ANovTe°mb€rhia9ri™'  )    Pharmacology  and  Therapeutics.  543 
drug  effects  of  value  in  combating  the  disturbances  of  functions  that 
are  encountered  in  disease?  The  final  answer  to  this  question  can 
seldom  if  ever  be  given  from  studies  either  on  normal  animals  or  on 
normal  men.  In  certain  instances  the  diseased  function  is  unusually 
susceptible  to  drug  action.  The  body  temperature  of  a  febrile 
patient,  for  example,  is  reduced  more  easily  by  antipyretic  drugs  than 
is  the  body  temperature  of  a  normal  person.  Digitalis  in  therapeutic 
doses  has  relatively  little  effect  on  the  heart  rate  when  this  is  con- 
trolled in  the  usual  way  from  the  sinus  region.  Its  reputation  for 
slowing  the  heart  of  patients  is  based  almost  exclusively  on  observa- 
tions which  were  made  on  those  suffering  from  auricular  fibrillation. 
Diuretics  of  the  caffein  group  produce  a  moderate  diuresis  in  the 
healthy  man,  and  may  be  ineffective  or  harmful  in  nephritic  edema, 
whereas  in  cardiac  edema  they  often  cause  a  veritable  flood  of  urine. 
The  dilatation  of  the  bronchi  produced  by  epinephrin  is  most  plainly 
demonstrable  in  conditions  of  bronchial  constriction,  whether  pro- 
duced experimentally  or  occurring  during  asthma.  Finally,  the 
treatment  of  infections  can  manifestly  be  tested  only  on  infected 
animals  or  human  beings. 
Not  infrequently  the  remark  is  made  that  the  value  of  a  thera- 
peutic measure  is  determined  solely  by  clinical  experience.  While 
I  have  no  desire  to  contradict  this  assertion,  it  should  be  pointed  out 
that  ordinary  clinical  observations  are  often  extremely  difficult  to 
interpret,  owing  to  the  vagaries  of  disease  and  to  the  many  remedies 
that  are  so  commonly  employed  in  a  single  case.  The  past  history 
of  therapeutics  warns  us  that  in  order  to  avoid  error  we  need  as 
much  assistance  as  possible  from  every  source.  Pharmacology  may 
not,  indeed,  answer  therapeutic  problems  directly,  but  at  least  it 
aids  in  their  solution.  It  shows  how  drug  action  may  be  made  the 
subject  of  accurate  study,  and  the  critical  attitude  which  it  adopts 
must  be  carried  over  into  the  interpretation  of  therapeutic  results, 
if  progress  in  that  subject  is  to  be  placed  on  a  firm  foundation. 
On  the  other  hand,  pharmacologists  could,  I  believe,  be  of  greater 
help  to  those  who  work  in  the  clinic  if  they  would  fully  realize  how 
their  results  may  be  given  a  form  more  suited  to  clinical  needs. 
What,  for  example,  is  the  effect  of  a  given  drug  in  small  doses, 
especially  when  given  over  a  long  period  of  time?  How  are  the 
effects  modified  when  animals  have  been  made  the  subject  of 
disease  ?  What  pharmacologic  problems  can  be  studied  on  man  him- 
self, and  especially  on  patients  who  are  taking  the  treatment  usually 
