CASE OF MYELOPATHIC ALBUMOSURIA 85 
authors, a process which, when it afiPects tiie skeleton as a whole, constitutes the disease known 
as osteomalacia or mollities ossium. On the other hand, we have the cases in which absorption 
of the hard parts of the bone is due to its invasion by some kind of new growth, a condition 
which, when it occurs locally, is familiar to surgeons as mveloid sarcoma. 
Within the last quarter of a century pathologists have come to recognise a more or less 
generalized absorption of the bones, arising from the simultaneous development of new growths 
in the bones in various parts of tlie body. This condition was first described as a distinct disease in 
1873 by VON RusTiziCY, of Kiew,* under the name of multiple myeloma, a designation under 
which several cases of multiple bone tumours have been recorded since. There can be no doubt 
tliat cases of multiple mveloma have been confounded with osteomalacia. The differential 
diagnosis between the two diseases is probably not always possible during life, but, as a rule, their 
clinical pictures are sufficiently distinct. Osteomalacia is almost confined to young women, often 
coming on in connection with pregnancy. All parts of the body are implicated — the extremifiRs 
in a marked degree — with the result that the patient is soon confined to bed. The bones are often 
bent into most fantastic shapes, but actual fractures are few. Multiple myeloma, on the contrary, 
mostly occurs in men in the latter half of life ; the bones of the thorax are those chiefly affected ; 
the patient is able to leave his bed until near the end, deformities are not extreme, and fractures 
are common. 
We have compared the microscopic sections in our case with sections from a case of 
undoubted mollities ossium which occurred in the Liverpool Royal Infirmary in i88o.t The 
sections were made by Mr. F. T. Paul, who lias kindly placed them at our disposal. In our 
case, as we have already shown, the interior of the bone is occupied by a cellular mass which is 
invading the hard parts. In Mr. Paul's specimens the cavities of the bone are occupied by what 
seems to be marrow, judging from the presence of large myeloplaques, and around this we find a 
layer of dense fibrous tissue, which seems to represent the bony tissue from which the salts have 
been removed. Briefly stated, it appears that in osteomalacia the bones are softened owing to loss 
of earthy salts ; in multiple myeloma the osseous tissue is atrophied without any obvious change in 
its chemical composition. In the one case the bones bend, in the other they break. 
The morbid anatomy of multiple tumours in the bones differs in different cases, and the 
records leave us uncertain whether the descriptions of multiple myeloma may not refer to two or 
more varieties of disease. There is, however, one circumstance which serves to differentiate these 
cases of bone disease into two distinct categories, namely, that some were attended by albumosuria 
and some were not. 
In this communication we will confine ourselves to cases in which albumosuria was 
observed, and of these only six well-attested instances were on record when the present case was 
first communicated to this society in April last year. Tiie leading features of these cases will 
now be considered. 
* J. von Rustizky : 'Multiples Myelom. Deutsch. 
Zeitchr. f. Chirurgie', Baml iii, s. 163, 1873. 
i' Specimens preserved in the Pathological lUuseum 
of Uni\crsity College Liverpool. 
