A BRIEF RESUME 
OF A 
Comparative Study of the Ophthalmoscopic Condi- 
tions seen in Interstitial Nephritis as Found 
in Dispensary Service and in 
General Hospital 
Practice. 
BY 
CHARLES A. OLIVER, A.M., M.D., 
One of the Ophthalmic Surgeons to the Philadelphia Hospital; one of the 
Attending Surgeons to Wills’ Eye Hospital, etc. 
REPRINTED FROM 
THE PHILADELPHIA HOSPITAL REPORTS, VOL. III. 
1896. A BRIEF RESUME OF A COMPARATIVE STUDY OF THE 
OPHTHALMOSCOPIC CONDITIONS SEEN IN INTER- 
STITIAL NEPHRITIS AS FOUND IN DISPENSARY SER- 
VICE AND IN GENERAL HOSPITAL PRACTICE. 
CHARLES A. OLIVER, A.M., M.D. 
Through the kindness of several of his colleagues, the writer has 
had the rare opportunity to study a series of ward cases of this type 
of disease, and thus compare their ophthalmoscopic findings with 
those that, by long experience, he has become so familiar with in the 
ordinary walking cases that are so frequently seen in eye-dispensary 
services. 
This difference, which was first pointed out to him by his teacher, 
Dr. William F. Norris, appeared so radical when he examined his first 
few cases that he decided that a brief paper upon the subject in these 
Reports might be of some practical use and value. 
Instead of the marked degenerative lesions in the optic nerve-head, 
retina and choroid, and in place of the gross alterations of the blood- 
vessels and lymph channels that are so common in the dispensary 
case, there appeared in every instance, in all manner of varying 
degrees (mere traces at times), a true neuro-retinitis with vascular and 
lymph-wall changes. 
The ophthalmoscopic picture presented most frequently by the 
Hospital case is one where associated with hemorrhages, which are 
most often recognized as flame and fan-shaped extravasations in the 
thickened fibre-layer of the retina, especially along the main vascular 
stems, there is nerve-head swelling and oedema from the very faintest 
haze and elevation to the most complete choking and blocking. In 
addition to these, just beginning diminution of the arterial currents, 
which is more marked when the disc is swollen with irregular thick- 
enings and opacifications of the vessel-walls themselves, can be recog- 
nized. At times, at points along the finer branches, the walls them- 
selves seem actually thinned and the contained currents bulging. Later, 
minute yellowish specks and flecks in the deeper retinal tissue and the 
choroid appear—the entire grouping of symptoms as evidenced 
through the magnifying power of the direct method of ophthalmo- OPHTHALMOSCOPIC CONDITIONS SEEN IN INTERSTITIAL NEPHRITIS 
scopy, being expressive of a disease which manifests its greatest brunt 
upon the vascular and neural system—a disease whose series of oph- 
thalmoscopic conditions form merely a part and parcel of what may 
be made plainly evident post-mortem to the increased power of the 
microscope throughout the related vascular and neural structures of 
the entire body. 
This picture is totally different from that which is seen in the walk- 
ing case at the eye-dispensary. In this variety of subject, there is oft- 
times a subsided neuro-retinitis with scars of frequently repeated past 
inflammatory action and marks of renewed disturbance. These, with 
localized degenerative atrophies of the optic nerve-head, retina and 
choroid, and fatty and granular degeneration areas, are all the prevail- 
ing conditions. Here the ocular changes have been less apparent in 
their various stages, and it is only during the late and incurable 
period of the general disease that the patient seeks the aid of a 
medical adviser for failing vision. In fact, they have been more 
insidious, and hence, in reality, more grave. Again, the dispensary 
case is the one where the general disease—although, as a rule, 
having existed for a much longer period of time than the hospital 
type—has never appeared one of sufficient moment to render the 
subject bedridden for any extended time, and frequently the history 
of this class of cases will show that the patient has been but seldom 
incapacitated from following his usual occupation. This type often 
comes primarily to the ophthalmologist complaining of defective sight, 
and, never having been apparently seriously ill, has allowed the early 
and inflammatory signs of optic nerve, retinal and choroidal disturb- 
ances to pass unnoticed. 
In the dispensary case the climax of the general disease, as it were, 
which, as a rule, has never been great, has passed away, and the vary- 
ing groups of ocular degenerations seen ophthalmoscopically represent 
in a rough way merely to what extent the recurrent inflammatory reac- 
tions have reduced these degenerate tissues and to what degree the 
existing exacerbations are allowed to proceed. 
In the hospital type of case here studied, the condition of affairs is 
far different. The eye-ground has, by reason of the patient’s general 
state, been allowed either an early examination or one when its dis- 
turbance is at its greatest height or during the incipiency of the degen- 
erative process.