Multiple myeloma (myelomatosis) with Bence-Jones proteid in the urine (myelopathic albumosuria of Bradshaw, Kahler's disease) / by F. Parkes Weber.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1903
Catalogue details

Licence: In copyright

Credit: Multiple myeloma (myelomatosis) with Bence-Jones proteid in the urine (myelopathic albumosuria of Bradshaw, Kahler's disease) / by F. Parkes Weber. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    trophy of bone marrow. As already mentioned, however, the tumours from different cases do not all resemble each other in their histological features, though they possess certain characters in common. The growth is generally so diffuse in its distribution, that it is impossible to determine that any one part represents a primary focus where the neoplasm may be supposed to have commenced. It does not invade other tissues by metastasis through the blood channels as sarcoma does, though in some cases the lymphatic glands have been involved (Case 3 in the Summary at the end). Owing to the softening and fragility of bones, the pains, and the progressive kyphosis caused by the disease, the diagnosis must, in the first place, be made between this condition and— (a) Osteomalacia. (b) Muscular rheumatism, lumbago, sciatica, etc. (c) Spondylitis deformans, (cl) Caries of the spinal column. (e) Invasion of the vertebral column and other bones by secondary malignant tumours. Owing to the progressive antemia and cachexia, one may think of (f) pernicious ansemia or other diseases associated with progressive cachexia. Owing to the possibility of confusing Bence-Jones proteid in the urine with albumin, the cases of multiple myeloma in which this body is present in the urine (i.e. the cases of “ myelopathic albumosuria ” of Bradshaw, “ Kahler’s disease ”) may at first be mistaken for (g) nephritis. (a) Osteomalacia. — From' the typical osteomalacia of women, multiple myeloma differs in the following respects:—The former attacks women during the child-bearing period of life. It affects, chiefly, the bones of the pelvis and lower extremities. It gives rise to great deformity by bending of the bones, but more rarely to :t spontaneous ” fractures. Multiple myeloma attacks men as often as women, or more often, and chiefly after middle life. Clinically, it appears to affect the vertebral column, ribs, and sternum specially, though the bones of the extremities have certainly been involved in some cases, as they were in the present case. It is likely to cause fractures of the ribs and deformity by bending of the vertebral column and sternum; in one case (Case No. 20 in the Summary) “ spontaneous ” fracture of one femur occurred, and in another (Case No. 24 in the Summary) “spontaneous” fractures of both femora are re- corded ; yet it does not give rise to the characteristic deformities of osteomalacia, resulting from yielding of the pelvis and bending of the bones of the lower extremities. It is possible, however, that there may be true cases of osteomalacia in males and in elderly females, in which the bones of the vertebral column and trunk are specially affected. (b) Muscular rheumatism, lumbago, sciatica, etc.—Several cases of multiple myeloma have, at least during some stage of the disease, been arranged under such headings. The occurrence of markedly bilateral thoracic, abdominal, or lumbago-like pains may first .direct