354 



EDEMA 



of the transudates in different parts of the body of a patient who died 

 of nephritis to have the foHowing composition : 



Table III 



As in this case, the general iiile is that while the proportion of 

 salts remains nearly constant, the proportion of protein in edematous 

 fluids in different localities varies in decreasing order as follows : 

 (1) pleura; (2) peritoneum; (3) cerebrospinal; (4) subcutaneous.*"* 

 In the last-named location the specific gravity of edematous fluids 

 may be as low as 1.005, and the proteins even less than 0.1 per cent. 

 (Hoffmann*''). An increase in solids occurs after the effusion has 

 existed for some time, presumably because of absorption of water and 

 salts, leaving a slowly increasing proportion of proteins. Further- 

 more, the composition of the patient's blood has considerable influ- 

 ence on the composition of the effusion; this is particularly true 

 in the case of ascites from portal obstruction, the contents of the blood 

 coming from the intestine during digestion modifying the composition 

 of the ascitic fluid. Thus IMiiller,"'** in a case of portal vein throm- 

 bosis, found in the ascitic fluid of a patient on an ordinary mixed 

 diet, 0.179 per cent, nitrogen; on a protein-rich diet, 0.2494 per cent. 

 N ; on a protein-poor diet, 0.1764 per cent. N. In cachectic conditions 

 the proportion of proteins is less than in stronger individuals, and, 

 as in the blood plasma, the albumin decreases more rapidly than the 

 globulin as the cachexia advances (Umber). ''^ 



Physical Chemistry of Edema Fluids. — The differences between 

 transudates and exudates depend almost solely on their protein 

 contents, for the non-protein elements are almost identical with 

 iioi-inal lymph and blood-serum, which naturally must be so since 

 any original or temporary deviation in osmotic pressure must be 

 rapidly e(|ualized by diffusion. Thus Bodon ''- finds the concentra- 

 tion of the electrolytes nearly constant in spite of considerable dif- 

 ferences in composition of various edema fluids, indicating that the 

 serosa permits passage of inorganic salts always in the same con- 



48 Javal (Jour. phys. et path.. 1911 (13), 508) places Ihc i\\\n\» in tliis order: 

 serum, peritoneal, pleural. su1)cutaniH)us, cerebrospinal. 



40 Deut. Arch. klin. Alcd.. 1SS9 (44), 313. 



r.o Dent. Arcli. klin. Med., 1903 (76), 563. 



51 Zeit. klin. Med., 1903 (48), 364. 



f'SPfliiper's Arch., 1904 (104), 519; also see GaU'otti, l.o Sperimentale, 1901 

 (55), 425. 



