The Graham Steell murmur: eponymous serendipity?

On 7 March 1888 Dr Graham Steell addressed the Manchester Medical Society in the premises of the Literary and Philosophical Society in George Street, Manchester. He chose as his subject 'The auscultatory signs of mitral obstruction and regurgitation', and later that year published two papers on the same theme in the Manchester Medical Chronicle. In one he wrote: 'I wish to plead for the admission among the recognised auscultatory signs of disease of a murmur due to pulmonary regurgitation, such regurgitation occurring independently of disease or deformity of the valves, and as the result of long-continued excess of blood pressure in the pulmonary artery'. His observations were later confirmed by pathological correlation, and more cases were reported, notably by Paul White. The early diastolic murmur of pulmonary incompetence caused by pulmonary hypertension is now associated eponymously with Dr Graham Steell. We review the life and work of this physician and conclude that the original source of the observation, subsequently validated by modern techniques, was probably George Balfour of Edinburgh, and that Graham Steell was fortunate to have this physical sign attributed to him.