364 EDEMA 



be excreted directly from the blood, independent of lymphatic abnor- 

 mality ; 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 

 liigher percentage of fat, the maximum observed being 6.4 per cent. 

 It is ascribed to fatty metamorphosis of cells, particularly in carcino- 

 matous and tuberculous exudates; Edwards was able to show experi- 

 mentally that a transudate may change from serous to cellular, and 

 later come to contain fat. 



Pseudochylous effusions are also observed, not onl}^ in the abdom- 

 inal 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 ( Joachim). ^^ Possibly in some cases the turbidity is 

 j)artly or largely (Poljakotf) ^'' due to poorly dissolved proteins. 

 Strauss ^"^ has noted the occurrence of this form of ascites particu- 

 larly in chronic parenchymatous nephritis, but believes the turbidity 

 has a local origin. Hammarsten has observed a similar turbidit}^ 

 due to mucoid substances, as also have Gouraud and Corset.^' The 

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

 gravity, lower fat and greater lecithin content than typical chylous 

 ascites. Gandin,^'' however, questions the possibility of always differ- 

 entiating the three types of turbid fluids as above indicated. Collect- 

 ing all the recorded analyses in the literature he finds wide discrep- 

 ancies, as indicated in the following table: (The maximum and mini- 

 mum percentage figures are given for each component determined 

 quantitatively, with the average in parentheses.) 



It is quite evident that although the pseudochylous fluids usually 

 contain little fat, they often contain more than the minimal content 

 found in the other forms. P^ach type of fluid overlaps the others in 

 one respect or anotiier. Gandin states that to produce a turbid fluid 

 but 0.01-0.1 per cent, of finely emiilsionizcd fat is necessary, and lie 



34Munch nied. W'odi., 1003 (50), 1015; also thristen. Cent., f. inn. Med.. 1005 

 (26), 320; Wallis and ScJiolherj,', Quart, .lour. Med., 1010 (3), 301; 1011 (4). 153. 



35 Fortsclir. d. Med., 1003 (21), lOSl ; also iiauslialter, Coinj)!. Heiid. Soc l!i(d., 

 1910 (6H), 550. 



30 Note to Poljakoll's article; also Hiochein. Ceiitr., l!(i):{ (1). 437. 



37Conipt. Rend. Soc. Biol., 1006 (60), 23. 



