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To the Editor.
—During last year, I sent to three medical journals a short report of a case describing a woman whose first and isolated symptom of her myasthenia gravis (MG) was, for some weeks, intermittent and short-lasting difficulty in pronouncing the γ sound. I stressed that no previous reports on such a peculiar speech disturbance as the early symptom of MG have been previously published. I suggested that this speech disturbance was due to the greater strength needed by the tongue muscles to pronounce γ sounds in Italian. The manuscript was rejected by all journals. I think this is probably right since my observation was not interesting enough to be published in such prestigious journals. More interesting were referees' comments, as given verbatim below.
—"To assist in the review, without violating confidentiality, I asked several clinicians (both speech pathologists and neurologists) about their experience with the first
D'Alessandro R. Geographic Opinions on Speech Impairment in Myasthenia Gravis. Arch Neurol. 1992;49(4):346. doi:10.1001/archneur.1992.00530280026008
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