Acute spontaneous hypoglycæmia

ATTACKS OF CLOSED LIDS Besides the oculogyric attacks, in which the eyes turn in some direction, there are others in which the lids close and cannot be opened. These are not uncommon. Some patients will tell you that there seems to be something behinid the lids which is pulling, and which prevents them opening the eyes. These are probably only a variation of the other more common form. The grounds for such a view are to be seen in the serial pictures from the case of facial palsy (Fig. 3). Vhen the woman is told -to open the closed eyes the first thing that happens is not that the lid goes up, but that the eye begins to move downi, and until it has reached its proper position the lid does not show any sign of opening. Just as in closure of the eyes, the two parts of the act are not synchronous but consecutive; but now the order is reversed. Until the normal tone of the eye muscles has been resumed the leivatores palpebrarum cannot come into action. In the attack of " closed lids " the eyes go out of action when the lids close, and, as in the oculo'gyric attack, they cannot be brought into position again. Until they are, the eyes cannot open. Within the walls of this college, many years ago, your great physician Hughlings Jackson no doubt often repeated his famous aphorism: " Nervous centres know nothing of muscles; they only know of movements." The complexity of the muscular actions in the movement of closing and opening the eyes is an excellent example of this great truth.