An Open Letter to the Medical Profession

"The proper medicinal value of Malt Extracts must be held to depend on the AMOUNT OF DIASTASE which they con tain. In Malted Barley we have at command an un

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limited supply of diastase powder.”

WM. KOBERTS, M.D., F.R.S.,

PROF. CLINICAL MEDICINE, OWENS COLLEGE; PHYSICIAN TO THE MANCHESTE INFIRMARY, ETC.

Since the introduction by us of the manufacture of malt extract in this country, many prepar tions of this class, possessing more or less merit, have been placed on the market; and some, at leas the device of adventurers on the alert for catchword medicinal novelties, being mostly inert malte grain syrups. Hence it has been our endeavor to have the quality of malt preparations determine by appropriate tests which may be conveniently applied by every one interested in the admini tration of pure and reliable medicines. Every package of this Extract is accompanied with directio for making such tests, and the trade every-where have been long and repeatedly notified of our readiness return the price in money or replace with fresh amylolytically active extract, any and every sample of o extract found to be deficient

ex

pre

The superior amylolytic power of our Malt Extract has been proved not only y long clinical per ence in hospital and private p actice, but by careful and repeated analysis by some of the leadin organi che ists of bot Europe and Am rica, whose r ports thoroughly authenticated we are pared to furnish n ap, lic tion. The mere physical roperties of inferior proparations being liablē mislead, we have thr ug our r presentatives, by means of honestly made and classically accurat test, de nonstrated th diastatic str gth of our Extract, n the presence of thousands of physician pharmacist and apothe aries, both in private and at meetings of medical and pharmaceutical societie in every part of the United States.

The Trommer Company were the first to undertake the manufacture of Malt Extract in America, and th first in any country to employ improved processes in its preparation, with the object of preserving unimpaire ALL the soluble constituents of carefully-malted barley of the best quality, including, especially, the importan nitrogenous bodies which possess the power to digest starchy food.

We guarantee the uniform strength and purity of our malt extract. We are engaged exclusively this manufacture, and produce one quality only, and challenge any statement to the contrary by whom soever mad→. We are able to furnish thoroughly convincing roof of its excellence, in the form of testimonials of physicians and chemists of high repute in America and Europe, many of whom in deference to a growing sentiment in the profession are averse to having their names appear in advertisements. We take pleasure, however, in submitting them in another manner to those who request it, free of expense. It is more than suspected that another classf testimonials which laud to the skies the wares of certain manufacturers, while denouncing an article of long established merit, have been in some instances too easily obtain d. Suspicion is further arou ed by the tergiversations and inconsistencie charact rizing certain eager contributions which on occasion have found space in medic 1 journals, ex hausting the vocabulary f good words in one issue, while in another the same preparation is pronounced to be an inferior pr duct of a house engaged in fraudulent practices. The readers of such contributions would probab'y be edified if made acquainted with some facts having possible relations to their con tradictory character.

For the general convenience we publish an approved method for the

ESTIMATION OF DIASTASE.

For carefully making this, have 12 clear and uniform 2-oz. vials filled with distillel water, and two drops Iodine Solution prepared from 2 grams Iodine, 4 grams Iodide of Potassium and 250 grams water, a good thermometer and starch mucilage. To prepare the mucilage, 10 grams starch are stirred with 30 grams water and poured into 125 or 150 grams boiling water. The hermometer is then introduced and the temperature allowed to cool to 100° F. and maintained so by the water bath. Ten grams extract of malt dissolved ir 10cc, water are then stirred into the mucilage, the time being accurately noted. After one minute a good extract will have converted the thick mucilage into a thin liquid. As soon as this change has taken place it is necessary to examine the progress of the conversion of starch into soluble starch, dextrin and sugar at the end of every minute, by the following method:

After the expiration of the first minute, transfer two drops, by means of a glass rod, into one of the 2-oz. bottles. Th bottle is shaken and placed near a window At the end of every minute repeat this manipulation with a new bottle until the coloration is no longer produced. The time necessary for effecting this change gives the indication as to the amount of diastase present. Undecomposed starch mucilage gives a greenish blue co'or and after standing some time a blue precipitate. Soluble starch, the first product of the change, yields with Iodine, a dark blue solution without a precipitate. If the amount of soluble starch equals that of dextrin and sugar, the color of the solution will be purple. As the soluble starch disappears, the solution will be a decided red color if dextrin predominates, or faintly red if the sugar be in excess; and colorless. This experiment is very interesting and is simple to perform. For convenient methods for the estimation of solid matter and water, dextrin, sugar, etc., and determination of albuminates and free acid, refer to American Journal of Pharmacy

TROMMER EXTRACT OFMALT CO.

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NASHVILLE, SEPTEMBER, 1887.

No. 9.

Original Communications.

SYMPATHETIC OPHTHALMIA, WITH REPORT OF CASES.

BY J. G. SINCLAIR, M.D., NASHVILLE, TENN.

Professor of Diseases of the Eye, Ear and Throat Medical Department
University of Tennessee.

MR. PRESIDENT AND GENTLEMEN :-Sympathetic ophthalmia is an inflammation of the eye, which takes place in consequence of some organic lesion of the fellow eye, and is one of the most dangerous diseases to which the eye is subject. I deem it of sufficient practical importance to call the attention of the Society to some of the prominent points in its pathology and treatment.

That it is such a dangerous form of inflammation is borne out by
the fact that it adds a large contingent to the blind population of every
country. It is a disease that is sometimes so insidious in its attacks,
that it frequently reaches such a stage before the patient is aware of his
condition, as to almost defy any treatment to restrain its progress, and

Essay read before the Fifty-fourth Annual Meeting of the Tennessee State
Medical Society, April, 1887.

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ORIGINAL COMMUNICATIONS- SINCLAIR.

is so destructive, that when once established, it is seldom ever checked sufficiently to preserve any amount of practical vision.

It arises from various causes, but by far the largest proportion of cases of sympathetic inflammation is due to inflammatory action, superinduced by an injury to its fellow eye, with or without a foreign body remaining within the eyeball. The time at which sympathetic inflammation usually arises is from three to six weeks after the injury has been inflicted upon its fellow eye; but cases occasionally occur when years intervene between the time of injury and the development of the sympathetic trouble; and again, on the other hand, it may be only a few days.

The causes of sympathetic ophthalmia, as already stated, are generally wounds, especially of the ciliary region, either incised, punctured or contused wounds, with laceration of the iris and capsule of the lens. It is a question in my mind whether sympathetic ophthalmia ever occurs unless the ciliary body is involved in the injury, directly or indirectly, for we see cases where severe injury has been done to the cornea and iris, and even the crystalline lens has been seriously damaged, yet no sympathetic inflammation developed, unless the wound is of such a character as to allow a prolapsus of the iris that may by dragging upon and irritating the ciliary processes cause the sympathetic trouble. Some of the idiopathic causes are iridocyclitis, iridocyclochoroiditis and iridochoroiditis. But it is a difficult matter to say whether the second eye is not affected from the same constitutional condition of the system as led to the trouble in the first eye.

Hence, we see that it is one of the most important subjects in ophthalmic practice, and I deem it of sufficient importance to justify me in taking up the time of the Society in giving the history of the following cases, selected from my case book, bearing upon some of the most important points in this disease, and sufficient time has now elapsed since these accidents occurred to relieve the mind of any apprehension from sympathetic trouble.

Mr. D—, æt. 63, was brought to the clinic of the Medical Department of the University of Tennessee, in October, suffering intensely from a severe pain in the left eye and supraorbital region. On examination I found both eyes sightless. He gave the following history of his case. Thirty-two years before, while working on a railroad in Virginia, he had his right eye injured by the premature explosion of a blast, driving a tool they called a scraper, between the eyeball and the upper wall of the orbital cavity, causing a severe contused wound of

About two years after this he contract to build two sections of During that year he went to

the eyeball, but there was no laceration of any of the structures. The pain was severe, but soon subsided sufficiently to enable him to resume his work, and he could see distinctly. During the night and next day the eye felt very tender to the touch, and the night following it became very painful. In the morning he consulted a physician who ordered a poultice to be applied at once, and gave some drops to be put into the eye, which he said burnt like fire. Light became very painful to the eye, and he had to take morphine to relieve him of the continuous pain. About four weeks after the accident the pain suddenly ceased and he said the water ran out of his eye. Shortly after this he was able to go to his work again; could see light out of the injured eye, but could not see any thing distinctly. removed to Tennessee where he had a the N. and D. R. R., near Columbia. St. Louis to consult an oculist, but without any benefit. About seven years afterwards the other eye began to trouble him; it would tire very soon in reading; soon began to have some pain in the eyeball and forehead, considerable lachrymation at times, sight began to fail and finally was lost altogether. Did not seek any medical aid for the left eye. Occasionally during the last ten years he would suffer from severe attacks of neuralgia, becoming more frequent of late, and about four weeks before I saw him became almost continuous, and so severe, especially at night, that he could not sleep unless under the influence of large doses of morphine. I advised its enucleation, to which he readily consented, and putting him under the influence of ether I at once removed it in the presence of the class, ordered a dose of morphine and sent him home.

On dividing the eyeball to see the pathological condition of the eye, as I usually do, I found this bony formation, showing ossification of part of iris and ciliary body. This specimen is not only interesting because of its bony formation, but because it shows what sometimes takes place from long continued irritation.

Mr. J. L.—, æt. 57, farmer, consulted me about his eyes December 16, 1881 He stated that about one year before, while killing hogs, he was struck upon the right eye with a gambril stick, causing a severe contused wound both of the lid and eye-ball. The pain was so severe that he had to leave off work for an hour or more, bathed the eye in cold water and returned to his work. Had some pain during the night, and next morning there was considerable divergent squint, with a good deal of extravasated blood both in lid and eyeball. Sev

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eral days passed before he consulted a physician, who prescribed a collyrium of some kind, but without any benefit. The pain increased and considerable photophobia. He himself applied a poultice to the eye, and took some morphine. About six weeks after the accident a white spot appeared on the cornea, which increased in size until sight was nearly gone. This continued for several weeks, when it began to disappear, but left a spot over the pupil, though he could see some better. In June following he noticed something growing on the ball, and the pain increased, and he had to take morphine in order to get any sleep at night. He was advised to go to a mineral spring in Alabama, where he spent several weeks, and while there the doctor advised him to have the eye ball lanced, which was done and relieved him of pain for a few days, but the eye continued tender. Soon after this the left eye began to have a tired feeling, a burning sensation at the edge of the lids; could not read for any length of time, light became unpleasant to the eye, it felt gritty and watery and he had to wear colored shades. Gradually getting worse, in December he was advised to consult a specialist, and he came under my care on the 16th of December, as already stated. I found vision of right eye destroyed, ball shrunken and painful. Complained of indistinct vision in left eye, some photophobia, and a disinclination to use it. There was lachrymation, and spirits very much depressed over his condition. I advised the removal of the injured eye at once, to which he readily consented. He was placed under ether and it was enucleated, and a quarter of a grain of morphine taken at once, and ordered to be repeated in an hour if necessary, and two or three drops of a two grain solution of atropia to be dropped into the left eye three times a day, and warm water applications. In ten days he was discharged well, except that the left eye was still weak. Some weeks after he returned for an artificial eye.

Have seen and heard from him several times since; the last time was about one year ago, and he was quite well. Could read for any length of time without fatigue.

Mr. L. P—, æt. 22, near Texarkana, on September 28, 1879, was struck in the right eye by a nail that he was attempting to drive into a hard piece of timber. He felt that he was seriously hurt and called on a physician, who used a collyium of some kind, made cold applications and gave him a purgative. The eye was painful that night, and next day had to take morphine to ease the pain. In about two weeks the inflammation subsided and he returned to his work.