COMPOSITION OF EFFUSIONS 357 



mucin; it has been especially studied by Unibcr," who finds it (juite 

 similar to the synovial mucin isolated in arthritis by Salkowski, and 

 calls it serosaviucin. 



Non-Protein Organic Contents. — Proteoses,"' leucine, and tyrosine may be 

 present in small quantities in exudates, being produced by autolysis" (Umber); 

 and also mucoid substances (Hammarsten). Nucleoproteins may be present from 

 leucocytic disintegration in exudates, as well as the products of their further 

 splitting, such as purines and phosphates, daldi and Appiani'*" found uric acid 

 constantly in amounts between 0.0055 g. and 0.0714 g., in all exudates, of which 

 seven were tuberculous and two neoplastic. In three transudates amounts from 

 O.OOt) to 0.011 g. were found. Allantoin is said to have been found in exudates 

 (Moscatelli),*' but this is doubtful. 



All the other innumerable components of plasma may be found in edematous 

 fluids; thus sugar^^ and urea (Carriere)**^ are often present, as well as other ex- 

 tractives. The amount of urea varies quite as it does in the blood of the same 

 individual, ^^ and it seems probable that all the crystalloid substances present 

 in the blood pass freely into and from inflammatory exudates, so that an equi- 

 librium between blood and exudates is approximated.*'' Sugar is said sometimes 

 to be greater in amount in transudates than in the blood, but in exudates it is 

 usually, if not alwaj's, lower than 0.1 per cent.*^ Glycogen is not present (Car- 

 riere;.*^ By using more accurate methods than have been employed by most of 

 the observers quoted above, Denis and Minot"" found urea, uric acid and creatinin 

 to occur in exudates and transudates in the same concentrations as in the blood, 

 but the sugar content of ascitic fluids is somewhat higher than that of the blood. 

 Creatin, fats and cholesterol are much lower in transudates than in exudates in 

 which they approach the concentration in the blood. In ascitic fluid the urea, 

 uric acid and cholesterol are influenced by the diet. 



Lipins. — Lecithin is always present, partly bound to globulin and partly free 

 (Christen). ^^ Cholesterol is present particularly in fluids that have been standing 

 for a long time in the body, appearing often as visible crystals shining in the fluid; 

 it probably originates from degenerating cells. Ruppert has described a case of 

 pleural effusion with 1.129 per cent, of cholesterol when tapped the first time, 0.22 

 per cent, the second and 0.05 per cent, the third. Hedstrom reported finding in 

 an old pleural effusion, 4.5 per cent, of chole.sterol; one year later there was but 

 0.09 per cent. Zunz*' has described a carefully studied case in which 14 aspira- 

 tions were made; the cholesterol content was about 3 per cent, at first, but fell 

 suddenly to 0.48 per cent, and then remained between 0.5 per cent, and 0.28 per 

 cent. Lecithin varied from 0.1 to 0.04 per cent. As there did not seem to be 

 enough cells present in the fluid to have yielded the obtained cholesterol through 

 their disintegration, Zunz suggests that it may have been secreted by the walls 



"' Zeit. klin. Med., 1903 (48), 364; also Hoist, Upsalalakar. Forhand., 1904, 

 p. 304. 



'8 Opie, Jour. Exp. Med., 1907 (9), 391. 



'3 Histidine and arginine were found in a carcinomatous exudate by Wiener 

 (Biochem. Zeit., 1912 (41), 149). 



8° Riforma Med., 1904, p. 1373; also Carriere, Compt. Rend. Soc. Biol., 1S99 

 (51), 467. 



81 Zeit. physiol. Chem., 1899 (13), 202. 



82 Sugar was found in only 8 of 23 fluids by Sittig (Biochem. Zeit., 1909 (21), 

 14) ; but is present in pulmonary edema fluid in proportion equal to or even greater 

 than the blood (Ivleiner and Meltzer). 



83 Javal and Adler, Compt. Rend. Soc. Biol., 1906 (61), 235; Rosenberg, Berl. 

 klin. Woch., 1916 (53), 1314. 



8^ Wells and Hedenburg, Jour. Infect. Dis., 1912 (11), 349; Scheel, Nord. Med. 

 Laeg., 1916 (77), 610. 



85 Hegler and Schumm, Med. Klinik, 1913 (9), 1810. 



86 Compt. Rend. Soc. Biol., 1899 (51), 467. 



87 Arch. Int. Med.. 1917 (20), 879. 



88 Cent. f. inn. Med., 1905 (26), 329. 



83 Travaux Ambulance de L'Ocean, La Panne, 1918, Tome II, Fasc. 1. 



