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December 28, 1964

Leo Lamphere

JAMA. 1964;190(13):1137. doi:10.1001/jama.1964.03070260049022

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To the Editor:—  On the afternoon of Oct 7, 1964, a robust 50-year-old white male was brought by ambulance to the emergency room complaining of sharp right anterior chest pain preceded by cough and bloody sputum, followed later by constricting substernal chest pain with radiation into the left arm. He allegedly experienced these symptoms while working on a moving van. He offered a history of recent thrombophlebitis. Severe varicosities, swelling of both legs, stasis dermatitis, and an ecchymotic area of swelling and tenderness in the left groin were noted. He appeared to be in acute respiratory distress but demonstrated no cyanosis.The patient was given meperidine (Demerol) hydrochloride while an electrocardiogram and portable chest x-ray were done; both were negative. Both deltoids and both gluteal regions were markedly indurated, seemingly due to multiple injections. The patient explained that he had received Depo-Heparin sodium by a previous physician. Later, a massive

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