i68 Bence Jones Protein — Multiple Myelonia [Dec. 



mentary canal is diseased. The agent that converts the digestive 

 prodiicts may therefore fail to function. In consequence, the in- 

 completely synthesized products are taken into the blood stream and 

 then ehminated as matter foreign to it. This theory seems im- 

 probable on account of the fact that in cholera, when marked 

 changes are present in the columnar epithehiim, Bence Jones pro- 

 tein is not excreted, ahhoiigh, of course, in cholera the said changes 

 may be insufficient in kind or degree to produce the result. Abder- 

 halden and Rostoski (30) have shown that Bence Jones protein 

 yields a "precipitin" which is active with human serum. It must 

 therefore represent assimilated material and cannot be an exoge- 

 nous product derived directly from intestinal processes. 



IV. BENCE JONES PROTEIN AND MULTIPLE MYELOMA— MYELO- 

 PATHIC PROTEOSURIA (KAHLER'S DISEASE) 



In 1889 Kahler (54) and Huppert (55) reported a case of mul- 

 tiple myeloma from clinical and chemical Standpoints, respectively, 

 and in 1897 Bozzola (56) reported a case under the title of "Sulla 

 Malattia di Kahler " thus recognizing Kahler as the first to show the 

 relationship between proteosuria (so-called) and primary bone dis- 

 ease. These lesions, however, were classified in 1873 as myeloma 

 by Von Rustizky (45). 



Careful study of cases of Bence Jones proteinuria shows that 

 there must certainly be some relation between the excretion of 

 Bence Jones protein and diseased conditions of the bones. Al- 

 though we cannot say that Bence Jones protein is peculiar to the 

 growth known as multiple myeloma,^ it is certain that Bence Jones 

 protein is present in the urine in 80 per cent. of the cases exhibiting 

 this condition. In cases of excretion of Bence Jones protein un- 

 accompanied by multiple myeloma, disease of the blood-forming 

 Organs or of bone has been present. 



Weinberger (57) found Bence Jones protein in urine from a 



^Various names applied to multiple myeloma: Myeloma multiplex (Rustizky), 

 sarcoma multiplex ossium (Buch), pseudoleucaemia myelogenes (Runeberg), 

 Osteomyelitis maligna (Grawitz), ostosis sarcomatosa (Hammer), endothelioma 

 intravascular (Markwald), lymphosarcoma multiplex ossium (Wieland), myelo- 

 sarcoma (Schmaus), lymphadenia ossium (Nothnagel), erythroblastoma (Rib- 

 bert), plasmoma malignum (Hoffman). 



