Multiple Myeloma

Abstract

Case 1. E. S., aged 49 years, white, a printer by occupation, consulted one of us (V. W. K.) on Feb. 1, 1935. He complained of weakness, shortness of breath on exertion, and pain involving the lower dorsal and upper lumbar segments of the back. This symptom-complex was ushered in in May, 1934, when he experienced a sudden pain in the back in the region of the floating ribs. Since then his symptoms have gradually increased in intensity till now he has difficulty in moving about freely and in getting out of bed. He has had a cough for the past six months but there is no expectoration. Coughing, sneezing, and breathing deeply aggravate his pain. He has lost no weight yet is unable to work because of weakness. He has a whitish precipitate in the urine which is more noticeable toward the end of micturition. Clinical examination reveals a very pal e, well developed male, six feet in height, weighing 180 pounds. His pulse rate is 99 ; temperature 96; systolic blood pressure 132, diastolic 98. The blood coun t reve als 10,500 white blood cells, 4,180,000 red blood cells. The hemoglobin is 58 per cent. The differential blood count is as follows: small lymphocytes, 22 per cent ; large lymphocytes, 2 per cent; po1ymorphonuclears, 75 per cent ; large mononucl ears, 1 per cent . Chemical examination of the blood reveals 166 mg. of cholesterol per 100 c.c.; 68 mg. sugar per 100 cc.; 15 mg. calcium per 100 c.c., which is an increase from the average normal amount of 9 to 12; phosphorus 3 mg. per 100 c.c., which is a relatively low normal amount. The Wassermann reaction is negative. Gastric analysis reveals the following: Fasting—0 free HCl—18 c c., total acidity 10 30 minutes—0 free HCl—112 c.c. , total acidity 6 1 hour—0 free HCl—20 c.c., total acidity 5 The phenolsulphonphthalein intravenous kidney function test reveals 14 per cent at the 15-minute interval, 13 per cent at 30 minutes, and 15 per cent at one hour. The water test is shown below. There is 0.7 per cent urea present at the first hour and 0.9 per cent at the second hour, whereas there normally should be over 2 per cent of the 15 grams given. The urine is cloudy, acid in reaction, and contains 10 per cent albumin. The albumin is of the BenceJones variety. In sharp contradistinction to the urine, the blood contains only a small percentage of Bence-Jones albumin. The x-ray examination reveals multiple punched-out areas of rarefaction involving the ribs and sternum. The upper thirds of the radii are markedly osteoporotic. The lower ends of the femora contain tiny rarefied areas. The nght fibula shows several demineralized areas extending from the medullary canal outward into the cortex. The skull is peppered with punched-out atrophic areas varying in size from a bird shot to a silver dollar.