CHYLURIA AND LYMPHURIA . 1609 



Pathology. — ^This has been worked out principally by Mackenzie 

 and Manson, and more recently by Low and Wise. The presence 

 of chyle in the urine is due to the rupture of dilated chyle-containing 

 lymphatic vessels. Owing to some obstruction in the thoracic duct 

 with varicosity of lymphatics below the seat of obstruction, the 

 lymphatics in the bladder walls become dilated and rupture, and so 

 the chyle passes into the bladder. 



Low has demonstrated that lymphyuria takes place when the blockage 

 of the lymphatics is below the thoracic duct and receptaculum chyli. Chemi- 

 cally the only difference between lymph and mesenteric lymph or chyle is 

 that the latter contains a much larger amount of fat, which is derived from 

 the lacteals of the intestine. According to Delamere, the fat contained in 

 lymph does not exceed 3-0 per mille., while in chyle it may be as much as 

 6-5 per mille. 



Symptomatology.— The onset of the attack is usually abrupt, 

 without marked symptoms, though vague pains may be felt, and 

 at times there may be fever, pains in back, perinseum, and thighs. 

 Usually, however, the patient simply asks advice because he is 

 passing milky or bloody urine. 



As a rule the urine clears in the course of time, but it is merely an 

 intermission, and the symptoms will in due course recur, and inter- 

 missions and attacks will follow each other for years; on the other 

 hand, however, it may be continuous, and not intermittent. The 

 duration of the intermissions may be days, months, or ^^ears, while 

 the attacks may be attributed to exertion or emotion. After con- 

 tinuing for some time it may lead to exhaustion, neuralgic pains in 

 difl-erent parts of the body, disordered bowels, coated tongue, dry, 

 harsh skin, and a state of cachexia. 



If the urine clots in the bladder, there may be severe pain and 

 strangury. The urine generally presents the appearance of milk, 

 but may be pinkish in colour from admixture with blood, and a 

 large portion may clot into a semitransparent gelatinous mass. It 

 is usually passed in fair quantity, and it will be noticed that the 

 morning urine is usually very clear, while that at night is much 

 more milky or red. On standing, in true chyluria, the fat accumu- 

 lates on the surface, giving rise to a cream-hke appearance. Under 

 the microscope, as a rule, no fatty globules, however minute, are 

 observed, but white corpuscles, especially lymphocytes, and red 

 corpuscles, and at times Micro filar ics and crystals of calcium oxalate, 

 may be seen. The specific gravity is low, varying from 1015 to 1020. 

 The reaction is usually acid. On shaking the urine with ether, the 

 fat can be removed and estimated, when it will be found to vary 

 from 0-8 to i-8 per cent. After the removal of the fat, the urine 

 can be tested for albumen, which is always present, and which 

 usually persists for some time after the fat has disappeared. The 

 quantity of albumen varies from 0-6 to 0*9 per cent. Albumoses and 

 sugars are absent. 



When the urine does not contain any distinct amount of fat one 

 speaks of tymphuria, and if blood is present hcemato-lymphuria. The 



