Sixteenth edition. Robert Berkow; ed. 2844 pages. Rathway, New Jersey: Merck Research Laboratories; 1992. $26.00.

Imagine yourself a third-year medical student finishing a new admission one-half hour before rounds begin. The patient is a jaundiced, pregnant Peace Corps worker with a history of babesiosis. You are panic stricken; where do you turn for information in a hurry? The Merck Manual, of course.

The goal of this text is "to provide clinical information to ‘health care providers.’ " Indeed, the book is a staggering compilation of medical knowledge ranging from basic physiology to detailed descriptions of procedures. If one needed to know everything from warts to Starling's law and could only have one book, this is the book.

The text is primarily divided into organ systems, with some specialty sections such as pediatrics. The quality of the writing varies noticeably; it is succinct and pertinent in some parts and rambling in others. Much filler in the text could have been omitted. For example, it seemed unnecessary to define "cough" as "a sudden explosive expiratory maneuver that tends to clear material from the airways." These unnecessary inclusions cause the reading to be cumbersome at times.

The largest new section covers the human immunodeficiency virus (HIV). A concise, readable review of the basic pathophysiology, with extensive references to aspects of HIV, is covered in sections other than Infectious Disease. I did not find a discussion of HIV-related diarrheas, rheumatologic disorders, or oral lesions and dental problems.

As a general internist, I found the book's clinical utility inconsistent. Much of the material is geared to the medical student level. At times the discussions were detailed and applicable, whereas in other sections they were incomplete.

I used the book as a reference in my practice for a week. I found a helpful description of trachoma, and I used the neurology section to diagnose a lower brachial plexopathy. Conversely, no reference is listed in the index for pancytopenia. A new section on asthma in pregnancy seems outdated, recommending nebulized isoproterenol for "mild episodes" but giving minimal emphasis to inhaled corticosteroids, and no mention of the use and safety of anticholinergics in pregnancy. The dermatology section was well written, but, as we all know, a picture is worth a thousand words.

The Merck Manual is a time-honored, valuable reference for the person who needs to know a little bit about everything but not everything about one particular thing.