BENCE-JONES' PROTEIN 499 



per cent of the cases exhibiting this condition. Tn cases of excretion of 

 Bence-Jones' protein unaccompanied by multiple myeloma disease of the 

 blood-forming organs or of bone have been present. 



Weinberger found Bence-Jones' protein in urine from a case of chlo- 

 roma; Vidal from a case of tuberculous osteoarthritis ; Kahler from pri- 

 mary lymphosarcoma of the spinal cord ; Oerum from a case whose bone 

 tumors were multiple metastases of a gastric carinoma. The case of 

 osteomalacia which was reported by Jochman and Schumm was subse- 

 quently shown to be one of multiple myeloma, and that of Askanazy, re- 

 ported as one of lymphatic leukemia, was undoubtedly one of multiple 

 myeloma. Fitz described a case of myxedema excreting the Bence-Jones' 

 protein. Miller and Baetjer, cases of nephritis excreting this protein. 



Decastello has reported four cases of leukemia associated with Bence- 

 Jones' proteinuria. Collins reported a case of undoubted multiple myel- 

 oma that was observed for several months and in which there was no excre- 

 tion of Bence-Jones' protein. Naunyn reported a case in which the whole 

 skeleton was riddled with metastatic carcinomatous growths, without the 

 presence of Bence-Jones' protein bodies in the urine. Boggs and Gutherie 

 have reported four cases of leukemia and one case of metastatic carcinoma 

 in which the Bence-Jones' protein was excreted in the urine. Scheele and 

 Herxheimer reported a case of multiple myeloma with no Bence-Jones' 

 protein in the urine. 



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

 to Weber, as follows : The tumor cells derived from bone-marrow cells, 

 however much they may resemble morphologically true bone-marrow cells, 

 are prone to abnormality (including unusual degenerative changes) than 

 real myelocytes. Furthermore, 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 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 sel- 

 dom 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 pre- 

 sent 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 doing them any 



myelitis maligna (Grawitz), osteosis sarcomatosa (Hammer), endothelioma intravas- 

 cular ( Markwald ) , lymphosarcoma multiplex ossium ( Wieland ) , myelosarcoma 

 (Schmaus), lymphadenia ossium (Nothnagel), erythroblastoma (Ribbert), plasmoma 

 malignum (Hoffman). 



