July 15, 1944


JAMA. 1944;125(11):790-791. doi:10.1001/jama.1944.02850290030010

In 1930 Harriet Edgeworth reported relief of asthenia, dysphagia, diplopia and disturbance of speech when she took ephedrine by mouth. Walker in 1934 administered physostigmine salicylate to a patient with myasthenia gravis because it was thought that the muscles in myasthenia behave like muscles poisoned by curare, so that physostigmine, an antagonist to curare, might counteract the unknown substance which seemed to be exerting a curare-like effect on the motor nerve endings. Subsequently a synthetic analogue known as neostigmine replaced physostigmine as the remedy of choice, owing to its less toxic side effects. The remarkable response to neostigmine given by hypodermic injections led to its use as a diagnostic measure by Viets and Schwab. These authors1 gave neostigmine bromide orally to 44 patients with myasthenia gravis and supplemented it with ephedrine sulfate, potassium chloride and occasionally guanidine. Forty-three of their patients had a characteristic reaction to the combined therapy

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