S U R G E R Y. 
748 
and pericranium exhibit dark red-coloured spots; and, on 
other occasions, the tunica arachnoides and pia mater are 
studded with numerous white spots, which, on being cut 
into, are found to be small bags, or abscesses containing a 
white viscid fluid, like cream. 
It appears, that children are far more subject, than adults, 
to fungus haematodes of the eye; for out of 24 cases, with 
which Mr. Wardrop has been acquainted, 20 have been in 
children under 12 years of age. Bichat informs us, that 
more than a third of the patients, on whom Desault operated 
for carcinoma of the eye, were under the same early age; 
and this circumstance is not surprising, when we reflect, that 
this eminent surgeon did not discriminate fungus hsematodes 
from cancer. The truth is, the latter distemper mostly 
afflicts persons advanced in years; while the former prevails 
most frequently in children; a circumstance strongly proving 
the dissimilarity of the two affections. 
According to the observations of Mr. Wardrop, when 
the fungus hsematodes takes place in children, they generally 
lose the sight of the affected eye, before the disease is at all 
noticed by the parents. In many cases, however, the ap¬ 
pearance of the diseased substance at the bottom of the eye 
is preceded by a blow and inflammation of the organ. But 
when no external violence is concerned, the first perceptible 
symptom is merely a little fulness of the vessels ofthe white of 
the eye. Sometimes the iris is full of vessels, its colour changes 
and the pupil is considerably dilated and motionless. The 
child seldom complains of much pain; but sometimes ap¬ 
pears languid and feverish. 
In adults, the disease generally begins without any apparent 
cause ; though, sometimes, it seems to arise in consequence 
of a blow. As in children, it commences with a slight red¬ 
ness of the conjunctiva, and an impairment of vision. 1'hese 
symptoms increase slowly, and at length are followed by 
headaches, which often become exceedingly agonizing, 
especially during the night, and continue with violence, 
until the'eye bursts, and the humours are discharged. 
In most cases, only one eye has been affected with the 
disease. In some examples, however, the distemper extends 
to both. 
As surgeons are utterly unacquainted with any internal or 
external medicine which have the power of checking or 
curing the fungus haematodes of the eye; and as it is the na¬ 
ture of the disease to extend its ravages till the patient is de¬ 
stroyed, the only chance of preservation depends upon the 
early extirpation of the affected eye, care being also taken 
to remove every part in the orbit having any appearance of 
participating in the distemper. Hitherto, however, the 
disease has mostly recurred after the operation, and ultimately 
proved fatal. Indeed when we consider that the disorder 
generally spreads along the optic nerve, we must be prepared 
for this uufortunate truth. 
A blindness which occurs when all the parts of the eye 
appear healthy, is called Amaurosis, or Gutta Serena. It 
arises from inaction of the optic nerve. If this inaction 
arise from any permanent change in the structure of the 
nerve, or of the part of the brain, to which it goes, the case 
is hopeless, but a mere debility of the nerve may be cured. 
The blindness, produced by the gutta serena, is generally 
preceded by an appearance of numerous insects, or sub¬ 
stances like pieces of cobwebs, interposing themselves be¬ 
tween the objects and the eye. The origin of a cataract, on 
the other hand, is usually attended with a simple cloudliness 
in vision. 
As Beer has observed, the various cases of gutta serena all 
admit of being comprised in two classes; one attended with a 
diminution in the irritability of the whole eye, and where the 
patient constantly seeks a strong and brilliant light; the 
other characterized by great tenderness and irritability of the 
organ, and an aversion to every light which is bright or 
vivid. 
When amaurosis has prevailed several years in persons 
of advanced age, whose eyesight has been weak from their 
youth ; when it has come on slowly; at first, with a mor¬ 
bid increase of sensibility in the immediate organ of sight, 
then with a gradual diminution of sensation in this organ, 
to the state of utter blindness; when the pupil is motionless, 
and has lost its circular shape, without being very much di¬ 
lated ; when this aperture is dilated in such a degree, that the 
iris seems as if it were wanting, and its margin is irregular 
and fringed; and when the bottom of the eye, independent¬ 
ly of any capacity of the crystalline, presents an unusual 
paleness, like that of horn, or else a greenish hue; the 
malady may generally be considered incurable. Those cases 
may also be deemed irremediable which are attended with 
universal headache, and a constant sense of tension in the 
eyeball; which are preceded by a violent, protracted ex¬ 
citement of the whole nervous system, and by general de¬ 
bility, and languor of the whole constitution. There is no 
remedy for such cases as are preceded or accompanied by 
epileptic fits, or frequent hemicrania; nor for such as are 
the consequence of severe, obstinate, internal opthalmies. 
We may also set down those cases as incurable, which, 
besides being of long standing, have originated from violent 
concussions of the head, or blows on the eyeball. The 
same may be said of amaurosis, when it arises from a violent 
contusion, or laceration ofthe supra-orbitary nerve: when it 
proceeds from the entrance of foreign bodies into the eye¬ 
ball ; when it is attended with exostoses on the forehead, * 
sides of the nose, or os maxillare ; and when conjoined with 
a manifest change in the figure and dimensions of the whole 
eyeball. 
Recent and sudden cases, in which the pupil is not ex¬ 
cessively dilated, and in which the disk of this aperture re¬ 
tains its regularity, while behind it the bottom of the eye is 
of a deep black colour; cases which are not accompanied 
by any acute and continual pain in the head and eyebrow, 
nor by any sense of constriction in the eyeball; cases which 
originate from violent emotions of the mind ; excessive ful¬ 
ness of the stomach; irritating matter in the viscera; ple¬ 
thora ; suppression of some habitual evacuation; great loss 
of blood; nervous debility, not of an inveterate nature and 
in young subjects; are all, generally speaking, curable. 
All surgeons agree, that this disease, in its curable and 
incomplete state, commonly depends on a morbid irritation 
in the digestive organs, sometimes complicated with general 
nervous debility, in which the eyes participate. 
Hence, the chief indications in the majority of recent, in¬ 
complete cases, is to empty the stomach and bowels; then 
to strengthen the tone of the digestive organs, together with 
that of the whole nervous system; while at the same time 
efforts are made to invigorate the action of the nerves of the 
eye in particular. 
For the latter purpose, Scarpa directs the vapour of the 
aqua ammonire purse to be applied to the organ, till a co¬ 
pious secretion of tears and redness are brought on; then 
the practitioner is to desist a little ; but he must renew the 
application in this manner three or four times at once, and 
persevere till the amaurosis is cured. 
The action of the ammoniacal vapours may be aided by 
other external stimulants, applied to such parts of the body 
as have a great deal of sympathy with the eyes. Blisters to 
the nape of the neck; frictions, with liniments on the eye¬ 
brow ; sternutatories; and electricity ; are the chief auxili¬ 
ary means. 
In the amaurosis, arising from the suppression of the 
menses, the first evident indication is to re-establish the 
evacuation of blood from the uterus. 
When the crystalline lens, or its capsule, is affected with 
opacity, the species of blindness, thence resulting, is denomi¬ 
nated a cataract. The opacity originates, for the most part 
gradually, and augments in the same manner. Sometimes, 
however, it makes its appearance suddenly, and in a very 
high degree. The first effect of an incipient opacity is a 
mist before the eyes, surrounding every object, and after¬ 
wards gradually increasing so much in density, as to render 
things quite invisible. The opacity, behind the pupil, in¬ 
creases in proportion as the cloudiness in vision augments. 
As the lens is thick at its centre, and thin at its edge, the in¬ 
cipient opacity, when viewed externally, always seems the 
greatest 
