But 15 years later the title of Adolf Striimpell's

"Lehrbuch der speciellen Pathologie und Therapie

der inneren Krankheiten (Leipzig, 1883) has added
"of internal diseases," and in the preface he declares
that he has tried to bring out "the established facts
with reference to internal diseases." What, then, is
meant by "internal disease"? All branches of surgery
are obviously excluded and the term is clearly used
in contrast to external disease, namely, disorders of
the skin. Much was made in Germany of dermatol¬
ogy at this time, as witness the numerous treatises
of four or more volumes dealing with the subject.
Because of the frequent skin lesions of syphilis the
dermatologist included syphilis in his domain, and
thence extended it to venereal disease in general.
There was therefore much for him to do. All this,
however, was excluded from the innere Krankheiten
in distinction to the external diseases—dermatology.
It was of course only a short step from internal dis¬
eases to the generic term internal medicine and
from this to internist as a designation for him who
ORIGIN OF THE TERM "INTERNAL practiced internal medicine.
MEDICINE" By 1882 the term was in common use in Germany.
So the transactions of the first congress of internal
GUEST EDITORIAL medicine are entitled without further comment
Arthur L.
"Verhandlungen des Congresses für innere Medicin"
Bloomfield, M.D. (Wiesbaden, 1882). The important journal, Central-
RECENTLY Keefer1 and Rhoads2 dis- hlatt für klinische Medicin which first appeared in
cussed the origin and meaning of the 1881, suddenly changed its name in 1894 to Central-
term "internal medicine." They did not Matt für innere Medicin. In the first number of this
bring out, however, what was well known volume the editor states that this change was made
at the turn of the century when German medicine to do away with the misunderstanding that the.
dominated American medical thought, that "internal journal dealt only with purely clinical matters. He
medicine" is simply a translation of the German said, "our purpose is to give a survey of everything
innere Medizin. We must therefore seek the mean- which the world-literature offers in the domain of
ing of the term internal medicine by ferreting out 'internal medicine.' Apropos of this point of view
"

the origin of the German innere Medizin. J. von Mering in his textbook of internal medicine,
In looking over the important German treatises "Lehrbuch der inneren Medizin" (Jena, 1901), says
on medicine one finds that until the last quarter of "The domain of internal medicine has by the accre¬
the 19th century they were all designated as text- tion of the most various experimental disciplines
books of pathology and therapy without any sug- reached such a scope that one man can no longer be
gestion of the words internal medicine. Felix Nie- fully authoritative in all its branches. Only the in¬
meyer, in his "Lehrbuch der speciellen Pathologie
und Therapie" (Berlin, 1859), says "One will readily vestigator is competent to critically sift the endless
discover everywhere [in the book] the scientific accumulation of detail so that the best can be
offered to students and general practitioners." So
striving to apply the newer physiology to the expla-
nation of the pathological and therapeutic facts, and quite early there was applied to internal medicine
to deduce the symptoms of the illnesses as a neces- a wider concept than that of the simple clinical de¬

sary consequence." The concept of "internal" medi¬ scription of disease; the physiological and chemical
cine was, however, not yet emphasized. Ten years basis was included. This concept of "internal medi¬
later, in the preface of Niemeyer's seventh edition, cine" was repeatedly stated by the Germans. The
Berlin, 1868, there was still no mention of "internal preface to Mohr and Staehelin's monumental
medicine." "Handbuch der inneren Medizin" (Berlin, 1911)
opens as follows: "This book is built up above all
From the Department of Medicine, Stanford University School of on a pathologic-physiological basis." In the second
Medicine, San Francisco.
1. Keefer, C. S.: What's Ahead for Internal Medicine, New England
edition (1925) they said "our leading thought is to
J. Med. 258:1087 (May 29) 1958.
2. Rhoads, P. S.: Internal Medicine and Training of Internists,
present 'internal medicine' even more thoroughly
A. M. A. Arch. Int. Med. 102:515 (Oct.) 1958. on a pathologic-physiologic basis."

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 It is clear then how the concept of "internal medi¬ persons, such as travelers, crew members, and
cine" developed in Germany so as to comprise non- ground personnel. Probably several million persons
surgical diseases, exclusive of dermatology; the term living very near airports will notice differences be-
also implied a scientific attitude quite different from tween the noise of jet aircraft and that of conven-
that of the practischen Arzt, the general doctor. tional
propeller airplanes. Although these persons
In tracing the use of the term in the United States, may complain of the noise, they are not likely to be
one must remember the immense influence of Ger¬ deafened because the sound intensity will be lower
man medicine on ours before World War I. Doctors than the hazardous levels.
in huge numbers went to Germany to study; micro¬ Several thousand persons in the United States
scopes, instruments, and laboratory glassware were work at airports. The so-called ramp personnel,
imported from Germany; one did not do a research, those who work outside and inside the terminal
one did an Arbeit; did not speak of laboratory
one buildings and the operators in maintenance areas
assistants, of
spoke the Diener. Small wonder
one of airports, will at times be working in dangerous
then that many expressions were simply translations sound levels. In an article "Airports and Jet Noise," '
of the German. The word, "Archives" is simply a Miller, Beranek, and Kryter show that the sound-
translation of German Archiv. The English use of pressure levels 100 ft. from the center of the four-jet
the term, however, is absurd, since it is a place to engine array during warm-ups and ramp operations
keep records and presumably should be used for may be as much as 110 db. This condition is not
dead storage and not for new material. So domi¬ desirable, especially if a person is exposed to such
nated by German thought was American medicine noise intensity for long periods. If a person, attend¬
that the Archives of Internal Medicine was launched ant, or passenger should get nearer than 100 ft.
in 1908 without a word of prefatory material. the noise can cause injury to the ear.2 The ramp
Forchheimer's well-known book, "The Prophylaxis attendants and service crews are required to use
and Treatment of Internal Diseases" (New York, noise reduction ear plugs and ear muffs during the
1906), evidently was copied from the German engine run-ups and other ground operations. When
innere Krankheiten. So too we have through the the jet engines are being serviced they are placed
years such textbooks as Musser's "Internal Medi¬ in acoustically treated test cells to protect the
cine" (Philadelphia, 1932) and Yater's "Fundamen¬ mechanics and to reduce the noise radiated to nearby
tals of Internal Medicine" (New York, 1954). The residential areas. Beliable evidence indicates that
American Medical Association nevertheless did not passengers emplaning or deplaning will not be
replace its section on the Practice of Medicine by subject to hearing trauma. The occupants in the
one on Internal Medicine until 1945. fuselage of the plane are also protected. If, how¬
In Britain things are different. Although much ever, a passenger or a helper should step too close
closer to Germany, British medicine shows little to the exhaust of the jet engines, an injury within
evidence of German influence. To my knowledge, the ear could occur. Because people vary in their
the term "internal medicine" is not used in Eng¬ response to loud noises, the maximum safe noise-
land. There is no textbook on "internal medicine" intensity level cannot be stated as a single over-all
nor is there a journal with "internal medicine" as value. If a worker or passenger comes near the
part of the title. exhaust stream of a jet engine, as much as 120 db.
So whatever implications may now be attributed in the 150 to 300 cycles per second band can be
to it, the origin of the term "internal medicine" is impressed on an unprotected ear. This is a danger¬
quite clear. ous sound intensity level.2 Prolonged exposure to
noise (in the 300 to 600 or 600 to 1,200 cycles per
second bands) of the order of 85 db. suggests
NOISE OF JET ENGINES MAY initiation of a noise-exposure control program and
BE A HAZARD tests of hearing for those exposed to this noise.3
All physicians might well inform themselves
While progress in aviation provides greater speed about this hearing hazard which is an unfortunate
in travel and comfort, it introduces a noise hazard by-product of progress in air travel.
which if not recognized and understood can cause
deafness. Until recently the noise of jet engines 1. Miller, L. N.; Beranek, L. L.; and Kryter, K. D.: Airports and
has been a problem associated primarily with the Jet Noise, Noise Control 5:24-31 (Jan.) 1959.
2. Industrial Noise Manual, Detroit, American Industrial Hygiene
military air bases and experimental airfields of Association, April, 1958.
plane manufacturers. Since commercial aviation 3. Guide for Conservation of Hearing in Noise, Subcommittee on
has entered the age of jet powered aircraft, the Noise in Industry, Committee on Conservation of Hearing, American
Academy of Ophthalmology and Otolaryngology, Noise Control
noise of jets will have some effect on many other 3:23-31 (May) 1957.

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