PERITONEAL FLUID. 339 



the addition of acetic acid. This precipitate is soluble with difficulty 

 in an excess of acetic acid. 



Numerous analyses, by many investigators, 1 of the quantitative 

 composition of pleural fluids under pathological conditions have been 

 published. From these analyses we learn that in hydrothorax the specific 

 gravity is lower and the quantity of protein less than in pleuritis. In 

 the first case the specific gravity is generally less than 1.015, and the 

 quantity of protein 10-30 p. m. In acute pleuritis the specific gravity 

 is generally higher than 1.020, and the quantity of protein 30-65 p. m. 

 The quantity of fibrinogen, which in hydrothorax is about 0.1 p. m., 

 may amount to more than 1 p. m. in pleuritis. In pleurisy with an abun- 

 dant accumulation of pus, the specific gravity may rise even to 1.030, 

 according to the observations of HAMMARSTEN. The quantity of solids 

 is often 60-70 p. m., and may be even more than 90-100 p. m. (HAMMAR- 

 STEN). Mucoid substances have also been detected in pleural fluids by 

 PAIJKULL. Cases of chylous pleurisy are also known; in such a case 

 MEHU 2 found 17.93 p. m. fat and cholesterin in the fluid. 



The quantity of peritoneal fluid is very small under physiological 

 conditions. The investigations refer only to the fluid under diseased 

 conditions (ascitic fluid). The color, transparency, and consistency of 

 these may vary greatly. 



In cachectic conditions or a hydrsemic condition of the blood the fluid 

 has little color, is milky, opalescent, watery, does not coagulate spon- 

 taneously, has a very low specific gravity, 1.005-1.010-1.015, and is nearly 

 free from form elements. The ascitic fluid in portal stagnation, or in 

 general venous congestion, has a low specific gravity and ordinarily 

 less than 20 p. m. protein, although in certain cases the quantity of pro- 

 tein may rise to 35 p. m. In carcinomatous peritonitis it may have a 

 cloudy, dirty-gray appearance, due to its richness in form-elements of 

 various kinds. The specific gravity is then higher, the quantity of solids 

 greater, and it often coagulates spontaneously. In inflammatory proc- 

 esses it is straw- or lemon-yellow in color, somewhat cloudy or reddish, 

 due to leucocytes and red blood-corpuscles, and from great richness in 

 leucocytes it may appear more like pus. It coagulates spontaneously 

 and may be relatively richer in solids. It contains regularly 30 p. m. 

 or more protein (although exceptions with less protein occur), and may 

 have a specific gravity of 1.030 or above. On account of the rupture 

 of a chylous vessel, the ascitic fluid may be rich in very finely emulsified 

 fat (CHYLOUS ASCITES). In such cases 3.86-10.30 p. m. fat has been 



1 See the works of Menu, Runeberg, F. Hoffmann, Reuss, all of which are cited in 

 Bernheim's paper in Virchow's Arch., 131, 274. See also Paijkull, 1. c., and Halli- 

 burton's Text-book, 346; Joachim, 1. c. 



2 Arch. gen. de med., 1886, 2, cited from Maly's Jahresber., 16. 



