REPRINT FROM 
VIRGINIA. 
MEDICAL MONTHLY. 
VOLUME XIX-No. 8. 
WHOLE NUMBER, 224. 
RICHMOND, NOVEMBER, 1892. 
The Therapeutic Merit of Combined Remedies. 
By STEPHEN J. CLARK, M.D., of New York, N. Y. 
In nearly every case where quinia is indicated, it can be advantageously com- 
bined with antikamnia, which thus becomes a valuable adjunct to quinia. Quinia, 
for example, is a most decided febrifuge, and its action is usually promptly reliable; 
but when combined with this member of the aromatic series, its action is markedly 
increased. Some individuals, however, cannot take any of the coal-tar derivatives; 
consequently the use of antikamnia will be inhibited in such cases ; on the other 
hand, some patients cannot take quinine. 
An important benefit to be derived from the addition of antikamnia to quinine 
is that it removes the sense of fullness in the head, constriction about the forehead 
and tinnitus aurium-so common when the latter drug is administered alone ; the 
disturbing action of quinia on the auditory nerve is suspended to a great extent, 
and the usual quinine deafness is absent. The combination of these agents in tablet 
form is a happy one. 
The combination of antikamnia with quinia is valuable in the racking headache, 
with high fever attendant upon malarial disorders. It is likewise valuable in cases 
of periodical attacks of headache of non-defined origin ; of the so-called "bilious 
attacks of dengue ; in neuralgia of the trigemini; in that of "ovarian catarrh 
and, in short, in nearly every case where quinine would ordinarily be prescribed. 
Binz claims specific antiseptic powers for quiniaother writers are in accord 
with him on this point, and report good results from large doses in septicaemia, 
pyaemia, puerperal fever, and erysipelas. It is a germ-destroyer of the bacilli of in- 
fluenza (la grippe). A full dose of quinine and antikamnia will promptly relieve 
many cases of this disease. In the gastric catarrh of drunkards, this combination is 
valuable. Quinia is a poison to the minute organism-sarcina; and antikamnia 
exerts a soothing, quieting effect on the nerve filaments. A full dose of antikamnia 
and quinia will often arrest a commencing pneumonia or pleuritis. This combina- 
tion is also useful in the typho-malarial fever of the South-particularly for the 
hyperpyrexia-both quinia and antikamnia, as previously said, being decided fever 
reducers. 
The germicide power of quinia is the explanation of its success in the treat- 
ment of malarial disturbances. Thus it is also a prophylatic against the various 
manifestations of malarial poison, and as such it can be relied on. The cause of 
malaria as a disease consists of pigmented bodies, which penetrate the interior of 
the red blood corpuscles-pigmented bodies of various shapes and flagellate organ- 
isms-both having amoeboid movements-the filaments being in active vibration. THE THERAPEUTIC MERIT OF COMBINED REMEDIES. 
In meningeal troubles, attended by marked acceleration of the heart due to the 
rise in the fever temperature, full doses of quinine and antikamnia at intervals of, 
say, about four hours, will be productive of good. In measles, large doses of the 
combination at night-say ten grains of each for adults (doses for children in pro- 
portion), will relieve the distress of the catarrhal pneumonia, and modify, in great 
degree, the amount of the exudative products. The periodical neuroses, which may 
be either regular or irregular in their manifestations, but which are dependent on 
the malarial germ for their origin, are all controllable by the combination of quinine 
and antikamnia. Examples of such neuroses are asthma, laryngismus stridulus, 
summer catarrh, etc. Indeed, for the hemicrania and neuralgias of malarial origin, 
the combination of quinine and antikamnia, just alluded to, may be declared a 
specific. 
The dose of quinine may be made smaller than usual when administered with 
antikamnia. Thus, one or two tablets of two and a half grains each of quinine and 
antikamnia will prove sufficient for great utility in puerperal mania, in the head- 
aches of advanced age, accompanied with vertigo and despondency. 
This combination is capable, by the combined influence of each drug on the 
nervous system and blood, of restraining all the processes which develop heat, 
organic changes, and muscular motion ; therefore, it is "the only thing needful" in 
the treatment of the hyperpyrexia of malarial fevers. In the vast majority of cases, 
when necessary to administer quinine, if antikamnia be added to the prescription, 
the results will be surprising. 
Formerly, the idea prevailed that in order to render the treatment of periodical 
fevers efficient, .the gastro-intestinal tube should be cleaned out by emetics and 
cathartics. This, however, is a fallacy, as the conditions they are intended to re- 
move depend mainly on the malarial poison, for which the combination of quinine 
and antikamnia is the specific cure. 
In speaking of the treatment of pneumonia by quinine and antikamnia, 
Prof. Palmer says: "The effects desired, and certainly as a rule produced, 
are a decided reduction of temperature, a marked diminution in the frequency 
of the pulse, a decided moisture of the skin or free sweating, a slower and 
more easy respiration, or relief from pain, and the feeling of fullness of the chest, 
a diminution of the cough and of the tenacious and bloody character of the expec- 
toration ; and, in short, not only is there a checking of the fever, but of all evi- 
dences-general and local-of the pulmonary engorgement and inflammation." 
In Meniere's disease, or "labyrinthine vertigo," this combination has, by per- 
sistent use, entirely removed the trouble in many cases. The curative effects of 
quinine and the coal-tar antipyretics in sunstroke are well known, and have been 
used recently with great benefit in numerous instances in this country and in India. 
In hysteria, and even in epilepsy, the combination of quinine and antikamnia is of- 
ten indicated, and will frequently give the desired results. In whooping-cough and 
hay fever, quinine and antikamnia will prove beneficial. 
The tablets of equal parts of quinine and antikamnia, spoken of in this article, 
can be administered by the rectum, with good effect. They should first be dissolved 
in whisky, and then water can be added in any quantity needed-always remember- 
ing the total quantity of each drug in such enemata. 
66 West Tenth Street.