This is a hand drawn cachet of a stethoscope.  It appears to have been drawn in black marker.  The cachet is signed, but the signature is difficult to make out.  I appears to be either the letters "CAM" or "COM" which is why I've titled the cachet with both names.  In style, it reminds me of the Cancer Question Cachet (M33) found earlier in this exhibit.  I don't know if there is any connection between the two covers.  I doubt it, but still found the similarity interesting since the designer of both cachets is unknown.  It is also unknown if the cachet is an add-on or an original.  I tend to believe that it is an older add-on cachet, but it is difficult to be certain.  If you can provide any information about either cachet, please drop me a line at smith@in.net.