General lymphadenomatosis of bones, one form of 'multiple myeloma' / by F. Parkes Weber.

  • Frederick Parkes Weber
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: General lymphadenomatosis of bones, one form of 'multiple myeloma' / by F. Parkes Weber. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    obtained from unstained sections. They can be seen to dissolve readily in dilute hydrochloric acid, without effervescence, when the section is observed beneath the microscope without a coverslip. Having, with scissors, cut out the areas containing the spherules from several sections, he placed them together in a watch glass, and added dilute nitric acid. To the solution thus obtained he added (after removing the tissue itself) a solution of nitro- molybdate of ammonium, which threw down a typical canary - yellow precipitate, proving positively that the tissue examined contained phosphates (earthy phosphates). In order to control the experiment, he treated similarly the portions of the sections which contained no spherules, and got no trace of yellow precipitate, thus showing that the phosphates were dire to the spherules. An abnormally large amount of phosphates (derived from the absorption of so much osseous tissue) must have passed through the kidneys. It is probable, however, that even in this case the minute calculi have only been deposited in portions of the kidney whose vitality was lessened by a fibrotic change, just as calcareous salts are precipitated in tuberculous lung tissue, etc., and gouty deposits are accumulated in injured joints more readily than in sound ones. There is some difficulty in finding a suitable name for the affec- tion just described. The disease consisted in an almost simultaneous growth of the lymphadenoid tissue, in most, if not all, parts of the bony skeleton, for although the long bones and the scapulae and innominate bones were not examined, it is unlikely that they entirely escaped, when even the diploe of the calvarium was beginning to be affected. It is because there is no evidence of any primary tumour or tumours in the present case that I prefer the word lymphadenoma- tosis, as employed by W. G. Spencer (x), to the ordinary and more simple word, lymphadenoma or lymphoma. For the same reason I speak of the osseous disease as being “ general ” and not “ generalised.” There were no metastases from the bones to the other parts of the body except to the cervical lymph glands, but in the latter position the growth was in the same kind of tissue (lymphatic), though not in the bones; it may therefore not have been a metastasis, in the proper sense of the word. It is because of the (at least comparative) absence of metastasis, and also absence of infiltration of the parts around the bones, in spite of the apparently rapid growth of the newly-formed tissue, that I think the terms lymphosarcoma and sarcoma are un- suitable in reference to the case. Lymphosarcomatosis, or sarcomatosis, are better terms, but not so satisfactory as lymphadenomatosis. The expression “multiple myeloma” has been used by various writers in refer- ence to somewhat similar cases, but this term, although undoubtedly of clinical convenience, has the objection of indicating merely the position of the neoplastic growth, and not the nature of the newly-formed tissue. The growth in different cases published as “ multiple myeloma ” has admittedly not always presented the same histological characters. It is unfortunate that the blood was not examined in the present instance, for it might be suggested that the case was one of myelogenic leukaemia, or even of pernicious anaemia with reaction in the bone marrow. The man’s appearance during life, and the colour of his blood after death, did not give one the impression of much leukaemia, and no