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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.

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 inte

rior 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."

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 their 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 skilled wood turner and had a small shop in the basement of his home with a wood-turning lathe, stocked different types of wood and originally used to turn flutes. He was an accomplished flutist who often gave recitals at the homes of his friends. In 1817, he created stethoscopes from turned pieces of wood with a 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.

Original version of the Laennec stethoscope c. 1817 made from boxwood and turned by Laennec. It is not suprising that Laennec used boxwood as one of the early woods he tested to make stethoscopes, because as a flutist he knew that flutes were usually made of European boxwood, a finely grained, light colored wood that is very good turning material and carries musical sounds very well. 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 1819 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 in this collection shown above has the same features as a surviving stethoscope that Laennec also made and gave to his friend Professor Lobstein of Strasbourg (www.woodlibrarymuseum.org)

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.       An unusal first version Laennec stethoscope was also made as a short stehtoscope measuring about 8.5 inches long.


       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.

Shown on the left is a photo of the Hopital Necker, Rue de Sevres, Paris, circa 1900. Note the large cental 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). The plaque is still in place today. To the right of the plaque is a 2011 photo of the renovated original Necker Hospital with its current courtyard in the foreground. On the far 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 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.

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.

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 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

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

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).

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 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.

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.

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.

SIR JAMES McGRIGOR'S STETHOSCOPE

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.

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

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.

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

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.
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THE WILLIAMS STETHOSCOPE

Photograph of Charles James Blasius Williams, circa 1840.
(Photo courtesy of the National Library of Medicine)

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.



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.



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.

Portraits of Sir William Fergusson circa 1847 to 1874.
(Photos courtesy of the National Library of medicine)

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).

William Henry Hill was born on September 11, 1862 in Ormskirk, Lanchishire, England. He entered the University of Edinburgh Medical School in 1880 at the age of 18, and graduated in 1886 with a degree in medicine (Bachelor in Medicine [MB]) and surgery (Master in Surgery [CM]). During medical school he completed his medical and surgical clinical clerkships at the Royal Infirmary of Edinburgh. The University of Edinburgh required that a candidate for Degrees in Medicine and Surgery must have attended for at least 3 years the medical and surgical practice at the Royal Infirmary of Edinburgh (or a university recognized general hospital elsewhere). After graduation, Dr. Hill practiced in Silloth, Cumberland, England in 1887 and then in Churchfields, Old Basford, Nottingham, England from 1888-1915, as recorded in the annual London and Provincial Medical Directories. He married Fanny Cox in 1892, and they had three sons, one of whom a became a doctor (Charles Ernest Hill) also educated at the University of Edinburgh and Royal Infirmary of Edingburgh. Dr. Hill was member of the General Council of the University of Edingburgh, Medical Officer and Public Vaccinator for the Basford District of the Basford Union and Medical Referee for the British Empire, Pearl, Prudential and Victoria Assurance Companies. He practiced medicne and surgery for 29 years, and died on March 17, 1915 during the "Great War."

Shown above is 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).
This stethoscope belonged to William Henry Hill, MB. CM. who used it at the Royal Edinburgh Infirmary on General Medicine wards 32 & 33 during his clinical clerkships as a medical student at the University of Edinburgh. He did his medical and surgical clinical clerkships at the Royal Infirmary 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, as recorded in the Royal Infirmary ledger of Perpetial Tickets 1881-1882 (click on image to see the ledger detail). Also shown are three pages of the Undiversity of Edinburgh Medical Graduation Records for Dr. Hill, revealing the courses he completed from 1880-1886 and Professors who taught these courses (click on image to see the detail of the courses). In the middle of page 3 is a notation "Royal Infirmatry Edinburgh from November 1st 1880 to April 1886." Also at the bottom of page 3 under the handwritten title "Hospital" is a notation that he acted as the Clerk to Dr. John Wyllie for 6 months and as Dresser to Dr. Joseph Bell for 3 months. Dr. Wyllie would later become the Chair of Medicine at the University of Edinburgh Medical School and Dr. Bell's medical student Arthur Conan Dolye said he modeled the chracter Sherlock Holmes after Dr. Bell because he was a great observer and diagnostician. (Images of the Register of Tickets and Courses of Study were provided by the Edinburgh University Library Special Collections). On the upper 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.

Dr. Hill died on March 17, 1915 during the "Great War" (World War I), which is memorialized in one of the eight Basford St. Leodegarius church bells reading "In Memory Of William Henry Hill M.B.C.M. Who Died March 17TH 1915 During The Great War." Church parishioners also palced a large stone plaque on its south aisle wall which is shown below:

(To the Memory of William Henry Hill M.B. Church Fields, Basford. For upwards of 27 Years. A medical practitioner in this neighbourhood Born Sep.11 1862. Died March 17th 1915. This tablet has been erected by his Friends and Patients To record their sense of the loss sustained by his death and as a token of their appreciation of his upright character, his zeal and ability as a physician and surgeon and the unfailing kindness which he shewed to the Sick Poor committed to his care)

Shown above in the middle is an engraving of the Royal Infirmary of Edinburgh at Lauriston Place from the Illustrated London News in 1879, the year the Royal Infirmary at Lauriston Place opened.. 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). On the the left is a 2015 photo of the current Royal Infirmary medical buildings that were rennovatd to become a residential part of the Edinburgh Quatermile development. The buiding in the foreground is the rennovated medical wards 31, 32 and 33 (top three floors). Click on the image and enlarge the photo to see examples of the upper part of each window opened, which was the Florence Nightingale design to allow cross ventilation of the Infirmary wards. The image on the right is the architectural drawing of the "Edinburgh Futures Institute" of the University of Edinburgh. In 2017, The Universtity began restore the historic former Royal Infirmary surgical hospital to create a multidisciplinary building to form a wide range of teaching and learning spaces combining sciences, humanities, arts, business and external partners. The Institute is scheduled to open in 2021 in the heart of the Quartemile development.

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.

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

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 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.

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.

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. On the left is a Medical Purveyor report for the Confederate States Army that lists stethoscopes as part of hospital supplies. Also displayed is a hand written inventory from Hospital Ward H, Conesus, NY, 1865 showing a stethoscope as part of the ward Articles.
(center 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.

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.

Metal monaural stethoscope with swivel joint

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.

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.

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.

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.

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.

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

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.

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.

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THE MONAURAL STETHOSCOPE