1

TELE - STETHOSCOPE
B.S. BIO-MEDICAL ENGINEERING, BATCH 2008

BY
MUHAMMAD KASHIF SHAH

2008-BM-049

MALIK KHOWAJA

2008-BM-019

SUPERVISOR
ENGR. IJLAL SHAHRUKH ATEEQ

DEPARTMENT OF BIO-MEDICAL ENGINEERING

SIR SYED UNIVERSITY OF ENGINEERING & TECHNOLOGY
UNIVERSITY ROAD, KARACHI-75300
DECEMBER, 2011

ACKNOWLEDGEMENT

It is blessing of Almighty Allah who helped us to complete the project sincerely. He has helped
us in every moment of our life and in every step towards the successful completion of this task.
We are very grateful to Prof. Dr. M.A. Haleem Chairman of Biomedical Engineering Department
and who faculty of Biomedical Engineering Department. We are also very thankful to our
Supervisor Eng. Ijlal Shahrukh providing guideline for completion of our task.
But this all would be simply incomplete without some further assistance of Eng. Aneel Khowaja,
0Eng. Muhammad Faraz Shaikh and Eng Kamran Hameed. They have helped us a lot in
understanding various applications and for all moral support and guideline that they have given
through their experiences. We are certainly thankful to all these people who helped us.
In the last but not the least, we are thankful to our parents for their guidance and unconditional
support towards us without whom this would have not been possible.

DECLARATION

All statements of fact in this report are true and correct and we have made claims of acquired
competencies in good faith. The report is all our own work and is a true representation of our
personal competence in written English. We confirm that we understand that students of the
SSUET are required to display a commitment to exercising professional and ethical
responsibility in all aspects of their work.

Table of content
Abstract........................................................................................................................ 5
List of Figures............................................................................................................. 6
List of Tables............................................................................................................... 6
1.1 Introduction............................................................................................................... 7
1.1.1 Historical Background............................................................................................ 8
1.1.2 Theoretical Investigations........................................................................................ 9
1.1.3 Health Consequences............................................................................................ 10
1.1.4 Working Principle................................................................................................ 10
1.1.5 Main Features..................................................................................................... 10
1.2 Applications / Usages in Biomedical Engineering..............................................................11
1.3 Design Methodology.................................................................................................. 12
1.3.1 Project Design.................................................................................................... 12
1.3.1.1 Phases......................................................................................................... 12
1.3.1.2 Block Diagram........................................................................................ 13
Materials and Methods.................................................................................................... 14
2.1.1 Materials........................................................................................................... 14
2.1.1.1 Techniques and Equipments Used to Implement.....................................................15
2.1.2 Methods............................................................................................................ 15
2.1.2.1

Tasks Performed......................................................................................... 15

2.1.3 Final Implementation............................................................................................ 18

Results........................................................................................................................ 18
3.1 Figures and findings........................................................................................ 18
3.2 (Basic Algorithms/Software Coding Information)...........................................................20
3.3 Calculations.......................................................................................................... 20
Discussion................................................................................................................ 21
Conclusion................................................................................................................ 23
List of References.......................................................................................................... 24

Abstract
Our project relates to Tele-stethoscope which is specially designed to provide state of art
technology to medical and health professionals to provide best possible practices to the seniors,
people with disabilities, and people in distant areas who may have difficulties to grab a proper
health care facility. Initial stage of this project was to consult our professors, health professionals
and sketch a concept design. Even though, electronic stethoscopes are available in market but
they are out of reach of a common man. We revisited the cost and put up a cost analysis which
has turned this instrument more economical. Research was completed to identity the frequencies
of head sound which stethoscope needed to filter. The concept includes all the attributes that a
tele-stethoscope should include. Next step was to design analog circuit which comprises pre-amp
and post amp stages and then the interfaced to Pc via a free open source. Project was then tested
with the help of Skype voice call messenger and we successfully transmitted cardiac sounds with
such high quality and precision.

List of Figures
Figure 1: Phases of Project12
Figure 2: Block diagram of Tele-stethoscope13
Figure 3: Circuit Diagram..18
Figure 4.1: Chest piece without placing on chest (heart Position)18
Figure 4.2: Chest piece Placed on chest (heart position)...18
Figure 5.1: Audacity recording without placing chest piece on chest (heart Position).19
Figure 5.2: Audacity recording with chest piece placed on chest (heart Position)....19

List of Tables:
Table 1: History of Stethoscope...8
Table 2: Components and total cost...14

1.1 Introduction
For past many years, doctors and medical practitioners used Stethoscopes to diagnose the
diseases (from heart to lungs) and still experienced physicians can diagnose a large number of
clinical conditions just from the use of Stethoscopes.
Cardiac auscultation is considered to be hardest task due to number of reasons and as heart
sounds are of low frequency and the intervals between the sounds are short. This certainly gives
a hard task to examine and get the accurate cardiac sounds to diagnose.
For the same reasons, numerous methods and instruments were designed to achieve precise
cardiac sounds such as Phono-mechanocardiograms, Doppler echocardiography. Several
attempts were made to develop Special Stethoscopes in 1960s and gathered some remarkable
achievements which allows group of people to hear heart sounds but still there were
disadvantages of getting the desired output due to requiring the plugging of many tubes to a
single machine that disperses and makes sound less intense.
In 1980s electronic stethoscopes were developed which had extra functions in comparison to the
conventional acoustic stethoscopes by the use of amplifiers and analog filters.
Our objective is to follow the same trend and develop an electronic stethoscope with
modifications and alterations which provides us to send cardiac sounds live on internet to the
mobile receiver. (Synchronization)
In This Project we Introduce a Modern technology electronic stethoscopes, take advantage of
modern technologies to reduce these disadvantages. They allow to adjust the volume of
auscultations and to store them on a PC. Also, top level devices are mechanically designed to
reject most of the environmental noise. Software tools for the record, display and replay of
acquired sounds. We provide online web streaming for emergency condition.

1.1.1 Historical Background

Stethoscope is one of the basic symbols of bio and medical sciences. It is one of the revolutions
in the field of medicine. It is the first ever tool which able the world to get the auscultation of the
body.
Auscultation is the act of listening, either directly or through a stethoscope or other instrument,
to sounds within the body as a method of diagnosis.[1]
In 56 BC, one of the Chinese invented a tool called Meng which believes to be the predecessor
of modern stethoscope. The first stethoscope was invented in Paris, France. It comprises of a
wooden tube and was monaural. The devices were almost identical to the historical hearing aid;
though this tool was identical to ear trumpet which we called a Microphone.
Continuous developments were made since then and finally we get a commercial stethoscope
which is now most common and basic part of medicine.
Overview of the continuous development sited since 1816

Year

Development

1816

First Stethoscope was invented

1829

The first flexible stethoscope built but not very

clearly described

1840

Golding Bird explained a stethoscope he had

been using with flexible tub.

1851

Arthur Leared invented a binaural stethoscope

1852

George Cammann perfected the design of the

instrument for commercial production

1873

descriptions of a differential stethoscope were

presented

1940s

Rappaport and Sprague designed a new

stethoscope consisting of two sides, one of
which is used for the respiratory system, the
other for the cardiovascular system

1960s

Dr. David

Littmann,

a Harvard

Medical

School professor, created a new stethoscope

that was lighter than previous models
1970s

3M-Littmann

introduced

the

tunable

diaphragm
1999

Richard Deslauriers patented the first external

noise reducing stethoscope, the DRG Puretone

2004

Philips' brand electronic stethoscope model

Table 1 History of Stethoscope [2][3][4][5][6][7][8]

1.1.2 Theoretical Investigations

The human body sound signals which have relatively low amplitudes can be amplified by an
electronic stethoscope. It creates a window which discards high and low level frequency range
sounds and only amplifies mid-range sounds. This attenuation helps to cut off the distortions and
noise which are unwanted. As the signal is captured through a human body, its needed to be
transformed from the acoustic signals into electrical signals which can further be amplified and
processed for better listening as compared to the acoustic stethoscopes which are all depended
upon the same entities.

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The method of setting up a microphone within the chestpiece to detect sound is considered the
least favorable method due to the impact of the surrounding noise on the sound signals which
directly affects the sound quality.
Another mechanism is used in replacement to the microphone is setting up a piezoelectric crystal
on top of a metal shaft, while the base of the shaft is attached to a diaphragm. Another alteration
is the use of Electromagnetic diaphragm which contains a conductive inner body to create a
capacitive sensor. It responds to sound waves similarly as an acoustic stethoscope does, with the
variation in the electric field which works similarly as the change in the air pressure in an
acoustic stethoscope. This provides the amplification of the signals and also protects the sound
quality.
An electronic stethoscope may as well be used as a sound recording device or a wireless device
minimizing the surrounding noise disturbance and enhancing the quality of the signal.
Nowadays, computer based software are used for targeting the telemedicine studies and analysis.
1.1.3 Health Consequences
People suffered from heart diseases are in danger of heart failure at any time which can cause
sudden death. The Tele-stethoscope provide instant contact with their doctor if they suffer sudden
heart illness and doctor can diagnose the actual disease and save their life before they
hospitalized.
1.1.4 Working Principle
This electronic stethoscope has the feature of clear sound; it can replace the ordinary stethoscope
without amplification function. The working principle of this circuit is that this electronic
stethoscope circuit is composed of microphone pre-amplifier; it is shown in the figure 1.1. The
preamplifier circuit is made of capacitors and resistors. The pin number 1 of the Pre-amp is then
connected to the low pass filter. Another leg of the filter is connected to capacitor (1mf) which is
connected to a switch. Switch allows us to either connect the circuit to a PC interface (Sound
card) or to the headphone. In between switch and headphone, power amplifier (post amplifier) is
connected. This enables us to provide required power to the headphone and can control the
volume (Gain is 20).
1.1.5 Main Features
1. Amplification of heart sound.

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2. Filtered Signal.
3. Background Noise Free Signal.
4. Signal Recording and Visualizing software.
5. Low Cost.
6. Low Power
7. Online live transmission of signals.
8. Portable

1.2 Applications / Usages in Biomedical Engineering

The evolution and applications of the electronic stethoscope with telemedicine initiatives has
been intertwined and right hardware/software product are been introduced. Through the
Electronic Health Record, service readings could be taken from the comfort of your home and
automatically uploaded to the central server for medical practitioners to review. This would be
extremely advantageous for seniors, people with disabilities, and people in remote areas who
may have difficulties reaching a proper health care facility. The application of Tele-stethoscope
can be immense and it would certainly revolutionize the acceptance of Bioengineering to a
different level.

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1.3 Design Methodology

1st phase
1.3.1 Project Design

Preparation of feasibility report

1.3.1.1 Phases

2nd phase
Searching for the components availability

3rd phase
Working on the design of the project

4th phase
Preparation of Presentation and Final Report

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Figure 1 Phases of Project

1.3.1.2 Block Diagram

Microphone

Pre-Amplifier

Filters

Signals transferred to computer

Post Amplifier

Headphone

Software for recording dataOnline

& display
live transmission

Figure 2 Block diagram of Tele-stethoscope

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Materials and Methods

2.1.1 Materials
S#

Component

Value

Quanti

1
2

ty
Stethoscope
1
Electret Condenser Microphone High input Impedance (2.2 1

3
4
5
6
7
8
9
10
11
12
13
14
15

Capsule
Pre Amplifier
Power Amplifier
Headphone
Potentiometer
Switch
Audio Female Jack
Resistors
Capacitors
LED
Audio male jack
Audio male cable
Assembly
Battery (3v)

Cost
1000Rs
50Rs

K)

LM358P
LM386N

1
1
1
20k
1
2pin and 3pin
2
Stereo & mono
3
Resistor Pack
1
220uf,2.2uf,1uf,33uf,47nf
6
Green
1
Stereo & mono
2
Stereo
1
Plastic fabric Casing box
1
1.5AA cells
2
Total cost
Table 2 components and total cost

25Rs
25Rs
500Rs
20Rs
26Rs
30Rs
70Rs
12Rs
2Rs
30Rs
40Rs
1300Rs
70Rs
3200/-Rs

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2.1.1.1 Techniques and Equipments Used to Implement

Equipments and technology use to demonstrate our project are

Skype to Skype (Through internet)

Source free software Audacity

Computers/Laptops

2.1.2 Methods
The third phase of this project comprise of three sub stages
1. The Modification of the prototype to obtain, filter and amplify the cardiac sounds.
2. The Introduction of a software Program to record, reproduce and visualize them.
3. The testing of the prototype.
1.1.2.1 Tasks Performed
After all the theoretical work, we were set to build up a prototype (Stage 1), a device
similar to conventional stethoscope which filters and acquire sound. The stethoscope was
designed with following components.
1. Condenser Microphone
2. Pre-Amp
3. Post-Amp
4. Low Pass Filter
6. Head-Phones
7. Switch
8. Batteries

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This device filtered out high frequencies without losing the actual heart sound and
attenuates the noises and distortion. Our Electronic Stethoscopes frequency range is 20
500 Hz. In a standard mechanical stethoscope, there are two settings, or sides, that can be
used to listen to internal sounds. The bell has a detection range of 20 500 Hz and is
designed to be able to hear the sound of the heart and blood vessels pumping. The other
side of the mechanical stethoscope is the diaphragm. The diaphragm has a range of 200
1000 Hz and is used to listen to the higher frequency respiratory sounds [9]. By utilizing
Electret condenser microphone capable of picking up sounds with a frequency as low as
20 Hz and a low pass filter designed to eliminate sounds above 500 Hz, the desired
frequency range was achieved for the Electronic Stethoscope.
The output of this device was then interfaced with the line-in/Mic-in of sound card
(computer) which then record and visualize the sound into the computer through software.
Also for flexibility and acquire more options, I had connected Post Amplification circuit
to Headphones as well. So if user (Doctor) wants to use this device conventionally, they
can do so.
We have done the audio acquisition, analog design to amplify the signal from the
condenser microphone and how I interfaced with the headphone and Audacity.
We have used Electret Condenser Microphone for my project with keep following features
in my mind.

Impedance: 2.2 K

S/N Ratio: 58 dB

Sensitivity: 45dB 4dB

Frequency: 20Hz ~ 20kHz

Electret material is a stable dielectric with embedded charge. As sound waves are incident
against the microphones diaphragm, the capacitance of the microphone can change dynamically
[10]. These microphones are low cost devices that were once considered low quality. Current
electret microphones are comparable with capacitor microphones except that they carry more
noise. The main problem with implementing an electret microphone in a stethoscope amplifier
circuit is that it will pick up background noise that may be difficult to filter out. The advantages

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with an Electret microphone are that relatively simplistic amplification circuits can be utilized in
order to produce a waveform and that Electret microphones are simple to manufacture.
The main objectives of the analog circuit were to amplify the signal from the condenser
microphone with a reasonable signal-to-noise ratio, maintain low power consumption, and be
cost effective. Frequency response, gain, noise, and harmonic distortion also must be taken into
account when designing the analog circuit. The circuit was separated into four main stages:
preamplifier, amplifier, low-pass filter, and voltage buffer.
The preamplifier was created to increase the low-signal from the condenser microphone to linelevel for further amplification. This was accomplished by providing a voltage gain from the
microphone to the circuit. The LM358 is an operational amplifier (op-amp) that is used in the
preamplifier circuit to achieve a voltage gain of 3. The gain can be varied by increasing or
decreasing the resistor between pin 1 and pin 2 or the resistor between the microphone and pin 2.
The LM358 was chosen because it is a low-power device that draws a small amount of current. It
can be powered by a 1.5AA x2 Battery. There are other various op-amps that can be used in this
circuit; however, the LM358 is very inexpensive.
A low-pass RC filter was used to limit the audible frequency. The filter has a characteristic of
500 Hz cut-off frequency; this was achieved by using a 1.6k resistor and a 0.1F capacitor. For
future improvement, two filters can be implemented to simulate the bell and diaphragm. A
typical bell has the detection range of 20 500 Hz for sounds of the heart and blood vessels; this
can be implemented using a low-pass filter. These filters would be used by the physicians to
focus on heart. A switch is applied to determine which mode would be used.
The amplifier is used to supply the necessary power to drive the headphones. The LM386 is a
low voltage audio power amplifier that is used to achieve a gain of 20. In addition to the gain in
this stage, the volume control was implemented. The volume was controlled by varying the
20K variable resistor. From the amplifier stage, the signal travels to headphone.
In the second stage I had introduced free open source software Audacity for recording and
editing sounds. This software is widely used to record live audio, change the speed or pitch of the
recording and many other features which I believed is the best fit for my project.

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2.1.3 Final Implementation

Figure 3 Circuit Diagram

Results:
3.1 Figures and findings

Figure 4.1 Chest piece without placing on chest (heart Position)

Figure 4.2 Chest piece Placed on chest (heart position)

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From figure 4.1 and 4.2 we can clearly see that without the chestpiece being placed on the chest,
only gives some background voice with a very low negligible magnitude as the air continuously
strikes on the diaphragm. However, as we place it on the chest (heart positions) it ultimately
gives a clear heart sounds with good magnitude.

Figure 5.1 Audacity recording without placing chest piece on chest (heart
Position)

Figure 5.2 Audacity Recording with chest piece placed on chest (heart Position)

Similarly as shown in Figure 5.1 and 5.2, It clearly shows that when the chest piece
is free and not being placed on the chest, it only passes the signal of negligible
magnitude which is caused due to continuous air pressure on the diaphragm of the
chest piece whereas as in figure, when the chest piece is placed on the chest gives
the heart signals that are smooth and optimal. The software is then able to apply
various operations as per need for further analysis of the patients heart signals.

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3.2 (Basic Algorithms/Software Coding Information)

We have used free open source software Audacity for recording and editing sounds. It is
available at their official Website http://audacity.sourceforge.net
3.3 Calculations
Filter Calculation
Low Pass Filter
Cutoff Frequency: Fc=1/2RC
Let,
Fc=500Hz and R=150
So, C=1/(2**Fc*R)
C= 1/(2*500hz*150 )
C=2.12uf
C=Approx 2.2uf (standard value)
Gain Calculation
Preamplifier Gain
Its an inverting amplifier so Gain=Av=1+Rf/Ri.
Where Rf=R5=2.2k and Ri=R2=1k
So Av=1+R5/R2 = 1+(2.2k)/(1k) = 3.2
Av= 3
Power amplifier Gain
Av=20 (set by leaving pin 1, 8 and 7 open)

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Discussion
Old Studies/Work Related to Project
There have been numerous studies on Electronic/Tele stethoscope since few decades and
enormous developments have been made. The two studies from which we have taken the
references to our project have enlightened us.
Old studies have shown to get a graphical output of the heart sound through a source free
software i.e. SONY which filters out the signals up till 100Hz. They have designed their
circuitry with the help of transistors and other filters. The circuit operates at a voltage of
1.5V. Their main purpose was to record the graphical studies of the heart sound for further
analysis by medics. They have also tried the usage of SKYPE for live transmission with
hundreds of recordings for testing.[11]
Other studies have shown that they initially recorded the signals into a microcontroller based
storage device and then transferred the recorded data into the computer. They did this for
recording purpose. They used OPamps for amplification and buffers for isolation.
So far till now, there has only been some work done in the bio-medical department of SSUET
regarding digital stethoscope. Their designed digital stethoscope prototype circuitry was
much more complex and took a very large space for the setup and thus could not be used as a
portable device. Moreover, they did not even interface it with the computer. Their main focus
was to record the signals into the microcontroller based storage device.
We have reviewed all the past contributions and references which were dedicated to that
project and designed our very own Stethoscope with a much more integrated and easy
circuitry making it occupy a very small space and can be used portably like traditional
stethoscopes. It can also be used to interface directly with the computer through a
soundcards mic in jack without the need of any storage device to record the signals. We
have tested this device to work exceptionally well and smoothly over SKYPE for live
transmission as well, which has never been done before within SSUET. As shown in figure
4.1 and 4.2, weve also recorded the filtered heart signals through the source free software
AUDACITY for further studies of heart sound by the medics.

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All the Problems Encountered by us are as follows,

1. The first problem encountered was to fit Electret condenser mic into the tube which was a
big challenge for us and it took several weeks to do this stuff and finally we were
succeeded.
2. Another challenge was to use Electret condenser mic as it cant be used directly unlike
piezoelectric disk contact microphone and has to fit into the chest piece.
3. Hard to find cylindrical shaped electret condenser microphone.
4. To design 500Hz cutoff frequency low pass filter
5. Not able to find Single pre-amplifier IC in market so we have to replace it with dual preamp IC (LM358)
6. Firstly we have put LM386 on maximum gain but the results were clipping out so we
modified it to 40 gain with the consultation of our supervisor even though we found
clipping in our results so we used the gain of 20 (minimum for this IC) and around 70%
output achieved that is better volume control.
7. At the time of assembling we lost (damaged) quite a bit of components
8. Earlier use of Audacity software popping errors my windows when clicking in the track
or in effect dialogs but we found out that I have to reinstall my operating system
(Windows) as few system files were missing / corrupted in my system which was then
fixed and finally we came up with some delightful outputs/results.
Suggested Improvements for Future

There are other various op-amps that can be used in this circuit as preamplifier which gives fine
output; however, the LM358 is very inexpensive.
In future development, the first thing that needs to be considered is noise reduction. One option
would be the LM1984 which is called the Dynamic Noise Reduction System; unfortunately, our
time constraint did not allow us to implement this stage. Therefore, the signal from this stage
travels to the amplifier stage.
If low pass (500Hz) and band pass (200Hz to 1 KHz) filters can be used separately, we can get
clear heart as well as respiratory lungs sounds.

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Conclusion
The design of our tele-stethoscope consists of two major sections; the analog and the other PC
interface. Electret Condenser microphone was used in the project. This microphone has attributes
to detect cardiac sounds but was effective to surrounding noise. Another option was piezoelectric
microphone which could have easily used and better option to get cardiac sounds but the size and
ergonomics was not up to our preference as we have to fit it into chest piece.
The prototype tele-stethoscope analog circuit comprised of a headphone, pre-amp, post-amp, low
pass filter and switch. The pre-amp and amplifier increased the voltage to levels that could drive
the headphone. A low pass filter was then used to limit signals frequency to 20-500Hz.
The filter is then connected to a switch. Switch allows us to either connect the circuit to a PC
interface through Sound card or to the headphone. Open source Audacity software is used to
record the desired cardiac sounds. The Skype messenger is then used to transmit sound signals
from one laptop to another. Skype is world renowned voice call messenger and known for his
high quality audio transmission.
Results show that the signal is transmitting very clearly and shapely on Skype to Skype
conferencing.
Since when we submitted the feasibility report, the predicted cost for the project that we
approximated was Rs. 10,050/-. However, with the completion of the project, the total cost which
we calculated after finalizing the project was Rs. 3,200/- excluding the other expenses which was
caused due to buying other components which were wasted and disposed during the creation of
the project. Therefore summing the project cost and those other expenses, this project cost us a
total of Rs. 6,000/-.

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List of References:
[1]

Freeweb

dictionary

for

all

technical

definations

http://www.definitions.net/definition/auscultation
[2] Laennec, Ren (1819). Auscultation of the diagnosis or treatment of diseases of the lung and
heart, Paris, Brosson & Chaud.
[3] Wilks, p.490, cites Comins, "A flexible stethoscope", Lancet 29 August 1829.
[4] Samuel Wilks, "Evolution of the stethoscope", Popular Science, vol.22, no.28, pp.488-491,
Feb 1883
[5] Golding Bird, "Advantages presented by the employment of a stethoscope with a flexible
tube", London Medical Gazette, vol.1, pp.440-412, 11 December 1840.
[6] "History of Littmann Stethoscopes at a glance". 3M.com. Retrieved 25-01-2010.
[7] Stethoscope Littmann Stethoscopes for Medical Students,website:
http://www.davidgregory.org/medical/stethoscope.htm
[8] "TRIMLINE Medical Products". Retrieved 25-01-2010.
[9] Abbruscato, Richard C. (Burnsville, MN), Remote stethoscope signal processing
system,United States Patent 5550902, 08-27-1996
[10] Projects Unlimited Inc., Electret Condenser Microphone Basics, [Online document],
2010,

http://www.digikey.com/Web%20Export/Supplier

%20Content/PUI_668/PDF/PUI_ElectretCondenserMicrophone%20Basics.pdf
[11] Indian Journal Exp Biology, Vol 45, Jan 2007