Canadian Medical Association Journal 1995; 153: 815
Some years ago, while serving as an internist with the Royal Canadian Air Force in Europe, I went out to the local gasthaus for a quiet evening with several German friends. Just as we were savouring the first sips of our second round of Parkbrau, the wife of one of my companions appeared in the doorway. She was, frankly, a bit of a shrew at the best of times, but on this occasion, she outdid herself.
After homing in on our table, she proceeded to scream at her husband at a volume and pitch calculated to shatter half-litre steins, let alone mere wine glasses. My background of intermediate German was inadequate for translating the staccato barrage of words, but in any case many of them would not have been found in the basic tourist vocabulary.
However, I was able to catch the gist of the monologue. I learned that Heinz was a dirty, mean, low-down, selfish, uncaring son-of-a-bitch for sitting there sipping beer while his little daughter lay deathly ill at home. From the amazed look on Heinz's face it was apparent that this was the first he had heard of the illness. Anyway, we set down our beers and dutifully followed her home. The procession reminded me of a mother skunk leading her brood down a country road, except our tails were down.
We climbed the three flights of stairs to the apartment where a number of neighbours had gathered in silent vigil around the child's cot. In it lay a little girl about 2 years old who was indeed very ill. Her temperature was 40 degrees, her pulse and respirations rapid and her colour somewhat muddy. Medical facilities in the town were rather limited at that time; the elderly family doctor closed up shop at 6 pm on the dot and the local hospital had no Emergency Department. A dozen pairs of eyes focused on me with that familiar "you're-a-doctor-do-something" expression.
I proceeded to do all the obvious things that require no equipment: checked her throat, neck, abdomen and so on without turning up anything helpful. Finally, for want of anything better, I bent down and put my naked ear to her chest. The look of consternation on the faces of the bystanders indicated that they thought I was about to collapse into the cot beside my poor patient. To my amazement and relief, the breath sounds came through loud and clear and the left lower lobe rewarded me with pure bronchial breath sounds and showers of rales.
I was able to stand up and confidently proclaim that the child had a lobar pneumonia of considerable extent and needed, above all, immediate antibiotic treatment. We were able to scrounge some ampicillin from the air base, and by the time the diagnosis was confirmed radiologically the next afternoon the child's temperature had fallen and she was well on the way to recovery. I must confess that we were all too shaken by the events of the evening to return to the pub.
The case made me realize for the first time that the only real value of the stethoscope, apart from reducing the risk of catching tuberculosis or pneumonic plague, is to spare the doctor's intervertebral joints when he examines a patient on a low bed.
I wonder how many respirologists have ever listened to a chest with the naked ear. Try it some time - you may be surprised.
But a word of caution: only try it on a patient of your own sex, whom you know very well. Today, your motives are likely to be misconstrued.