pos THE BINAURAL STETHOSCOPE


THE BINAURAL STETHOSCOPE

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In the early 1850's there was a rush of designs for a new stethoscope that used both ears. This new "binaural" ('bi-aural') instrument was felt to be the future of auscultation. Actually, the idea for a binaural stethoscope was first introduced in 1829, just ten years after the publication of Laennec's text illustrated his original instrument. The idea belonged to Nicholas Comins, who devised a stethoscope that he described as "a bent tube" that had several hinges, allowing the physician to not have to assumeuncomfortable positions during the examination. He offered the suggestion of making hisinstrument binaural, but there are only sketches of his instrument.

READ COMINS' DESCRIPTION OF HIS STETHOSCOPE

Arthur Leared presented a model of a "double" stethoscope made of gutta-percha at the Great Exhibition in London in 1851 The first commercially marketed model was that of Nathan Marsh of Cincinnati in 1851. His model was made of india rubber and contained the first recorded diaphragm chest piece. However, it proved bulky and cumbersome,and quickly faded. The diaphragm would not re-surface for 50 years. In 1852, Dr. George Cammann of New York produced the first recognized usable binaural stethoscope. He was working as a physician at the Northern Dispensary in New York City and had seen Marsh's model. He also had a model of a soft metal, multiple-tubed stethoscope made by H. Landouzy in 1841, which was designed for two people to listen at the same time. And Charles J. B. Williams claims to have made a binaural stethoscope with lead tubes in 1843. Cammann did not claim to have the original idea for a binaural stethoscope, only to have developed a practical instrument that could be used in clinical practice. Cammann had some help in designing his stethoscope and, interestingly, never patented the stethoscope believing it should be freely available to physicians. The stethoscope was named Cammann's Stethoscope by the manufacturer of the original instrument, George Tiemann. Cammann's model was made with ivory earpieces connected to metal tube that were held together by a simple hinge joint, and tension was applied by way of an elastic band. Attached to these were two tubes covered by wound silk. These converged into a hollow ball designed to amplify the sound, and attached to the ball was a conical shaped, bell chest piece.

Original Cammann, 1852

     Close up 
      
 
      
 
             
 
 
 
 
 
 
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 Velvet 
 covered and mark     
            Close up 
      
 
      
 
            
 
 
 
 
 
 
 of 
 
 hand 
 engraving           
 
The earliest known original model Cammann binaural stethoscope made by George Tiemann, circa 1852. This is an exceptionally rare and important early 1850s initial model Cammann binaural stethoscope with the front of the yoke delicately hand-engraved Dr. Cammann's / Stethoscope. Tiemann / N. YORK is stamped on the reverse side. Note the velvet sleeves covering the very short  tubes. The large and flaring chestpiece was turned from ebony wood, and the earpieces are ivory. This stethoscope was obtained from the Intenational Museum of Surgical Science, Chicago, Il, when it reorganized its science collection and is the same instrument pictured in American Surgical Instruments, by James M. Edmonson, p. 106, figs. 138 and 139.
(Photos courtsey Alex Peck)

Prior to 1855 George Tiemann marked his medical instruments as Tiemann, after 1855 used the mark G. Tiemann & Co. and later used the mark Tiemann & Co. The markings on the models shown below help date these stethoscopes and are consistent with the introduction of the Cammann stethoscope in 1852.


 Cammann Stethoscope, Circa 1852                    Cammann Stethoscope, Circa 1855                    Cammann Stethoscope, Circa 1860

  Close up of engraving                      Close up of mark                    Close up of mark

To the left is an original Cammann stethoscope, circa 1852. The yoke of the hinge joint is hand engraved Dr. Cammann's Stethoscope and the reverse is stamped Tiemann N[ew]. York. This initial model had a large and flaring ebony chestpiece and ivory earpieces. The flexible woven tubes were covered with velvet and were very short as compared to later models. This stethoscope and the one above are the only two hand engraved Cammann stethoscopes known to exist.

The Cammann stethoscope shown in the middle photo dates to 1855. The left side of the yoke of the hinge joint is stamped Dr. Cammann's Stethoscope, but is not hand engraved. The right side is stamped G. Tiemann & Co. Note that the wood bell does not have as large a flare and the velvet covered tubes are a little longer. This is the only example of this Cammann stethoscope known to exist.

On the right is Cammann stethoscope, circa 1860. The left side of the yoke is marked Dr. Cammann's Stethoscope but is not hand engraved. The right side is marked Tiemann & Co. Note that the flexible tubes are longer, not covered in velvet and are attached by gutta percha connectors to the binaural ear tubes. The two parts of the stethoscope could be detached for carrying and reattached for auscultation.

TIPS ON DATING CAMMANN TYPE INSTRUMENTS




Dr. George Cammann        Nothern dispensary minutes         Nothern dispensary minutes         Northern Dispensary        Northern Dispensary        Northern Dispensary

A Photo of New York physician George P. Cammann, circa 1855, who developed the binaural stethoscope while working at the Northern Dispensary. The Northern Dispensary was built in 1831 to provide medical care to the "sick and poor"and was open from 1831 until 1989. The Dispensary is the only building in New York City that has two sides on one street (Waverly Place) and one side on two streets (Christopher and Grove Streets). The three sided building occupies the triangle formed by those streets. Shown above are the photos of the Northern Dispensary in 1885 and 2006, looking the same as it did in 1852 when Dr. Cammann deveolped his stethoscope. Notice the young boy pausing on his bike, while trying to decide which fork in the Waverly Place road to take, which splits into a left and right street at the tip of the Northern Dispensary triangle. Dr. Cammann was appointed to the Dispensary in 1832 as an Attending Physician and worked there for 28 years until he resigned in 1859 and then contiunued to serve as a Consulting Physician until his death in 1863. Shown above are photos of pages from the June 7, 1832 and October 7, 1859 minutes of the Proceedings of the Trustees of the Northern Dispensary appointing Dr. Cammann to the Dispensary and thanking Dr. Cammann for his faithful service to the Dispensary, respectively. He was also a member of the St. James Episcopal Church, Fordham and one of the church's four Royal Bavarian Stained Glass Windows portraying Saints John and Peter healing of a man by the Jerusalem Temple's Beautiful Gate, installed when the church was built on its present site in 1864-65, was in memory of Dr. Cammann for his humanitarianism. The window dedication reads "In Memory of Geo. P. Camann M.D. dec. Feb. 14. 1863."
( Dr. Cammann photo courtesy of the Burns Archive, Nothern Dispensary minutes courtesy of the New York University Archives, Northern Dispensary photo by Jefferson Siegel and stained glass window photo courtesy of St. James Episcopal Church, Fordham).

READ "THE SELF ADJUSTING STETHOSCOPE OF DR. CAMMANN"



Cammann models were designed with different types of tension mechanisms in order to hold the binaural ear pieces together so they would be firm against the auscultator's ears. The original tension mechanism designed by Dr. Cammann was an elastic band stretched between the two ear pieces. Below are various examples of the tension mechanism.

Cammann Stethoscope with Elastic Band     Cammann Stethoscope with spring     Cammann Stethoscope with Ford mechanism      Cammann Stethoscope with Screw Mechanism

To the far left is Cammann stethoscope with elastic band, which was the original tension mechanism designed by Dr. Cammann, W.F. Ford & Co, circa 1870. Next is Cammann stethoscope with spring tension mechanism, circa 1880 and a Cammann stethoscope with Ford's patented wire spring tension mechanism to hold ear peices together, Hazard, Harzard & Co, circa 1890. On the far right is a Cammann stethoscope with screw tension mechanism, Sharp & Smith, circa 1880.


The Cammann stethoscope usually came in a carrying case, although most of these were lost over time. The cases are more difficult to find than the actual stethoscopes at this point. Various examples of such cases are shown below.


Cammann in original tin case               Cammann in original leather case             Cammann in original cardboard box

Cammann stethoscope in its original tin case, circa 1870.

Cammann stethoscope, circa 1880, marked Dr. Cammann Stethoscope, Tiemann & Co. and its leather case. The tooled leather case is marked Dr. John Hatton (1838-1898) who graduated the Iowa University Medical College in 1870 and practiced in Des Moines.

Cammann stethoscope in its original cardboard box, circa 1890. The label is marked Cammann Stethoscope, with elastic rubber band tension spring, Chas. Truax, Greene & Co., Chicago Illinois.




Unusual Cammann stethoscope with horn bell, brass ear tubes and ivory ear tips marked H.G. Kern, Philadelphia, circa 1860.

As was the case with Laennec's model, Cammann's was not embraced completely for quite some time. It was not until Austin Flint (who had previously spoken against the binaural in 1856) endorsed it in 1866 that it became widely used. During the later half of the 19th century, well educated physicians used advances in medical technology to aid their ability to diagnose diseases in their patients. The stethoscope rapidly became the main symbol of the highly skilled physician.

Doctor in his office

A photo dated May 1889 of a physician in his office with a medical text on his lap, surrounded by medical equipment including a Bauch & Lomb microscope and Cammann stethoscope on his desk. The use of the microscope and stethoscope by physicians represents the advances in technology applied to the practice of medicine in the nineteenth century.



The Harvard Medical School (HMS) was founded in 1782 as the Massachusettes Medical College in Cambridge. John Warren, Professor of Anatomy and Surgery, and one of the three original medical college faculty, was instrumetal in moving the school to Boston. As there was no hospital in Boston at that time, teaching medical students was devoid of clinical experience. In 1811, his son, John Collins Warren,  was a leader in establishing the Massachusetts General Hospital (MGH), the third oldest hospital in the United States. Like most hospitals founded in the 19th century, MGH was intended to care for the poor. In 1869, a progressive curriculum was instituted at the school,  new departments of basic and clinical sciences were established, a three-year degree program was introduced, and the apprenticeship system was eliminated. Harvard Medical School became a professional school of Harvard University, setting the United States standard for the organization of medical education within a university.

                        
                          MGH         HMS                     
       

Pictured above on the left is the Bulfinch Buiding of MGH, circa 1880, with its famous ether dome on top of the buiding. Ether was first used for anesthesia during surgery at the MGH in 1846. The dome shaped and glass ceiling of the surgical theater not only enabled surgeons to operate with natural daylight but also to remain awake while performing surgery on their sleeping patients as the fumes from ether rose to the top of the domed amphitheater. HMS moved off the Cambridge campus to Boston and was located adjacent to MGH from 1846 through 1883. The HMS is pictured in the foreground in the photo on right with the adjacent MGH in the background, circa 1875.  In 1886, Reginald H. Fitz, Visiting Physician at MGH and the Shattuck Professor of Anatomical Pathology at HMS, published his seminal paper on "Perforating Inflammation of the Vermiform Appendix; with special reference to its early diagnosis and treatment". For the first time the term appendicitis was used to describe the most inflammatory disease of the right lower quadrant of the abdomen which was caused by inflammation of the appendix and that treatmant was early surgical removal of the inflammed appendix. 


THE HUSE COLLECTION

The unique medical collection displayed below is from Dr. Charles Archelaus Huse's medical office circa 1884 in Worcester, Massachusettes. The collection includes Dr. Huse's Cammann stethoscope, surgical instrument kit, urethral silver catheters, patient records, patient receipts, letter from the Dudley & Sheppard instrument company dated 1877 where Dr. Huse purchased his medical instruments, medical student ticket to Harvard Medical School dated 1879-80, and sign from his office in Worcester. Dr. Huse was born on August 7, 1855 in Worcester, graduated Brown University in 1878 and  Harvard Medical School in 1881. After graduation from Harvard, he served as the Boston Board of Health Assistant Port Physician for 14 months stationed at Deer Island. In the summer of 1882, he moved back to his home town of Worcester and established his practice of medicine and surgery. He was a member of the Massachusetts Medical Society and the Worcester Society for Medical Improvement from 1882-1884. Dr. Huse died prematurely at age 29 from "peritonitis" after a nine day illness on July 3, 1884, just two years prior to the publication of the classic paper by his former Harvard Professor, Dr. Fitz, identifying the cause of most cases of peritionitis as the rupture of an inflammed appendix. The Huse antique medical collection represents a truly unique look at this promising young physician and the practice of medicine in the late 19th century.
 


               Charles Huse             Huse Collection             Dr. Huse and Classmates


The middle photo shows Dr. Huse's outside office sign from 136 Austin Street, Worcester, Massachusettes, circa 1884, along with a ticket for C. A. Huse to attend Harvard Medical School in 1879-80. On the left is a potrait cdv photo of Charles A. Huse as a student at Brown University circa 1878 and on the right is a cabinet photo of him with his clasmates at Harvard Medical School circa 1881. Huse is sitting on the steps of HMS in the center of his class photograph.

  
Huse Stethoscope          Huse Letter          Dr. Huse's instruments


Displayed are Dr. Huse's Cammann stethoscope marked Shepard & Dudley, N.Y., and surgical instrument kit, obstetrical forcep and urethral dilators all marked Shepard & Dudley, New York. Also shown is a letter from the proprietor of Shepard & Dudley, New York, dated July 14, 1877, to Friend Charles [Huse] asking if he would like to join their family for a summer vacation. The letter implies that Charles knew them because he purchased the medical equipment that he intended to use as a medical student from their store.



    Day-Book Page         Physician Day-Book & Journal       #7 Winnie Clark

       CDV Winnie 



























Clark        CDV 


























backmark       

Dr. Huse kept meticulous records of each of his patients in his Physician's Day-Book & Journal shown above. Note patient # 7 on page 6 displayed to the left and in a close up of the page on the right, who Dr. Huse diagnosed as having Dyspepsia on May 4, 1883. This patient was Miss Winnie Clark whose carte-de-visite albumin photoghraph, circa 1880, is shown with her wearing a beautiful Victotian mohair wool hat and ornate gold chain. Hand written in old stlye dip pen ink on the back of the cdv is Miss.Winnie.Clark / Worcester Mass, as well as the backmark of the photographer: Fitton, 345 Main St., Worcester, Mass.


Dr. Huse's bills

Dr. Huse's records included individual bills for each patient, a copy of each bill and a Physician's Hand-Book to keep track of payments. A routine visit to the doctor cost $1.00 !



Bellevue Hospital in New York City is the nation's oldest public hospital. It was founded in 1736 as the Alms House, a six bed infirmary for the poor, and was located at the site of the current City Hall in lower Manhattan. In 1794, the Belle Vue farm on Manhattan's East Side was used to quarantine victims of the yellow fever epidemic in New York City.  In 1811, the Kips Bay farm, just north of Belle Vue, was purchased by the city for a larger almshouse. McKim, Mead & White designed the Bellevue Hospital buildings between 1908 and 1939 that stand today on the land of the Belle Vue and Kips Bay farms on First Avenue and 27th Street. The Bellevue Medical College was established in 1861 and the first School of Nursing in the nation based on Florence Nightingale's philosophy was opened in 1873 at Bellevue. In 1841, the University Medical College was established as the Medical Department of the University of New York on First Avenue and 26th Street. The College changed its name to New York University in 1896.  In 1898, Bellevue Medical College and University Medical College of New York University consolidated as the University and Bellevue Hospital Medical College, ultimately changing its name to New York University School of Medicine in 1960.  Bellevue Hospital remains today the nation's premier public hospital and continues its long tradition of serving as a primary teaching hospital of NYU Medical Center.


            NYU                        Bellevue Hospital

On the left is a photo of the Unversity College of Medicine (NYU), 1886. On the right is a photo of Bellevue Hospital, 1886.
These photos are taken from the "University of the City of New York / Medical Department / Forty-Sixth Annual Announcement of Lectures and Catalogue / Session 1886-87 /New York: 1886"



            Bellevue Ward 20                        Drs. Nammack and Tingley


Photo of Women's Ward 20 at Bellevue Hospital in New York City, circa 1888.
The photo has a legend identifying the hospital, ward, physicians and nurses bearing the mark of the Bellevue Hospital Photography Department, NY City. The enlarged photo on the right shows Dr. Nammack holding a Cammann stethoscope in his left hand, Dr. Tingley taking notes, presumaby of Dr. Nammack's ausculatory findings and nurse Ried with an open chart. Note that Dr. Nammack is also holding his patient's hand, perhaps to reassure her, as he discusses his observations.

Dr. Wm. H. Nammack

Photo of Dr. Wm. H. Nammack, circa 1900, from the book A History of Long Island by William S. Pelletreau.
Dr. William H. Nammack was a 1886 graduate of Bellevue Medical College and was one of  four "successful candidates for appointment in the Bellevue Hospital ". He served as a House Physician on the 3rd Medical Division at Bellevue Hospital in 1886-1887. In September of 1887, Dr. Nammack was appointed the Medical Superintendent of the Insane Pavillion of Bellevue Hopsital. He remained a member of the outside hospital medical staff for another nine years. Dr. Nammack was a physician and surgeon who originally practiced general medicine at 11 Rutgers Street in New York City. In 1892, he established his home and surgical practice in Far Rockaway. Dr. Nammack was visiting physician and pathologist at St. Johns's Hospital in Long Island City,  and  aslo served as the Coroner of Queens for a number of years. He was a memeber of the Bellevue Hospital Alumni Society, New York State and County, Queens County and Nassau County Medical Associations, and Society for the Relief of the Widows and Orphans of Medical Men. His son Griswold D. Nammack, grandson Griswold P.D. Nammack, brother Charles E. Nammack, and nephew Charles H. Nammack were also all physicians affiliated with Bellevue Hospital. Dr. Nammack's great grandson Thomas W. Nammack is the Headmaster of The Montclair Kimberley Academy, Monclair, New Jersey, and provided part of this history of the Nammack family.

Dr. Witter Kinney Tingley was also a graduate of Bellevue in 1886 and another of the four graduates to serve as a  House Physician on the 3d Medical Division in 1887-1888. Dr. Tingley practiced General Medicine in Norwich, Connecticut and served as President of the Norwich Medical Association in 1890. He was one of the incorporaters of and Visiting Physician to Backus Hospital in 1892.

Dr. Robert Alexander Murray was a graduate of University Medical College (NYU) in 1873 and a House Physician on the 2d Medical Division from 1874-1875. Dr. Murray practiced General Medicine and specialized in Disease of Women at 235 West 23d Street , New York City. He served as Attending Physician, Diseases of Women, at the Northwestern Dispensary, New York City, from 1876-1883 and Assistant Professor of Obstetrics at University Medical College (NYU) from 1876-1886. He also served as an Instructor in Obstetrics, New York Polyclinic from 1887-1888. Dr. Murray authored various articles on obsterical subjects in medical journals.


Ms. Ried, Autisdale and Chase were Nurses at Bellevue Hospital.




                  Bellevue Rounds                   

Another photo of Rounds at Bellevue Hospital from the Bellevue Hospital Photography Department, circa 1891. Similar to the previous photo, a physician is using a Cammann Stethoscope to auscultate the heart of a young patient, while a medical student takes notes of the physical diagnostic findings and a nurse holds an open chart.
( Photo courtesy of the NYU School of Medicine Archives )


READ DR. CAMMANN'S SON'S ADDRESS REGARDING HIS MODIFICATION OF HIS FATHER'S STETHOSCOPE



Several physicians came up with their own ideas for stethoscopes using materials that were commonly found in a physician's office. For example, in 1884, E. T. Aydon Smith described a stethoscope he invented:  "..the chest-piece of which is formed by a pair of ear-specula, the tubes are Jaques' India-rubbercatheters, and the ear-pieces those of an otoscope."He designed his instrument to be used as a simple binaural, a differential stethoscope (by using one of the ear-pieces and chest-pieces for each ear), a tourniquet (by wrapping the rubber around the arm) and, also as a urinary catheter for both males and females. Quite a diverse instrument!

Another modification was Dr. Cammann's modified instrument (D.M. Cammann, M.D., not the same as the original), incorporated a chest piece with a rubber ball, which was used as a suction cup to apply it to the chest. This would leave the hands free to percuss to chest. It was found to be of little value to the untrained ear.

New improvements to the stethoscope focused on the tension mechanism to hold the ear-pieces to the head of the physician. There was a design of a spring-tension mechanism which had a screw that could be turned to open or close the ear-pieces. The first of these new models was KNIGHT'S model, which had a characteristic design on the poles that attached to the ear-tubes. The Charles Truax catalog of 1890 states that
"Knight's stethoscope does not differ materially from the pattern of Cammann. The principal change is in the form of the spring, which in this case is spiral, acting on two levers in the form of a toggle joint."

The screw mechanism became a great success and would be included in the models that followed for many years.


Knight Stethoscope          Knight in box

Knight's Stethoscope with two bells and a Flint Pleximeter and Percussion Hammer that is shown with its original wood carrying box, Codman & Shurtleff, Boston, circa 1880. On the left the instruments are shown out of the box and on the right placed inside the box. The bells were interchangeable in that each could be screwed on and off the body of the stethoscope depending on the choice of the physician.


A unique modification of the Cammann bell was Ware's model. This model was a practical adaption of the bell in which a smaller bell could be screwed into the larger bell such that the larger bell never had to be removed. The smaller bell was utilized for a more precise localization of sound during auscultation, most especially during auscultation of the heart. 


Dr. Osler's stethoscope            Sir William 



















































Olser           Ware's bell

A Knight's Stethoscope with Ware's bell, circa 1870s, that belonged to Sir William Osler while he was a student and later a faculty member at the McGill School of Medicne. Dr. Osler's stethoscope was obtained from his grand niece, Marian Grace Francis, who found it among Dr.Osler's dissecting equipment in the Francis household. Marian Grace was the daughter of William Willoughby Francis, the son of Osler's cousin Marian Osler Francis. The Francis household was a home away from home for Dr. Osler while he was at McGill and he was very close to her children and especially to his godson, William, who was most often referred to as his nephew. William W. Francis was the cataloger of the Osler library and the first librarian of the Osler Library at McGill. This stethoscope is rare in and of itself because of the Ware's bell, not to mention the provevnace through the Francis family to one of medicine's most revered physicians, Sir William Osler. The photo of Dr. Osler was taken in the 1870s when he was a member of the medical faculty at McGill and physician and the first pathologist at Montreal General Hopsital. Dr. Osler was an ardent "student" of pathology in the great tradition of Laennec and others who applied their post-mortem findings to better understand the pathophysiology of disease. Thus Dr. Osler's grand niece finding his stethoscope among his pathologic dissecting equipment is not suprising.
(Photos courtesy Alex Peck)


McGill School of Medicine           Montreal General Hospital   

The first medical school building of McGill School of Medicine shown on the left opened in 1872, just after Dr. Osler graduated form McGill. The photo on the right is Montreal General Hopsital, circa 1872. Dr. Olser would later say that "When I began clinical work in 1870, the Montreal General Hospital was an old coccus and rat-ridden building, but with two valuable assets for the students - much acute disease and a group of keen teachers" (
The Medical Clinic, British Medical Journal, January 3, 1914 ). Dr.Olser once said he hoped his tombstone would say only,"He brought medical students into the wards for bedside teaching." And his most noteable teaching to his students at the bedside of patients was "Listen to your patient, he is telling you the diagnosis", emphasizing the impotance of taking a thorough history as part of the complete examination of a patient.


There was still a desire to improve the sound conduction through the tubes. Around 1882, Bartlett designed a stethoscope that used metal ear-tubes with silk covered rubber tubes leading to a wooden chest piece. This model was also called "Bartlett's Laennec" stethoscope and was an ingenious design. Truax describes Bartlett's Laennec model as "The Laennec stethoscope, devised by Bartlett, belongs to the heavier class of stethoscopes, the instrument throughout being stronger that those of the ordinary Cammann pattern... a heavy spring, somewhat similar to the pattern of Knight."
 
Bartlett's Stethoscope          Bell's Stethoscope         Cammann horn stethoscope

Bartlett's Stethoscope shown on the left was a heavier version of the Knight model, circa 1880.
Bell's Stethoscope, circa 1875, has an all metal chest piece with rubber rim in this adaptation of the Knight model.
The
Cammann stethoscope on the right has an unusual horn bell, brass ear tubes and ivory ear tips and is marked H.G. Kern, Philadelphia, circa 1860.



There were many different modifications to Cammann's original instrument. Scott Alison came up with a 'Differential Stethoscope' that consisted of two independent chest pieces, and was designed to allow the listener to compare the sounds of two areas of the chest. This instrument was also found to be impractical because it muffled certain sounds. Most references list this piece as circa 1885, but it was actually first illustrated in the John Weiss & Son catalog in 1863.


Alison's Differential Stethoscope          Alison's Differential Stethoscope, close up of chest pieces          Allison's Differential Stethoscope, 1930        Allison's Differential Stethoscope, 2000

Alison's Differential Stethoscope is displayed on the left, circa 1860. The close up shows the ebony bell chest pieces. It is signed "Ferguson, London."
On the far right is an example of a modern differential stethoscope with metal diaphragm chest pieces, circa 2000 and next to it is a differential Stethoscope with plastic bell chest pieces, circa 1930.




In 1885, Charles Denison came out with an entirely new model, based on Bartlett's. His was based on the idea of funneling sound to the ears, much like the monaurals. His earpieces were made of hard rubber which led into woven tubes and a large chest piece. It came with three interchangeable chest pieces for hearing different types of sounds. The tension between the earpieces was accomplished by a clever screw mechanism.Denison's model was widely accepted. So widely, that many makers began marketing inferior pieces of the "Denison Stethoscope." Denison became outraged at the poor quality of stethoscope being manufactured with his name. He delivered a powerful speech in which he stated precisely how his stethoscope was to be made, condemned the makers of poor instruments, and praised one American company for their quality craftsmanship.

Denison stethoscope, Mutter Museum                  Dennison's Stethoscope without large bell          Dennison's Stethoscope with large bell

Denison's Stethoscope, circa 1885.
Left example with multiple size bells, courtesy of the Mutter Museum. Right examples are in this collection, shown without and with large bell. The stethoscope was used withhout the bell for auscultation of children.

READ DENNISON'S "THE ESSENTIALS OF A GOOD STETHOSCOPE"



As Denison's was becoming popular, more improvements to Cammann's original design began to surface. Most of these did away with the resonating bell in favor of simpler bells. An important development was the Davis modification in which the the ear pieces were held in place by a metal tension band. Although the Cammann was still being produced at the turn of the century, most physicians were using these more convenient models. 

Davis Stethoscope with wire tension spring                   Davis Stehtoscope 

Davis modification of the Cammann Stethoscope which incorporated a wire metal tension spring between the metal ear tubes. In this early model, the wood chest bell was attached to the ear piece by a flexible tube which inserted into the wooden ball connecting the ear piece, circa 1880.On the right is a later model Davis stethoscope with simple bell and metal tension mechanism between ear pieces, circa 1890 .

                

Matthews Stehtoscope                 Unusual Stethoscope

On the left is a Matthews stethoscope with detachable chest piece and ear tubes for easy portability, circa 1882.  Shown on the right is a very unusal folding stethoscope with ivory ear pieces and a unique bell that is a smaller version of the original Cammann bell with a insertable plug designed after the William's plug, circa 1890. This two piece bell is made of wood and allowed the auscultator to change the size of the bell by inserting or removing the plug.



Convenience came in several ways. Longer tubes added more flexibility, but other methods were used as well. Around 1880, Lynch's stethoscope was marketed, which folded onto itself and thus greatly reduced it's length. Sheppard's model (1890), by contrast, folded the earpieces together reducing the width of the instrument.


Lynch Stethoscope       Lynch Stethoscope folded                     Sheppard's Stethocope       Sheppard's Stethoscope box top

Lynch's folding stethoscope, circa 1880. This piece folds top to bottom as shown on the right. Sheppard's folding stethoscope in its original box shown on the right. This piece folds in half. On the left is the top of the cardboard box which is marked "Sheppard's Stethoscope / patented July 7th, 1890."


The next landmark improvement was the invention of the 'Ford's Bell' chest piece in 1885. This simple model was made of steel with either gutta-percha, ebony, or even ivory at the base. It funneled sound into two tubes, usually made of rubber, which led to the earpieces.

Ebony Ford's bell stethoscope             Ivory Ford's bell stethoscope           Metal Ford's bell stethoscope

Three examples of early Ford's bell stethoscopes with a simple metal band tension mechanism holding the ear tubes together. On the left the Ford's bell is made of ebony, circa 1890. In the middle the Ford's bell chest piece is made of ivory with,circa 1895. On the right the Ford's bell is made of metal, circa 1895.


  Down Brothers stethoscope           Down Brothers locking mechanism           Stethoscope with Herschel mechanism

Three examples of binaural stethoscopes with interesting tension mechanisms to hold ear tubes together.
On the left is a Down Brothers stethoscope with finger rest, interesting screw spring tension mechanism, ivory ear tips and Ford bell made of ivory, circa 1900. The ivory bell unscrews to creat a smaller bell for the examination of children. In the middle is a binaural stethoscope marked Gallante, circa 1890. The wood chest piece and ear tips are typical of French binaurals of this period. Note the spring tension mecahnism between the ear pieces. The right photo shows a Holborn stethoscope with a slender, wood bell typically used for children, Herschel's locking mechanism with lever and ivory ear tips, circa 1900.


Down Brothers stethoscope, finger rest      Down Brothers stethoscope, army        Down Brothers stethoscope, cushion                    Stethoscope with horn; bell       British stethoscope       Metal folding stethoscope


The left three examples areDown Brothers stethoscopes with Ford's bells made from differnet materials.
On the left the stethoscope has a finger rest and Ford bell made of aluminum, circa 1920. In the middle is a folding stethoscope with the mark of the "British Army" with ivory Ford bell and wood ear pieces, circa 1910. On the right is a folding stethoscope with an anti-chill, rubber cushioned Ford bell, circa 1910.

On the right are three examples of binaural stethoscopes with Ford's bells made of various materials.
On the left is a folding stethoscope with a horn bell, circa 1910. In the middle is stethoscope marked "British Made" with an interetsing folding mechanism and wood Ford bell, circa 1900. On the right is a folding stethoscope with flexible metal tubing and a plastic Ford bell, circa 1920.



Many binaural stethoscopes only had flexible rubber tubes connecting the ear pieces to the chest piece. The ear pieces fit into the ear inorder to hold them in place. Although the stethoscope was convienent to carry in the doctor's pocket, the ear plug method was less than optimum for stable placement of the binaural ear pieces.


Ivory Reversible Stethoscope             Ivory Japanese Stethoscope            Gutta_Percha Stethoscope

Binaural stethoscopes with flexible rubber tubes to connect the ear pieces to the chest piece, circa 1880.
The example on the left is Chinese and has ivory ear pieces and a reversible ivory chest piece. Each end of the reversible chest piece was a different size and shape, presumably to examine different parts of the body. The middle ivory example is Japanese. The one on the right has a gutta percha chest piece.



There were also other types stethoscopes designed to enhance the quality of ausculatory sounds. The most notable and widely copied stethoscope was the Phonendoscope developed by Bazzi and Bianchi in 1894. It was the first stethoscope to incorporate the use of a diaphragm membrane. The phonendoscope was small circular unit with two diaphrgam membranes placed next to each other.  A  small steel solid rod which had a small gutta-percha chest piece was attached to the diaphragm for locaization of chest and especially heart sounds. The unit could be used with or without the localizing rod. There were two long runner earpieces that attached to the top of the unit. It was totally collapsible and measured only three inches in diameter. The idea was that the small chest piece could fit between the ribs and convey better sounds. While the Phonendoscope was marketed in America exclusively by the G. Pilling Company of Philadelphia, it was made and used in many other countries.
                                        
Phonendoscope in wood case          Phonendoscope, apart          Phonendoscope, together

Examples of two American Phonendoscopes made by G.Pilling & Co. On the left the phonendoscope is in its original velvet lined, wood box, circa 1909. The photo in the middle is another phonendoscope in its original metal case with the chest piece in the case and its extension screwed onto the top for carrying. To the right the stethoscope is put together for auscultation with the ear pieces made of gutta-percha attached by flexible tubes with metal ends to the chest piece and the extension tube screwed into the diaphragm of the chest piece.

Berlin Phonendoscope             German Phonendoscope             French Phonendoscope

Three examples of phonendoscopes made in Europe. On the left is a model with an adjustable valve to vary the intensity of sound made by Osker Skaller A.G. of Berlin. In the middle is a German model with gutta percha ear pieces and on the right a similar French model with glass ear pieces, circa 1900. All the phonendoscopes are displayed in their original, velvet lined, leather covered,carrying cases.



Double Phonendoscope


An unusal double phoendoscope made by Pilling that could be used as a differential stethoscope, circa 1910. There are two short localizing rods that when screwed into the diaphragm were used for examination of the heart. There are also two long localizing rods that were characteristic of mechanical stethoscopes used for listening to sounds of mechanical equipment. There is no record of the Pilling company making mechanical stethoscopes.


An interesting variation of the phonendoscope was designed by Dr. Schreiber, which could be used as either a typical monaural stethoscope or converted into a monaural phonendoscope.


Schreiber's stethoskop          Schreiber's stethoskop            Schreiber's stethoskop          Schreiber's stethoscope head

Schreiber's Stetheskop made of metal, circa 1900.
As shown from left to right, it could be set up as a monaural or by sliding the chestpiece down the stem to expose the shaft, a phonendoscope chestpiece could be attached to the stem. A close up of the phonendoscope chestpiece is shown on the far right.



Another intriquing example of this type of stethoscope is the WINCARNIS STETHOSCOPE. The two small discs are interchanged and placed against the small plastic diaphragm, allowing the listener to vary the loudness and quality of the sounds conveyed. The earpieces, made of ivory, are plugged into the top of the piece in the same fashion as the Phonendoscope. There are only two other known examples of this piece, one of which is located in the London Science Museum.


Wincarnis Stethoscope, apart              Wincarnis Stethoscope in case

Wincarnis stethoscope, circa 1890. On the right the stethoscope chest piece is shown in its original case. On the left the flexible tubes with ivory ear pieces and the chest piece taken apart are displayed. Note the plastic diaphragm against which either of the two wooden disks would rest


Marsh's Stethoscope, or Marsh's Stethophone, is a very interesting invention. It comes with a small dial on the back which has a pointer and the letters 'L,' 'S,' and 'W' engraved on it. These stood for 'Loud,' 'Soft,' and 'Weak,' respectively. The examiner would dial in the type of sound he was listening to in order to be able to hear it better.


Marsh Stethophone case          Marsh Stethophone            Marsh Stethophone chest piece           Marsh Stethophone assembled

Marsh's Stethophone, circa 1896
This is one of two examples known. The other is in the collection of the Armed Forces Institute of Pathology.


The Magniphone Stethoscope was an unusual device made by The Rectophone Company, but there is no other information about this piece. It is not listed in the catalogs of the Mutter Museum, the Armed Forces Institute of Pathology Collection, The Wellcome Collection, or the Dittrick Collection.

Magniphone

Magniphone Stethoscope, circa 1900.

The piece below is very interesting in that it combines the binaural ear piece of a stethoscope with a very long tube and wide bell charcteristic of a hearing aid or conversation tube. In fact, this piece is neither a stethoscope or hearing aid, but rather a "re-educative binaural tube to enable the patient to read or speak to himself and thus stimulate the dormant auditory centre by natural means of the voice" in order to treat middle ear deafness (Mayer&Phelps, circa 1931)

Re-educative scope

Re-educative scope, circa 1931.

CONTINUE TO EXAMPLES FROM THE 20TH CENTURY


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