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MGA News

Autumn 2002

Dr Mary Walker - A Pioneer in the Treatment of Myasthenia Gravis

Dr J D Johnston and Mr Brian Houston

The first Dr. Mary Walker Memorial Lecture will be delivered at the Queen Elizabeth Hospital, London UK on the 10th of October 2002 by Professor Aiden Halligan. Professor Halligan is Professor of Obstetrics and Gynaecology at Leicester University Medical School and has published extensively in the management of hypertension in pregnancy. Professor Halligan is also Director of Clinical Governance for the National Health Service and is Head of the Clinical Governance Support Team, part of the Modernisation Agency of the National Health Service. It is intended that the Dr. Mary Walker Memorial Lecture will be an annual event at Queen Elizabeth Hospital. But who was Dr. Mary Walker and why should this lecture be of interest to people with myasthenia gravis?

Mary Walker (b.1888, d.1974) was born and brought up in Wigtown, Scotland. She was one of four children, the daughter of a Judge. Mary Walker graduated in 1913 with MB ChB from Glasgow & Edinburgh Medical College for Women (women were trained separately from men at this time following a decree by the General Medical Council in 1874 ‘so as to preserve public order’, a reflection of Victorian values). She served for the Royal Army Medical Corps in Malta and Greece during World War I and then returned to England to take up post in 1920 as a salaried Assistant Medical Officer in ‘Poor Law Service’ at St. Alfege’s Hospital, Greenwich.

In 1934, whilst still a Medical Officer at St. Alfege’s Hospital, Dr. Mary Walker discovered that a subcutaneous injection of physostigmine could (temporarily) restore muscle function in a patient with myasthenia gravis. Physostigmine was used at that time as an antidote for curare poisoning. Dr. Walker had thought that the signs and symptoms of myasthenia gravis resembled curare poisoning and that myasthenia gravis might be caused by a circulating curare-like substance --- if this were so then the signs and symptoms of myasthenia gravis would be alleviated by physostigmine. The first case of myasthenia gravis to be successfully treated with physostigmine was ‘Mrs. M.’ and the case report was published in the Lancet 2nd June 1934, pp1200-1.

Physostigmine was manufactured by Hoffman-LaRoche, Switzerland. Dr. Walker worked in collaboration with Hoffman-LaRoche to search for an oral analogue of physostigmine --- physostigmine could only be given parenterally and had troublesome side-effects. Dorothy Codling, a 34 yr old chambermaid who had had myasthenia gravis for at least 6 years and who had been treated(unsuccessfully) at Middlesex Hospital, London, presented to Dr. Walker in late 1934. Dorothy Codling became the first person to be given subcutaneous prostigmin and then, in the following weeks, was the first person to be given oral prostigmin (mestinon). The dosage and schedule of oral prostigmin administration devised by Dr. Mary Walker is still that used today for cases of myasthenia gravis. Dorothy Codling and the effect of prostigmin was presented at a conference held at the Royal Society of Medicine, London in 1935 and Case was later published: Walker MB (MRCP). Case showing the effect of prostigmin on myasthenia gravis. Proc Roy Soc Med. 1935; 28(I): 759-61.

Dr. Mary Walker was awarded Membership of the Royal College of Physicians in 1932 and obtained an MD in 1935 from Edinburgh University for her work on myasthenia gravis. Her MD thesis was awarded the Gold Medal for that year. Dr. Walker went on to outline the relationship between hypokalaemia and familial periodic paralysis and was rewarded by the Royal College of Physicians of London in 1963 with the Jean Hunter Prize for her work in muscle disorders. Dr. Walker was offered prestigious posts at teaching hospitals in London e.g. Elizabeth Garrett Anderson Hospital but her financial circumstances meant that she had to continue in a salaried post. The last years of Dr. Walker’s life were spent at her family home in Wigtown, Scotland from where she continued medical practice by working part-time at Glasgow Royal Maternity and Women’s Hospital.

Why hold the Dr. Mary Walker Memorial Lecture at Queen Elizabeth Hospital, London? St. Alfege’s Hospital was demolished in 1970 as part of a modernisation programme for the National Health Service. It was originally replaced by Greenwich District Hospital and that hospital was in turn replaced in 2001 by Queen Elizabeth Hospital. The Hospital Trust intends that the Memorial Lecture will be held annually and will be delivered by a person who is at the forefront of his / her speciality, not necessarily neurology.

The quality of life of everyone with myasthenia gravis has been transformed by the pioneering work of Dr. Mary Walker --- all of us with myasthenia gravis owe this lady a large debt of thanks. Dr. Walker could easily have let her achievements go to her head but those who knew her have remarked on her quiet, unassuming and reserved manner. She is an inspiration to us all. We hope that the Memorial Lectures will be fitting tribute.

Published work of Dr. Mary Walker:

  1. Walker MB. Treatment of myasthenia gravis with physostigmine. Lancet 1934;(I):1200-1.
  2. Pritchard EAB, Walker MB. The effect of prostigmin on the symptoms and on the myogram in myasthenia gravis. Proc Physiol Soc. 1935;84:35P-36P
  3. Hamill P, Walker MB. The action of prostigmin (Roche) in neuromuscular disorders. Proc Physiol Soc. 1935;84:36P-37P.
  4. Walker MB (MRCP). Case showing the effect of Prostigmin on myasthenia gravis. Proc Roy Soc Med. 1935;28(I):759-61
  5. Walker MB. Potassium chloride in myasthenia gravis. Lancet 1935;(ii):47.
  6. Laurent LPE, Walker MB. Oral and parenteral administration of Prostigmin and its analogues in myasthenia gravis. Lancet June 27 1936;1457-9.
  7. Walker MB (MD). Myasthenia gravis: a case in which fatigue of the forearm muscles could induce paralysis of extra-ocular muscles. Proc Roy Soc Med. 1938;31(II):722.
  8. Aitken RS, Allott EN, Castleden LIM, Walker M. Observations on a case of familial periodic paralysis. Clin Sci. 1937;3:47-57.
  9. Walker MB. Some discoveries on myasthenia gravis: the background. Br Med J. 1973;2:42-3

More information about the life and times of Dr. Mary Walker

  1. Viets H. The miracle at St. Alfege's. Med Hist. 1954;9:184-6
  2. Keeney AH, Keeney VT. Mary B. Walker, M.D. and the pioneering use of prostigmin to treat myasthenia gravis. Doc Ophthalmol. 1997;93:125-34.
  3. Keesey JC. Contemporary Opinions about Mary Walker. A shy pioneer of therapeutic neurology. Neurology. 1998;51:1433-9.

Website:

A more complete biography with photographs and documents from the 1930s may be seen at
http://www.members.aol.com/jdjandsje2/dr_mary_walker/index.htm

Obituary

Dr. Walker’s obituary and remembrances appeared in the Lancet 7th December 1974 p.1401 and the Lancet 28th December 1974 p.1582

MGA NEWS Autumn 2002
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