VARIETIES OF EDEMATOl S I'LL IDS 363 



p](l\\ai'(ls ■■ found but 60 definitely established cases of cliylous or 

 cliyliforni ascites in the literature up to 1895; and of 31 indisputable 

 cases studied at autopsy, in 21 there was established the existence of 

 a ruj)tui'e in the thoracic duct or lacteals. Boston-* in 1905 was 

 able to collect 126 cases, includin*? both chylous and chyliform as- 

 cites, and notes an associated fosinophilUi in a case studied by him. 

 Chylous ascites tluid often, but not always, contains sugar,-'^ but 

 it may disappear after havinj>- once been present ; the amount of fat 

 is small, usuall\' about 1 per cent., and the fluid is rich in solids. 

 If due to a ruptured thoracic duct, it may ])e ])()ssible to detect special 

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

 usually alkaline or neuti-al. 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. 



Chijlothorax 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 figiires were obtained by 

 Salkowski "^ and others. 



Chyluria,^^'^ which seems to depend upon an abnormal connnunica- 

 tion between the lymphatics of the receptaculum chyli and the kid- 

 ney,^- shows no particular chemical features beyond those of an ad- 

 mixture 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. In some cases chyle escapes directly 

 into the bladder or ureter from the lymphatics, in others the fat may 



23 ;Medicine. 1S95 (1), 257; also see "Chem. ii. morph. Eigensehaften fett- 

 haltiiie Exsiulaten," St. ^Mutermilch, \Varscliau. 1003; Comev and IMeKibhen, 

 Boston Med. and Surg. Jour., 1003 (14S), 100. 



24 .Jour. Amer. Med. Assoc, 1905 (44), 513. 



25 For example, v. Tabora ( Deut. nied. Wocli., 1004 I 30), 1505) found as high 

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



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



2T A sample of the composition of 1 liter of chylous ascitic fluid is shown by 

 the analysis in the case studied by Comev and McKibben Hoc. cit.) : Specific 

 gravity, 1.010; solids, 21 gm. ; protein, 0.75 gm.; urea, 1.28 gm.: fat, 1.45 gm. : 

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

 nucleo-albumin. and uric acid absent. 



2SZeit. f. Heilk., 1006 (27), 1. 



2n Zeit. phvsiol. Chem., 1006 (40), 266. 



soZeit. phvsiol. Chem., 1010 (67), 42. 



3iVirchow"s Arch.. 1000 (108), 180; also Tulev and Graves, Jour. Amer. :\Ied. 

 Assoc. 1016 (66), 1844; Patein, Jour, pharm. Chim., 1015 (11), 265. 



3ia Review of literature bv Sanes and Kahn, Arch. Int. iled., 1016 (17), 181. 



32 See Magnus-Lex-v. Zeit. klin. Med., 1008 (66), 482. 



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



