528 THE CHEMISTRY OF TUMORS 



lomas (e. g., the cases of Bence-Jones and of Jochmann and Schumm). 

 Similarly the case reported by Askanazy as leukemia with Bence- 

 Jones protein in the urine, on reexamination was found to be multiple 

 myeloma. However, at least eight eases of true chronic leukemia with 

 Bence-Jones proteinuria have been reported.^- Coriat^^ describes 

 a substance found in a pleuritic fluid which gave the reactions of the 

 Bence-Jones body, and he believes that it may have been formed from 

 serum globulin through the digestive action of the leucocytes or bac- 

 teria, Zuelzer reports finding the same body in the urine of a dog 

 poisoned with pyridin.^'* It is a striking fact that the kidneys elim- 

 inate such great quantities of this protein without being permeable 

 to the very similar normal blood proteins, and usually without show- 

 ing evidence of structural changes. Also that when injected into 

 animals it does not escape freely in the urine as it does in man. It 

 may be found in the blood and exudates of patients with myeloma, ^^ as 

 much as 7.8 per cent, having been found in the blood by Jacobson.^^ 

 Miller and Baetjer" report finding a protein corresponding closely to 

 Bence-Jones protein in the urine of three apparently normal persons 

 and in two cases of hypertensive nephritis without evidence of bone 

 disease, thus opening the question as to whether, after all, this protein 

 is invariably associated with bone disease. Simon^^ has observed that 

 the protein may be accompanied by dialyzable substances giving the 

 ninhydrin reaction, probably amino-acids or peptids. 



Origin of the Protein. — As to the place of formation of this pe- 

 culiar protein, there is much diversity of opinion. Magnus-Levy 

 advanced against the idea that it is formed by the tumor cells, the 

 following arguments: In the urine of myeloma patients are excreted 

 great quantities of the protein,— as much as 30 to 70 grams per day, 

 — whereas the total amount of protein in all the tumor tissue in the 

 body seldom exceeds, or, indeed, equals this quantity. It seems im- 

 probable that so little tumor tissue can form so much urinarj^ protein, 

 and Magnus-Levy suggests that it must come from the food proteins 

 as a result of altered protein metabolism. Against this view, however, 

 are the following facts: (1) The Bence-Jones body has been found 

 (but not constantly) in the myeloma tissue, but not in other organs 

 or tissues; (2) the quantity in the urine is not dependent upon diet; 

 (3) it is associated almost exclusively with this form of tumor. Simon 

 considers it probable that the protein is formed from serum-globulin, 

 perhaps by an enzymatic action of the tumor cells, and once formed, 

 it is rapidly eliminated by the kidneys, as are all foreign proteins. 



32 Boggs and Guthrie, Bull. .Johns Hopkins Hosp., 1913 (24), 368. 

 " Amer. Jour. Med. Sci., 1903 (12G), 631. 



'* Wolgemuth (Arb. a. d. Path. Inst, zu Berlin, Festschrift, 190(5, p. 027) 

 states that normal human bone marrow may contain true albumosos. 

 "Taylor el al, Jour. Biol. Chem., 1917 (29), 425. 

 "^ Jour. Urol., 1917 (1), 167. 

 " Jour. AiiuT. Med. Assoc, 1918 (70), 137. 

 ".Jour. Anicr. Med. Assoc, 1918 (70), 224. 



