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To the Editor:—
In reading the report by Dr. Robert C. Moehlig on his case of myasthenia gravis recently published (Myasthenia Gravis: Treatment by Implantation of Desoxycorticosterone Acetate Pellets, The Journal, July 13, p. 123), I was struck by the fact that little effort was made to confirm the diagnosis of this rare and somewhat obscure disease. The rapid onset of symptoms over a period of seven days to a point of orthopnea and prostrating fatigue is certainly unusual in myasthenia gravis. It appears from the examination that the patient had bilateral ptosis, dysphagia, dysarthria and general weakness, all symptoms which are consistent with the diagnosis, but it is not clearly indicated that he had the primary symptom of myasthenia gravis, namely fatigue on muscular motion with recovery after rest. This, moreover, was not brought out by the Jolly reactions, nor is there a record of the other tests now
Viets HR. MYASTHENIA GRAVIS. JAMA. 1940;115(10):876. doi:10.1001/jama.1940.02810360064026