CHYLOUS EFFUSIONS. 303 



Blister fluid is generally rich in solids and proteids (40-65 p. m.). 

 In a burn blister Morner 1 found 50.31 p. m. proteids, among which were 

 11.59 p. m. globulin and but 0.11 p. m. fibrin ; also a substance reduc- 

 ing copper oxide, but no pyrocatechin. 



Chylotis Effusions. 2 Fat may be present in effusions in 

 sufficient quantity to cause a milky appearance, either from 

 escape of chyle from a ruptured or obstructed thoracic duct, or 

 through fatty degeneration of the cells in the effusion or the 

 lining of the walls of the cavity. The former are designated 

 as chylous, the others as chyliform or adipose fluids, but it is 

 not always easy to distinguish between them. The composition 

 of the fluids in true chylous exudates will vary according to 

 the food taken and the amount of fat the food contains, and 

 will resemble the composition of chyle, except to the extent 

 that it is modified by the absorption going on in the cavity. 



Analyses of human chyle are scanty. The most recent are those of 

 Panzer and of Carlier. Panzer 3 found 90.29-94. 53 per cent, water ; 

 5.47-9.71 per cent, solids; 0.80-1. 04 per cent, inorganic salts; 2.16 

 per cent, coagulable proteid ; 6. 59 per cent, ether-soluble material ; 

 also diastatic enzyme, soaps, and occasionally traces of cholesterin, 

 lecithin, and sugar. Carlier,* in a specimen from a child, obtained 

 very similar results, except that the salts were much less abundant. 



Edwards 5 found but 60 definitely established cases of chylous 

 or chyliform ascites in the literature up to 1895 ; and of 31 

 indisputable cases studied at autopsy, in 21 there was established 

 the existence of a rupture in the thoracic duct or lacteals. Bos- 

 ton 6 in 1905 was able to collect 126 cases, including both 

 chylous and chyliform ascites, and notes an associated eosino- 

 philia in a case studied by him. Chylous ascites fluid often, 

 but not always, contains sugar, 7 which is diagnostic if present 

 in more than traces, and if diabetes is excluded, but it may 

 disappear after having once been present ; the amount of fat is 

 small, usually about 1 per cent., and the fluid is rich in solids. 

 If due to a ruptured thoracic duct, it may be possible to detect 



1 Hammarsten, Amer. ed., 1904, p. 224. 



2 General features reviewed by Edwards, Reference Hdbk. Med. Sci., 

 1901 (3), 78. 



3 Zeit. physiol. Chem., 1900 (30), 113. 

 * British Med. Jour., 1902 (ii), 175. 



5 Medicine, 1895 (1), 257, gives literature; also see "Chem. u. morph. 

 Eigenschaften fetthaltige Exsudaten," St. Mutermilch, Warschau, 1903 ; Comey 

 and McKibben, Boston Med. and Surg. Jour., 1903 (148), 109. 



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



7 For example, v. Tabora (Dent. med. Woch., 1904 (30), 1595) found as 

 high as 0.864 per cent, of sugar in a typical case. 



