Changing the care of muscular dystrophy

DAVID GARDNER-MEDWIN 1936-2014

David Gardner-Medwin was a naturalist, an expert on the 18th century Tyneside engraver Thomas Bewick, and a paediatric neurologist who specialised in muscular dystrophy.

Muscular dystrophy is a genetic condition which usually affects young boys and for which until recently there has been no effective treatment. In the 1970s progressive muscle wasting often resulted in death before teenage years and in some parts of the country a fatalistic approach was taken to the disease with little attempt to treat the symptoms.

Gardner-Medwin wnet to Newcastle, UK, in 1965 to work as a research fellow with Professor John, now Lord, Walton. There he set out to determine whether it was possible to detect which mothers carried the gene for muscular dystrophy by measuring electrical impulses from the muscles. As a result he spent long hours sitting with the mothers of disabled boys and was told of the many practical problems which affected their sons and how uncoordinated their care was. Such discussion spurred him to set up a multidisciplinary service with the child and the family at its centre.

The resultant clinic became an exemplar of how to manage muscular dystrophy, and in 2009 the Muscular Dystrophy Campaign produced the Walton Report, which highlighted dramatic improvements in life expectancy for those patients treated in the way that Gardner-Medwin had set out. The report showed that the average age of death for muscular dystrophy sufferers in the north east of England had risen to 30 years. By contrast for those in the south west, for example, it was only 19. These figures led to Newcastle becoming a WHO reference centre for the muscular dystrophies.

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David Gardner-Medwin was born in London on November 13, 1936, the eldest son of the architect Robert Gardner-Medwin. His Canadian grandmother was the sister of John McCrae (who wrote In Flanders Fields) and Thomas McCrae, who was a colleague of the great physician Sir William Osler. David was, in fact, distantly related to Osler by marriage, and Osler (of whom he kept a signed photograph in his study) was to prove a great influence in his life.

He was brought up in Canada, Barbados and Edinburgh, becoming an avid bird watcher during his time at Edinburgh Academy. His first scientific paper, written while he was at Kings College, Cambridge, was a study of bird migration across the Pyrenees. His English grandmother gave him a copy of Bewicks Birds for his 21st birthday - the start of a serious interest in book collecting and in Bewick.

After Cambridge, Gardner-Medwin trained at St Bartholomews Hospital. Osler had insisted that doctors should not practise clinical medicine without understanding pathology, so Gardner-Medwin spent a year in this discipline. Yet it was neurology that fascinated him, and his ambition was to work in Newcastle under Walton and Henry Miller. After several years doing just that, he learned that Newcastle was looking for a paediatric neurologist. He duly trained in paediatrics with Donald Court, and then went to Boston on a Harkness Fellowship. On his return he was appointed as a consultant, for 20 years single-handedly serving a population of more than three million.

He did important research and wrote a paper noting that because muscular dystrophy is only diagnosed when boys are about four, two or three more boys might be born with the condition before the eldest was identified as a sufferer. This led Gardner-Medwin to suggest that a simple screening test should be added to the routine heelprick test that all babies have. This was not implemented as it was considered that, as there was nothing that could be done therapeutically to prevent the disease developing, it was not worthwhile. Now, with real therapeutic advances on the horizon, screening is once again being considered.

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Changing the care of muscular dystrophy