18th February 2013
Obituary - Dr Marcia Wilkinson
Dr Marcia Isobel Pamela Wilkinson (Mrs Marcia Sefton née Harvey) was appointed the first medical director of the City Migraine
Clinic when it opened in 1970 with financial support from The Migraine
Trust. The Migraine Trust continued supporting the clinic, then known as the Princess Margaret Migraine Clinic, up until it transferred to the NHS. Dr Wilkinson died peacefully in her sleep on 4 February 2013.
ObituaryObituary written by E. Anne MacGregor, Barts and the London School of Medicine and Dentistry, February 2013
Former consultant neurologist Hackney Hospital and the Elizabeth Garrett Anderson Hospital, London; Medical Director the Regional Neurological Unit, the Eastern Hospital, London; honorary consultant neurologist and medical director, the City of London Migraine Clinic, London (b 1919; q Somerville College, Oxford 1943; MA FRCP DM, d 4th February 2013).
Born in Yorkshire into an army family, Marcia was schooled at Wycombe Abbey before going up to Oxford to study medicine. Post qualification, she was house physician to the late Lord Brain, who played a significant part in the rest of her career. Her first publication, in 1947, on the surgical release of carpal tunnel syndrome, was co-authored with Lord Brain and is considered by many to be a landmark paper on the subject. Marcia’s input into the causes of carpal tunnel was significant. To quote Alastair Compston: “Russell Brain was also open to correction as when Dr Anne Bolton (Mrs Valentine Logue) and Dr Wilkinson could not agree with Brain’s hypothesis that flexion during daily activities was responsible for the symptoms of median nerve compression at the wrist. Rather, they suggested that it was due to extension, as any housewife would know. There followed the insertion of manometers in the wrists that proved the point; and Brain was gracious in acknowledging his mistake.” (Compston A. From the Archives. Brain 2011;134(5):1254-8. doi: 10.1093/brain/awr083)
In 1949, Marcia spent ten months as a full-time Nuffield research fellow in the Bernhard Baron Institute of Pathology at the London Hospital, studying cervical spondylosis, which included the morbid anatomy of 17 cases of cervical myelopathy occurring in association with cervical spondylosis. Degenerative changes had previously been called spondylitic; as she found no evidence of inflammation, Marcia favoured the term spondylosis. This became the subject of her DM Thesis, submitted in 1959 with further papers and books published jointly with Lord Brain.
She completed her neurological training under Lord Brain at the Royal London Hospital, researching carcinomatous neuromyopathies under the sponsorship of the British Empire Campaign. She took up her first consultant post in 1953 at the Elizabeth Garrett Anderson Hospital in London where she worked until 1984. In 1957, she was appointed consultant neurologist at Hackney Hospital in East London.
In 1963, Marcia became Director of the Regional Neurological Unit at the Eastern Hospital, Hackney. She set up a rehabilitation unit for the young disabled - many with severe head injuries from car accidents - which was highly successful. Patients were kept in the unit as long as they seemed to be improving, with the average length of stay being five months. This was radically different from most rehabilitation units, where patients were usually limited to four to six weeks. Marcia considered that maximum recovery could occur only if the patient was put in optimal conditions while the improvement was still taking place, which might take several months. Most patients spent half the day in physiotherapy and the other half in the occupational therapy department. As in most progressive departments, rehabilitation concentrated on daily living activities, such as dressing and eating, and on useful work (cooking, typing, carpentry). The unit was fortunate to have its own garden, which was not just for sitting in – gardening was found to be a particularly helpful restorative activity. Marcia’s approach to developing the unit was to work as a team. She wrote: “While the physiotherapists or occupational therapists will tell one what the patient can do with maximal help and encouragement, the nursing staff will tell one what he actually does; often these are very different.” The results were impressive - 87% of those surviving were able to return home.
As a migraine sufferer, treatment and research into migraine was of personal interest. In October 1963 she started a migraine clinic at the Elizabeth Garrett Anderson Hospital. The objects of the clinic were to provide treatment for the patients and an opportunity for research into migraine. From the beginning it was clear that this was a much needed service. The early work on dietary migraine and the role of tyramine and other vasoactive amines was done in the clinic in conjunction with Dr Edda Hanington and Professor Eleanor Zeimis. The late Elizabeth Garrett Anderson’s doctoral thesis on migraine, presented in 1870, proved an important influence on Marcia’s approach to migraine management. Learning of the thesis, she sent for it from Paris. In 1966 she translated it into English from the original French, being interested “both in the subject and in the person of this resolute and lucid woman.” The importance of nutrition, regular meals, regular habits and the treatment of the attack with effective medication supplemented with rest and great quantities of hot tea were fundamental principles that Marcia followed in her own practice. Marcia’s straightforward approach rings a resonant bell to this day: “The treatment given should not make them any worse, so the simplest and least toxic drugs should be given in the minimal effective dose.”
An additional opportunity to further her research came with the opening of the City Migraine Clinic in 1970, with Marcia appointed as Medical Director. The British Migraine Association, a patient organization, had been founded in 1958 with the aim of encouraging the creation of headache clinics and supporting research. Recognising the need for medical input, the Association supported the establishment of the Migraine Trust, which held its inaugural meeting in 1965. Russell Brain was the first chairman of the group, which met to discuss how further research could best be done; it was agreed that a clinic based in the City would be ideal. The clinic would be open during working hours so that patients could access the clinic for treatment if they had a headache while at work. Premises were found in an old tailor's shop in property belonging to St. Bartholomew's Hospital and the City Migraine Clinic was formally opened by HRH the Princess Margaret, Patron of the Migraine Trust on 19th May 1970.
The City Migraine Clinic was the first centre in the world to see patients with acute migraine and the opportunity to assess and manage patients during an attack led to the importance of metoclopramide in addition to analgesia, to promote gastric motility and aid analgesic absorption. This combination of treatment, together with rest in a quiet darkened room enabled the majority of patients to return to work within two or three hours. The numbers of patients seen is an indication of the clinic’s achievements: during its first four years 2,000 patients were treated during an attack and another 6,000 were referred by physicians. With the need for larger premises, the Clinic moved to Charterhouse Square and the Princess Margaret Migraine Clinic was opened on 17th May 1973.
The success of this simple approach to migraine treatment was sometimes met with considerable disbelief. As Marcia wrote: “Professor Jes Olesen came over from Denmark and saw around the clinic, as he was proposing to start one in Copenhagen. At the time he did not seem convinced by what we had found but about six weeks later he rang me to say that he had found our regime was as successful in Denmark as it had been in London.”
During her years at the Royal London Hospital, Marcia had met Dr Nat Blau with whom she shared a common personal affliction with migraine. When the Migraine Trust withdrew from management in 1979, transferring the Clinic to Charing Cross Hospital, Marcia contacted Nat expressing her wish to keep the Charterhouse Square clinic open. With only 24 hours before it was due to close, they had achieved the necessary funding. The City of London Migraine Clinic opened in 1980 as an independent medical charity, with financial support from the British Migraine Association and donations from the City. While the service was free to NHS patients at the point of contact, donations were encouraged, tailoring the level to the patient’s income with a suggested donation equivalent to ‘the cost of a meal out’. Research flourished, with a wide range of industry sponsored trials as well as independent projects.
With an international reputation, Marcia was frequently invited to give guest lectures around the world. Together with similarly influential colleagues, she was a founding member of the International Headache Society and president of the organisation from 1985-1987. She served as second Editor in Chief of the Society’s journal, Cephalalgia from 1989-1992 and was Chairman of the Education Committee until 1994. She was elected an honorary life member of the Society in 1997.
She received many awards, including the Distinguished Clinician Award from the American Association for the Study of Headache in 1982. The most pertinent accolade was the 1st Elizabeth Garrett Anderson Award, which she received in 2000, presented to a woman whose work has made an extraordinary contribution to relieving the burden of those affected by headache. She was an Honorary Fellow of the American Neurological Association and Honorary Member of the Scandinavian Migraine Society, the British Association for the Study of Headache, as well as the Anglo-Dutch Migraine Association who created an annual lecture, which has been given in her name since 1993.
She retired in 1999, moving to the country to be closer to her children and grandchildren. This gave her more time to spend on her hobbies of gardening and stamp collecting, extending her late father’s collection of rare stamps.
She died peacefully in her sleep on 4th February 2013. She is survived by her two daughters, both of whom have become highly successful in their own careers of law and medicine, and five grandchildren.