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The Trommer Extract of Malt Company guarantee to the Medical Profession the excellent quality and absolute reliability of their Extract of Malt, and all its combinations.

EXTRACT OF MALT

With Cod Liver Oil.

First proposed by Dr. F. H DAVIS, of Chicago.

(See Transactions of American Medical Association, for 1876, page 176.

Is presented to the medical profession as an efficient, palatable and very staple combination, consisting of equal parts of the Extract of Canada Barley Malt and the best quality of genuine Norwegian Cod Liver Oil. Many patients take this preparation who cannot take the oil in any other form. It may be employed in all cases where Cod Liver Oil is appropriate, but is peculiarly adapted to those complicated with disordered digestion.

EXTRACT OF MALT

With Cod Liver Oil and Phosphorus,

Consists of equal parts of Extract of Malt and pure fresh Norwegian Cod Liver Oil, Phosphorus being added in the proportion of 1-100 grain to the dose, and so combined as to be perfectly protected from oxidation. The Trommer Extract of Malt Company prepare this combination agreeably to the suggestion of Dr. Wilson Fox. It is specially adapted to cases of phthisis, bronchitis, pernicious anæmia, and diseases of the nervous system.

EXTRACT OF MALT

With Cod Liver Oil and Iodide of Iron,

Added in the proportion of one grain to the dose. This combination is intended to meet those cases where the physician desires to add a more energetic alterative and restorative to the treatment with Cod Liver Oil and Extract of Malt. The manufacturers have received numerous letters from prominent physicians, referring to it in terms of high praise.

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TROMMER'S EXTRACT OF MALT.

The rapidly increasing demand for our IMPROVED Extract of Malt, during the four years that it has been manufactured and offered to the medical profession in America, justifies the belief that in its production here we are meeting a generally felt want.

Long experience in manufacturing Malt Extract has enabled us to completely overcome the many difficulties attending its manufacture in large quantity; and we positively assure the profession that our Extract of Malt is not only perfectly pure and reliable, but that it will keep for years, in any climate, without fermenting or molding, and that its flavor actually improves by age. Our Extract is guaranteed to equal, in every respect, the best German make, while, by avoiding the expenses of importation, it is afforded at less than half the price of the foreign article.

The Malt from which it is made, is obtained by carefully malting the very best quality of selected Toronto, Canada, Barley. The Extract is prepared by an improved process, which prevents injury to its properties or flavor by excess of heat. It represents the soluble constituents of Malt and Hops, viz: MALT SUGAR, DEXTRINE, DIASTASE, RESIN AND BITTER OF HOPS, PHOSPHATES OF LIME and MAGNESIA, and ALKALINE SALTS.

Attention is invited to the following analysis of this Extract, as given by S. H. Douglas, Professor of Chemistry, University of Michigan, Ann Arbor.

TROMMER EXTRACT OF MALT CO.:-I enclose herewith my analysis of your Extract of Malt:

Malt Sugar, 46.1; Dextrine, Hop-bitter, Extractive Matter, 23.6; Albuminous Matter, (Diastase), 2.469; Ash-Phosphates, 1.712; Alkalies, 377; Water, 25.7. Total, 99.958. In comparing the above analysis with that of the Extract of Malt of the German Pharmacopoea, as given by Hagar, that has been so generally received by the profession, I find it to substantially agree with that article. Yours truly, ŠILAS H. DOUGLAS,

Prof. of Analytical and Applied Chemistry.

This invaluable preparation is highly recommended by the medical profession, as a most effective therapeutic agent, for the restoration of delicate and exhausted constitutions. It is very nutritious, being rich in both muscle and fat producing materials.

The very large proportion of Diastase renders it most effective in those forms of disease originating in imperfect digestion of the starchy elements of food.

A single dose of the Improved Trommer's Extract of Malt contains a larger quantity of the active properties of Malt than a pint of the best ale or porter; and not having undergone fermentation, is absolutely free from alcohol and carbonic acid.

The dose for adults is from a dessert to a tablespoonful three times daily. It is best taken after meals, pure, or mixed with a glass of milk, or in water, wine, or any kind of spirituous liquor. Each bottle contains 11⁄2 lbs. of the Extract.

Our preparations of Malt are for sale by druggists generally throughout the United States and Canadas, at the following prices:

THE

Chicago Medical Times.

WILSON H. DAVIS, M. D., Editor and Publisher.

ANSON L. CLARK, M. D., Editor.

Where the uterus is bent upon its cervix the result is called flexion; if the fundus inclines backwards it constitutes retro-flexion; if forward, ante-flexion; and in either of these cases the os and vaginal portion of the cervix may occupy a normal position in the pelvis. The point of flexion is usually at the internal os, and the angle may be quite acute. Normally the uterine canal is not straight, but curved, constituting a normal or physiological ante-flexion. In considering the possibility of uterine displacements it should be borne in mind that the fundus of the uterus is not arbitrarily fixed by any of its attachments, but especially in an antero-posterior direction may vary its position quite considerably. In fact, the condition of the bladder or rectum as to emptiness or repletion will make quite extensive changes in the position of the fundus uteri.

If the fundus drops forward, carrying the os and cervix backward and often upward, the axis of the organ acquiring no change in normal curvature, the result is called anteversion. If the proceeding be reversed, the result is retro-version.

As a matter of fact, neither flexions or versions usually occur in perfect separation one from the other; ante-version being usually accompanied by an increased degree of anteflexion, and retro-version by a degree of retro-flexion. The extreme points of version may be said to consist in a complete inversion of the axis of the organ; thus in anteversion the fundus would lay low and directly behind the symphysis pubis, while the os, with difficulty, if at all, reached, would be found near the promontory of the sacrum; in retro-version, the fundus would be found low down in the hollow of the sacrum, while the os, pointing in the direction of the umbilicus, would be found above and behind the symphysis pubis. Such degrees of version being however very seldom observed.

Causes of Version. In a state of complete emptiness of the bladder, the uterus, owing to the natural tipping forward of its axis, falls still farther forward, and becomes temporarily really ante-verted, great distension of the bladder produces mechanically a retro-version, from either of which conditions the organ usually assumes its normal condition upon removal of the cause. If, however, a laxity of the ligaments supporting the uterus, such as may be induced by rapid or recent child bearing, be present, or if from chronic inflammation, or the presence of fibroids, or from any other cause, the fundus be preternaturally enlarged or heavy, there is a tendency for the malposition to become permanent. If this be further assisted by sudden violent exertions, such as lifting, straining at stool, falls or leaps from a height, as from a carriage to the ground, we have very good cause for permanency of the condition.

It is also worthy of consideration that owing to the intervention of the peritoneal fold, known as Douglas' space, between the uterus and rectum, distension of the latter organ, unless very excessive, does not produce anteversion of the uterus.

Causes of Flexion.--Add to the causes producing version a thinning or weakening of the cervical portion of the uterus from any accidental cause or diseased condition of

FLEXIONS AND VERSIONS OF THE UTERUS.

107 the organ, and flexion may result instead of version, and once produced by the obstruction to the circulation, or partial strangulation brought about by the flattening of the blood vessels at the point of flexion, the congestion of the fundus and consequent enlargement produced tends to make the condition perpetual. Indeed, no less an author than Hewitt believes that most cases of uterine enlargment, congestion and chronic inflammation are traceable to flexions as a cause, a position, however, not accepted by other gynecologists, or in harmony with my own observations. No inconsiderable number of flexions are congenital, their presence not being discovered until after the arrival of puberty, or more frequently the presence of some pelvic trouble, not at all connected with them, tends to an examination and their discovery.

Relative Frequency.-No reliable data can be given to exhibit the relative frequency of these malpositions, since the experience of no two observers has been alike. Owing to the natural anterior obliquity of the uterus it might be supposed that the prevailing versions and flexions would be of the anterior variety, but as a counter-balance we have the support of the bladder in front, perpetually tending to prevent anterior displacements. My own impression is

that I most frequently meet with anterior displacements. Effects of Version and Flexion.-As consequences of these displacements, may be mentioned, miscarriage, hypertrophy, descent, dysmenorrhea, menorrhagia, amenorrhea, and sterility.

The disturbed condition of the circulation, causing congestion of the uterus, cannot fail to materially interfere with the functions pertaining to maternity, and we accordingly find that where by the increasing size of the uterus the flexion or version is not early remedied, abortion usually follows. While, as producing causes, ante-flexion and retro-flexion are probably equal, more miscarriages occur with ante-flexion because pregnancy is more likely to occur with this form of flexion.

Reference has already been made to the fact of conges