MVKI.OI'ATIIir ALIUWIOSI in A 521 



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

 Similarly the case reported by Askaiiazy as leukemia with Bence- 

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

 myeloma. However, at least eight cases 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. It may be found in the blood and 

 exudates of patients with myeloma.*'-" 



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

 culiar protein, there is much diversity of opinion. ]\Iagnus-Levy ad- 

 vanced against the idea that it is formed b}' the tumor cells, the fol- 

 lowing 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 urinary 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. 

 Normal bone marrow does not contain this protein (Nerking**^). 

 Rosenbloom '^^ has found evidence that Bence-Jones protein may pos- 

 sibly be derived from the osseo-albumoid of the bones. AYeber and 

 Ledingham ^^ have suggested that it comes from the cytoplasmic resi- 

 due of karyolyzed plasma cells. The observation that under benzol 

 treatment the amount of Bence-Jones protein in the urine of leukemic 

 patients is reduced (Boggs and Guthrie *"'-'') is also good evidence of 

 its myelogenous nature. The fact that Abderhalden and Rostoski *"^ 



60a Boggs and Guthrie, Bull. Johns Hopkins Hosp., 1913 (24), 3G8. 

 fii Amer. Jour. Med. Sci., 1903 (126), 031. 



62Wolgemuth (Arb. a. d. Path. Inst, zu Berlin. Festschrift, 1906, p. 627> 

 states that normal human hone marrow mav contain true albumoses. 

 62a Taylor et aJ., Jour. Biol. Chem., 1917 (29), 425. 



63 Biochem. Zeit., 190S (10), 167. 



64 Arch. Int. Med., 1912 (9), 236. 



65 Folia Hematol., 1909 (8), 14. 



66 Zeit. physiol. Chem., 1905 (46), 125. 



