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Distance communication

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Communication over distance for health purposes has a long history. Signal flags were used on ships and ports to indicate outbreaks of contagious diseases. People of Australia carried “message sticks” to communicate news of death and disease to distant tribal gatherings.  Consulting by written communication was common from the mid-1600s through the 1700s because of the lack of local access to physicians in some areas.  Also in the 17th century, distance diagnostic medicine occurred with patients sending urine samples to distant physicians. These physicians provided diagnoses based on uroscopy. They used “prescription-by-post” to deliver medicine and instructions on recommended treatment. iv  

The first use of electronic communication for health purposes in the United States occurred during the American civil war. The union army used the telegraph to communicate injured person reports, direct patient transport, and request medical supplies.The newly constructed telegraph was used in Australia in 1874 in the care of a wounded person and to connect a dying man with his wife 2,000 kilometers away. v In 1879, a report in The Lancet  described a telephone call between a mother and a physician to determine whether a baby had croup. In that report, the physician listened to the baby’s cough through the phone to reach his decision.  In 1905, Willem Einthoven demonstrated the transmission of heart sounds from a hospital to his laboratory using the telephone. He called it a “telecardiogram.”  Five years later, two New York cardiologists reported the remote transmission of electrocardiograms (ECGs) for diagnosing “hypertrophy and arrhythmia’s.” vi  

In 1910, Sidney Brown, an engineer in England, made developments to the telephone and stated that it was now possible to accurately listen to the sounds of a stethoscope that a patient held in place miles away and “to arrive at a correct diagnosis.” In the 1920s, Haukeland Hospital (now Haukeland University Hospital) in Norway began using two-way radio communications with ships to consult with physicians and to direct treatment.  Similar services developed in other countries during the next decade. Police reportedly began using mobile two-way radios in 1923 in Australia to communicate. By 1925, the theoretical concept of the “radio doctor” providing distant care using audio and video was described.vii