The Merck Manual of Diagnosis and Therapy, referred to asThe Merck Manual,[1]is the world's best-selling medical textbook,[2] and the oldest continuously published English language medical textbook.[3] First published in 1899, the current print edition of the book, the 20th Edition, was published in 2018. In 2014, Merck decided to moveThe Merck Manual to digital-only, online publication, available in both professional and consumer versions; this decision was reversed in 2017, with the publication of the 20th edition the following year.[4]The Merck Manual of Diagnosis and Therapy is one of several medical textbooks, collectively known asThe Merck Manuals, which are published by Merck Publishing,[5] a subsidiary of thepharmaceutical companyMerck Co., Inc. in the United States and Canada, and MSD (asThe MSD Manuals) in other countries in the world. Merck also formerly publishedThe Merck Index,An Encyclopedia of Chemicals, Drugs, and Biologicals.
The first edition ofThe Merck Manual was published in 1899 by Merck & Co., Inc. for physicians and pharmacists and was titledMerck's Manual of the Materia Medica.[6][7] The 192 page book which sold for US $1.00, was divided into three sections, Part I ("Materia Medica") was an alphabetical listing of all known compounds thought to be of therapeutic value with uses and doses; Part II ("Therapeutic Indications") was an alphabetical compendium of symptoms, signs, and diseases with a list of all known treatments; and Part III ("Classification of Medicaments(sic) According to their Physiologic Actions") was a listing of therapeutic agents according to their method of action or drug classification.[3] Many of the terms used are now considered archaic, such asabasia,astasia,errhines andrubefacients -sternutatories, and many of the agents listed are now not considered to be standard therapeutic agents but were considered useful at the time, including poisonous compounds such asmercury,lead,strychnine andarsenic. There were 108 remedies listed forindigestion (dyspepsia), includingalcohol, arsenic,cocaine,gold chloride, mercury,morphine,nux vomica,opium,silver nitrate, strychnine, and "Turkish baths (for malaise after dining out)".[7]: 118 Bismuth,calcium,magnesiumsalts were also on the list, which are ingredients found in many modern gastrointestinal treatments available today. Arsenic was recommended for over 100 illnesses includinganemia,diarrhea,hydrophobia,elephantiasis, andimpotence. The formulas include "aletris cordial", a "uterine tonic and restorative", which contained "aletris farinosa or True Unicorn combined witharomatics".[7]: 15 The manufacturer, Rio Chemicals of St. Louis was clear to differentiate the inclusion of true unicorn rather than false unicorn in its preparation.[8][a]
The earliest versions did contain drugs that are still in use today for the same purposes, for exampledigitalis forheart failure;,[7]: 90 [11]: 166 salicylates forheadache[11]: 166 rheumatism[11]: 225 andfever,[7]: 124 [11]: 227 nitroglycerin for cardiacangina pectoris;,[7]: 88 andbismuth salicylate fordiarrhea[7]: 114
Merck also began publishingMerck's Archives of the Materia Medica, a monthly journal consisting of papers related to drugs and uses, which was available for an annual subscription ofUS $1.00.[7][11]
The second edition ofThe Merck Manual was published in 1901, was expanded to 282 pages and included new sections on poisons and antidotes, tables and conversion charts, and a detailed explanation of the metric system.[11]
The 5th edition, published in 1923 was delayed due to paper shortages caused byWorld War I, and the release of the 6th edition was delayed until 1934 due to theStock Market Crash. The editor of that edition, Dr. M. R. Dinkelspiel had overseen the growth and reorganization of the Manual to discuss specific diseases, diagnosis and treatment options, and external specialists reviewed each section. The 8th edition of the Manual was delayed byWorld War II until 1950. The 13th edition, released in 1977 was the first time the textbook was produced usingmagnetic tape andIBMpunch cards, the previous version having been typed on a manual typewriter. The Centennial (17th) Edition published in 1999 included a separate facsimile version of the 1899 1st edition.[3]: 113
It is reported that both AdmiralRichard E. Byrd took the book with him on his expedition to the South Pole in 1929 andAlbert Schweitzer had a copy of The Merck Manual with him at his hospital mission in Africa in 1913.[6][12]
The recommended doses given in Part 1 of 1901 edition ofThe Manual were for adults when given by mouth. It included the following dose adjustment recommendations:
The DOSES, unless otherwise stated, are for adults and per os. To determine the dose for children, add 12 to the age, and divide by the age; 1 divided by the result represents the fraction of the adult dose suitable for the child. For example, a child three years old will require
of the adult dose. Of powerful narcotics, children will require scarcely more than one-half of this proportion. Children bear opiates poorly; while they stand comparatively large doses of arsenic, belladonna, ipecac, mercurials, pilocarpine, rhubarb and some other purgatives, and squill. For hypodermic injection the dose is ordinarily about one-half of that given.[11]: 7
The Merck Manual is organized, like many internal medicine textbooks, into organ systems (see List of Medical Topics below) which discuss each major diseases of that system, covering diagnosis (signs, symptoms, tests), prognosis and treatment. It provides a comprehensive yet concise compendium of medical knowledge into about 3500 pages, by emphasizing practical information of use to a practicing physician. In addition to 24 sections covering medical topics, it includes a pharmacology section listing drugs by generic and brand name, a list of drug interactions and a pill identifier, a News and Commentary section, videos on procedures and examination techniques, quizzes and case histories, clinical calculators, conversion tables and other resources.[13] The text is characterized by the combination of conciseness, completeness, and being up-to-date. It is updated continuously by an independent editorial board and over 300 peer reviewers that contribute to the textbook, which goes through an average of 10 revisions by both internal and external reviewers before publication. The internal editorial staff consists of 4 physician reviews, one executive editor and four non-medical lay editors.[3] The latest version has been translated into 17 languages. In addition to the online version,The Merck Manual Professional Edition is also available as a mobile app in bothiOS andAndroid platforms,[6] produced by Unbound Medicine, Inc.[14]
K1.Cardiovascular Disorders2.Clinical Pharmacology3.Critical Care Medicine4.Dental Disorders5.Dermatological Disorders6.Ear, Nose, and Throat Disorders7.Endocrine and Metabolic Disorders8.Eye Disorders9.Gastrointestinal Disorders10.Genitourinary Disorders11.Geriatrics12.Gynecology and Obstetrics13.Hematology and Oncology14.Hepatic and Biliary Disorders15.Immunology; Allergic Disorders16.Infectious Diseases17.Injuries; Poisoning18.Musculoskeletal and Connective Tissue Disorders19.Neurologic Disorders20.Nutritional Disorders21.Pediatrics22.Psychiatric Disorders23.Pulmonary Disorders24.Special Subjects
The Merck Manual was listed in the 2003Brandon Hill "Selected List of Books and Journals for the Small Medical Library" as a recommended medical textbook for diagnosis, geriatrics, and patient education.[15]
The Merck Manuals were awarded five 2015 eHealthcare Leadership Awards including a Gold Award for Best Healthcare Content for Professionals, and a Distinction Award: Best Overall Healthcare Site, Consumer[16] at the nineteenth annual Healthcare Internet Conference held in November 2015 in Orlando, Florida.[17]
Merck Publishing offers resources for "The Merck Manual Award" provided annually to outstanding medical students. The qualifications for the award are determined by each medical school.[18] Medical schools that give this award include University of North Carolina School of Medicine, University of Central Florida School of Medicine and the University of Illinois School of Medicine.
First published in 1990, sections ofThe Merck Manual were made into a separate volume dealing with diseases and management of illnesses in the elderly. It has gone through three print editions, the last version published in 2000.[19] Since the transition of The Merck Manual in 2015 to a web only based version, the Manual of Geriatrics is accessible through the Professional and Consumer portals of the online text.[20] A search engine on the Merck Manual site allows searches limited to the contents ofThe Merck Manual of Geriatrics.[21]
The Merck Manual of Patient Symptoms is a concise, pocket size reference guide intended for medical students and allied health care professionals in training. It covers symptoms, diagnosis and treatment.[22]
The Merck Manual of Medical Information – Home Edition was published in 1997 and was a re-edited version of the Professional version using less technical language intended for patients, caregivers and people interested in medical topics without training in health fields. This edition sold over 2 million copies. TheSecond Home Edition was released in 2003, and the third edition was published in 2009 asThe Merck Manual Home Health Handbook, and sold over 4 million copies.[23] Since 2015 the Consumer version content is available only via the online Merck Manual website.[24] A condensed consumer-oriented version was published atThe Merck Manual Go-To Home Guide for Symptoms in 2013.[25]
In 2014,The Second Home Edition was extracted from the Professional version ofThe Manual and published asThe Merck Manual of Women's and Men's Health[26][27]
A consumer version ofThe Merck Manual of Geriatrics was released in print in 2004 asThe Merck Manual of Health & Aging, which included information on aging and the care of older people in non-technical language for the public. The content was incorporated into the Consumer version of the online Merck Manual in 2015.[3][28]
The Merck Veterinary Manual[29] has been published since 1955 for professional veterinarians and other professionals in the veterinary field. It is the most widely used veterinary medicine textbook.[30] It is still published in a print version[31] and the 11th edition is scheduled for release on July 12, 2016.[32] TheMerck Veterinary Manual has been translated into seven languages, includingCroatian,French,Italian,Japanese,Portuguese,Romanian andSpanish.[33] It is also available as a mobile app in bothiOS andAndroid platforms, as well as an online version.[34]
A consumer version written in non-technical language as a joint publication between Merck andMerial released as theMerck/Merial Manual for Pet Health (Home Edition) was first published in 2007.[35]ISBN 978-0911910995. A consumer oriented version of the Merck Veterinary Manual is available online as thePet Health Edition.[36]