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Related post: Method of Obtaining Shuddha Guggulu Himalaya Sign.
I. The patient should be directed to sit with the
occiput braced firmly against the back of a chair or
against the wall.
2. The patient is directed to follow the operator's
hand with the eyes (Fig. i).
3. Whenever it is found that the patient has ro-
tated the eyes upward as far as it is possible, she
is again directed to follow the hand of the operator
while it is lowered in an arched manner, keeping
the hand about three feet distant from the eyes, and
bringing it to a point on a level with and in the
median line of the patient's chin.
The degree at which the eyes are rotated down-
ward at the time the spasm of the superior lid is
seen will vary greatly in diflferent patients : the
greater the exophthalmos the earlier will the spasm
Case I. — Figure 2 represents the sign as displayed by
a female, aged 33 years, a patient of the Philadelphia
Hospital. In this figure No. i, by a lateral view, shows
the point at which spasm developed when the eyes were
following the operator's hand from above downward ;
and it also illustrates the high grade of exophthamos
present. No. 2 describes the eyes when the patient
was in the act of looking upward. No. 3, in addition
to marking the point at which spasm of the superior
lid developed, depicts a distinct convergence, which
became more and more marked as the eyes were rotated
downward. No. 4 was taken when the patient closed
the eyes as tightly as was possible.
This patient and several others of the series were
unable to use the muscles of the forehead to assist
in closing the eyes, while certain others were able
to force the eyelids together by the aid of these
muscles. The sign illustrated is not to be con-
founded with that portion of Graefe's sign which
points to immobility of the superior eyelid with trac-
tion of the lid, which is probably the result of spasm.
In Graefe's sign Buy Shuddha Guggulu the spasmodic condition of the su-
perior lid is present when the eye is at rest, while
in the sign herein described and illustrated the spasm
nnlv takes place as the eye is being rotated from
aho\r downward, and the lid continues to follow the
pupil immediately after the spasm.
August IT. 1!)07.]
WILLIAMS: CHILDREN'S FRESH AIR RESORTS.
The special sign of spasm of the upper Hd when
the patient attempts to rotate the eye from above
downward is oflfered not as a constant sign of
Graves's disease with marked exophthalmos, but as
one present in a series of fifteen cases, and as a
sign found to be uninfluenced by the anatomical
formation of the eyelids and of the bony structures.
1 53 1 South Broad Street.
THE PHYSICAL RECONSTRUCTION OF SCHOOL
CHILDREN BY MEANS OF FRESH AIR.*
By LixsLY R. Williams, A. M., M. D.,
Chief of Clinic. Department of Medicine, Vanderbilt Clinic,
Columbia University ; .Assistant .\ttending Physician,
City nospital, etc.
In considering the subject of physical reconstruc-
tion of school cliildrenby means of fresh air homes,
one must consider not only the child, but the fresh
air home ; and in considering the child, he must be
considered as one of a family. New York, with
its huge population, has many hundreds of thou-
sands who, from one year's end to the other, never
escape the confines of the city. Various estimates
have been given, but it is probably in the neighbor-
hood of eight hundred thousand. On several occa-
sions an attempt has been made to ascertain just
how many of these eight hundred thousand that
need it, Himalaya Shuddha Guggulu do get away by means of charitable agen-
cies. During the summer of 1903 figures were col-
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