Five Ways the New Merck Differs from the 1899 Edition

May 17, 2018

Volume 164, Issue 5

Now in its 20th edition, the ultimate medical guide looks (and weighs) a lot different than it did over 100 years ago.

It’s much larger.

The 20th edition of The Merck Manual of Diagnosis and Therapy, released in April, is divided into 24 sections and has more than 3,500 pages. It weighs 5 pounds, 15 ounces, and is just under 3 inches thick. The first edition, published in 1899, weighed 4.2 ounces and, at 4.25 inches wide, was made to fit in a coat pocket. The last edition that could conceivably fit into a large coat pocket was in the 1960s, says Robert S. Porter, MD, editor-in-chief for the Merck Manuals. “Other than a masochist, nobody since the 1950s would keep it in their coat.”

Very few of the treatments listed in the 1899 version are of any real use today.

“I went through and tried to pick out the things that were still done and things that worked, and I think I found a dozen things in there that are conceivably still done and another half dozen that might have worked. Everything else is useless,” Porter says.

Some useless treatments were relatively harmless, like using olive oil to fade freckles, but others could be dangerous.
“There was a recommendation to give hot baths for sunstroke and heat exhaustion. That would probably just outright kill someone,” Porter says. Similarly, giving magnesium salts for diarrhea. “It’s a laxative. You get more diarrhea.” The manual also recommends cocaine for angina. “It’s a coronary vasoconstrictor!”

There are some odd conditions listed in the first edition.

The first edition was named Merck’s Manual of the Material Medica, subtitled “A Ready-Reference Pocket Book for the Practicing Physician.” It was divided into three parts: The Materia Medica, Therapeutic Indications, and Classification of Medicaments. The medicaments were listed in alphabetical order and included many herbal tinctures and such curiosities as uranium nitrate. The therapeutic indications include common diseases or conditions such as diabetes, asthma, and inflammation, but also some more curious conditions such as gleet, sexual exhaustion, and hystero-epilepsy. The uranium nitrate? That was a treatment for diabetes.

The latest edition makes use of current technology.

The printed edition is not the definitive edition of the new manual, according to Porter. The content of record for the manual is the online material, where it is always up to date. The digital edition also allows more content than a book can hold and multimedia features. This differs, of course, from the 1899 edition, which had a nice leatherette cover.

"The 19th edition, published in 2011, was to be last one put to paper. In the end, the editors decided to print the 20th edition to accommodate both users who get their medical information online and those who prefer a book," Porter says. The Merck is also available as free apps, Porter notes.

Pharmacists are involved.

There are two pharmacists on the manual’s editorial board and the section on clinical pharmacology was written by four. No authors are listed for the 1899 edition, so it's not known if any pharmacists took part in its creation.

So why should a pharmacist use the Merck? The manual is an excellent resource for pharmacists who might need to brush up on a medical condition, says Porter. It is the place to find information on any condition a pharmacist doesn’t deal with often.

Despite all the changes between the two editions, one thing remains consistent: Pharmacists and health professionals in 1899 needed a convenient and thorough resource for looking up medical information. With medical knowledge now doubling every 18 months, this is truer than ever.

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