MULTIPLE MYELOMAS AND "ALBUMOSURIA" 429 



leucin, but no glycocoll. He found the nitrogen distributed as 

 follows: amid-nitrogen, 9.9 per cent.; humin-nitrogen, 9.8 per 

 cent. ; diamino-nitrogen, 6.4 per cent. which last was com- 

 posed of: histidin, 0.9 per cent. ; arginin, 2.4 percent. ; lysin, 

 3.0 per cent. Attempts to prove the identity of the body by 

 the precipitin reaction have failed. 1 



Occurrence of " Myelopathic Albumosuria." At 

 the present time (1906) there are between forty and fifty authen- 

 ticated cases of " myelopathic albumosuria" in the literature, 

 but the number is rapidly increasing as the general appreciation 

 of its characteristics is widening. Not all cases of multiple 

 myeloma show the presence of Bence-Jones proteid in the urine 

 however. 2 It is still uncertain as to whether this substance is pro- 

 duced specifically in multiple myeloma or is present occasion- 

 ally in other conditions. Multiple bone involvement by other 

 tumors does not cause " albumosuria." 3 There is no evidence that 

 it occurs in the normal body, even in the bone-marrow, or that 

 it is produced as a step in the splitting of any form of proteids. 

 A few cases of supposed osteomalacia have been reported, with 

 the Bence-Jones body in the urine, but on more careful inves- 

 tigation these seem to have been unrecognized myelomas (e. g. y 

 the cases of Bence-Jones and of Jochmann and Schumm). 

 Similarly the case reported by Askanazy as leukemia with 

 Bence-Jones proteid in the urine, on reexamination was found 

 to be multiple myeloma. Coriat 4 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. 5 



Origin of the Proteid. As to the place of formation 

 of this peculiar proteid, 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 proteid, 

 as much as 30 to 70 grams per day, whereas the total amount 

 ef proteid in all the tumor tissue in the body seldom exceeds, 



1 Rostoski, Verb, der Phys. Med. Gesell., Wurzburg, 1902 (35), 30 ; Munch, 

 med. Woch., 1902(49), 740. 



2 See Collins, Med. Record, 1905 (67)', 641. 



3 A case of this kind has, however, recently been described by Oerum 

 (Ugeskrift f. Lager, 1904, No. 24), in which the bone tumors were multiple 

 metastases of a gastric carcinoma. 



*Amer. Jour. Med. Sci., 1903 (126), 631. 



5 Wohlgemuth (Arb. a. d. Path. Inst. zu Berlin, Festschrift, 1906, p. 627) 

 states that normal human bone marrow may contain true albumoses. 



