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To the Editor:—
In the article "The Therapeutics of Prostigmin" by Drs. Goodman and Bruckner (The Journal, March 20) there is much cause to reflect. The patient was given 45 mg. of prostigmin orally at a single dose. This is considerably larger than the small single oral doses usually given to patients suffering from myasthenia gravis. After such a dose the subject exhibited characteristic signs of overdose (diarrhea, miosis, sweating, and so on) and there is a reasonable presumption that the patient was more than usually susceptible to the drug. The reaction described, while unpleasant, cannot be regarded as being dangerous.I have treated six patients suffering from myasthenia gravis with aminoacetic acid, ephedrine, beta-aminoprophylbenzene and other methods. In all but one case the best therapeutic effect was obtained with prostigmin given orally in amounts averaging from 60 to 120 mg. daily in single doses of 15 mg. at intervals.
Thorner MW. "THE THERAPEUTICS OF PROSTIGMIN". JAMA. 1937;108(17):1449-1450. doi:10.1001/jama.1937.02780170067027