766  Value  of  Drugs  in  Internal  Medicine.  | Am'-^^ r"i92iarm* 
related  pneumococcicidal  substance  that  is  less  harmful  to  the  body, 
just  as  the  discovery  of  the  relatively  innocuous  spirillocidal  arsphe- 
namin  succeeded  that  of  the  blindness-producing  atoxyl?  ' 
FUNCTIONAL  PHARMACOTHERAPY. 
Though  less  ideal  and  important  than  etiologic  therapy,  much 
good  can  be  accomplished  by  the  internist  who,  making  use  of  a  so- 
called  functional  pharmacotherapy,  tries  to  restore  to  normal  some 
function  that,  through  disease,  has  become  disturbed  or  abolished. 
This  can  easily  be  made  clear  by  citing  a  few  examples.  Thus, 
a  patient  with  valvular  disease  of  the  heart  may  get  on  well  for 
years,  thanks  to  the  reserve  force  of  his  cardiac  muscle.  But,  sooner 
or  later,  the  function  of  the  heart  muscle  begins  to  fail,  and  breath- 
lessness,  tachycardia,  arrhythmia,  passive  congestion  and  edema  ap- 
pear. In  digitalis,  the  pharmacotherapist  possesses  a  remedy  that, 
properly  used,  will  often  slow  the  heart  rate  and  increase  the  con- 
tractility and  tonicity  of  the  muscular  walls  of  the  heart  so  that  the 
circulatory  insufficiency  will  disappear.  Or,  a  patient  in  whom  atrial 
(auricular)  fibrillation  exists  may  have  the  normal  initiation  and 
conduction  of  atrial  stimuli  restored  by  means  of  a  few  doses  of 
quinidin.  Or,  again,  a  patient  whose  arteries  are  becoming  sclerotic 
may  have  spasms  of  the  coronary  vessels  and  the  severe  pain  of 
angina  pectoris  that  can  be  relieved  by  dissolving  a  tablet  of  glyceryl 
trinitrate  under  the  tongue,  which,  by  dilating  the  pathologically  con- 
tracted coronary  arteries,  removes  directly  a  responsible  functional 
disturbance.  Similarly,  we  can  relax  the  bronchospasm  of  a  typical 
attack  of  bronchial  asthma  by  the  injection  of  a  few  minims  of  a 
solution  of  epinephrin  (i :  1,000),  and  we  can  spur  the  atonic  wall 
of  the  intestine  to  contract  in  a  postoperative  case  by  means  of  a 
hypodermic  injection  of  solution  of  hypophysis  (pituitary  extract). 
In  all  these  instances  we  make  use  of  a  functional  pharmacotherapy. 
Another  example  may  be  chosen  from  the  field  of  metabolism. 
Thus,  in  gout,  uric  acid*  is  not  adequately  excreted  by  the  kidneys, 
being  retained  in-  the  blood  or  deposited  in  the  tissues  about  the 
joints.  The  function  of  uric  acid  excretion  by  the  kidneys  can  be 
temporarily  increased  by  the  administration  of  cinchophen  or  neo- 
cinchophen,  substances  that  also  exert  an  exceptionally  efficient  anal- 
gesic effect  in  acute  attacks  of  gout. 
What  we  know  as  "organ  therapy"  may  also  be  regarded  as  one 
kind  of  functional  pharmacotherapy.   If  dried  thyroids,  for  example, 
