STUDIES ON THE CHEMISTRY OF SEROUS EFFUSIONS.
A comparison of the results obtained in the analysis of the different effusions shows that they vary, (1) according to location, and (2) according to the disease in which they are produced. Thus the subcutaneous effusions are totally different in their composition from the abdominal or pleuritic fluids; and again the abdominal fluid of nephritic origin is different from those of cardiac or other origin. The cutaneous effusions are characterized by a very low protein content and a small amount of incoagulable nitrogen. Of the protein present in these fluids, the globulin constitutes the greater portion. In the mixed cardionephritic fluids the ratio of globulin to albumin is lower than that in normal blood serum; but when compared with the blood sera of cardionephritic cases there appears to be a certain parallelism. The chloride content of these fluids is considerably above that found in normal blood serum, but is comparable with those of corresponding cases. The effusions occurring in serous cavities differ from the cutaneous ones by their higher protein content. The highest values are attained in the pleural fluids, in which the protein present is almost the same as that in normal blood serum. The incoagulable nitrogen in these fluids is uniformly low. The chlorides vary in amount according to the nature of the case. In the effusions of inflammatory origin the values are lower than those found in the blood. In the pleural fluids of other than inflammatory origin the chloride content is either the same or higher than that of blood serum. The globulin-albumin ratio in all of these fluids except one (table III, fluid 61) is higher than that of normal blood serum. Otherwise the highest value is presented by a pleural fluid from a case of nephritis (table III, fluid 205) and the lowest by an empyema fluid (table III, fluid 30). The latter case is of especial interest because of the theory, first propounded by Schmidt, that the leucocytes in the purulent fluid are largely responsible for high globulin content. The abdominal fluids in general are less rich in protein than the pleural effusions. Those of cardiac origin give the highest protein values, but the globulin-albumin ratios are lower than in the pleural fluids or in the blood sera of corresponding cases. Only in two fluids does the globulin reach a percentage of 62 and 52.2. In both these cases the chloride content is also high. The incoagulable nitrogen in all of them is rather low. In one fluid of purely nephritic origin the protein content is low and all of it is globulin. This is suggestive, when compared with the values obtained in the analysis of the blood sera from nephritic cases. The results obtained in the analysis of abdominal fluids from cardionephritic cases approach very closely those obtained in purely cardiac cases.
Laboratory of Physiological Chemistry of the Pathological Department of the Mt. Sinai Hospital, New York.
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Epstein