13 



V. THE BENCH JONES PROTEIN AND MULTIPLE 



MYELOMA, MYELOPATHIC PROTEOSURIA (KAH- 

 LER'S DISEASE). 



In 1889 Kahler and Huppert reported a case of multiple 

 myeloma from clinical and chemical standpoints, respectively, 

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

 Malattia di Kahler" thus recognizing Kahler as the first to 

 show the relationship between proteosuria and primary bone 

 disease. These lesions, however, were classified in 1873 a s 

 myeloma by Von Rustizky. 



Careful study of cases where the Bence Jones protein was 

 excreted shows that there must certainly be some relation 

 between the excretion of the Bence Jones protein and dis- 

 eased conditions of the bones of the patient. Although we 

 cannot say that the Bence Jones protein is peculiar to the 

 growth known as multiple myeloma, 1 it is certain that the 

 Bence Jones protein is present in the urine in 80 per cent, 

 of the cases exhibiting this condition. In cases of excretion 

 of the Bence Jones protein unaccompanied b'y multiple mye- 

 loma, disease of the blood-forming organs or of bone was 

 present. 



Weinberger found the Bence Jones protein in the urine 

 from a case of chloroma; Vidal in a case of tuberculous osteo- 

 arthritis; Kahler in primary lympho- sarcoma of the spinal 

 cord; Oerum in a case where the bone tumors were multiple 

 metastases of a gastric carcinoma; Kottnitz and Von Noorden 

 in cases of leukaemia. The case of osteomalacia, reported 

 by Jochman and Schumm, was subsequently shown to be one 

 of multiple myeloma, and that of Askanazy reported as one 

 of lymphatic leukaemia was undoubtedly one of multiple 

 myeloma. However, Von Jaksch and also Fitz have shown 

 that proteosuria (so-called) may be a marked feature of myx- 



1 Various names applied to multiple myeloma: Myeloma multiplex 

 (Rustizky), sarcoma multiplex ossium (Buch), pseudoleucaemia myelo- 

 genes (Runeberg), osteomyelitis maligna (Grawitz), ostitis sarcomatosa 

 (Hammer), endothelioma intra vascular (Marckwald), lymphosarcoma 

 multiplex ossium (Wieland), myelosarcoma (Schmaus), lymphadenia 

 ossium (Nothnagel), erythroblastoma (Ribbert), plasmoma malignum 

 (Hoffman). 



