Why doesn't anyone have dropsy anymore?

The 1899 Merck Manual is being released along with the 1999 version.

By Mary Roach
July 2, 1999 8:00PM (UTC)
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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.

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"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-of-the-century medicine had a distinctively good-cop, bad-cop quality. While one doctor might advocate "leeches, back of ears" as a treatment for headaches, another would prescribe sitz baths. Under Seasickness we find both "champagne, iced, small doses frequently repeated" and "mustard plaster to the epigastrium." Depending on whom you went to, a sprained ankle might be treated with a "hot foot bath prolonged for hours" or a cold douche.

"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."

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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.)

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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.

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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.


Mary Roach

Former Salon columnist Mary Roach is the author most recently of "Gulp: Adventures on the Alimentary Canal." Her previous books include "Stiff," "Spook" and "Packing for Mars."

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