Before it evolved into one of the bestselling medical texts ever published, the Washington Manual began as a series of notes and observations compiled by internal medicine residents rounding at Barnes Hospital in the early 1940s. These “treatment pro tips” were collected throughout the course of a year of clinical rounding, and then assembled into a quick reference guide that was printed via typewriter. The first 16 editions of the Washington Manual were printed in very small numbers in-house by the university’s Department of Internal Medicine, and they rarely circulated outside of the university’s affiliated hospitals.
Known better as the Washington Manual rather than its full formal name — the Washington Manual of Medical Therapeutics — most internal medicine residents who trained at any hospital in the second half of the 20th century would instantly recognize a copy of the booklet because of its distinctive size. The 5-inch by 8-inch spiral bound format was designed precisely to fit inside of a physician’s lab coat pocket. This “guide to all things internal medicine” would have been available in abundance at any teaching hospital, especially in the days before you could carry a cell phone or tablet with easy access to tools like UpToDate — or the Washington Manual app that you can now download at the App Store or Google Play!
The earliest editions of the Washington Manual were created in the 1940s as a series of straightforward clinical notes for in-patient treatments. The responsibility of organizing and compiling these therapies fell to the chief resident(s) in internal medicine at Barnes Hospital each year, with additional Washington University faculty serving as uncredited reviewers and contributors. Dr. Wayland MacFarlane, who served as chief resident at Barnes Hospital in 1942, and who later held a faculty position at the Washington University School of Medicine, is credited as the author of the first edition of the Washington Manual printed in 1943.
The format of the 1940s version of the manuals, which were known as Therapeutic Notes at that time, were typescript pages held together with brass fasteners. These pages served as a brief guide to best practices in internal medicine at Washington University’s affiliated hospitals, and very few people outside of medical students and hospital house staff would have ever seen a copy. Because these manuals were printed in such few numbers, they are exceeding rare. In fact, only one surviving copy of Therapeutic Notes is known to exist today. Of the seven editions that were said to have been printed in the 1940s, the Becker Archives holds only one of them — the 3rd edition of Therapeutic Notes, which was compiled in 1945.
In 1950, the manual was given a new name — the Outline of Medical Therapeutics — and it was printed in larger numbers (a few hundred copies were distributed across campus). Additionally, it was provided in a hardier 8.5-inch by 11-inch spiral-bound format, with a sturdy front and back cover. The larger number of copies and the more durable binding allowed the 1950s versions to be more widely circulated, albeit, just to medical students, residents, interns, and hospital house staff at the Washington University medical center. With the exception of just three years (1957, 1959, and 1961), a new version of the manual was printed each year by the Department of Medicine at Washington University from 1950 to 1962.
The 16th edition of the Washington Manual printed in 1962 is notable for several reasons. Most importantly, 1962 was the first year it came to be known as the Manual of Medical Therapeutics. The 16th edition was also the last year for the manual to be internally printed by the Department of Medicine. A whooping 4,000 copies of the 16th edition were distributed to personnel across the WashU medical campus.
Beginning with the release of the 17th edition in 1964, Washington University partnered with an outside publishing company (Little, Brown, and Company) to print more manuals to keep up with the ever-growing demand for them. There were 25,000 copies of the Washington Manual printed for the 17th edition in 1964, which was also the first year it was available in the hallmark 5-inch by 8-inch spiral bound pocket-sized format.
Working with a publisher led to much wider distribution, and it significantly increased the popularity of the Washington Manual. By the 1980s, it was one of the most widely purchased medical textbooks in the world each year. New editions of the Washington Manual continue to be published today, and the scope is no longer limited to just internal medicine. There is a Washington Manual for surgery, pediatrics, neurology, psychiatry, and other specialties too.
The Becker Archives recently digitized the two precursors to the Washington Manual. You can now access our copy of Therapeutic Notes (1945), and all copies of the Outline of Medical Therapeutics (1950-1962) in the Digital Commons@Becker.