CASE OF MYELOPATHIC ALBUMOSURIA 87 
The post-mortem examination showed the existence of softening of the ribs, sternum, and 
vertebrae. Microscopically the condition was found to be :— extreme osteoporosis with formation 
of numerous Howship's lacunas, determined by the multiple proliferation of a tissue consisting of 
rather large round cells (round-celled sarcoma, so-called myeloma). 
In this case several bony tumours were found in connection with various affected bones. 
Kahler's paper contains an exact clinical picture of the case. The diagnosis made during 
life was osteomalacia ; but the author suggests that the occurrence of albumosuria might, in future, 
serve to distinguish multiple myeloma from osteomalacia. 
IV. The next case was under the care of Stokvis, of Amsterdam, and was published in 
1 89 1.* There was albumosuria but no indication of bone affection during life. After death, 
however, the bones were found highly brittle, and the place of the marrow was taken by a red 
gelatinous mass. 
There were also in the connective tissue, the mviscles, the periosteum, and the serous 
membranes numerous dry firm tumours of yellowish-white colour. Unfortunately, no 
microscopical examination was made, and it is quite possible that the tumours scattered about the 
body had nothing to do with the growth in the bones. In this case it is stated that the humerus 
was affected. The kidneys contained some chalky deposits, but appeared to be normal in other 
respects. 
V. The next case was observed in the clinic of Stintzing, of Jena, in i895.t The 
patient was a man aged 61, who presented marked deformity, the back being in a position of 
extreme kyphosis, and the head sunk between the shoulders. Pains in the back and the chest 
were severe. The urine was investigated with great care by Professor Matthes,J of Jena, who 
carr.e to the conclusion that the albumose which was present was really a body distinct from 
digestive albumoses, and, indeed, from all other bodies known to chemistry. The diagnosis made 
during life was osteomalacia. The post-mortem showed that there was extreme softening of the 
bones confined to the trunk, the enlarged marrow spaces being occupied by a dark bluish-red soft 
tissue. Microscopic examination of a piece of affected rib gave the following result : — 
The compact tissue was wanting in places. Where it was present it was very much 
thinned, and contained numerous wide, irregular lacunae, filled with a vascular spindle-celled 
tissue. Beneath the compact tissue, and replacing it where it was wanting, was a zone of tissue 
consisting of closely packed round cells, intersected by irregularly running bands of spindle-cells. 
It was of unequal thickness, and projected unevenly into the marrow. In it were some rather 
large islets of cartilage and numerous necrotic patches, which stained feebly and uniformly and 
were free from cells and lacunas. The microscopic diagnosis was therefore given as 
chondro-sarcoma. 
VI. All the foregoing cases were men. The sixth case was a woman aged 36, who was 
* Zeehuisen. ' Ueber Hemialbumosurie. Jahresher. f. Thier-Chem.,' B'l. xxi, s. 41 2 ; Bil. xxii, s. 525 ; and Bd. xxiii, s. 577. 
■\ Seegelken. ' Ueber Multiples Myelom und StofFwechsehintersiichiingen bei derselben. Deutsch. Archiv f. klin. Med.,' 
Bd. Iviii, 1897, s. 276. 
I M. Matthes. ' Ueber Eiwess-Korper im Urine bei Osteomalacie. Verhandl, dcs Congress, f. innere Meil.,' xix, 
Neumeister. ' Lehrbuch der phys. Cheni.,' Aiifl. ii, 1897, s. 804. 
