364 EDEMA 



usually alkaline or neutral, and some specimens coagulate spontane- 

 ously. Specific gravity varies from 1.007 to 1.040, the average being 

 about 1.017. Perhaps the most important characteristic is the varia- 

 tion produced by changes in diet.^^ Zdarek'^" found in a chyle-cyst 

 2.7 per cent, of fats, 7.2 per cent, of proteins, and 0.05 per cent, of 

 sugar; feeding of fats increased their amount in the cyst and star- 

 vation decreased it. Schumm''^ found in the solids of such a cyst 

 35.76 per cent, of fat, some of which was in the form of calcium soap. 



Chyloihorax fluid is, of course, quite similar to that of chylous ascites. Thus, 

 Buchtala^^ found 91.34 per cent, of water, 8.66 per cent, solid, 4.86 per cent, 

 protein, 2.5 per cent, fat, 0.26 per cent, cholesterol, and 0.94 per cent. ash. Similar 

 figures were obtained by Salkowski^^ and others. 



Chyluria,''* which seems to depend upon an abnormal communication between 

 the lymphatics of the receptaculum chyli and the kidney,^^ shows no particular 

 chemical features beyond those of an admixture of a considerable amount (100 to 

 1000 c.c. per day) of chyle with the urine. Carter"' found the amount of fat in 

 the urine to rise with increase of fat in the food. Pecker^^ observed a rise from a 

 former average of 1.5 gm. fat per liter to 9.75 gm. after eating oils and milk. In 

 some cases chyle escapes directly into the bladder or ureter from the lymphatics, 

 in others the fat may be excreted directly from the blood, independent of lymphatic 

 abnormality; in some cases the fluid entering the urine is true chyle and in others it 

 is lymph. 



Ascites adiposus is characterized by the absence of sugar and by a higher 

 percentage of fat, the maximum observed being 6.4 per cent. It is ascribed to 

 fatty metamorphosis of cells, particularly in carcinomatous and tuberculous exu- 

 dates; Edwards was able to show experimentally that a transudate may change 

 from serous to cellular, and later come to contain fat. 



Pseudochylous effusions are also observed, not only in the abdominal and 

 thoracic cavities, but even in the fluid of the edematous legs and scrotum ; these 

 resemble chylous fluids in being turbid or milky, but are said to contain little or no 

 fat. The turbidity is ascribed chiefly to lecithin, which is largely combined with 

 the pseudoglobulin of the fluid (.Toachim).'^ Possibly in some cases the turbidity 

 is partly or largely (Poljakoff)'* due to poorly dissolved proteins. Strauss*" 

 has noted the occurrence of this form of ascites particularly in chronic parenchy- 

 matous nephritis, but believes the turbidity has a local origin. Hammarsten has 

 observed turbidity due to mucoid substances, as also have Gouraud and Corset.*' 

 The pseudo-chylous effusions have a lower freezing point, a lower specific gravity, 



^^ A sample of the composition of 1 liter of chylous ascitic fluid is shown by 

 the analysis in the case studied by Comey and McKibben {loc. cit) : Specific 

 gravity, 1.010; solids, 21 gm.; protein 9.75 gm.; urea, 1.28 gm.; fat, 1.45 gm.; 

 inorganic matter, 8 gm.; peptone (?) and sugar, present; fibrinogen, mucin, 

 nucleo-albumin, and uric acid absent. 



'« Zeit. f. Heilk., 1906(27),!. 



'1 Zeit. physiol. Chem., 1906 (49), 266. 



^' Zeit. physiol. Chem., 1910 (67), 42. 



" Virchow's Arch., 1909 (198), 189; also Tuley and Graves, Jour. Amer. Med 

 Assoc, 1916 (66), 1844; Patein, Jour, pharm. Chim., 1915 (11), 265. 



''* Review of literature by Sancs and Kahn, Arch. Int. Med., 1916 (17), 181. 



" See Magnus-Levy, Zeit. klin. Med., 1908 (66), 482. 



""^ Arch. Int. Med., 1916 (18), 541. 



"Jour, pharm. chim., 1917 (16), 139. See also Patein ibid., 1917 (16), 230 



78Muncli. mod. Woch., 1903 (50), 1915; also Christen. Cent. f. inn. Med. 1905 

 (26), 329; Wallis and Scholberg, ()uart. Jour. Med., 191f (3), 301; 1911 (4), 153. 



'» Fortschr. d. Med., 1903 (21;, 1081; also Haushalter, Compt. Rend. Soc. Biol., 

 1910 (68), 550. 



8« Note to Poljakoff's article;" also Biochem. Centr., 1903 (1), 437. 



8' Coin))!. Rend. Soo. Biol., 1906 (60), 23. 



