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The Merck Manual, 17th ed.

University of Miami School of Medicine
Miami, FL

The Merck Manual, 17th ed. Mark H. Beers, MD, Robert Berkow, MD, eds. Whitehouse Station, NJ: Merck Research Labs, 1999.

It is a rare or, possibly, non-existent physician who hasn’t, at one time or another, been in possession of one of the seventeen editions of the Merck Manual. What makes the 17th edition unique is that it is the Centennial Edition. The first edition was published in 1899, and this last edition was published in 1999.

Another feature making this Centennial Edition interesting is the fact that the book is boxed together with a replication of the 1st edition published, as we have said, in 1899. Compared to this latest 17th edition, the 1st edition had only 192 pages. When we compare the two editions, we can clearly see how far the medical sciences have come during this last century: the latest Centennial Edition is made up of 2,833 pages divided into 23 clinical sections. Furthermore, the importance that nutrition has acquired in this last century is seen by the fact that the first of these 23 clinical sections is totally dedicated to Nutritional Disorders. And even if this in itself does not demonstrate the importance which nutrition has acquired in this last century, let me stress the fact that out of the 23 sections making up this Centennial Edition at least 1/3 of the sections have to do directly or indirectly with nutritional topics such as Gastrointestinal Disorders, Endocrine and Metabolic Disorders, Hepatic and Biliary Disorders, Dental and Oral Disorders and so on.

To whet the scientific curiosity of the health care provider, let us quote some of the material in the 1899 1st edition. On the first page of this edition is a list of the clinical laboratory analyses available at the time and the approximate cost of each:

Sputum for TB Bacilli $3.00

Urine for TB bacilli $3.00

Milk for TB bacilli $3.00

Blood for Widal’s typhoid reactions $2.00

Pus for gonococci $3.00

And if we want a more sophisticated study, we have the following:

Water for general fitness to drink $10.00

The cost of this first ambitious publication was $1.00 in 1899, while the Centennial Publication costs a respectable $35.

The second part of the 1st edition (1899) is dedicated to Therapeutic Indications. Let’s give here a couple of these indications taken at random:

1. Asthma (includes over 50 recommended drugs).

   Hydrocyanic acid
   

   Caffeine: 1 to 5 grm.
   

   Potassium nitrate
   

   Quinine: during intervals when attacks are periodic
   

   
   
2. Epilepsy

   Acetanili
   

   Camphoric Acid
   

   Atropine
   

   Borax
   

   Valerian: good if due to worms
   

   
   
3. Fever

   Acehectanilid
   

   Acids or Acid Drinks: to allay thirst and aid digestion
   

   Acid, Carbolic
   

   Acid, Phosphoric
   

   Acid, Citric
   

   And over 70 other chemicals in alphabetical order concluding with
   

   Triphenin
   

   Valerian
   

   Veratrum Viride
   

   Warm Sponging
   

   
   

Given what the book reveals of medicine at the end of the 19th century, it will be small wonder if physicians one hundred years from now are surprised to read the status of the materia medica practiced by us today; indeed, my grandfather, a physician in those days when rounds were made in a horse-and-buggy, used to say: "It’s easier to kill than to cure a patient."

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