Merck Manual: 118 Years and Counting...

Not up to snuff on your emmenagogues and discutients? Grab a copy of the Merck Manual of the Materia Medica 1st edition,1899. It went through nineteen editions until 2011, when it transitioned to online only. It was the oldest continuously published English–language textbook of medicine, and Merck, a drug company founded 350 years ago, sold it at cost.

At the turn of the last century the assortment of drugs available to the practicing physician was already vast. The Merck Manual listed every one that, through empiricism, tradition or commerce, had come into use by Western medicine. As the editor said, “Memory is treacherous…But a mere reminder is all… [the doctor] needs…to prescribe exactly what his judgment tells him is needed for the occasion.”

Merck

The Merck

Friedrich Jacob Merck in 1668 bought the Angel Apothecary in Darmstadt Germany. Over 350 years it was transformed into one of the worlds largest pharmaceutical companies. A descendent, George Merck, came to New York to establish a subsidiary in 1891. When WWI broke out, the subsidiary was seized by the US Government to keep it’s assets from going to support the Kaiser. The company reverted back to private hands, and went to work mass producing penicillin and developing vaccines. It merged with Sharp and Dohme in 1953, becoming MSD. The German branch survives as a separate company, largely family owned. Each has many billions in annual sales. 

 Merck Germany (Angel Apothecary)

Merck Germany (Angel Apothecary)

 Merck USA, NJ Headquarters

Merck USA, NJ Headquarters

MSD did get a black eye from the Vioxx scandal of 2004, which involved suppression of cardiac risks, and a phony company–backed journal that touted the drug. On the other hand, Merck and Wellcome fund a lab in India devoted to low cost vaccines for developing countries. And of its esteemed scientist, a Walter Reed veteran, Maurice HIlleman, it has been said that his vaccines ‘saved more lives than any other 20th century scientist’

And MSD has taken public stances on social issues. In 2012 they ended donations to the Boy Scouts of America in protest of discrimination against gays. In 2017, MSD’s black CEO resigned from a Presidential Council, citing Mr. Trump’s handling of the Neo-Nazi violence in Charlottesville, VA.

 Merck Family coat of Arms

Merck Family coat of Arms

The Manual

The Merck Manual was, in part, a promotional tool. Included is a list of ‘some’ of Merck’s awards. In 1830 they won a Gold Medal from the Pharmaceutical Society of Paris “For the Relief of Mankind.” Fifteen distinguished awards were cited, concluding with one from the Columbian Exposition, Chicago 1893.

The Manual starts off with a description of Merck’s Analytic Laboratories. For $3 you could get sputum (or urine or milk) checked for TB. If cost $2 for white and red blood cell counts, and $10 to see if your water was fit to drink. On the back page we learn that, “when in immediate need of drugs and chemicals…” a doctor could place an order any day of the year, before 9 pm, but only by telegram sent from a pharmacist having a Merck ‘jobber’. This procedure was “for the protection of the profession against the unauthorized use of poisons, etc.

 Admiral Byrd in Antarctica

Admiral Byrd in Antarctica

 Doctor Schweitzer in Gabon

Doctor Schweitzer in Gabon

Regardless of its promotional value to the company, the Manual was highly prized by physicians for its content. Dr. Albert Schweitzer took one to Africa when founding his famous hospital. Admiral Byrd made sure it was on hand for his expedition to the South Pole. I doubt there is an English–speaking physician alive today who hasn’t thumbed through one or more of its many editions.

The 1899 edition was pocket size, its 199 pages and binder only an eighth of an inch thick. The inside cover quotes, without attribution, Horace Mann: “Every addition to true knowledge is an addition to human power.” (This is the same lecture in which Mann said, “To pity distress is but human; to relieve it is Godlike.”). There is also a calendar and a variation of the Merck family coat of arms. The title page bears the price $1.00 and the phrase multum in parvo—“much in little.” 

There are three parts:

THE MATERIA MEDICA as in actual use to-day by American Physicians.

THERAPEUTIC INDICATIONS for the use of the Materia Medica and other agents.

CLASSIFICATION OF MEDICAMENTS according to their Physiologic Actions.

Any agent having a Merck–branded version, was listed with “Merck” appended to its name. There were many such in the 82 pages from Absinthin to Zinc. Here are the fist two entries:

 Merck Manual 1899. Yes, there is a typographic error.

Merck Manual 1899. Yes, there is a typographic error.

Wormwood is a potent distillation of Artemisia absinthiumAbsinthin on the other hand is a naturally occurring lactone derived from the same plant, and gives the bitter taste to absinthe, the “Green Fairy”.

These examples illustrate a few things. One is the use of trade names alongside generic ones. Another is the potential for drug mix-ups. Note the difference in dosages, should the two be interchanged. The precision use of agents from the same plant shows we are well beyond simple herbalism, further evidenced by the reference to “The GALENIC PREPARATIONS of the United States Pharmacopoeia.” It was an era of standardization.

One additional agent, arsenic, exemplifies the circuitous path of medical knowledge. In 1899 the recognized treatments of cancer included coffee powder as a disinfectant and tumoral injections of acetic acid (vinegar). Arsenic therapy was pioneered by Virchow, for syphilis, making it the first “chemotherapy” drug (but for organisms). For cancer it was used topically to slough off tumor. It was deemed“sometimes successful when the knife fails, but is dangerous.” Today, arsenic trioxide is highly effective in a rare form of leukemia (APL).

The Executive Editor and Editor in Chief, on the occasion of the 100th anniversary edition (1999) reviewed the Manual’s publishing history. The earliest editions were restricted to purchase by doctors and pharmacists.

 Editions of the Merck Manual

Editions of the Merck Manual

The Merck Manual is no longer a book, let alone a mere drug compendium. That job has been taken over by the Physicians Drug Reference, or PDR—a tome so laden with obtuse information, (written by the manufacturers), that it could serve as a diving stone. 

In 2014, editor in chief Dr. Robert S. Porter, announced, “The Manuals are now all-digital. … Publishing a printed book every five years and sending reams of paper around the world on trucks, planes and boats is no longer the optimal way to provide medical information.

The various editions of the Manual chronicled the progress of modern medicine. Touted as “the worlds most widely used medical reference," it now has Home and Veterinary Editions. 

Retro-pharmacology

So, what’s an emmenagogue for? Why, that’s to increase menstrual flow. As to ‘discutient,' even with the internet, a definition is a bit hard to get at. Most authorities redirect to ‘resolvent,' which is “…a remedy that causes resolution of a swelling or inflammation”—perhaps an anti-inflammatory? 

The Manual lives on line now, but the print editions can be found for sale. The older it is the harder the search. Except for the 1899 edition, which was released as a facsimile in 1999.

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