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History, Technology

Give the doc a phone: a historical long-view of telephone use and public health in Britain

Alexander Graham Bell’s early telephone, known as the ‘butterstamp’ telephone, which acted as both transmitter and receiver.

In Cornwall, a thousand patients have recently been given equipment to measure their own vital signs, such as blood pressure and oxygen levels, from home, and transmit them to a central hub where clinicians monitor the readings and keep in contact with the patients by telephone if required. This scheme, which you can read more about here, is a trial for a much larger plan more generally known as ‘tele-health’, on which more here and here, and was first brought to my attention by an interesting feature on BBC Radio 4’s ‘You and Yours’ programme the other day. Indeed, another item on the same programme some days later concerned a different pilot project whereby people phoning GP practices had their numbers passed on to the GP, who would then ring them back to chat and decide whether they should be coming in to the practice for a face to face appointment. Not everyone was happy about the idea of this arrangement, as they were concerned about losing the personal touch of the face to face meeting. More on that here. This inspired me to compare the modern use of the telephone by health professionals with the early use and reception of the telephone by medical communities when it was first invented. There are some interesting similarities and differences.

Studying telephone use is central to my PhD research, and my thesis will eventually discuss uses of and responses to the telephone from a wide variety of groups within late Victorian British society. However, members of the medical community were particularly important in the earliest days of the telephone. One of the very earliest telephone exchanges in the UK connected those employed in the medical profession in Glasgow from 1879, just three years after the telephone was invented in America by Alexander Graham Bell, himself a Scot by birth. Exchanges for the legal and commercial communities were added later, but the first inter-connected users were the doctors, pharmacists, hospitals and infirmaries. And, leading the way with a feature which would not become common in other exchanges until years later, night-time and Sunday service at the manual exchange was provided from the beginning.

Even without an exchange, the telephone was to prove its worth to medical practitioners. One rural doctor noted in a letter to the Lancet in November 1888 that the telephone had become particularly useful in helping him and his partner, who lived some five miles away, to efficiently run their practice. The telephone was quickly put to use within buildings such as hospitals. One testimonial letter, which was included in a list of subscribers published in February 1880, was written by the Lady Superintendent at the Hospital for Sick Children in Manchester in early August 1879, and stated:

 “[The recently installed telephone] is of the greatest value in connection with the Fever Ward, enabling me to always be in communication without risk of infection. I expected it would be useful, but I had no idea that it would prove the real comfort that it is. Already we begin to wonder how we managed before, and we would not be without it again on any account.” 

The benefits of using a telephone instead of the more traditional speaking tube when communicating with patients with contagious diseases were recognised very early. Whereas a speaking tube allowed the breath to pass through from one speaker to another, commentators at the time noted with pleasure that the telephone enabled the personal touch of a direct conversation without the danger of spreading disease. The medical journal the Lancet recommended its installation in sick rooms in private houses as well in December 1885, and further specified some design requirements for these telephones:

“All of us must have felt the heartaching anxiety of longing to hear the voice of a dear friend when either ourselves lying on, or the friend being confined to, a bed of sickness. The comfort of hearing the voice, with all its intonations, in such a case does not need to be described in words. To be really and generally serviceable, telephones for use in cases of sickness should be simple in their construction and cheap; but it is indispensable that they should be so made as to communicate the faintest whispering sound, so as to require no sort of effort on the part of the speaker, and they should be provided with mouth- and ear-pieces so light as to’ admit of their being held by a weak and trembling hand to mouth and ear during the conversation.”

A very early commercial telephone; the circular transmitter is located above the hanging receiver.  These were known as ‘Silvertown Sets’, after the factory which made them.

And in November 1887, at the height of a scarlet fever epidemic in London, the Lancet again remarked about the telephone:

“A certain gain which it confers is of course the comparative leisure allowed to attendants on the sick. There is no answering bells to find out what is needed, the door of the sick-room is less frequently opened, and fatigue generally, as also the risk of infection, is materially lessened.”

Furthermore, it was not just as a replacement for the existing technology of speaking tubes that the telephone was employed in these early days; many medical practitioners also utilised the technology of the telephone, which really enabled the clear transmission ad reproduction of complex sounds for the first time, to improve existing instruments, or to devise entirely new equipment and methods of diagnosis. The Lancet reported on several such instances: for example, from 1878 many were already suggesting that a telephone-like device might replace the traditional stethoscope, still little more than a tube of wood with shaped attachments at either end for application to the doctor’s ear and the patient’s chest. A description was given in March 1879 of a new stethoscope design inspired by the telephone which had “a disc of thick skin at each end”, and the sound of the heart would be conveyed from the one to the other more efficiently than by a normal stethoscope. The editors, however, preferred the old design.

Other medical men used the telephone to find bladder-stones in their patients, or used it as a metal detector to successfully locate bits of metal stuck in people’s bodies. The action of electrical induction between the device and the piece of metal caused the telephone to emit a noise which alerted the user to the discovery of the needle, bullet, or whatever had become painfully lodged in the unfortunate individual (possibly the original ‘machine that goes “ping”’..?). In 1879, one inventor, David Edward Hughes (who also invented the microphone, amongst many, many other useful things), produced a new instrument called an audiometer. This could produce sounds of varying volume, and could be used to very accurately test a person’s hearing, allowing the practitioner to record the results in order to make comparisons over time or against other individuals. Benjamin Ward Richardson, a medical man, used the telephone as an instrument to make the pulse audible, for use in diagnosis and in teaching.  He reported his experiments with this instrument, called a ‘sphygmophone’, to the Royal Society, also in 1879.  He explained that the normal sound of a healthy pulse was not unlike the two words “bother it”.  The Lancet commented that this was “Not a bad commencement for a talking pulse.”

However, the introduction of the telephone was not always a positive thing for the medical community. One doctor wrote to the Lancet in January 1886 to complain that he had been on holiday at a seaside town, and had seen in the window of a local chemist’s store a sign which advertised that a certain doctor could be contacted by telephone from that store. The doctor in question, the letter writer noted, lived some way away, while another doctor’s practice was located literally across the road. This seemed to the writer to be most unprofessional, and the journal editors agreed. Indeed, not all doctors welcomed the ability of the general public to be able to contact them as easily as this at all, as one doctor complained in the Lancet in December 1883:

“As if the Telegraph and the Post Office did not sufficiently invade and molest our leisure, it is now proposed to medical men that they should become subscribers to the Telephone Company, and so lay themselves open to communications from all quarters and at all times. It must be admitted that this would have its conveniences. The only fear we have is that when people can open up a conversation with you for a penny, they will be apt to abuse the privilege; and that to have a dozen telephonic consultations in one day, or conversations that might be thought to supersede a consultation, would be a doubtful addition to one’s advantage or repose.”

One wonders what this correspondent would have had to say about recent proposals that doctors should be carrying out more consultations over the telephone. In addition, it was not just their profession and their “repose” they were concerned about. Just as we are familiar in the last decade or so with worries about the impact of radiation from mobile phones on our bodies, as has been documented and discussed by Jon Agar in his book Constant Touch, so were late Victorian medical men worried about some new telephone-specific ailments to which they were now required to attend. For example, one Manchester doctor wrote to the British Medical Journal in early August 1879 with this account:

“A woman, about thirty-five years of age, manageress at a small ware manufactory in Manchester, which was connected with its office (two miles off) by a telephone, was listening to a message, when a violent clap of thunder took place, and which appeared to be conveyed through the wire. The effect on the listening ear was that of complete numbness and deafness, accompanied by a sensation of giddiness, slight nausea, and tinnitus aurium. …. I have examined her lately, and found both ears and hearing distance quite normal; nearly a fortnight elapsed, however, before perfect hearing returned.”

Mounted telephone unit with separate transmitter (left) and receiver (right); the transmitter was designed by Francis Blake, and the receiver was Bell’s design.

In September 1889 the BMJ identified “telephone tinnitus” in those who used the telephone for a considerable amount of any working day, with patients suffering from “nervous excitability, with buzzing noises in the ear, giddiness, and neuralgic pains.” This irritation and over-sensitivity was said to be akin to that experienced by those who worked with loud machinery. The Lancet reported similar conditions. But this was not the only problem, because, while the telephone could be used to reduce the risk of infection in some areas, concerns were raised that it might itself actually provide a new source of infection through its improper use. In January 1887, the BMJ reported on concerns that “the promiscuous use of the mouth-pieces of public telephones” led to a risk of infection.  It recorded a recommendation from one doctor that:

“…the mouth-piece should be disinfected every time after, or still better, before it is used.  In other words, some disinfectant fluid should be kept at every telephone station, and the speaker should, first of all, dip the mouth piece into the fluid, and then wipe it with a clean towel.”

This concern was to be reiterated over many years – decades, even – in both the BMJ and the Lancet as a serious worry about public health.

As new tele-health programmes come increasingly to the fore as cheaper, quicker ways to look after public health, I wonder what these early telephone users might have thought of our advances. I’m not sure everyone would have been so surprised; after all, sending information about your vital signs to the nurses is just an advance on telegraphy, already very widespread, and although the telephone was very slow to take off in the domestic sphere, being used more for business, this contact between the patient and doctor would be more of a change in degree of telephone use than a change in kind.

A story was told (in the Lancet in November 1879) of an American doctor who, when phoned in the middle of the night by a lady anxious that her daughter’s baby was coughing alarmingly, asked for the child to be held up to the telephone so that he could hear it. He heard the cough, pronounced that it was not serious, as had been feared, and all went back to bed happily. Maybe today, if the baby’s vital signs were being compiled and monitored remotely, the doctor might have pre-empted its symptoms, or lack thereof, and saved the mother a lot of bother. Despite past and current misgivings about removing the personal touch from healthcare, the telephone, when employed with appropriate discretion and expertise, has long been a useful tool in the medical world. Ain’t technology marvellous.

As well as the journal items mentioned in the text above, I have also made use of the following secondary sources which might make for interesting further reading:

  • Baldwin, F. G. C., The History of the Telephone in the United Kingdom (Chapman and Hall, 1925)
  • Emmerson, Andrew, Old Telephones (Shire Publications Ltd., 1986)
  • Johnson, Valerie, ‘Plus ça change…? The Salutary Tale of the Telephone and its implications for Archival Thinking about the Digital Revolution’ in Journal of the Society of Archivists, vol. 32, no. 1, April 2011
  • Occomore, David, “Number, Please!” a history of the early London telephone exchanges from 1880 to 1912 (Ian Henry Publications, 1995)
  • Young, Peter, Person to Person: The International Impact of the Telephone (Granta Editions, 1991)
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