The Merck Manual of Diagnosis and Therapy. 17th ed. (1999)

The Merck Manual of Diagnosis and Therapy. 17th ed.Berkow R, Beers MH, eds., Whitehouse Station, NJ: Merck Company, 1999. ISBN 0911910-10-7. 2833 pages, $35.00 The 17th edition of The Merck Manual is the “centennial edition,” and it is a gem! In 2833 pages, all of medicine is reviewed, albeit briefly, in 23 chapters by a 17-person editorial board assisted by 25 reviewers, 21 contributors, and 276 consultants, only one of whom has an appointment in an anesthesia department. What especially makes this edition a gem is the accompanying complimentary copy of the first edition published in 1899, and the contrast between that 192-page edition and the centennial edition bears witness as to how far medicine has come in the past 100 yr. The first edition is essentially a list of drugs in the United States Pharmacopoeia and their indications, ranging alphabetically from absinthin (for anorexia and constipation) to zinc valerianate (for diabetes insipidus and neuralgia). Interestingly, the recommended treatment of eclampsia, indexed as “puerperal convulsions,” includes chloroform but not magnesium sulfate, also listed in the first edition, while one is admonished never to administer chloroform near a flame as “an irritating perhaps poisonous gas” may be produced. What of the 17th edition? Yes, just covering all of medicine in a single volume is an ambitious task. The 177-page index is itself a masterpiece, which cross-references subjects, e.g., there are 8 references under “anesthetics” and 75 under “pain.” Of necessity, attempting “to provide useful clinical information to practicing physicians, medical students, interns, residents, nurses, pharmacists, and other health care professionals in a concise, complete, and accurate manner” (as stated in the foreword) frequently sacrifices completeness to be concise. The 7-yr enterprise culminating in the 17th edition is certainly current. Topics such as prion diseases, death and dying, and drug therapy in the elderly are all addressed. What of anesthesia? While there is no section devoted to anesthesia, the material covered in various areas is accurate, albeit brief, e.g., obstetric anesthesia is succinctly covered in three paragraphs that acknowledge the dominance of epidural anesthesia among regional techniques and caution against the use of general anesthesia in routine delivery. Similarly, the contribution of “an anesthesiologist experienced in pain management” in the treatment of pain in the dying patient is acknowledged. In summary, The Merck Manual remains the most widely used general medical textbook, with more than 10 million copies sold worldwide in 16 languages. As the medical profession becomes more specialized, the need for ready availability of quickly accessible information about other specialties can be met with this textbook. Truly, the price of $35.00 makes this a most underpriced gem. The 16th edition was made accessible on the Internet at no charge. Although the Internet has made much information about medicine available, perhaps the authenticity of much of that other information lacks the rigorous review process of The Merck Manual.