8o 
THOMPSON YATES LABORATORIES REPORT 
spaces and spreads outwards, causing absorption of the hard parts of the bone. In the few instances 
in which albumosuria had been found in connection with multiple myeloma, the existence of the 
latter had only been recognised on the post-mortem table ; it had never been suspected during the 
patient's life ; but the records of these cases led Dr. Bradshaw to suspect that this might be a 
case of multiple myeloma, and to watch carefully for the advent of local indications of bone disease. 
This suspicion was strengthened when, near the close of 1897, patient complained of severe 
pains and tenderness about the ribs, sternum, and back, and it became almost a certainty when, 
early in 1898, there appeared obvious signs of diminished rigidity of the bones, consisting of an 
unnatural yielding of the chest walls to the pressure of the hand or the stethoscope, curvature of 
the spine, and subsequently spontaneous fractures of the ribs. During the progress of the case there 
were remarkable remissions in the intensity of the symptoms, both local and general. In January, 
1898, the patient was unable to leave his bed on account of the pains, and suffered from a severe 
attack of bronchitis, followed in February by pneumonia affecting one lung and accompanied by 
rusty sputum. For some days he seemed to be in extremis. After this he gradually improved ; 
the pains subsided almost entirely, the lungs cleared up, and in the spring he went to reside with 
friends in Cheshire, and for two or three months was able to get up and down the stairs and to take 
short walks out of doors. About the middle of July the pains returned with great intensity, and 
he was unable to leave his bed ; deafness was noticed on one side, uncontrollable vomiting came 
on and he died, apparently from exhaustion, on August loth. The peculiar character of the urine 
persisted till the end, but a specimen passed a few days before the fatal issue contained a little 
albumin in addition to the large quantity of albumose. 
Owing to the death having taken place in a private house some valuable time was lost 
before arrangements could be made for removing the remains to a mortuary and holding an 
autopsy. A limited examination only was permitted, but it was amply sufficient to confirm the 
diagnosis made during life. 
The following are the chief points of the necropsy, which was made by us 59 hours after 
death. There were also present Dr. James Barr, Mr. W. T. Thomas, and several other 
practitioners who were interested in the case. 
Externally there were no indications of decomposition. Rigor mortis was present. On 
removing the integument from the thorax a small quantity of subcutaneous fat was found. 
The whole bony framework of the thorax, the sternum, ribs, and vertebras, presented a 
striking departure from the normal. The bones were so brittle that they could be broken by a 
slight pressure with the finger, a condition more noticeable in some spots than in others, and there 
were several complete fractures which had doubtless occurred during life. On the right side 
the Vlth rib was found broken across about 3 inches from its cartilage, and there was an 
incomplete fracture of the Vllth rib in a corresponding situation. The Vlllth rib presented a 
slight irregularity which seemed to be due to a fracture which had united. On the left side the 
Vth and Vlth ribs were broken about half an inch from their cartilages. 
The change was very pronounced in the sternum, which broke while it was being removed. 
The gladiolus contained a large irregular cavity filled with a red mass resembling splenic pulp. 
