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 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
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
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
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:
The mechanism to hold binaural ear pieces in
place has been a constant challenge in the development of the
modern stethoscope. One very interesting mechaism was developed a
relatively short time ago and represents the continued
ingenuity that has characterized the development of the
stethoscope throughout its long history.
In 1980, a newly licensed Psychiatric Technician often had to struggle with agitated patients while trying to get his stethoscope in place in order to take vital signs. He adapted the Littmann stethoscope and devised a binaural headset tension mechanism to effect a scissor type action such that the stethoscope could be grabbed with one hand and squeezed as shown on the cover of the stethoscope box, which enabled the two tubular parts of the ear piece to be opened and easily put on or taken off the ears. This then 22 year old innovative young man, Janson M. Pope, Jr., sent me his stethoscope shown above ( Stethoscope with One-Handed Headset Operation, USA Patent # 4406346, September 27, 1983 ).
Dr. Tarek Loubani, an
emergency physician working in the Gaza strip, developed a 3D-printed
stethoscope as part of a project to bottom-out the cost of medical
devices. Loubani together with a team of medical and technology
specialists designed the stethoscope and tested it against global
standard benchmarks, finding it performed as well as the gold-standard
Littmann Cardiology 3 stethoscope, which served as the basis for the 3D
design. The Glia project was born in 2012, where Loubani and his
medical colleagues were in short supply of the life-saving equipment
and forced to listen to the heartbeats of scores of Gazans with ears
placed on chests (Immediate auscultation). Dr. Loubani says the concept
of the 3D-printed stethoscope was inspired after he tested his nephew's
toy stethoscope and found it performed much better than expected. Since
costs remained high despite the expiration of 1960s-era Littmann
stethoscope design patents, Glia's team of boffins built the
3D-printed device, which has been released as an open source model for
anyone to use and can be printed at a cost of $2-5.
A variety of twentieth century stethoscopes contained in their cardboard boxes with a label identifying the type of stethoscope and manufacturer are shown below.
The stethoscope became the hallmark of the physician and had a profound effect on the art of physical diagnosis. It remains today an indespensible diagnostic instrument. Although Laennnec invented the simple wooden cylinder stethoscope nearly 200 years ago, few modern stethoscopes show any significant acoustical improvement since the time of Laennec (Ertel PY et al. Stethoscope Acoustics: Transmission and Filtration Patterns. Circulation. 1966;34:899-909).
We hope you have enjoyed your tour of the history of the stethoscope. Please come back soon.
We are always interested in acquiring new items for the collection. If you have any items for sale or questions, please do not hesitate to contact us.