[Paleopsych] NYT: Merck Manual, the Hypochondriac's Bible

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Sun Nov 20 18:44:11 UTC 2005

Merck Manual, the Hypochondriac's Bible
[Mr. Mencken was quite a hypochondriac, but I don't recall his ever mentioning 
the Merck Manual.]


    A copy of The Merck Manual of Medical Information has lived on my
    night table for over 25 years.

    Sometimes the thick red book tops the bedside pile; other times it's
    buried under a stack of newer obsessions. But it's always within easy
    reach for emergencies, bouts of insomnia and ordinary bedtime

    My postcollege roommate introduced me to The Merck in 1979. In the
    beginning, I paged through her copy each time I needed reassurance
    about some twinge, tingle or suspected tumor. When I realized I was
    borrowing it every day, I knew it was time to buy my own.

    The Merck, as we devotees call it, was first published in 1899. It was
    a little book, only 192 pages, aimed at doctors, pharmacists and,
    presumably, those in situations that had no doctors or pharmacists.

    Albert Schweitzer took a copy of it to Africa in 1913; 16 years later,
    Adm. Richard Byrd hauled one to the South Pole.

    I hauled my copy mostly to the bathroom, where I would lie in a
    steaming tub and pore over my symptoms du jour. Sometimes I'd turn
    pages at random, dipping into chapters like a dowser hunting for
    water, trusting to intuition and luck to find whatever I was looking

    Back then I read The Merck the way some people go to horror movies,
    seeking the cathartic release of other people's troubles, the rush of
    catastrophe averted. I might have problems, but at least I didn't
    have, say, cardiac tamponade - "the most serious complication of
    pericarditis," according to the book. I didn't have tropical sprue or
    a pulmonary embolism or, God forbid, Budd-Chiari syndrome.

    At least, I didn't think I had any of them. I was pretty sure, on the
    other hand, that I did have hypochondria, or, in the lingo of The
    Merck, hypochondriasis.

    When, in my 20's, I learned that I had mitral valve prolapse, I
    inspected at some length The Merck's line drawing of the heart. This
    was in the pre-Internet era, when you couldn't just Google a
    four-color, 3-D rendering of the heart or any other internal organ.

    There was a diagram of the heart's electric circuitry, a road map more
    engrossing to me than any terrestrial topography. There was a
    representation of the left anterior descending artery, the superior
    vena cava, the atrioventricular node.

    I studied atrial fibrillation and flutter, sick sinus syndrome and
    tachycardia. The very words were glorious, Latinate, thrilling in the
    way they both distanced me from what was going on in my body and
    deepened my understanding.

    I learned the fine art of diagnosis from The Merck, too, despite the
    fact that I never got around to attending med school. To this day, I
    am known as something of a lay medical expert among my friends and
    family. They bring me their symptoms; I tell them what to ask their
    doctors. When I don't have a hunch, I look it up. I am, if I say so
    myself, very often right.

    In my 30's, I turned to The Merck whenever my children got sick. I
    preferred it to the pediatric bible of my generation, Dr. Benjamin
    Spock's "Baby and Child Care," whose prescriptive, often judgmental
    tone got on my nerves. Even when The Merck led me astray, it seemed
    better attuned to the situation.

    Once at 2 in the morning, when my 8-year-old broke out in a blistering
    rash and spiked a fever of 104, my frantic page-turning prompted me to
    diagnose smallpox. (I was wrong, obviously; she had Kawasaki syndrome,
    which in some ways isn't so far off.)

    On the other hand, The Merck can be frustrating when you're in
    worried-parent mode. Try looking up a simple stomachache in the index.
    You'll find a list under stomach that includes "acid in,"
    "arteriovenous malformations in," "bleeding in," "intubation of,"
    "obstruction of" and "tumors of" but nothing under garden-variety
    stomach pain.

    Still, The Merck is more than just a handy reference book. While I can
    now find online answers to any question that occurs to me (and many
    that haven't), my copy of The Merck is dog-eared, its front cover
    curling back, its two-inch-wide spine broken in several places.

    For one thing, it's a tangible object; its unimaginative chapter
    headings and small type inspire a bibliophile's affection the way a
    computer monitor never could.

    But my attachment goes beyond the merely physical. For me, The Merck
    is a talisman against the frightening unknown. Pretty much all of the
    life-shattering ailments that have struck my family and friends have
    been things I've never heard of. So by worrying about ailments like
    endocrine neoplasia or Refsum disease, I am actively warding them off,
    keeping myself and my loved ones safe.

    Of course, I'm aware this is magical thinking on, say, a 3-year-old's
    level. Still, so far, so good. It is human nature to want to name
    things, to put a face on the bogeyman. The scariest thing of all -
    death - has a name, and it is no less scary for having one. But
    there's an entry for that, too, in The Merck Manual. And somehow that
    comforts me.

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