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 iş 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 fróm 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.:-1 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, SILAS 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:

Symptoms. In addition to what has already been mentioned among the results of flexions and versions, certain more or less symptomatic pains are usually felt. Backward displacements are, in a large percentage of cases, accompanied by pains in the back and running down the back of the thighs; the rectum is also mechanically affected by the pressure, causing, at some times, constipation; at others, irritation, accompanied by tenesmus and the secretion of mucus, and movements of the bowels may be accompanied by pain, even of a very severe character. The ability to walk or stand upon the feet is often largely interfered with, on account of "uterine lameness."

In forward displacements, the pains are more likely to be felt in the vaginal or hypogastric regions and upon the anterior or interior surface of the thigh; vesical take the place of rectaldifficulties, and the bladder, constantly pressed upon by the fundus uteri, is thus mechanically contracted in capacity, and becomes irritable, a urinary tenesmus, with frequent urination, and, in time, catarrhal discharges take place.

In addition with either form of version, a series of nervous phenomena are observed, especially in nervous subjects, so

varied in manifestation as to defy description, and so obscure in cause as often to completely mislead the observer. Every phase of hysteria, in its protean forms, nervous dyspepsia, functional disorders of the heart, neuralgias that make life a burden, and even insanity may follow in the track of these displacements.

Diagnosis. The diagnosis is not usually difficult. In anteflexion the fundus uteri is felt through the vaginal wall behind the symphysis pubis, where it might be mistaken for a tumor. The direction taken by the uterine sound in introduction will, however, be natural, and its passage be effected without material trouble if the difficulty be a tumor; while if flection be present the sound will pass with difficulty, if at all, and the direction taken by its point will show the direction of the uterine axis.

In retro-flexion, the fundus is easily felt in the hollow of the sacrum, and the introduction of a finger in the rectum will serve to confirm and make more positive a vaginal diagnosis. The uterine sound also subserves the same purpose as in anteflexion. Versions are easily recognized by the touch, and the subject requires no further mention here.

Prognosis.-The treatment of flexions and versions is often tedious and difficult, and the final result often depends upon the fidelity of the patient to instructions and treatment, as well as the patience with which she will persist. Various circumstances, also, enter into the composition of a case, among which may be mentioned irritability or tenderness of the uterus, the amount of relaxation of the vagina and uterine ligaments, the duration of the disease and the general health of the patient. Given favorable circumstances, our prognosis is favorable; otherwise, it is safer not to promise too much, so far as cure is concerned. Relief from urgent symptoms may almost always be afforded. Cases of congenital flexion are seldom amenable to more than relief from distressing symp

toms.

Treatment. The first indication is to restore the uterus to its natural position; the second, to retain it in place. The pressure of the exploring finger is, in many cases, sufficient to

carry an ante or retro-flexed uterus into its proper position, so easily, even, that in some cases the reduction has, in this way, been accomplished without the knowledge of the physician, who thereby failed to properly diagnose the case.

Comparatively few cases will, however, be so easily reduced, and it will often prove advantageous to secure the benefit of position to assist, Thus, in ante-flexion and version, the patient should lie upon the back, with the pelvis elevated and the shoulders depressed. In retro-flexion and version, the knee-elbow position will assist us. But, even then, we may fail; and, to meet such cases, various instruments have been invented, under the general name of "uterine repositors."

In this field there is yet room for the inventive genius of the gynæcologist, for none of these instruments is as near perfection as the circumstances of the case seem to demand. By many the uterine sound is used in their stead, and, in most cases, answers as well. It is, however, open to a quite serious objection: in its introduction it is necessarily introduced with a considerable degree of curvature, corresponding in amount with the degree of version or flexion present. Reduction being then effected by a semi-rotation of the handle, it is evident that an extreme amount of lateral version will be brought about, while the pressure thus brought to bear upon the mucous membrane of the cavity may be such as to injure it. In this respect and for these reasons, in extreme cases the repositor is the more desirable instrument. Occasionally, I have found the introduction of the sound would reduce the displacement, as one might straighten a glove finger by introducing the finger. Reduction of flexions has been brought about by the introduction of tents and dilation of the cervical canal.

To retain the uterus in position has taxed the inventive genius of very many. In some few cases in which, previous to the present attack, the position of the uterus had always been normal, the simple reposition of the organ, with a few hours of rest, will be found sufficient, or the same treatment daily pursued for a few days may be required. But a very small per cent. of the cases we shall be called upon to treat will, however, be of this class, most of them being of long