dr. mary walker and myasthenia gravis

Two doctors in London ---> Dr. Mary Walker ---> Myasthenia Gravis

Dr. Mary Walker is shown (right) at work in St. Alfege's Hospital, Greenwich.
This photograph appeared in The Kentish Mercury, 15th March 1935 and is used with permission of the editor.

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Dr. Mary B. Walker (1888 - 1974)

Myasthenia Gravis

Dr. Mary Broadfoot Walker was an Assistant Medical Officer at St. Alfege's Hospital from 1920 to 1936. In that time, and using few resources, she was the first to demonstrate that an hypodermic injection of physostigmine could (temporarily) reverse the weakness of myasthenia gravis.

The rationale for using physostigmine was as follows: curare was used at this time as an antidote for tetanus: physostigmine was known to be an antidote for curare: if myasthenia gravis was caused by a curare-like substance (or 'curarizing substance') then physostigmine would block the effects of this substance.

Her first patient, 'Mrs. M.', had had intermittent weakness for 14 years and had been admitted to St. Alfege's Hospital about 2 months prior to the treatment given by Dr. Walker because of an exacerbation. Mrs. M's muscle power was restored about 30 mins after the hypodermic injection of physostigmine sulphate (gr. 1/60) --- the effect lasted up to 4 hours. The case was written up in the Lancet 2nd June 1934, pp. 1200-1 and was also reported in the local newspaper The Kentish Mercury on 15th March 1935.

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'Mrs. M.' before (left image) and after (right image) injection of physostigmine.

Before - patient cannot raise left eyelid. After - eye is fully open.

These photos were reproduced from a cine film and appeared in reverse (right for left) in The Lancet 1934 (i) 1200-1. They are reproduced here with correct orientation.

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Walker MB. Treatment of myasthenia gravis with physostigmine. Lancet 1934 (i) 1200-1.

p. 1200 on left, p. 1201 on right.

Reproduced with permission of The Lancet Ltd. Copyright remains with The Lancet Ltd.

Physostigmine had to be given by injection and had unwanted adverse effects and so Dr. Walker worked in collaboration with Hoffman-La Roche to assess oral prostigmine.

In early 1935 'Miss C.' became the first person to receive oral prostigmine for management of myasthenia gravis at a dosage regime that is still used today.

The case of 'Miss C.' is shown below. 'Miss C.' had had myasthenia gravis since February 1928 and had been admitted several times to The Middlesex Hospital without improvement. 'Miss C.' was transferred to St. Alfege's Hospital in October 1934 and given hypodermic prostigmin 2.5mg and atropine g (1/100) three times daily with an excellent response (shown below).



'Before'	'Before the injection. Unable to raise herself in bed. Trying to lift a teacup, cannot do it. Ptosis'	'10 min after (approx). Sit up easily in bed, ptosis disappeared'	'15 min after the injection. Using a heavy floor polishing brush'
Sequence of picture showing Miss C. before and after injection of physostigmine. The reverse of each photograph bears the handwriting of Dr. Mary Walker describing the scene. Dated 1934.
Photographs courtesy of Mrs. Pamela Furtek.
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	Left. Miss C. is unable to stand without the aid of a nurse (you can see the nurse's peaked bonnet behind Miss C. and the nurse's hand underneath the right arm of Miss C). Right. Two pages written by Dr. Mary Walker giving the presenting history of Miss C. These pages are the handwritten draft of a typed manuscript. Dated 1935.
Photograph and script courtesy of Mrs. Pamela Furtek.
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		Dr. Mary Walker at the bedside of Miss C. Photograph dated 1935.
Photograph from the archives of Greenwich District Hospital
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The process of finding the correct dose of prostigmine and frequency of administration is written about in Dr. Walker's MD thesis published in 1935 via Edinburgh University.

Dr. Walker went on to describe a clinical sign in myasthenia gravis that later became known as 'the Mary Walker effect': a patient with myasthenia gravis carries out vigorous exercise of a forearm with a tourniquet applied at the elbow and inflated to 200mmHg; the tourniquet is released when the patient tires and partial ptosis develops a few minutes later. The nature of the agent responsible remains open to speculation. The technique is described in full in the British Medical Journal 1973(2) pp. 42-43.

It is difficult to imagine now the difficulties that were faced by a woman medical doctor in Britain during the first part of the 20th century. 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. Dr. Walker left St. Alfege's Hospital in 1936 and went to work as a Medical Assistant at St. Leonard's Hospital, Shoreditch then moved to St. Francis' Hospital, Dulwich and then to St. Benedict's Hospital, Tooting (all hospitals in London).

Many people have remarked on her quiet and reserved manner. This wonderful lady is an inspiration to us all.

	Photo of Dr. Mary Walker c. 1950
Photo courtesy of Mrs. Pamela Furtek.
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Compiled by:

J. D. Johnston