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THE BOWLES STETHOSCOPE

The practical diaphragm stethoscope was developed and patented by Dr. Robert C.M. Bowles in 1894. The original version had a flat diaphragm chest piece that could be used with or without a short rod that screwed into the diaphragm in order to localize heart sounds. The chest piece could be connected to a typical Cammann type binaural ear piece or, alternatively, could simply be used by applying the ear directly to the hollow opening of the chest piece. In 1901, Bowles patented a version of this stethoscope that became the commonly used type in the early 20th century. The sole manufacturer of the Bowles stethoscopes in America during the first half of the 20th century was George P. Pilling Son Co. of Philadelphia.


DR. MUHLENBERG'S STETHOSCOPE


       


A Pilling Special Bowles Patent stethoscope with original rubber tubing, circa 1901. The stethoscope belonged to Dr. William F. Muhlenberg, great, great grandson of Henry Melchoir Muhlenberg, the founder of the Lutheran Church in America. Dr. Muhlenberg was born in 1852 in Gettysberg, PA, attended Muhlenberg College and recieved his medical degree from the Unniuversity of Pennsylvania in 1872. He was a prominent surgeon who practiced in Reading, PA and was on the staff of Reading Hospital. Dr. Muhlenberg served as President of the Berks County Medical Society in 1883. He died in 1915 from Myocarditis in Reading. His stethoscope came from the estate of Dr. Muhlenberg's grandson, Dr. John Peter Gabriel Muhlenberg of Berks County, PA, whose namesake was his great, great, great, great uncle of one of George Washington's revolutionary war Generals serving with him at Valley Forge, John Peter Gabriel Muhlenberg son of Henry Melchoir Muhlenberg.


A Bowles combination stethoscope was patented in 1902. It had a diaphragm chest piece, which was intended to be used interchangeably with a Ford chest piece. This was the first type of combination bell and diaphragm stethoscope.


                                  

The photos shown above on the left are the Pilling version of this stethoscope, circa 1910. The stethoscope is displayed with the Bowles diaphragm chest piece separate from the Albion Ford chest piece and with the Bowles diaphragm chest piece inserted by a Bloomfield connector into the Ford bell, converting the stethoscope to a Bowles diaphragm model. The photos shown on the right are the Klagges model of this stethoscope, circa 1940. The stethoscope has plastic Ford bell and Bowles diaphragm chest pieces displayed in the same manner as the photos on the left. Note the metal cover that is clipped onto the Bowles chest piece to protect the plastic diaphragm when it is not in use for auscultation. 


At the turn of the century when membrane stethoscopes were coming into widespread use on binaural stethoscopes, the use of a membrane on monaural stethoscopes was distinctly unusual, although an early twentieth century Aesculap catalogue shows a metal monaural with a membrane cap that could be placed on or taken off the chest piece. Below is a unique example of a monaural membrane stethoscope.


                  


Shown above is a unique monaural Membran Stethoskop and its original box made in Germany, circa 1920. The stehtoscope has a membrane that screws onto both inter-changealble chest pieces, as well as in the ear piece. The membranes are made of a clear plastic material (although they look black in the image). There is an anti-chill rubber ring that fits onto the rim of the chest piece as shown in the chest piece on the left. There is no makers mark on the stethoscope, and this sethoscope may have been made specially for an individual physician.



Also during the first part of the twentieth century, there was considerable interest in developing stethoscopes that differentiated the intensity of heart and lung sounds. Notable examples were the Diffrerential Stethoscope of Dr. O. Leyton and the Symballophone of Dr. William J. Kerr.

                                 

A unique Leyton Differential Stethoscope, circa 1918. Dr. O. Leyton based its design on the differential stethoscopes developed by H. Bock and M. Y. Oertel. The differential stethoscope was used to determine the relative intensities of heart sounds. The screw mechanism could be adjusted to allow for greater or lesser transmission of sound through the chamber and therefore record the intensity of sound. The stethoscope head shown on the two photos to the left was sold either separately or with binaural earpieces. The photos on the right show the original box that contained the stethoscope head and article with a description of the construction of the stethoscope and instructions on how to use the differential stethoscope.

 

William J. Kerr, M.D. was appointed the first full-time Professor and Chair of the Department of Medicine at the University of California San Francisco (UCSF) School of Medicine in 1927. He received his medical training at Harvard Medical School, graduating in 1915. Dr. Kerr's special interest was cardiolgy, in particular the use of instruments to aid the precise diagnosis of cardiovasular diseases. In 1937, he described "a modified stethoscope for the lateralization and comparison of sound" in the American Heart Journal and received a patent for his symballophone in 1940. In 1950, the Board of Regents released plans to build a new 12 story hospital and medical sciences building on the UCSF site overlooking Golden Gate Bridge. The cross shaped hospital was designed by architects Timothy and Milton T. Pfluger and named after the former Dean of the medical school, Herbert C. Moffit. Dr. Kerr convinced the California legislature to add funding for an additional 13th floor in the new hospital buiding to be held as a shell floor for future cardiovascular research. Thus when National Heart Institute funding became available, UCSF had available space and under Dr. Kerr's guidance a Cardiovascular Board dedicated itself to the creation of the Cardiovascular Research Institute (CVRI) on this floor. The floor plan of the 13th floor allowed multiple departments to work together as a single unit and established the importance of interdisciplinary research in medicine.


THE KERR SYMBALLOPHONE

           

William J. Kerr, M.D., circa 1940 and a photo of the document describing the use of the symballaphone that came with each stethoscope.
                          

                                                  

The Kerr Symballophone was very similar to Alison's differential model, but used two diaphragm chestpieces rather than bell chestpieces. In addition, sounds from either chest piece could be heard in both ears so that the examiner could compare sounds emanating from differnt parts of the chest. On the right is the Kerr Symballophone, circa 1940. Note the metal chest pieces and close-up of the double-looping tube connections of the binaural earpieces, such that each ear could hear the sound from either chestpiece. On the left is an example of the Symballophone, circa 1950s. Note that the chest pieces are now made of light weight bakelike instead of metal and that the rubber tubes are very long, presumably so that disparate parts of the chest could be auscultated and compared. The close ups show the leather case that contained this Symballophone. The stethoscope was used by Dr. Willaim Faulkner (1896-1976), a thorarcic surgeon who was at UCSF during the tenure of Dr. Kerr's leadership of the UCSF Department of Medicine.

 
The bell chest piece was very good for hearing the low-pitched sounds of the chest, however, there was the need to hear higher pitched sounds during auscultation. The diaphragm chest piece employed a membrane over the bell that allowed the higher pitched sounds to come through but blocked out the lower ones. It started to be used around 1900 and became a standard part ofthe modern stethoscope. The earliest models were designed to function as a small phonendoscope and came in a pouch for easy portability.
20thycenturyimg/Pilling_case_small.jpg

           

The early diaphragm models resembled the older bell models but had a rigid membrane covrering the bell. These micro-phonendoscopes were very popular in Europe in the early part of the 20th century. On the left is an Oertel model signed F. Davidson, London, circa 1905. The entire stethoscope is made of metal, including the flexible metal tubes, and came in a leather pouch. On the right is a similar Oertel design, but with rubber tubes attaching the ear pieces to the chest piece. It came in a canvas pouch, circa 1900.

                        

This Oertel model stethoscope was used in the 1920s by the Dutch physician L.M.S. Lekkerkerker-De Jong in Hilversum, Holland. This same physician's card is shown on the left and the photo on right is a European physician from that period with an Oertel model stethoscope draped around her neck. Note in the photo that the Oertel has flexible ear pieces, while Dr. Lekkerkerker's Oertel has a folding binaural metal earpiece and the metal chestpiece has an anti-chill rubber cushion but not a diaphragm.

                                                    

Examples of the Bowles stethoscope are shown above from left to right: Bowles Flat Iron Stethoscope in original wood box, circa 1898; Bowles Stethoscope in original wood box, large size, circa 1901; Bowles Stethoscope in original cardboard box, medium size, circa 1909; Bowles Stethoscope with extra hard rubber bell (with connector inserted into the bell) in its original wood box, circa 1915; Bowles Stethoscope in original cardboard box, circa 1930.

 

                              

The Bowles chest piece was designed with concentric circular grooves to enhance transmission of sound from the diaphragm into the tube connecting to the ear piece. Shown above starting from the left is the chest piece with 1. metal protective cover clipped on, 2. plastic diaphragm in place and 3. plastic diaphragm removed to reveal the grooves. In the middle photo is a rare sales sample Bowles stethoscope in its original wood box that was probably made for an Atlantic City medical meeting (note the label on the top half of the box) in June 1909. The box is 5.5 inches long and 1.5 inches wide. The sample bowles stethoscope is only 5 inches long. Bowles diaphragm chest pieces came in midget, small, medium and large sizes and with one or two connection tubes. Shown above on the right are the midget two tube, medium (regular) two tube and large one tube size chest pieces .

  

                                                       

From left to right are: Pilling Bracelet Stethoscope with metallic band for the arm and diaphragm button to facilitate measuring blood pressure, circa 1920; Early Sprague-Bowles Stethoscope incorpoarting the Ford bell and Bowles diaphragm into one chest piece with lever to switch between the two and Herschel clamp to adjust ear piece tension, circa 1926; Sprague-Bowles Stethoscope with a typical lever-valve to switch between the Ford bell and Bolwes diaphragm chest piece in original box, circa 1943; Rieger-Bowles Stethoscope with an improved lever-valve to switch between Ford bell and Bowles diaphragm chest piece, circa 1950; Rieger-Bowles Stethoscope with folding earpiece in original cardboard box, circa 1963.

 

                                                                

From left to right are: Kehler Stethoscope in original mahogany box, circa 1897; Kehler Improved Stethoscope with original cloth case, circa 1901; Fleischer Triple Head Stethoscope in original cardboard box and with cloth case, circa 1940; Fleischer Stethoscope with localizing rod screwed into the diaphragm, circa 1950; Meredith Swivel Stethoscope with faux tortoise shell diaphragm and bell, circa 1930.

                               

                                                   

From left to right are: Phonophore Stethoscope with rubber anti-chill cushion, circa 1910; Minature phonendoscope with hinged localizing rod, circa 1920; Teske Stethonoscope in original leather case, circa 1930; Pollard Stethoscope with tension screws to adjust the stretch of the diaphragm (missing), circa 1940;Pilling Heart Beat Stethoscope with tension adjustment of the diaphragm (missing), circa 1930. 

                    

            


A photo on the left of the Cardiac Clinic at the New York Post Graduate Medical School and Hopsital (now Tisch University Hospital of NYU Medical Center) is shown with a physician standing who is using a ford bell stethoscope to auscultate a patient's heart and another physician sitting who is taking the blood pressue of a patient, circa 1910. On the right is a glass lantern slide with a label that reads  "Doctor using stethoscope to listen to patient's heart; nurse making record on chart. Cornell Med. Center, NY" circa 1911.
( NYU Photo courtesy of the NYU School of Medicine Archives )

He found that costs remain high despite the expiration of 1960s-era stethoscope design patents, and so gathered Glia's team of hackers and hardware boffins to build the 3D-printed device.

It cost about US$10,000 to develop, and has been released as an open source model for anyone to use.

                                            

The left photo is a Western Electric "3A" Stethoscope, circa 1925. The device was portable (14 lbs) and the volume and fliter of ascultatory sounds could be adjusted by turning knobs on the amplifier panel. The photo shows the chest piece to the left of the case and the to the right the Y attachment for a binaural ear piece. A second "consultant" could also listen. The instructions for use of this electronic stethoscope were given on the plate on the inside of the cover which is also shown above. On the right is a RCA "Acoustic" Stethoscope, complete with instructions and technical information, circa 1943. The Faraday "Sonoscope" is shown on the far right in its wooden box and came with instructions and technical information, circa 1956.


THE RAPPAPORT-SPRAGUE STETHOSCOPE

A Sanborn Company and Hewlett Packard Rappaport-Sprague binaural stethoscope set that dates to the early 1960s.  The chestpiece is marked:  RAPPAPORT / SPRAGUE / STETHOSCOPE // SANBORN / COMPANY / WALTHAM / MASS, U.S.A.  The set includes a wallet marked HEWLETT / PACKARD / SANBORN / DIVISION, that holds chestpiece fittings and two sets of additional earpieces.  Hewlett Packard took-over the Sanborn Company, of Boston, in 1961 and changed its name to the Sanborn Division.  While HP produced the Rappaport Sprague for the next 40 years, the Sanborn Company was the original maker, following the design of Dr. Howard Sprague, a Boston cardiologist, and Maurice Rappaport, an electrical engineer and acoustics expert at Sanborn.  This instrument is one of the first of the Rappaport Sprague stethoscopes to be sold by HP, but is housed in its original Sanborn cardboard box. These stethoscopes were considered the finest acoustical instruments made for auscultation in the 20th century.  
(Photos courtesy Alex Peck)

Dr. David Littmann was a distinquished cardiologist and international authority on electrocardiography. In 1961 he described the "ideal" stethoscope in the Journal of the American Medical Association . The stethoscope included an "open chestpiece for the the appreciation of low-pitched sounds, a closed chestpiece with a stiff plastic diaphragm to filter out low-pitched sounds, firm tubing with a single lumen bore, the shortest practical overall length, a spring with precise tension to hold the ear tubes apart, and light and convienent to carry and use." The Littmann Stethoscope was referred to as a "two-sided chestpiece" stethoscope and was originally made by a small, Cambridge Massachusetts company, Cardiosonics. There were two models, the doctor's stethoscope and the nurse's stethoscope. The Littmann Stethoscope rapidly became the stethoscope of choice in America and its simple design is still the basis for most stethoscopes used in medical prcatice today.

THE LITTMANN STETHOSCOPE

                                                            

David Littmann, circa 1961. Note the Littmann stethoscope hanging from his neck in the photo.
On the left is the original Littmann stethoscope, circa 1961. The use of stainless steel and firm tygon (instead of rubber) tubing made from plastic enabled the manufacture of a model weighing only 3 onces. On the right is the original cardboard box that contained this stethoscope.
( Photo of Dr. Littmann from the Harvard/Roxbury VA Yearbook)

Ron Littmann, the grandson of Dr. David Littmann, provided this brief history of the development of the Littmann stethoscope below:

My Grandfather owned a house in Medford Mass where my father was born.  In his basement he had an old fashioned metal lathe he used to tinker with and where he created the stethoscopes and the chest pieces. Gus Machlup and his family fled Austria and came to America in 1939 to escape Hitler and the Nazi Regime. My Grandfathers house in Medford was like a duplex- split in half. He rented the other half to Machlup and his family. Gus was an entrepreneur. My grandfather was tinkering in his basement and he showed them to Gus and the rest was history. So as the story goes David created more and more out his basement and Gus convinced him that my grandfather wouldn’t have to put any more money in, Gus would foot the bill and they formed a business partnership to produce the Littmann stethoscope. David sold them out of his basement as Gus did the footwork. The cost back then was $25.00 per scope and if you bought 3 they were reduced to $18.75 each (no kidding). The scope caught wildfire and in 1961 together they had a production facility in Cambridge, Mass (Cardiosonics). The factory production was increased and it just took off from there. My grandfather was working on a special EKG lead of some sort when Cardiosonics was sold to 3M in 1967, and they continue to produce the Littmann stethoscope today.

               

On the left is the prototype of Littmann stethoscope, circa 1960, made by Dr. Littmann in the in the basement of his house. Note there are no markings on the stethoscope head. To the right is the prototype of the first 3M Littmann stehtopscope circa 1967. Note the marking 3M Littmann on the stethoscope head.
(Stethoscopes obtained from Ron Littmann)

          

Pictured above on the right are 3D Loubani stethoscpoes. On the left is a 3D printed stethoscope designed by an aspiring veterinarian at the University of Tennessee, bought online in 2017 from Shapeways for about $15.

In 2018, M3DICINE launched an "AI enabled" electronic stethoscope called Stethee. The device can be used like a traditional stehtoscope to auscultate patients, but also to amplify, filter and record sounds. The sounds can also be analyzed with an accompanying smartphone app. Its "Aida" artificial intelligence software is capable of providing insights about the recorded sounds in order to make approriate diagnoses, and even create a biometric signature for the patient based on gathered data. 

                  
                                         

Pictured above on the left is the Stethee, and to the right in addition to the Stethee the accompanying blue-tooth earplugs to allow the physicin to listen to the sounds and smartphones and smartwatch which record and display the characteristics of the sounds.

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