igii] Jacob Rosenhloom 169. 



case of chloroma; Vidal (58) from a case of tuberculous Osteo- 

 arthritis; Kahler (54) from primary lympho-sarcoma of the 

 spinal cord: Oerum (59) from a case whose bone tiimors were 

 multiple metastases of a gastric Carcinoma. The case of osteo- 

 malacia which was reported by Jochman and Schumm (12) was 

 subsequently shown to be one of multiple myeloma, and that of 

 Askanazy (19), reported as one of lymphatic leukaemia, was un- 

 doubtedly one of multiple myeloma. However, von Jaksch (60) 

 and also Fitz (61) have shown that proteosuria may be a marked 

 feature of myxedema. Collins (62) reported a case of undoubted 

 multiple myeloma that was observed for several months and in 

 which there was no excretion of Bence Jones protein. Naunyn 

 (63) reported a case in which the whole skeleton was riddled with 

 metastic carcinomatous growths. The urine of this case, although 

 repeatedly examined for Bence Jones protein, was found to be free 

 from that substance. Scheele and Herxheimer (64) reported a 

 case of multiple myeloma with no Bence Jones protein in the urine. 



The above mentioned case of Naunyn's may be explained, ac- 

 cording to Weber, as f ollows : The tumor cells derived from bone 

 marrow cells, however much they may resemble morphologically 

 true bone marrow cells, are more prone to abnormality (including 

 unusual degenerative changes) than real myelocytes. Further- 

 more, metastatic tumors in the bone marrow do not give rise to 

 Bence Jones protein for the reason that non-myelogenic tumor cells 

 are not affected in the same way. 



The view of Decastello (5) that Bence Jones protein is excreted 

 only by individuals with diseased kidneys is hard to reconcile with 

 the Statement of some that the serum proteins are never, and by 

 others that they are seldoni excreted with Bence Jones protein. One 

 would think that if the kidneys are diseased, albuminuria would 

 occur in a larger proportion of cases. Bence Jones protein is 

 excreted in 80 per cent. of the cases of multiple myeloma, but it 

 does not appear likely that so many would present kidney lesions. 

 It seems more probable that the kidney lesions result from the 

 excretion of Bence Jones protein rather than that they cause its 

 elimination, especially since Stokvis has shown that hemiproteose 

 after its subcutaneous injection passes through the kidneys without 



