My object in this thesis is to submit evidence in
favour of the view that the bone marrow contains a
substance of distinct therapeutic value in the treatment of some common skin affections. The clinical
records submitted as evidence, have been collected
in the course of the past three years (1901-1903).
The ideas which led to the investigations may be
shortly stated in a few introductory remarks.
Introduction, In the course of six months daily
observation of skin affections in the In and Outpatient Department of the Royal Infirmary in 1895-6 I
was led to doubt the correctness of the commonly accepted teaching as to the purely local origin of many
cutaneous affections. Observation of cases in the
wards convinced me that in the great majority of ordinary skin affection a careful general medical examination of the cases from the standpoint of the general
physician revealed facts of importance re the etiology
of the disease, A study of the temperature chart,
noting carefully sub-normal variations as well as
elevations of temperature, observation of the general and particularly of the cutaneous circulation in the affected and unaffected areas of the skin,
and the amount and character of the renal and alvine
discharges were the special points to which
attention was directed. Temperature variations, a
defective capillary reaction of the skin sometimes
with constriction of the radial arteries, and a deficient amount of urinary and alvine discharge with marked foetor of the latter, were very frequently observed and these symptoms usually improved or disappeared coincidentally with the disappearance of the
skin eruption. These facts strengthened my belief
that the system of regarding skin affections as
primary diseases of the skin was an erroneous one;
and they prepared the way for enquiry to determine
the accuracy of this view.
An appropriate line of investigation was suggested to me by two facts learned some years ago. In
1897 I had under my care a factory girl affected with
chronic and severe palmar eczema. She had been uni
der treatment as an Outpatient in the Skin Department
of the Royal Infirmary for three months in which
time several of the usual remedies had been tried
without material benefit. For a few weeks I tried
some variations in local treatment that suggested
themselves after careful perusal of the prescriptions
which she had received at the Royal Infirmary. These
were equally unsuccessful, and I lost sight of the
the patient. About a year afterwards I was informed
by a friend of the patient that the hands had
ultimately been completely cured as the result of
'an old wife's remedy' the use of marrow from a bone.
At a personal interview later the patient informed
me that recovery had taken place within a very few
days of the commencement of this treatment. The
marrow preparation was obtained by boiling a bone,
and skimming off the fat which was rubbed into the
affected part.
A further point which came under my notice about
this time impressed me considerably. I was the
engaged in an investigation on the articular changes
in animals in rheumatism and allied conditions.
This investigation was largely carried out at the
'Knackeries' at Loanhead, and in the course of it I
examined over two hundred subjects; in a little
more than one half of this series I examined the
local and general condition of the animal just before death, and in all of them I studied the appearances of the organs and tissues very soon after the
animals were killed. The most outstanding feature
in the post-mortem examination was the altered state
of the bone marrow. It was found that this structure was often profoundly altered even in cases in which the viscera and joint structures were relatively normal. The changes in the marrow were mainly those of a 'leucoblastic' nature, with in
many instances gelatinous degeneration. The naked
eye appearances were similar to those which have since
been fully described by Muir as present in man in
various infections. These facts learned five years
ago, led me to entertain the view that the bone marrow had some physiological and therapeutic properties of a nature previously unknown.
In broad outline my theory is that the bone marrow produces an internal secretion of vital importance in the economy; that this substance assists
in the prophylaxis against the injurious action of
various bacteria which in health exist as saprophytes
indifferent tissues; and that its defective production
is liable to be followed by a pathogenic action of
these same microorganisms. The results of this pathogenic acting vary much in different subjects, in accordance with the all important factor of individual
reaction. As the main sites of these bacteria are the
respiratory tract, skin, alimentary tract, and
vagina, it follows that diseases will be more or
less directly associated with one or more of these
surfaces as the main source of infection. I therefore determined to test the value of a preparation of bone marrow in as many skin cases as
possible. The preparation employed was an ethereal
extract, made as follows:- - Marrow was taken from
fresh long bones of an ox, great care being required
in the selection of the bones (see p. 77 ); it is
then extracted with ether for about thirty-six hours,
the ethereal extract being evaporated down in the
open, A solid fat remains which has a characteristic odour. One per cent Chloretone is added for purposes of preservation. (The initial therapeutic experiments were carried out with freshly made preparations to which no preservative was added).
My investigations have been limited to the use
of this particular preparation of bone marrow.
My object in every instance has been to introduce this
substance into the circulation through the raw or
abraded surface, usually over a limited part of the
affected area. As a preliminary, the cutaneous circulation was excited by means of bathing with hot water, in order to facilitate absorption.)
In nearly all the cases the treatment was carried out by myself or under my immediate supervision;
a considerable amount of time and
trouble being necessary for an efficient trial of
the treatment. As far as possible cases were obtained which, had proved refractory to ordinary
treatment, and in view of the well-known fact that
j some skin affections occasionally undergo spontaneous
cure in a remarkable manner, control observations
such as are fully described on p.18 were
frequently made in order to minimise the risks of
fallacy in the deduction. My sole objects in these
investigations was to determine whether this preparation of marrow possessed some therapeutic property; I am not concerned with a detailed comparison with
the results obtained by other forms of treatment.
The first two records, those of Lupus and Psoriasis,
are given in full detail as they illustrate clearly
the care necessary to obtain a suitable preparation
of the marrow and the careful oversight required in
the use of the remedy, The remaining cases are
summarised. With two or three exceptions none of
the cases were indoor patients and on this account
the records from the point of view of the general
medical bearings of the cases, are incomplete. On
the conclusion of the clinical records some notes will
be added referring to:
I. The preparation of marrow used (Myelocene).
II, Results of attempts to ascertain the exact chemical composition of marrow
which yielded a therapeutically active
substance, and marrow which was not
therapeutically active.
Ill, The evidence of the existence of an active
therapeutic substance in the preparation
of bone marrow used, (Myelocene)
