Dr Graham Steell and monaural stethoscopes: Cardiology before the ECG

Dr Graham Steell, MB CM MD FRCP (1851-1942), an Edinburgh graduate, was a physician at the Manchester Royal Infirmary (1878-1911) and professor of medicine at the Victoria Manchester University (1907-1911). He is mainly remembered for describing the 'Graham Steel murmur', however his name is also associated with the 'Graham Steell monaural stethoscope', which he designed. His clinical examination of the cardiovascular system at the bedside was meticulous, using only his stethoscope, percussion hammer, and a sphygmograph to record the radial pulse. His work is described in his monograph, Diseases of the Heart (1906) and other numerous papers. The University of Manchester Museum of Medicine and Health has a collection of monaural stethoscopes, percussors and sphygmographs. This article explores Dr Steell's clinical techniques and contribution to cardiology in an era before chest X-rays and electrocardiography, and also discusses the use of monaural stethoscopes and percussion hammers by the wider medical profession during the Victorian and Edwardian period.