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
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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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    to me quite possible—(1) that Bence-Jones albumosuria is always the result of disease of the bone marrow; (2) that it is clue to an abnormal metabolic or degenerative process in the myelocytes or in tumour cells derived from the myelocytes or their predecessors; (3) that the reason it is generally, though not always,1 associated with myelogenic tumour formation is that the tumour cells derived from bone marrow cells, however much they may morphologically resemble true bone marrow cells, are more prone to abnormality (including unusual degenerative changes) than true myelocytes are; (4) that non-myelogenic tumour cells are not affected in the same way, and therefore metastatic tumours in the bone marrow do not give rise to Bence-Jones albumosuria. Summary of Literature of Cases. I now give a summary of publications on cases in which Bence- Jones proteid has been detected in urine,2 whether the presence of bone disease was verified or not. I include some doubtful cases, in which the reactions of the proteid in the urine were not quite characteristic for Bence-Jones proteid. Amongst doubtful cases are those such as that reported by K. Hutchison (Case No. 30), in which, though a copious precipitate occurs on slightly heating the urine, yet this precipitate is not to any extent dissolved by further heating. In this connection it must be remembered that the experiments of Hammarsten,3 K. Spiro,4 Magnus-Levy,5 and others in regard to various proteids, show, as Hutchison and Macleod pointed out in their report on the present case, that the point of heat coagulation varies with the dilution and composition of the fluid, and the resolution of the coagulum depends likewise, to a great extent, on the composition of the fluid in which it is suspended. Amongst cases which are not included are those of albumosuria (other than “ Bence-Jones albumo- 1 An analogy between Bence-Jones albumosuria and melanuria may be drawn. The presence of melanin and melanogen in the urine is best known in cases of melanotic tumour, but has been noted likewise in wasting diseases. Melanotic tumours, however, are not always associated with the excretion of melanin or melanogen in the urine. Yet, as Dr. A. E. Garrod points out {St. Bcirtli. Hosp. Rep., London, 1903, vol. xxxviii. p. 25), melanuria has been undervalued for diagnostic purposes, because other conditions in which the urine blackens on exposure to air have been confounded with true melanuria. - In preparing the list I am indebted to the summaries given in various previous articles on the subject, particularly to that of Dr. C. E. Simon. I shall not here refer to the cases of “multiple myeloma without albumosuria,” several of which are quoted in my paper in the Trans. Path. Soc. London, vol. xlviii. On the whole subject of multiple myeloma, the important writings of F. W. Zahn {Deutsche Ztschr. f. Chi/r., Leipzig, 1885, Bd. xxii. S. 1), Hammer (Virchow’s Archiv, 1894, Bd. cxxxvii. S. 280), Marckwald [ibid., 1895, Bd. cxli. S. 128), R. Paltauf (“Ergebnisse der allg. Pathologic,” edited by Lubarsch and Ostertag, 1896, Bd. i. S. 676), K. Winkler (Virchow’s Archiv, 1900, Bd. clxi. S. 252), E. Wieland {ibid., 1901, Bd. clxvi. S. 103), and M. Borst (“Die Lehre von den Geschwulsten,” 1902, Bd. i. S. 492) may be consulted. 3 Arch. f. d. gcs. Physiol., Bonn, 1878, Bd. xviii. S. 65. 4 Ztschr. /. physiol. Chem., Strassburg, 1900, Bd. xxx. S. 182. 5 Loc. cit.