Beginnings: 002

Post-WW1 they had resumed schooling together. She was early teens, he late. Attracted he was for sure. Nothing more fluid in form, style and balance existed in school athletics. Entered in the 150 yards dash, as their peers called it back then, she’d start out of the blocks in front and stay there all the way to the tape. The one to watch. Every audience’s hero in a race, his alone just everywhere else.

Aged 18 her symptoms started.. double vision.. fatigue.. Gotta see the eye man, was early advice. He hardly listened — hadn’t he seen it all before — here, try these prism glasses..  you’ll be fine.. opthalmologist-speak. Fatigue.. why wasn’t that all the running, training. Besides, you are a growing woman and shouldn’t be doing that stuff.. y’know what men do.

Things were beyond argument when her limbs went weak. Found a neurologist, her father soon declared, eminent isn’t the word for him. He has agreed to see you. Only one condition, that you are honest and tell him truly..

Which she did, right after his physical examination. Not hysterical, she told herself and reiterated: “My symptoms, that’s what I’m worried about.” Shown the door for her trouble she vowed henceforth avoid the patronizing patina of perfect fools. Wherever possible.

Worse, and worsening (euphemisms like ‘disease progression’ not allowed), even to the point of being unable turn over in bed, eat properly, likewise for speech. It was her fiancé, now a medical student who came home with a possible diagnosis. Myasthenia gravis.

He knew how this rendered her vulnerable. To a so-called wisdom of the times: No known treatment thus many things to try. - (Disabilities and How to Live With Them(1952). London: Lancet).

Gold injections, thyroid and suprarenal extracts, lecithin, glycine, ephedrine — among a you-name-it brigade — later, and so discharging his extended learning as much as her frustration at false hopes, there came a day she would never forget in 1935.

Living alone save her nurse companion she declared herself indifferent to another injection. A new substance her fiancé enthused. In minutes this changed to a strange feeling. As she was to put it, “ When I lifted my arms, exerting the effort to which I had become accustomed, they shot into the air ... every movement I attempted was grotesquely magnified until I learnt to make less effort... strange, wonderful, and at first very frightening ... we danced twice round the carpet. That was my first meeting with neostigmine, and we have never since been separated.”

Neostigmine is an anticholinesterase drug. Its use is also diagnostic for myasthenia gravis, dramatic relief of weakness and fatigue confirming this disease.

Implicit to its use is knowledge of the biochemical balancing act a body performs by way of the central nervous system(CNS)—motot neuronal—muscle set ups. Body release of acetylcholine makes it the primary driver of nerve ending/muscle action.

This is not of permanent duration in and of itself, being reduced - hence controlled - by cholinestrase. Too much cholinesterase makes for too little muscle action via acetylcholine. The weakness, fatigue and loss of muscular function MG’s attendant and consequential symptoms.

So.. rebalance cholinesterase with anticholinesterase administration and.. and retrain muscles for more normal movement.. and voila!

I smiled, thought: the bigger bolt..  to eliminate slack in those rehaped lopper blade holes.. well not quite but pretty darn good.

He was looking away from me, out the window into the rear garden darkness. Can’t say why yet I sensed his mind upon a small plaque set beneath a tree there. After a long pause he spoke.

“The doctor was her locknut. Drug titrations, watching, always watchful. I mean complementary atropine to keep a check on her CNS’s buddy the autonomic.. and then those too much (cholinergic crisis) times including ats knocking up the rebalancer..”

“You were her doctor,” I said slowly, quizzically.

“No, no, I did surgery. But you know that. Her doctor was.. is a friend of ours.. I mean mine.. Look, if you’ve time tomorrow we could mebbe go over there.. drop in.”

He eyed me kindly, his look saying the subject was over, and the tone of his voice tellingly so. “You er.. you don’t happen to play chess do you.. like to help me with an opening I screwed up!”

Next time - 003 - bigger pictures.. contexts.. for trade, industry, jobs, government...