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One common reason why stethoscopes only have one bell is that they are designed for use with a single patient. When a doctor or nurse is using a stethoscope on multiple patients, they need to be able to quickly and easily change the bell to avoid cross-contamination. Another reason is that having two bells can make it more difficult to hear faint sounds.

Not every stethoscope has a bell. 

The bell is used to amplify low-frequency sounds, so it is often found on pediatric stethoscopes. Many stethoscopes intended for general use do not have a bell.

A stethoscope bell is effective at transmitting low-frequency sounds, whereas a diaphragm is effective at transmitting high-frequency sounds. A few stethoscopes are more effective at transmitting low and high frequencies when combined into a single device.