The Miracle at St Alfege's: seventy years on

The account by Michael Lee of the response of a single patient with myasthenia gravis to physostigmine, as reported by Mary Walker in the Lancet in 1934 (JRSM 2007;100:108-109), reminded me of a story about this event. In her account, Walker says ‘It occurred to me recently that it would be worth while to try the effect of physostigmine, a partial antagonist to curare, on a case of myasthenia gravis.’ Walker was the house physician and concerned that this patient with bulbar myasthenia was very likely to die from aspiration pneumonia. It is said that she telephoned Dr Charles Symonds, later Sir Charles Symonds, for advice on management. Sir Charles was the consultant neurologist at Guy's Hospital and also on the staff of The National Hospital, one of the most distinguished neurologists of his era. Symonds is said to have told Walker that myasthenia and botulinum poisoning had much in common clinically, and that it might be worth trying the effect of physostigmine; the result is history. It is said that Sir Charles was not pleased that Walker did not acknowledge his suggestion.