Evolution of Multiple Myeloma

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Abstract
THE IMAGE of a disease, including its natural history, depends in large measure on the sensitivity of diagnostic methods. Multiple myeloma was diagnosed at first only upon the occurrence of major skeletal and renal involvement. Later, when study of the marrow morphology became feasible, more subtle symptoms such as anemia could lead to the diagnosis. More recently, protein electrophoresis has added a new dimension to the study of myeloma and has made possible much earlier detection of this chronic, often slowly progressive disease. In the case reported here, paper strip electrophoresis of serum proteins led to a suspicion of myeloma six years before the diagnosis became evident by symptoms, laboratory criteria, and x-ray findings. Report of Case In November, 1956, a 61-year-old shipyard worker entered SVAH on account of painless hematuria for six months. Physical examination revealed a weight of 134 lb (60.8 kg) and tenderness in the upper right

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