Mary Roach
Why doesn't anyone have dropsy anymore?
The 1899 Merck Manual is being released along with the 1999 version.
1899 was not a good year to contract VD. In the 1899 Merck’s Manual of Therapeutic Indications, treatments for gonorrhea — or “gleet,” as it was also then known — included boric acid, “blisters to the perineum in obstinate cases,” cod liver oil and/or “copaiba locally smeared on a bougie and introduced.”
Oddly enough, the Merck’s Manual represented the state of the art for medicine in its day. “They really thought they were on the cutting edge of modern science,” says Dr. Robert Berkow, who has edited the Merck Manual — then and now, the bestselling physician’s reference book — for the past 25 years. The 1899 edition is being reprinted and packaged alongside the 1999 edition, as a way to celebrate the centennial of the Merck Manual and to make people stop bitching about HMOs and be thankful they’re not being given carbolic acid for their eye infections.
“It wasn’t until around 1920,” Berkow told me, “that the average patient with the average illness seeing the average physician came off better for the encounter.” In 1899, pneumonia patients were still being bled. (George Washington is now thought to have been done in not by pneumonia, but by overzealous bleedings on the part of his physician.) Poisons and acids were the aspirin and ibuprofen of the day. Arsenic and strychnine appear as treatments for literally dozens of ailments, from baldness and irritability to angina pectoris. Bedwetting was treated with belladonna, aka deadly nightshade (“very useful for children, but the dose must be large”).
The trick was to choose your doctor well. Turn-
“There were those who believed in the bitter pill, and those who believed in the spoonful of honey,” says Berkow. Which worked better? Most often, neither. Of the 96 treatments listed in the 1899 edition under Gonorrhea, not one of them cured it. (Penicillin doesn’t make an appearance until the 1950 edition.) “The placebo effect,” observes Berkow, “was one of the best things doctors had going for them.”
The placebo effect was the reason for “lead plasters,” “cotton jacket,” “licorice powder,” “injections of hot water” and the countless other spurious treatments of the 1899 Merck’s. Controlled trials were unheard of; everything was based on anecdotal evidence. “When you consider that a sugar pill for pain relief will get a 30 to 45 percent response,” says Berkow, “you can begin to understand how all those treatments came to be recommended.”
Berkow chose this moment to, as they say, introduce a bougie. He said he views the current mass-embrace of herbs and alternative medicine as a reversion to “medical practice ` la 1899.” To his way of thinking, there is little difference between Merck’s recommending licorice powder for typhoid fever and the current mass-market paperback “The Herb Book” suggesting wax myrtle and comfrey for internal hemorrhage. “There’s about as much scientific basis for both. It’s a paradox that at this point in our history, when technology and science have brought us to where we can do so much more diagnostically and therapeutically, people are trying to run the other way.”
I detected a tinge of melancholia in the doctor’s voice, though it was hard to say whether it was the topic at hand or merely the accumulated stress of having recently shepherded 290 authors through 15 to 20 rounds of revisions. I looked up melancholia in the 1899 Merck’s, whereupon I decided that I want to have it too. The treatments listed include cannabis indica, alcohol, cocaine, morphine, opium in small doses, gold and Turkish bath. (As with all the 1899 treatments, they appear in list form, with no instructions, leaving unclear whether the patient was meant to consume the gold, apply it topically or perhaps use it to cover the opium bills.)
While I stand firmly alongside Berkow in his respect for technology’s contributions to medicine, I must say I am saddened by technology’s contributions to medical nomenclature. Where once we had scrofula and gleet and dropsy, now we have superventricular tachyarrhythmia and glossopharyngeal neuralgia. More accurate, yes, scientifically precise, to be sure, but with the charm and aesthetic appeal of a cold douche. Gone are quinsy, tetter, glanders and farcy, pemphigus and wen. So long, exuberant granulations and cerebral softening. Fare-thee-well, fatty heart and hectic fever.
In keeping with the clinically dry techno-style of the modern era, the Merck Manual has lost its more elegant writing and evocative images: A “cigarette after breakfast” for constipation, or a tumblerful of Carlsbad waters, “sipped hot while dressing.” And my personal favorite, the evocative and enigmatic “removal inland” as a treatment for insomnia.
The 1999 edition in particular is impoverished by the deletion of the Merck’s all-time most popular passage, penned by Berkow himself, which names and describes three common varieties of flatus: “1) the slider (crowded elevator type), which is released slowly and noiselessly, sometimes with devastating effect, 2) the open sphincter or ‘pooh’ type, which is said to be of higher temperature and more aromatic, and 3) the staccato or drum-beat type, pleasantly passed in privacy.” The new author of the revised chapter, a candidate for removal inland if ever there was one, chose to leave it out. “We’ve already had two complaints,” said Berkow, with obvious satisfaction. “Just yesterday I got an e-mail — including sound effects — with descriptions of four other varieties. So maybe we’ll put it back next time around.”
No, the Merck Manual isn’t as much fun as it used to be. There’s a bit of zip to be found on Page 1,561, Fetishism (which lists “aprons” before “shoes” and “women’s underclothing” in the list of common fetishes) and in Table 307-1, Substances Generally Nontoxic When Ingested (Vaseline, blackboard chalk, shaving cream! Dig in!). But by and large, it’s all business.
And that’s just fine. First, do no harm. Then, work in a reference to elevator gas.
Don’t jump!
Exactly what happens when a person leaps off the Golden Gate Bridge? Reading this article is the safest way to find out.
In 1996, I jumped off a 350-foot-high bridge over a river gorge. I wanted to experience what it would be like to leap, head first, from a lethal height and hurtle toward my death. The death part itself I had no interest in experiencing — in fact, a fairly strong interest in not experiencing — so I had a bungee cord wrapped around my ankles. After the initial terror and involuntary-scream portion of the event, the fall was quite enjoyable. I didn’t flail or rotate helplessly like people pushed from balconies on TV, but dropped smoothly in dive formation. I felt the way, as a child, I imagined Superman feeling. It led me to believe that jumping off San Francisco’s Golden Gate Bridge would be a lovely way to go.
Continue Reading CloseThe last tourist in Mozambique
Want to chat with the president? No problem, as long as you're willing to go where nobody's ready for you.
Late one night in 1995, I dialed directory assistance for Maputo, Mozambique, and asked for the fax number for the Office of the President. I sent His Excellency a letter on a piece of Health magazine stationery, requesting an interview on the topic of meditation. I had read that President Chissano was a devotee of Transcendental Meditation, so much so that he required his cabinet members and his military recruits to be trained in TM. He even attributed the signing of the peace treaty with the guerrilla group RENAMO in part to the practice of TM in his country. A week later, the president’s secretary faxed me back. To my great and giddy disbelief, Chissano had agreed to see me.
Continue Reading CloseLadies who spray
If you sprinkle when you tinkle, cut it out!
Let’s say you are afraid of contracting VD from a toilet seat. You are misinformed, but we’ll get to that later. What do you do? You use a disposable toilet seat cover. There. Perfect. All is good with the world.
But all is not good with the world. In maybe a third of the stalls in women’s rest rooms these days (according to my desultory research), the toilet seat is liberally puddled with piss. Somewhere along the line, germ-phobic women began crouching above the toilet seat rather than sitting on a paper seat cover. Women have begun peeing like men, but they lack the courtesy to put up the seat. And since women cannot aim like men — they have nothing to aim with — a good many of them end up hosing urine on the seat. Very few, it would seem, bother to wipe it up.
Continue Reading CloseDeep, active penetration
How researchers at one toothbrush maker figure out ways to make dental hygiene a pleasurable experience.
You’re probably not getting deep, active penetration. Seventy percent of American adults aren’t. But I am. I’m getting deep, active penetration because I spent an afternoon at Oral-B Laboratories, where deep, active between-teeth penetration is a multimillion-dollar pursuit and where they hand out samples of their new deeply, actively penetrating $5 CrossAction toothbrush.
Apparently the CrossAction isn’t just any toothbrush. It isn’t, in the same way the Mach 3 wasn’t just any razor. Both were developed by Gillette (Gillette owns Oral-B), a company with a flair for extravagant, costly research into everyday toiletry items.
Continue Reading CloseTwelve steps in the end zone
Self-help for sports junkies (or the spouses who can't stand it).
According to Kevin Quirk, recovered sportsaholic and the author of the self-help paperback “Not Now, Honey, I’m Watching the Game,” my husband is addicted to baseball. I, in turn, am addicted to my husband. This means that five or six times a year I accompany him to the ballpark, though I care nothing about the San Francisco Giants and understand few subtleties of the game. I would love it if my husband were addicted to me rather than to Dusty Baker and his merry spitting men, and so I turned to Quirk’s book for help. More accurately, I suppose, I turned to Quirk’s book to make Ed feel bad about his passion for baseball, for I am a jealous and needy person. No doubt I suffer from some as-yet-unnamed personality syndrome that someone will one day write a book about, which Ed can then buy and use to make me feel bad, too.
Continue Reading ClosePage 1 of 6 in Mary Roach