Doctors’ Medical Bible Expands With Times : Health: As more is learned about diseases, the Merck Manual fleshes out its descriptions of ailments and treatments.
Patellofemoral stress syndrome, lateral epicondylitis and medial epicondylitis are new to the latest edition of the Merck Manual, the 16th edition of this nearly 3,000-page, 2 1/2-inch-thick mini-encyclopedia of medicine.
Those three conditions, also known, respectively, as runner’s knee, backhand tennis elbow and forehand tennis elbow, are part of a new chapter in the newest Merck, a chapter on sports medicine, a symbol of this best-selling medical text’s reflection not only of medical advances but of the culture of the day.
Robert Berkow, its executive editor for the last 18 years, said the manual, first published in 1899, is “the oldest continuously published general medical textbook in the English language.”
Editions are revised every five years, each a few pages thicker; the newest is 150 onionskin pages and about half an inch heftier than its predecessor. It is published in six languages besides English--Spanish, German, French, Italian, Portuguese and Turkish--and there are requests for editions in Urdu and Hungarian, and a Russian edition is under preparation.
It’s a bible for health professionals, with the last edition selling more than 1 million copies. The Merck has had some venerable users, among them Albert Schweitzer, who had one in Africa, and Adm. Richard E. Byrd, who took one with him on his journey to the South Pole. But there are many doctors who spurn it as clumsy and quickly outdated.
Dr. Carole Horn, a Washington internist, recalls that her father, a podiatrist, used it a lot, and “lots of my patients will quote it to me,” but she said she finds other ways to keep up to date.
However, Dr. Mark Monane, a Harvard Medical School instructor in geriatrics, said he’s been using it since he was a resident. “It made me look real smart on rounds,” he said. He likes it now because it is portable and easy to read.
The $26 book is edited for physicians, medical students and other health-care workers, Berkow said, and probably cannot be easily understood by the general public.
Still, he concedes that increased medical sophistication has expanded the audience for this compendium of things that can go wrong with body and mind and their mainstream treatments.
The first edition, Berkow said, was less than an inch thick. It had more than 100 treatments for gonorrhea, “none of them effective,” he said, “and more than 1,000 diseases that were treated with strychnine or arsenic, very popular ingredients in the concoction medicines of the day.”
Recently, Berkow said, “I looked back to see when ‘myocardial infarction’ (heart attack) was introduced--not until the 1950s. I don’t know what people died of before that,” Berkow said with the whimsy that makes its way into the book. “Acute gastritis, I think.”
There is also a new chapter on pediatric AIDS. HIV, said Berkow, is a prime example of the way the book is updated.
A few years ago, Berkow recalls, his advisers were urging him to drop tuberculosis from the book, but he resisted. “And now, of course, it’s making a big and frightening comeback.”
A new chapter this year discusses cross-cultural issues in medicine, subtitled “Folk Medicine or Ethnomedicine.”
The chapter was written by one of the few non-physician contributors among the 300 specialists represented in the manual, Berkow said, and it brings him to one of his favorite topics--the need for physicians to carefully interview all their patients, to communicate.
“I remember when I was in medical school in the 1950s, we didn’t have nearly the medicines or the technology, but doctors were uniformly happy--you couldn’t get them to retire--and patients were satisfied,” he said. “Today we really can save lives, but a high percentage of doctors are disgruntled and unhappy, and patients are dissatisfied.”
