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June 1, 1940


JAMA. 1940;114(22):2198. doi:10.1001/jama.1940.62810220003006a

Sometime in 1919, during the early days of epidemic encephalitis, I had under my care one of the most violent hyperkinetic types of the disease, with extreme restlessness, toxic delirium and intractable insomnia. The course was punctuated by repeated clonic and tonic spasms of brief duration. The patient, a young man in the early twenties, was so violent in his restlessness that he had to be restrained almost all the time and required the constant attendance of two nurses by day and night. He was given all sorts of sedatives and hypnotics in large doses without effect. The barbiturates, if anything, only increased the restlessness. Paraldehyde in large doses by rectum had a transient effect, never lasting for more than fifteen minutes at a time. Spinal tap and drainage of fluid did not seem to influence the course. In sheer desperation I tried the intravenous injection of 1 cc. of

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