358 EDEMA 



of the cavity. Weems^° has described a similar case, with 1.39 per cent, in the 

 first fluid drawn, but smaller amounts in fluids withdrawn later; this patient had 

 a marked hypercholesterolemia. ArnelP^ found 0.41 i)er cent, of cholesterol in a 

 tuberculous pleurisy. In most of these cases some fats have been present, Weems 

 finding 0.33 per cent, and Ruppert 0.36 per cent. 



Toxicity. — Contrary to earlier ideas, transudates are not demonstrably toxic, 

 even in nephritis (Baylac,^^ Boy-Teissier,.'^ Lafforcade'^), and therefore the toxic 

 manifestations frequently observed after reduction of edema in nephritis, and 

 ascribed to absorption of poisons in the transudates, are probably due to some 

 other cause. In inflammatory exudates, of course, the causative agents as well 

 as the products of cell destruction render the fluids poisonous. 



Enzymes and Immune Bodies. — All the enzymes of the plasma may appear 

 in edematous fluids, being in all cases probably more abundant in exudates than 

 in transudates. According to Carriere,^^ oxidases are inconstant, even in exu- 

 dates. Lipase is said to be much more abundant in exudates than in transudates. ^^ 

 (Concerning proteolytic enzymes see "Autolysis of Exudates," Chap, iii.) The 

 various immune bodies, cytotoxins, hemolysins, bacteriolj'sins, agglutinins, etc., 

 seem to pass freely into both transudates and exudates, and their presence is not 

 characteristic of either, ^^ but as a rule the proportion is much higher in exudates.^* 

 Peptid-splitting enzymes are usually found in such fluids, ^^ especially tuberculous 

 exudates,' and these enzymes seem to be different from both erepsin and trypsin. 

 Probably this type of enzyme is more often present than trypsin. Antitryptic 

 activity is usually high, unless exhausted by the presence of much trypsin from 

 cell-rich exudates. Purulent fluids are usually poor in opsonins;- in non-purulent 

 fluids the opsonin content varies with the amount of proteins.' Turpentine exu- 

 dates may sometimes be more strongly bactericidal than the serum of the same 

 animal.'' Exudates usually contain about as much complement as the serum, 

 but in suppuration the complement disappears; transudates contain little of either 

 complement or hemolysins.^ 



Precipitin Reactions, etc. — Edematous fluids have been often used as a source 

 of material in immunizing animals against human proteins. The precipitins thus 

 formed are specific for human serum or for the proteins of the effusion, but can 

 not be used to differentiate a transudate from an exudate, or a hj'drothorax fluid 

 from an ascites fluid (Quadrone).^ Immune bodies, complement, agglutinins and 

 antitoxins are present in effusions; e. g., the common use of blister fluid for the 

 Widal test. Furthermore, according to Hamburger,^ edema fluid is distinctly 

 more bactericidal than normal lymph. 



Varieties of Edematous Fluids^ 



On the preceding pages have been mentioned the chief differences 



in the characters of the effusions in the usual sites, ^ with their varia- 



90 Amer. Jour. Med. Sci., 1918 (156), 20. 

 " Hygiea, 1917 (79), 737. 

 '••2 Compt. Rend. Soc. Biol., 1901 (53), 519. 

 '■>^ Ibid., 1904 (56), 1119. 

 9^ Gaz. heb. Med. et Chir., Jan. 28, 1900. 

 "^ Compt. Rend. Soc. Biol, 1899 (51), 561. 



9" Zeri, II Policlinico, 1903 (10), No. 11; Memmi, Clin. med. Ital., 1905, Xo. 3; 

 Galletta, Chn. med. Ital. 1911 (50), 143. 



'■" Granstrom, Inaug. Dissert., St. Petersburg, 1905. 



98 Not corroborated by Ludke, Cent. f. Bakt., 1907 (44), 268. See also Delrez 

 Bull. acad. Rov. Med. Belg., 1919 (29), 733. 



99 Hall and WiUiamson, Jour. Path, and Bact., 1911 (15), 351. 

 iSee H. Koch, Zcit. Kinderhoilk., 1914 (10), 1. 



2 Opie, Jour. Expcr. Med.. 1907 (9), 515. 



3 Bohmc, Dcut. Arch. klin'. McmI., 1909 (96), 195. 

 Mlastaedt, Zcit. Inimunitat., 1912 (13), 421. 



"■ Aronstamm, Cent. f. Bakt., 1914 (74), 326. 

 eCent. f. Bakt. (Ref.), 1905 (3()), 270. 

 ' Virchovv's Arch., 1899 (156), 32S). 



" Chemistry of Pus and Sputum are discussed under Inflammation, Chapter xi. 

 9 Literature and r6sume on pleuritic exudates, see Ott, Chcm. Pathol, dor 

 Tubcrc, 1903, {). 392. 



