CHYLOUS EFFUSIONS 363 



sorts seem to pass readily into blister fluids'' although the complement-fixation 

 reaction is not so stroiiij as with the blood."* 



Hydrops of Gall Bladder. — The watery fltiid contains 99 per cent, water, a 

 mucin-like substance, but no otiier proteins and no bile acids." 



Fetal Bronchiectasis. — The fluid resembles closely liquor amnii.'" 



Chylous Effusions.^' — Fat may be present in effusions in sufficient 

 quantity to cause a milky appearance, either from escape of chyle 

 from a ruptured or obstructed thoracic duct, or through fatty degen- 

 eration of the cells in the effusion or the lining of the walls of the 

 cavity. The former are designated as chylous, the others as chyU- 

 form or adipose fluids, but it is not always easy to distinguish be- 

 tween them. The composition of the fluids in true chj'lous exudates 

 will var}' according to the food taken and the amount* of fat the food 

 contains, and will resemble the composition of chyle, except to the 

 extent that it is modified by the effusion or absorption going on in the 

 cavity. They are characterized by strong bactericidal powers as evi- 

 denced by lack of putrefaction after long standing. 



Analyses of human chyle are scanty. Panzer^^ found 90.29-94.53 per cent, 

 water; 5.47-9.71 per cent, solids; 0.80-1.04 per cent, inorganic salts; 2.16 per cent, 

 coagulable protein; 6.59 per cent, ether-soluble material; also diastatic enzyme, 

 soaps, and occasionally traces of cholesterol, lecithin, and sugar. Carlier,^^ in 

 a specimen from a child, obtained very similar results, except that the salts 

 were much less abundant. The proteins and fats vary greatly with the diet; thus 

 Sollmann^^ found variations in the proteins from 1.85 to 6.5 per cent. 



Edwards^'^ found that of 31 definitely estabUshed cases of chylous 

 or chyliform ascites studied at autopsy, in 21 there was established the 

 existence of a rupture in the thoracic duct or lacteals. Boston^^ in 

 1905 was able to collect 126 cases, including both chylous and chyliform 

 ascites, and notes an associated eosinophilia in a case studied b}- him. 

 Chylous ascites fluid often, but not always contains sugar," but 

 it maj^ disappear after having once been present; the amount of fat 

 is small, usually about 1 per cent., and the fluid is rich in sohds. 

 If due to a ruptured thoracic duct, it may be possible to detect special 

 fats taken in the food, e. g., butter-fats (Straus).®^ The reaction is 



" Eisenberg, Deut. med. Woch., 1909 (35), 613. 



58 Buschke and Zimmermann, Med. Ivlinik, 1913 (9), 1082. 



59Sjoquist, SvenskaLak. Handl., 1916 (42), 1291. 



«o Koeckert, Amer. .Jour. Dis. Chil., 1919 (17), 95. 



" Literature bv Gandin, Ergeb. inn. Med., 1913 (12), 218. 



" Zeit. phvsiol. Chem., 1900 (30), 113. 



" British xMed. Jour., 1902 (ii), 175. 



«< -\mer. Jour. Phvsiol., 1907 (17), 487; see also Hamill, Jour. Physiol., 1906 (35), 

 151. 



"Medicine, 1895 (1), 257; also see "Chem. u. morph. Eigenschaften fett- 

 haltige Exsudaten," St. Mutermilch, Warschau, 1903; Comey and McKibben, 

 Boston Med. and Surg. Jour., 1903 (148), 109. 



« Jour. .'^ler. Med. Assoc, 1905 (44), 513. 



«' For example, v. Tabora (Deut. med. Woch., 1904 (30), 1595) found as high 

 as 0.864 per cent, of sugar in a typical case. 



" Arch. Physiol, et Pathol., 1886 (Ser. 3, vol. 8), 367. 



