CHYLURIA.
Deflnition.—A peculiar condition of the urine in which it presents a milky, or chylous, appearance and contains the constituents of chyle, especially fat and albumin.
Varieties.—Two varieties of chyluria have been observed: (1) the tropical chyluria, which is of parasitic origin; (2) the non-tropical chyluria, the cause of which is unknown.
Symptoms.—Chyluria presents an ex tremely-varied clinical history, and the descriptions given of cases are most di verse. Its course is marked by an irregu larity and capriciousness which cannot be explained. The only constant symp tom is the presence of so-called chylous urine. This fluid usually: presents a peculiar whitish, opaque, milky appear ance; sometimes the color is not whitish, but pink from the presence of blood. Occasionally the blood is not intimately mixed with the urine and very soon forms an adherent coagulum at the bot tom of the vessel. In many cases, the urine, after some standing, will form a superficial stratum resembling cream or The odor of the urine is ordinarily acid, rarely urinous; its re action acid or neutral, rarely alkaline. Chylous urine ordinarily decomposes speedily and will then smell of sulphu reted hydrogen. Sometimes it has been observed that chylous urine could be kept for months without fermenting. The specific-gravity of the -urine as well as its appearance varies greatly in the same person at different times, even at different periods of the day. The urine may, in some cases, contain coagula be fore evacuation, which may cause local disturbance and pain while it is being passed. When blood-serum is added to chylous urine, large coagula will ordi narily lona.
Microscopical examination of the urine shows that it contains fat in molecular fonn, but milk-globules or large drops of fat are not seen; the urine further contains leucocytes and blood-corpuscles, both white and red. In some cases crys tals of uric acid have been observed, when the reaction of the urine is alka line, the characteristic crystals of phos phate of ammonia—magnesia—are ob served. Frerichs relates that in one
case he found the urine to contain a multitude of ripe and unripe sperma tozoa. In the tropical variety of chy luria, Lewis, in 1570, and after him many other investigators, found the em bryos of Filaria sanguinis in the urine.
By shaking the urine with ether, the fat molecules are dissolved and the urine clears up, completely or partially. Be sides, the ordinary fat-cholesterin and lecithin have also been found.
Chylous urine always contains albu min, generally in the form of serum albumin; but globulin, albumose, and pepton may likewise be present. Casein has never been observed; sugar is not ordinarily contained in chylous urine, but Pavy and Habershon are said to have found it in one case.
Quantitative estimation of the con tents of chylous mine have been made in great number; the amount of fat varies from 0.028 to 3.3 per cent., while the albumin was found in a quantity of 0.12 to 2.7 per cent. As may be seen, their relative proportion varies much.
The discharge of chylous urine usually occurs very suddenly; it may be con stant, but more frequently is intermit tent. The chyluria may cease for months and years and reappear without appreciable cause, even if the patient has made a complete change of climate. Tbe urine is, in many cases, chylous only in the early hours of the day, or presents, at that time, a much larger quantity of chyle than at other periods of the day. This intermittence has been observed as well in the tropical as in the non-tropical varieties of chyluria. In some instances the position of the body—recumbent or found to bear influence.
Case in which ehyluria occurred only in one micturitiou, after a fall from a height of about ten feet upon a lot of stones, from which it is probable that there occurred a rupture of a lymphatic at some point in the urinary tract. Hunt (Brit. Med. Jour., Feb. 22, '90).