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Excerpt from Clinical and Pathological Papers From the Lakeside Hospital, Cleveland, 1905 The nature of lymph and chyle are of importance in diagnosis. Foster, speaking of lymph, says, Broadly speaking, we may say that all the substances present in blood plasma are present also in lymph, but are aecom panied by a larger quantity of water. The presence of fat in lymph forms the distinction between lymph and chyle. The amount of fat in chyle in the thoracic duct varies, about 57} being the common amount. In dogs it has been found to vary from 27; to 1554 This increase is due almost entirely to the presence of neutral fats. A small part of the fat is present in fat globules of con siderable size, but the large proportion of it exist in a very minute stage of subdivision, resounding under themicroscope amorphous urates, and possessing Brown ian movements. This minute subdivision of the fat constitutes what is commonly spoken of as the molecu lar basis of chyle. Lymph is almost colorless, resem bling serum which one sees coming from wounds. Chyle resembles milk in appearance, and may or may not coagulate spontaneously. Spontaneous coagulation is due to the presence of fibrin, and when observed in wounds of the duct is probably due to the small amount of blood collected with the fluid, as chyle removed from an internal cavity, as in cases of chylous ascites, does not coagulate spontaneously. The most careful and exhaust ive examinations of chyle that have been found recorded are mentioned by W hitla in an article on chylous ascites. This contains a careful investigation by himself of the fluid drawn from the abdomen in a case of this charac ter, and a very extensive chemical examination by Hay, of Aberdeen; to these we would refer those wishing more extensive information. For clinical purposes, however, the presence of a milky fluid containing fat in minute subdivision is sufiicient for making a diagnosis of chyle. The detailed references mentioned above may be found under Physiology at the end of the paper. Having considered some theoretic and practical ques tions from an anatomic and physiologic standpoint, a more detailed study of the cases will be made. In 6 of the cases, Nos. 3, 6, 8, 13, 14, I7, injury of the duct or its branches was not suspected at the time of Opera tion, while the remaining 11 cases, Nos. 1, 2, 4, 5, 7, 9, 10, 11, 12, 15, 16, it was known beyond reasonable doubt to have occurred. The subclavian and internal jugular veins were exposed, but uninjured in 7 cases, Nos. 2, 5, 7, 9, 13, 16, 17. Exposure of the veins was not mentioned in 4 cases, Nos. 12, 14, although in case No. 8 they were undoubtedly exposed. The subclavian was injured in 2 cases, Nos. 1, 3; the internal jugular vein in 2 cases, Nos. 4, 11. In the 2 cases of accidental injury, Nos. 10, 15, the question of injury to the large vessels could not be determined, though such an injury seems probable in case No. 15, where there was consider able hemorrhage. In 4 cases only, Nos. 5, 7, 9, 16, was the injury to the duct itself absolutely determined, and the anatomy of the parts satisfactorily developed. In case No. 5 there was a longitudinal tear inch in a ves sel j inch in diameter; the distance above the innomi nate vein was not mentioned. In case No. 7 the duct was wounded 5 inch above the innominate vein, size of opening not being given. In case No. 9 there was a longitudinal wound of 3 mm., 1 cm. Above the subclavian vein. In case No. 16 the wound was 3 mm. Long and 1 to 5 cm. Above the clavicle. The height of the duct in the neck was determined in 3 cases: In (ases Nos. 7, 9, itwas 4 cm. Above its entrance into the vein, and in case No. 16 it was 5 cm. Above the sternum in the remain der the anatomic relations of the duct were not men tioned. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com
