Martha Westerberg studied the treatment of myasthenia gravis, presented at one of the first annual meetings of the American Academy of Neurology, and was the first female neurologist on faculty at the University of Michigan – all while raising five children, carrying a long cigarette holder, and unabashedly speaking her mind.

In 1934, the Scottish physician Mary Broadfoot Walker (1888-1974) noted that the symptoms of myasthenia gravis looked strikingly like those of poisoning with curare. In myasthenia gravis, the connection between nerves and muscles is impaired, causing episodic muscle weakness worsened by exercise. Curare, an “arrow poison” used by indigenous people in Central and South America, also affects the neuromuscular junction, and causes similar symptoms – like eyelid droop, double vision, and difficulty breathing. Walker tried treating a 56-year-old woman with physostigmine, a “partial antagonist to curare,” and found that her symptoms improved. This was one of the first successful treatments of myasthenia gravis, and helped physicians understand the pathophysiology of the disease.

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The effects of physostigmine were temporary, however. A similar medication, neostigmine, was better – but had to be taken several times a day, and rarely, caused bradycardia and even death. The search continued for a lasting medication to improve ongoing symptoms in myasthenia gravis.

Martha Westerberg was born in 1914 in Rockford, Illinois, and went to Rockford College, graduating with honors in physics. She then went to the University of Chicago for medical school, graduating in 1941.  She came to the University of Michigan for her neurology residency, and never left, becoming the first female faculty member in the neurology department in 1944.

In 1948, Westerberg published a preliminary report on edrophonium, a reversible acetylcholinesterase inhibitor marketed as Tensilon. This was the first published study of this medication for myasthenia gravis. Edrophonium helped Westerberg’s patients, but only briefly; and it only helped when the medicine was injected (oral doses did not work).

The American Academy of Neurology (AAN), a national organization for neurologists, was founded in 1948, and Westerberg soon became one of the first fellows of the AAN. In 1952, she presented her edrophonium research at the second interim meeting of the AAN in Louisville, Kentucky. Later that year, Kermit Osserman (1909-1972) and Lawrence Kaplan (1917-1992) would describe the use of edrophonium not to treat, but to diagnose myasthenia gravis: the “Tensilon test”.

Westerberg then published a report of 22 patients who tried a new cholinesterase inhibitor called pyridostigmine, branded Mestinon. All but one preferred it to neostigmine, the standard of care. Pyridostigmine is still used to treat myasthenia gravis today.

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She published her last article on the treatment of myasthenia gravis in 1961; possibly because she married Frederic R. Smith (1917-1974) in 1959, at the age of 45, and together they raised five children.

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In 1962 she became a full professor. She continued to see patients at the University of Michigan until her retirement in 1979. Her colleagues described her as idiosyncratic: she carried a cigarette holder; kept patient records stacked in her office, because she didn’t trust the Medical Records department to hold onto them; and she had a lively sense of humor, making her “position on matters clear to all those around her.”

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In 1990, her colleague and coauthor Russell DeJong (1907-1990) died. DeJong was a giant in American neurology: chair of the department of neurology at the University of Michigan; former president of the American Neurological Association, the American Board of Psychiatry and Neurology, and the American Epilepsy Society; and a founder of the AAN. Only three months later, Westerberg died – two great losses to the University of Michigan and the field of neurology.

Westerberg, M.R. and K. Magee (1955). Myasthenia Gravis. Neurology. 5(10)728.

Essay by Zach London, MD and Alison Christy, MD, PhD