turned piece of wood with hollow bore in the center. It was made of two pieces. One end had a hole to place against the ear and the other end was hollowed out into a funnel shapped cone. There was a plug that fit into this cone which had a hollow brass tube placed inside it. This plug was put in the funnel shapped end ot the stethoscope to listen to the heart, and removed to examine the lungs. Laennec published his classic treatise on mediate auscultation in 1819 in which he discussed mediate auscultation and illustrated the design of the stethoscope. A second edition was published in 1826, just after Laennec died from the very diseases he spent long hours studying with the aid of his stethoscope, Tuberculosis. The stethoscope was described as being 12 inches long and 1.5 inches in diameter with a 3/8 inch central bore hole throughout its length. His stethoscope could be bought for 2 francs along with the purchase of the Treatise on Mediate Auscualtation. 


Laennec Stethoscope assembled           Laennec stethoscope apart           Illustration 1819          Text 1819

Original version of the Laennec stethoscope made of a turned dense, finely grained, light colored wood, circa 1819. This cylindical stethoscope is made with three parts fitting together by wood screw thread and brass tube fitting with an overall length of 12.6 inches and a diameter of 1.5 inches. Both ends are slightly concave. This first version is illustrated in Laennec's first edition text on auscultation which described the stethoscope as having an overall length of 12 inches and a diameter of 1.5 inches. Laennec turned the first stethoscopes himself and these were somewhat longer than described in his text. The stethoscope shown above has the same features as a surviving stethoscope that is tracable to Laennec himself. On the left the stethoscope is assembled with the chest plug protruding from the funnel shaped chest end of the stethoscope. On the right the stethoscope is taken apart revealing the wood screw thread that attaches the two parts of the body of the stethoscope and the chest plug with brass tube fitting that holds the chest plug in place in the funnel shaped chest end.

Also shown is the title page from Laennec's 1819 text on mediate ausculatation with the plate illustrating his stethoscope.
      

                   
                                         
       The Necker Hospital was established in 1778 by Madame Necker, wife of Jacques Necker, Minister of Finance in the court of Louis XVI. Madame Necker was appalled at the conditions of Paris hospitals caring for the poor and opened a 100 bed hospital under her direction and at her own expense, that still bears her name today in order to provide a facility that would serve as a model of  efficiency and hygiene for hospitals of Paris. In 1816, Laennec was appointed physician at the Necker hospital in Paris at which his studies on auscultation would result in his most important contribution to medicine.                                       
                                                               
Hopital Necker                     Hopital Necker 1809

 Shown on the left is a photo of the interior court of the Hopital Necker, Rue de Sevres, Paris, circa 1900. Note the large court gardens that were used to grow herbs as sources of medications. In the center is a photo of the memorial plaque on the outside wall of the Hopital Necker commemorating Dr. Laennec's discovery of the stethoscope. The palque reveals a sculptured "cylindre" of the original model of the stethoscope made by Laennec as illustrated in his 1819 treatise and a later 19th century model of a typical monaural stethosocpe. There is also a snake (typical of a medical caduseus) wrapped around both stethoscopes and a motar (bowl used to crush ingredients in order to prepare medications). On the right is a illustration from "A Popular history of France" by M. Guizot of a ward in the hospital with Madame Necker (center in a gown) standing next to a nurse while visiting patients, circa 1778.


       Laennec examines a patient                    Laennec examines a patient

Laennec examining a tuberculous patient by "immediate" ausculatation with the unaided ear in the Necker Hospital, Paris in the photo of the left. In his left hand is the stethoscope that he used for "mediate" auscultation. Picture after the fresco by Theobold Chartan in the Sorbonne commemorating the invention of the stethoscope in 1816. The photo on the right shows Laennec examing a young boy by "mediate" auscultation with his stethoscope. This reproduction is taken from a painting by Robert A. Thom commissioned by Parke, Davis and Company as part of their "History of Medicine in Pictures" series, copyrighted in 1960.



Laennec stethoscope, together               Laennec stethoscope, apart              Laennec Text 1826         

  A second version Laennec stethoscope made of a turned finely grained, light wood, circa 1826. The cylindical stethoscpe has three parts fitting together by rounded wood pressure fitting and brass tube fitting and horn rings at the juncture of the three parts. It has an overall length of 12 inches and a diameter of 1.5 inches. This second version is illustrated in Laennec's second edition text on auscultation published in 1826, which described the stethoscope as having an overall length of 12 inches and a diameter of 1.5 inches. On the left the stethoscope is assembled for auscultation. On the right the stethoscope is taken apart showing the rounded wood pressure fitting which holds the two parts of the body together and the brass tube fitting which holds the chest plug in place in the funnel shaped end of the stethoscope.


Third version Laennec stethoscope, together              Third version Laennec stethoscope, apart                         Weiss mark

This stethoscope is the third version of the Laennec stethoscope, most likely developed in England as published in the third English edition of Laennec's text after his death (note that the Laennec design is shown on the right hand side of the illustration. The larger peices of the other stethoscope is a diagram of the original version of the Piorry stethoscope an example of which is shown below in the Piorry stethoscope section). It is marked Weiss, London, under a Crown and GR, which stands for George Rex (King George IV) who reigned from 1820-1830, thus clearly dating this stethoscope to that period. The only other known example with this mark is in the Wellcome Medical Museum, London. On the left the stethoscope is shown assembled for auscultation and in the middle taken apart. Note that a brass tube is no longer used to hold the chest plug in place and that the parts of the stethoscope are attached by a funnel shaped, wood pressure fitting. A close up of the maker's mark in shown on the right.



Laennec stethoscope apart            Nauche extension piece            Laennec stethoscope with extension

Unique second version Laennec stethoscope made of cedar wood with an extension piece made of cedar, ivory and horn, circa 1826. On the left is the main body of the stethoscope taken apart. In the middle the extension piece is taken apart. On the right the main body of the stethoscope is assembled and the extension piece screwed into the chest plug. The extension piece was based on the design of Nauche to allow fetal auscultation via the vaginal portion of the uterus.




Late Laennec stethoscope, short            Late Laennec stethoscope, adult    

These one piece stethoscopes are probably as far as the Laennec design of the stethoscope was developed, circa 1830.
On the right is the model for adults and on the left is an early obstetrical or pediatric model.

  

                     Stethoscopes were often carried in a medical bag when the doctor was making a house call on a patient. But such medical  bags called attention to the physician and the possibility that he may be carrying drugs, most especially opiates that were commonly used as medication in the 19th century. Medical canes were a method for carrying drugs in a form that would not reveal the identity of the physician. American medical canes are very scarce, and the example shown below is the only known medical cane that incorporates a stethoscope in the body of the cane.


cane, apart            cane, together           cane monaural stethoscope

Exceedingly rare and unique medical cane made of hard rubber with removable metal assembly that holds all the original fourteen cork-stopped medicine vials. The vials have their original label and medicine content. By removing the lower tube of the cane and attaching a bell and earpiece from the handle, a seventeen inch stethoscope is assembled. The brass presentation ring just below the handle is inscribed: From Dr. Parsons to Dr. Hallock Aug. 1882. Dr. Robert Parsons is listed in the 1880 census of Salida, Colorado. Dr. Richard Sanford Hallock, also in the 1880 Salida census, was born in Orange County, New York, in 1829 and died in Salida on March 25, 1891. Dr. Hallock moved from Oakfield, Iowa, to Colorado in 1879. He served late in the Civil War as an Assistant Surgeon with the 67th U.S. Infantry of Colored Troops. The cane was clearly used by Dr. Hallock, as the brass tip is worn from walking. In the middle photo the cane is assembled for walking, with the brass tip at the top of the photo and the hard rubber handle with inscribed brass ring at the bottom. In the left photo the cane is taken apart, showing the all original medication vials it still contains. The lower tube with the brass tip is on the bottom and the middle tube and handle taken apart is at the top of the photo.In the right photo the middle tube and the earpiece and bell components of the handle are screwed together to form a monaural stethoscope.  


Laennec was the first to describe the auscultatory signs we still use in medicine today, such as 'bruit,'
'rales,' bronchophony,' and 'egophony.' He was also well known for his work on cirrhosis, which is
still referred to as "Laennec's cirrhosis." The stethoscope allowed him to extensively study chest diseases and especially tuberculosis. He died in 1826 from this disease just following the publication of the second edition of his book.              


In his book, Laennec tells of how he went through several experiments to get from the rolled up
paper to the hollow wooden cylinder. He also gives the reader strict guidelines on how a proper
stethoscope is to be constructed, as well as used.
 
 


THE PIORRY STETHOSCOPE

This new instrument was not embraced immediately, but it eventually became recognized by physicains as a valuable instrument for physical diagnosis. There were several improvements to Laennec's stethoscope over the years, the most notable was that of Pierre Adolphe Piorry in 1828. Piorry also incorporated another diagnostic instrument, known as a "pleximeter" into his stethoscope


P.A. Piorry           P.A. Piorry          P.A. Piorry

Three portraits of Pierre Aldophe Piorry, circa 1830s.
( Photos courtesy of the National Library of Medicine)




Piorry Stethoscope, apart                 Piorry stethoscope assembled          Piorry Stethoscope, carrying

Original Piorry stethoscope made of wood and ivory, circa 1828. This is the stethoscope illustrated in Piorry's text on percussion as shown above and published in 1828.
Shown in the middle is the stethoscope assembled with the extension piece. The stethoscope could be used with or without the extension piece attached.
On the left it is shown taken apart to display the main stem, extension piece, chest plug that fits in the chest funnel end, pleximeter that screws on to cover the chest end, ear piece that screws on the the stem end, and finger thimble used as a plexor. On the right the same stethoscope is shown put together for carrying (the extension piece fits inside the main stem for carrying).


The Piorry stehoscope evolved to have a thinner stem without an extension piece and was about half the size of Laennec's. It was trumpet shaped, made of wood, and had a removable wood plug, ivory earpiece and chest piece. The ivory chest piece also served as a pleximeter. Most stethoscopes made after 1830 were modeled after the Piorry design. And the Piorry stethoscope was the inspiration for Sir Oliver Wendell Holmes to write his "STETHOSCOPE SONG." 



Piorry Stethoscope           Piorry stethoscope

Typical Piorry Stethoscope made from cedar. On the left the stethoscope is taken apart showing the main stem, plug that inserts into the funnel shaped chest end, ivory chest piece also used as a pleximeter and ivory ear piece that screws onto the stem as the ear plate, circa 1830. On the right it is assembled for auscultation.

Cased Piorry Stethoscope            Piorry Stethoscope and Percussiom Hammer

Cased Piorry Stethoscope made of cedar and ivory with Percussion Hammer, circa 1835.
On the right the assembled stethoscope and hand carved ebony percussion hammer with cork tip are shown taken out of the case
.

Piorry Stethoscope

Later model Piorry stethoscope made from ebony. The stethoscope is taken apart showing the ivory pleximeter with finger grasps and a smaller ivory ear plate, circa 1840.



Piorry type stethoscope            Piorry stethoscope

 A rare and wonderful example of medical scrimshaw is shown on this presentation Piorry stethoscope. The stethoscope is assembled for auscultation on the right. The scrimshaw is shown on the left. The ivory pleximeter which screws onto the funnel shaped chest end has a etching of a thumb lancet used for bloodletting, poppy seed used to make morphine and Asklepios's staff showing a rod and snake (the medical caduceus), and in latin the words Conjurat and Amice (from your wife with love). The ivory ear plate which screws onto the stem reveals the presentation date  May/11/1829/Paris etched on the inner surface.


THE HOPE PRESENTATION STETHOSCOPE 


James Hope presentation stethoscope             James Hope .

         A presentation stethoscope given by Dr. James Hope to one of his exceptional medical students in 1839. It is made of cherry wood and ivory and modeled after the Piorry stethoscope. Dr. Hope designed an ivory ear piece that was curved so as to better fit the ear. The stethoscopes were made by James Grumbridge, a turner and stethoscope maker in London. The silver band is engraved "Prize for auscultation awarded to C.J. Freeman by Dr. Hope, 1839." Mr. Freeman started his medical studies in 1837 at the Aldersgate Medical School in London. One of his courses was the Principle and Practice of Medicine taught by Dr. Hope. From 1838-1839, he completed 12 months of clincal experience at nearby St. Batholomew's Hospital. During his clincal clerkship, Mr Freeman presented a case that is discussed in Hope's textbook on Diseases of the Heart. The patient was in St. Bartholomew's Hospital from May 4-27, 1839. Dr. Hope writes that "the following case is a curiosity, as it presents a greater number of different murmurs (namely ,six, including that rare one- the direct mitral) than I have heard in any other instance: yet it will be seen that they were unraveled with the greatest clearness by a student! This gentleman was James Freeman, a pupil of my class on the practice of medicine, who brilliantly won my prize for auscultation for the year. I give this case in his own words, the accuracy of which I have verified by a personal examination of the patient." There were only a total of four such presentation stethoscopes awarded and the stethoscope pictured above is one of three known to exist today. Dr. Hope's portrait is also shown, circa 1842
(click here to read about Dr. Hope and the history of this stethoscope) .
(Photo of Hope courtesy of the National Library of Medicine)


SIR JAMES McGRIGOR'S STETHOSCOPE 


McGrigor stethoscope. together        McGrigor stethoscope        McGrigor mark       Sir James McGrigor oil portrait


Sir James McGrigor was the father of the Royal Army Medical Corps. Dr. McGrigor introduced the stethoscope into milirtary practice in Britain in 1821. The stethoscope is shown above both together and taken apart, with the chest plug made entirely of wood and the ear plate made of horn. It is an interesting variation of the Laennec and Piorry designs, in that it has the Laennec plug that inserts into the funnel shaped bell on the chest end (to asculatate heart sounds) and the thinner stem and ear plate like the Piorry stethoscope. Note that on the stem in an uneven, engraved mark that reads "McGrigor Maker." There is no record of an instrument maker named McGrigor. The uneven, engraved mark suggest that Dr. McGrigor designed and had this stethoscope made for himself (or even made the stethoscope himself). The oil portrait of McGrigor is by the early 19th century English portraitist John Jackson presented to his family by the medical officers of the Army.




The Piorry stethoscope became the standardfor doctors to use for auscultation in the mid 19th century. There were manty modifications of the Piorry design which made it easier to use and carry the stethosopce.
 

Piorry type stethoscope

An early Piorry type stethoscope with a large but simple bell chest end, thick stem and ivory ear piece, circa 1830 .



Laennec-Piorry stethoscopes            Llaennec-Piorry stethoscopes          

A pair of stethososcopes, circa 1830, that combine the characteristics of the Laennec (chest plug with tube) and Piorry (chest bell and ivory ear piece) stethoscopes.
On the left they are put together, on the right taken apart showing the plugs. Note that the stethoscope on the left has a solid wood plug, while the one on the right has the usual plug with a brass tube.
 




Piorry type stethoscope            Elliotson stethoscope

Elliotson's stethoscope, circa 1835. On the left it is put together for carrying and right taken apart.



Piorry type stethoscope

Typical European Piorry type stethoscope made of wood with a screw-on ivory earplate, circa 1875. This stethoscope was brought from Germany in the late 19th century by a pathologist from Hamburg, who immigrated and practiced in American Hospitals.




Charles James Blasius Williams developed another approach to the design of the stethoscope. He introduced a two-piece monaural stethoscope in 1843 with a trumpet shaped chest end that fit more comfortably and snuggly against the chest wall. His stethoscope had a removable ear piece.  
            

THE WILLIAMS STETHOSCOPE
     
          
Charles J.B. Williams           
Dr. Williams' Exposition         
       
Photograph of Charles James Blasius Williams, circa 1840.
(Photo courtesy of the National Library of Medicine)




William's stethoscope             William's stethoscope             William's stethoscope
             
Williams Stethoscope, circa 1845.
On the right the stethoscope has the ear-piece removed.
In the middle the ear-piece is inserted in the smaller end, leaving a trumpet shaped end for examination of the chest.
On the left the ear-piece inserted in the trumpet shaped end, leaving the smaller end for listening to the heart.



Flexible monaural stethoscopes were introduced around 1832. These were tubes of coiled spring covered with woven silk, usually 14 to 18 inches long, with a chest piece at one end and usually a very short, straight earpiece at the other. Flexible stethoscopes are often confused withconversation tubes, which looked the same, but were much longer than stethoscopes.

Flexible Stethoscope           Golding Bird Flexible Stethoscope          Arnold Flexible Stethoscope

Three examples of flexible stethoscopes.
On the left is an early model made with pewter ear piece and chest piece, circa 1832.
Golding Bird's model with wooden ear piece and chest piece is shown in the middle, circa 1875.
Arnold's model also made with a wood ear piece and chest piece is on the right. circa 1885.




Piorry Flexible Stethoscope            Piorry Flexible Stethoscope           Piorry Flexible Stethoscope

A unique Piorry Flexible stethoscope made of wood, ivory and horn, circa 1835. Note that the typical Piorry ear plate and chest piece are attached to the flexible tube shown in the middle photo. On the left the stethoscope is shown assembled for carrying. On the right the pieces are taken apart.



READ AN ARTICLE ON THE DIFFERENCES BETWEEN FLEXIBLE MONAURAL STETHOSCOPES AND CONVERSATION TUBES

               

THE FERGUSSON STETHOSCOPE

                                


The Fergusson model of the monaural stethoscope was designed in England and became the most popular model used in the later half of 19th century medical practice. It was made of straight grained, less dense woods with a small bore central hole such that sounds were readily transmitted. It measured approximately 7 inches in  length with a slender stem that had a rounded chest-end bell about 1 inch in diameter that rested comfortably on the patient. The ear plate was approximately 2.5 inches in diameter and fit snuggly over the ear in order to prevent disperson of the transmitted sounds. The Fergusson stethoscopes often had a maker's mark, physician's name or initials, or other identifying characteristic engraved on the ear plate.

Who designed this stethoscope? There were two British doctors with similar names during the later part of the 19th century who might have been involved in the  design of this model of the stethoscope.

Sir William Fergusson was a leading scotish surgeon, educated at at the University of Edinburgh and surgeon at the Royal Infirmary of Edinburgh where the stethoscope was in use at that time. He was appointed Professor of Surgery at Kings College Hospital in London when he was just 32 years old and eventually was appointed surgeon to both Queen Victoria and Prince Albert. Dr Fergusson was widely recognized for his operastive skills, conservative approach to surgery and invention of many useful surgical instruments. His text on "System of Practical Surgery" first published in 1842 was highly regarded, but only mentions the use of the stethoscope for ausculatation. Although he was aslo noted to be a be an excellent carpenter, rivaling skilled artisans, there is no record of his designing a stethoscope.

Dr. John Creey Ferguson was an Irish physician educated at Trinity College and The Royal Infirmary of Edinburgh. His close friend in Dublin was Dr. William Stokes, who was an expert on auscultation and wrote a text on stethoscopy while just a medical student! Dr. Ferguson spent one year in Paris studying with Laennec and Kergradec to learn the use of the stethocope, most especially for fetal auscultation. In 1830, Dr. Ferguson puplished his classic treatis on "Ausculatation the only unequivical evidence of preganancy" in the Dublin Medical Transactions (the only issue of this journal ever published). Dr. Ferguson was noted for his advocacy of using the stethoscope for fetal auscultation. He eventually becamethe First Professor of Medicine at Queens University, although he recieved little rcognition at home or abroad. There also is no record of his designing a stethoscope.

In addition, during the same period of time, there was a prominent instrument maker named David Ferguson who was the instrument maker to the St. Bartholomew's Hospital in London. Mr. Ferguson demonstarted the use of  a unique "teaching" monaural stethoscope at the International Exhibition of 1862 n London. Indeed, on this very website there is an Alison differential binaural stethoscope marked "Ferguson."

In view of the listing of the Fergusson model of the stethoscope spelled with two "s" in English instrument-maker catalogues of the day such as  Down Brothers, Arnold and Sons, Alllen & Hansbury and Maw (although it should be noted that in the classic American Armamentarium Chirurgicum by George Tiemann & Co. the name for this model of stethoscope was spelled Ferguson) and the prominence of Sir William Fergusson in England, most assume that he either designed this stethoscope or the stethoscope was named after him. However, the origin of the most popular model of the 19th century monaural stethosope that was used well into the early part of the 20th century remains unclear.


Fergusson 1847               Fergusson 1867                Fergusson 1874         

Portraits of Sir William Fergusson circa 1847 to 1874.

(Photos courtesy of the National Library of medicine)
                 
Fergusson  stethoscope               Pickthall               Coxeter &  Son           Maw  

The stethoscope on the left is a typical unmarked, wood Fergusson monaural, circa 1890. 
              In the middle is a Fergusson stethoscope with the name T. M. Pickthall hand engraved on the top of the ear plate, circa 1880 (click on the image to see the engraving).
          The Fergusson shown just to the right is made by Coxeter & Son with a hand engraving of a mascot carrying a flag and the initials F.C.H.S. circa 1870 (click on the image to see the engravings).
The Fergusson stethoscope to the far right is made S. Maw& Son, circa 1870 (click on image to see mark).


DR. W.H. HILL'S STETHOSCOPE

    
In 1729, the four bed Edinburgh Infirmary was established with funds from the Royal College of Physicians of Edinburgh at the head of  Robertson's Close in the heart of city. At first, it was also known as the Hospital for the Sick Poor, Physicians' Hospital or Little House. It was the first volunatry hospital in Scotland. Granted a Royal Charter in 1736, the Royal Infrimary of Edinburgh moved to new premises on what is now known as Infirmary Street in a 228 bed facility designed by William Adam in 1741. It was in this Royal Infirmary that Dr. James Hope first used the stethoscope and learned the art of auscultation at the bedside of patients, when he served as a House Physician and Surgeon in 1824-1825. In 1872, David Bryce was commissioned to design a new hospital, and in 1879 the Royal Infirmary moved to a "clean air" site at Lauriston Place. The main building of the Royal Infirmary at Lauriston conformed to the Florence Nightingale's pavilion design of medical and surgical wards. The Infirmary set apart a portion of the beds for clinical instruction by Professors of the University of Edinburgh and its Medical Department gave special instruction in Physical Diagnosis. Postmortem examinations were conducted by the patholgist in the Anatomical Theatre. Separate Wards were devoted to certain types of illness. Wards 32 (men) and 33 (women) were designated for General Medicine and ultimately in 1963 for Medicine of the Ederly (MOE).  In 2002, the Royal Infirmary of Edinburgh moved to its current home at Little France in the southern suburbs of Edinburgh. The MOE service still exists today in wards 201 and 202 in the new Royal Infirmary. The University of Edinbuirgh College of Medicine required that a medical student attend at least two years of medical and surgical practice at a General Hospital. Continuing the long standing relationship since 1750 of the Royal Infirmary and Medical College, the University of Edinburgh also moved the Medical College to Little France and located its new home, The Chancellor Building,  adjacent to the Infirmary.    


       Queen Mary Ward        hospital ticket        R.E.I. stethoscope         Royal  Infirmary of Edinburgh         University  of Edinburgh Medical College
 
A Fergusson wood stethoscope, circa 1880, with hand engraved initials R.E.I. / W.H. Hill. Wards 32. 33.
(click on image to see the detail of the engraving) 
The stethoscope belonged to William Henry Hill, MB. Mast. Surg. who used it at the Royal Edinburgh Infirmary on General Medicine wards 32 & 33 while he was a medical student at the University of Edinburgh. Dr. Hill graduated from the University of Edinburgh School of Medicine in 1886 with a degree in medicine (Bachelor in Medicine) and surgery (Master in Surgery). He did his medical and surgical clinical clerkships at the Royal Infirmary for at least two years as noted in the Student Register of Tickets. These tickets enabled medical students to participate in the "Medical and Surgical Practice" at the hospital and "visit the Wards and Operating Theatres, and attend  Post-Mortem Examinations". W.H. Hill purchased Royal Infirmary annual ticket No. 46 1st Nov 1880 and perpetual ticket  No. 200 21st Oct 1881. An example of a Royal Infirmary Hospital Ticket is shown above (click on image to see the detail on the inside of the ticket). The Medical Registers of qualified Doctors of the United Kingdom record Dr. William Henry Hill at Longtown, Cumberland in 1887 and at Old Basford, Nottingham from 1888-1918. The Nottinghamshire Archives 10 Mar 1908 record articles of partnership for "William Henry Hill of Basford, surgeon and Alfred Lewis Bartram of Bulwell, surgeon, as 'Hill and Bartram' of Basford, surgeons and general medical practitioners."

    Shown to the right is an engraving of the Royal Infirmary of Edinburgh at Lauriston Place from the book "Old and New Edinburgh" published in 1890. The four wings in the front of the Royal Infirmary are part of the surgical hospital and the four wings in the back are part of the medical hospital. The last wing on the right in the medical hospital contained wards 31, 32 and 33 (first, second and third floors, respectively). Aslo pictured on the left is a postcard of the Queen Mary Ward at the Royal Infirmary in 1911, looking much as it did when Dr. Hill used his stethoscope on wards 32 & 33. King George V and Queen Mary visited the Royal Infirmary on July 19, 1911 following their Coronation in London on June 22, 1911. They visited surgical ward 7 and medical ward 30, which were then named the King George V Ward and Queen Mary Ward, respectively, in commenoration of the Royal Family visit. 


On the far the right is an engraving of the University of Edinburgh Medical College located across from the Royal Infirmary at Tievot Place, circa 1884. The diagram of the building on the top right of the engraving by architect Robert Anderson shows the rotunda of McEwan Hall, the amphitheatre where medical lectures were presented to the medical students. 


In general, the Piorry design was the most commonly employed form. However, there were many variations in the shape and form of different models. Some stethoscopes were designed for special purposes. And some were made from special materials that generally signified a physician with "upper class" patients. 
Monaural stethoscopes from 1850 to 1900 are shown below.
     


Ivory Show Stethoscope                Silver plated Stethoscope             Bigg stethoscope       
   
  Shown above are a group of stehtoscopes made of unusual materials. An exquisite stethoscope carved from one piece of ivory, circa 1850.  It may have been a show stethoscope. A beautiful silver plated stethoscope, circa 1860. The hollow ear piece is constucted much like the base of similar silver items and served as a chamber to enhance the ascultated sounds. A well crafted monaural stethoscope made of ebony and marked "BIGG" ( click on image to see the maker's mark ) on the concave underside of the ear piece as shown on the right, circa 1850. This company was only in business until 1859. The unusual stethoscope on the far right is made of brass with cedar wood integrated into the brass ear piece, circa 1890. Note the curved shape of the wood ear piece with a gentle protrusion so that the ear sealed tightly against the stethoscope for enhanced sound transmission during ausculatation. The stethoscope could be taken apart and one piece screwed on top of the other for easy carrying (click on image).


Burrows Stethoscope               Stokes percussor ring

Burrows stethoscope with original rubber percussion ring around the ear plate, circa 1860. Stokes stethoscope with original rubber percussion ring around the ear plate, circa1880.


No hole stethoscope          Both stethoscopes           Hole stethoscope

Interesting examples of monaural stethoscopes that have a narrow oval chest end which was intended to examine the chest in between the ribs so as to better auscultate the lungs. On the left is a completely solid model, circa 1850. On the right is a similar version, but with the central hole bored throught the stethoscope, circa 1840. Note the middle photo which shows the chest ends of the stethoscopes with and without the hole.


Traube's stethoscope         Traube's stethoscope        

Traube's stethoscope in a case with precussion hammer and pleximeter by H. Hauptner, Berlin, circa 1876. The Traube stethoscope, Metallstiel percussion hammmer, and ivory pleximeter are shoun out of the case on the left.  

                   
Early Stokes' stethoscope            Ivory Stokes' stethoscope

Very early Stokes stethoscope made of wood, circa 1860. Stokes stethoscope carved from one piece of ivory, circa 1870.      


Hecker's stethoscope

Hecker's stethoscope made of wood with a horn chest piece and a horn extension to attach a flexible tube with a horn earpiece for student teaching.


CIVIL WAR SURGEON ROBINSON STORY


There has been considerable debate about whether stethoscopes were used by civil war doctors. The evidence that civil war surgeons did not use stethoscopes is usually referenced to the fact that the Harvard Medical School catalogue did not list ownership of a stethoscope until after the civil war in 1869. However, medical students owned their own stethoscopes dating back to the 1840s. There is ample evidence in civil war army medical documents that physical auscultatory signs related to diseases of the heart and lungs could only have been heard with use of the stethoscope. In his highly regarded Manual of Military Surgery published in May of 1861, Samuel Gross said that "Organic cardiac disease could easily be detected with the stethoscope." Both union and confederate army medical department regulations show stethoscopes as part of the medical supplies for civil war hospitals. In 1865, a hand written inventory from ward H at the Conesus Centre Army Hospital, N.Y. lists a stethoscope as part of their medical supplies. The 1863 Manual of Instructions for Military Surgeons by John Ordronaux, M.D. lists a stethoscope as part of Instruments for Special Diagnosis. A note in the section on Diseases of the Chest and Back states that "It is a good plan, in auscultating a party, to place him with his back against a wooden door or patition. The greater resonance of the pectoral sounds obtained by this process, will suprise those who have never bfore availed themselves of this simple acoustic medium." The manual also contains an illustrated Auscultatory Percusssion Chart. This information confirms that the stethosocpe was part of civil war medical supplies. 


            civil war monaural, circa 1865                   Hospital Inventory             Army Medical Supplies

 Shown above on the right is a page from the The Army Medical Department book that lists a stethoscope along with other instruments as part of the supplies for the civil war hospital. Also displayed is a hand written inventory from Hospital Ward H, Conesus, NY, 1865 showing a stethoscope as part of the ward Articles. A typical wooden monaural civil war era stethoscope is shown on the left.. 
(photo courtesy of Michael Echols)

Civil war confederate surgeon William R. Robinson received his undergraduate education at the West Point Military Academy from 1845-1849 and medical education at the Medical Department of the Univerity of New York from 1853-1857. Dr. Robinson would have been exposed to the use of the stethoscope for auscultation during his clinical courses at Bellevue Hospital under the tutelage of renown professors such as Valentine Mott, the "father" of American surgery, and John Metcalfe, who taught the course on "Physical Diagnosis and Diseases of the Chest." After graduaton,  Dr. Robinson was appointed Assistant Physician at the Seamen's Retreat Hospital on Staten Island, NY based on a letter of recommendation from his teacher Valentine Mott. In 1860, he moved to Galveston, Texas where he was again recommended as a superb physician by Dr. Mott. At the start of the civil war, he joined the Texas Rangers and was appointed an Assiatant Surgeon of the Texas Volunteer Forces, Provincial Army on Decemeber 10, 1861. He served in the 3rd Regimen of the Arizona Brigade in northern Texas and as Director of the confederate general hospital in Columbus, Texas. Towards the end of the war, he was an Acting (contract) Assistant Surgeon for the union army prison on Ship's Island, Mississippi. Dr. Robinson eventually returned to Newark, New Jersey where he practiced until his death in 1889. Dr. Robinson's journey is just one example of a West Point cadet serving in the confederate army during the civil war that divided family and friends into north and south camps.


 Dr. Robinson civil war letter, 1861      Dr. Robinson civil war letter, 1862     Dr. Robinson civil war letter, 1865               Dr. Metcalfe signed ticket      Dr. Mott signed ticket     Dr. Mott signed letter

On the left are three hand written, civil war Dr. Robinson letters. The first letter on April 28, 1861 is written by Dr. Robinson to his father from Port Sullivan, Texas. Dr. Robinson states "War has commenced! Abe Lincoln has thrown the first stone! The South will fight to the last - The result will be a long and bloody war." Another letter on  17 Nov 1862 is addressed to "Doctor Robinson Principle Director Hospital Columbus, Texas" and signed "Henry L. Webb Inspector Genl. Dept. of Texas."   In this letter Henry Webb tells Dr. Robinson that "W.E.B. Howe of Col. Elmore's regiment is ordered to  Columbus hospital. He is dying to go home to Hemstead to his family. If possible I wish you would gratify him and let him report to you at the end of such time as you think he will be able for duty. Mr. Howe had 3 brothers killed in the first battle of Manassas and two in this last fight, much is due to his family."  The last letter from the "Office of Camp of Priz. Ship Island Jan 14 65" reads "Dr. Robinson Sir, please hand in to this office a list, names specific and command of the prisoners of war  who are in the hospital."
 
  
On the right are two University of the City of New York medical school tickets for William R. Robinson's courses in the "Practice of Medicine" 1855-56 taught and signed by Dr. Metcalfe and "Operative Surgery" 1855-56 taught and signed by Dr. Valentine Mott, the "father" of American surgery (note the hand holding a scapel in the design at the top of the ticket). On the far right is a letter that Dr. Mott wrote on April 18, 1857 recommending Dr. Robinson for his first position after medical school at the Seamen's Retreat Hospital on Staten Island. 







Ivory Roberts Stethoscope      Ivory Robert's stethoscope                   Dutch stethoscope, together                  Metal monaural stethoscope with swivel joint      Swivel joint, bent

A Roberts stethoscope made of ivory, circa 1880. On the left the stem is shown inserted thru the earpiece for easy portability and on the right the stem is screwed upright into the ear piece for auscultation.The left wooden model is known as the Dutch Stethoscope, because of the tulip shaped bell, circa 1890. This stethoscope came apart in three pieces for carrying. Brass monaural stethoscope with a swivel joint for portability, circa 1890. On the left the stethoscope is upright and on the right the swivel joint is bent at a right angle for carrying.

Stethoscope with bell ear piece             Cedar stethoscope           Gutta-Percha stethoscope             Brass lined stethoscope            carved stethsocope

The gutta-percha model on the right is a simple stethoscope, with an ear plug end, circa 1880.  Unusual wood stethoscope with a large bell ear piece, circa 1850
the typical chest end is at the top of the photo.
Cedar stethoscope with curved, protruding ear piece made of gutta percha, which was intended to create a better fit in the ear, circa 1860. An interesting stethoscope with a brass rim at the ear-end and a brass lined funnel shaped chest-end. A hand carved, funnel shaped stethoscope made from a unique vermont wood.

        
Quain stethoscope             Quain stethoscope, inverted                        Portable stethoscope, together           Portable stethoscope, apart

On the left is a Quain's telescoping stethoscope where the chest-end screwed onto the stem ear-end for ausculatation and could be unscrewed for ease of carrying, circa 1880.
The  photos show the two parts screwed together for auscultation and the chest-end screwed on top of the stem ear-end for carrying. The two photos on the right show another version of a portable stethoscope with the parts screwed together and taken apart. The two stem pieces fit into the two holes in the ear piece for easy carrying.



Long Stethoscope, together        Long  stethoscope, apart                Doctor holding stethoscope               Long  stethoscope, A       Long  stethoscope, Maw

A ninetenth century photograph of Dr. William Lennard holding an unusually long monaural stethoscope in his right hand. This type of long stethoscope was intended to keep the doctor a distance from the infested patient.
(Photo courtesy of the Wellcome Library)

A very long (15 inches) pauper's stethoscope, circa 1850 is shown to the left of the photo. The stethoscope unscrewed in the middle so that it could be carried more easily, much like the original Laennec stethoscope. On the right, is a very long (14 inches) stethoscope circa 1880. The lower part of the stem has a hand carved letter A, which is similar to the branding of animals on a ranch. This extra long stethoscope is most likely a vetenary stethoscope. To the right is a long (10 inches) stethoscope made of gutta percha which was used to examine patients with fever, circa 1890. It is marked Maw on the ear piece.



Stethoscopes were also developed for obstetrical and pediatric auscultation. Laennec's friend Jacques-Alexandre Lejumeau de Kergaradec was the first doctor to use the stethoscope for fetal auscultation and this technique was discussed by Laennec in his second edtion text on ausculataion. The fetal stethoscopes that emerged usually had a very wide or flaring bell and a wide earplate, which prevented the stethoscope from rocking on the abdomen of the mother during fetal auscultation. Stethoscopes for children tended to be shorter than those for adults and were probably used as either pediatric or obstetrical stethoscopes.


Pajot Stethoscope           Pinard's Aluminum Fetuscope            DePaul stethoscope

A very short model (4 inches) with funnel shaped end and wide earplate called the Pajot Stethoscope used for fetal auscualtation, circa 1880. Pajot designed a shorter stethoscope than DePaul to avoid rocking on the mother's abdomen during fetal auscultation. An example of Pinard's aluminum fetal stethoscope (6 inches), with the characteristic very wide, deep bell circa 1900. The Pinard stethoscope rapidly became the fetal stethoscope of choice becqause the widely faring bell prevented rocking on the mother's abdomen during auscultation. DePaul stethoscope (5 inches) used for fetal auscultation, circa 1885. DePaul designed the stethoscope with a wider than usual bell to avoid it rocking on the mother's abdomen during fetal auscultation.


Pediatric stethoscope              Pediatric stethoscope              Silver stethoscope stethoscope

A  short (5 inches) ebony stethoscope with a small ivory earpiece most likey used for pediatric or obstetrical auscultation, circa 1840. Another short ebony stethoscpe (4.75 inches) with a silver lined chestpiece most likely used for pediatric or obstetrical auscultation, circa 1850. Solid silver stethoscope that is very short (3.5 inches), most likely used for obstetrical or pediatric auscultation.


Dr. Lowenstein's stethoscope       Dr. Lowenstein's case

This stethoscope belonged to Dr. Gustav Lowenstein from Frankfurt, Germany. Dr. Lowenstein fled Germany to Austria in 1933 and then emigrated with his family to America in 1935. The stethoscope was obtained in 2006 from his 78 year old physician son who said that the stethoscope originally belonged to his grandfather, who was also a physician. This cedar wood stethoscope is a Hosford's type, with a large bell ear piece designed to cover the ear to exclude external sounds, circa 1900.


The monaural instrument was used exclusively for about 30 years, and were used into the late 19th and early 20th centuries. In fact, they are still used today in countries such as those of the Former Soviet Union, and are still being used by midwives in the United Kingdom and Europe. However, eventually physicians decided to find out if an instrument using both ears would be better than the simple monaural. 


Hughes Stethoscope            Physician CDV        Bogardus backmark             Cammann stethoscope with original band          Dejeurne percussor             

Carte-de-Viste photo of a physician posing with a Hughes monaural and Cammann binaural stethoscope as well as a Dejeurne percussion hammer, circa 1865. As shown on the backmark, the photo was taken by the well known 19th century portrait photographer Abraham Bogardus, whose studio was located at 363 Broadway in New York from 1862 to 1869. Also shown are examples of these instruments from the same period. On the left is a Hughes monaural stethoscope, on the right a Cammann binaural stethoscop and on the far right a Dejeurne percsussion hammer. 


                    

CONTINUE TO THE BINAURAL STETHOSCOPE




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