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JAMA. 1894;XXII(13):453-454. doi:10.1001/jama.1894.02420920009001c.
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For the history of this case previous to the patient's admission to this hospital, I am indebted to Dr. W. H. Gunther.

J. B., admitted Oct. 18, 1893, aged 40 years. Occupation, sewer-builder; education, fair; a native of Canada; was first taken ill in the spring of 1893.

The first symptoms were observed by his fellow-workmen who noticed that at times the patient would stop in the midst of his work and appear unconscious of his surroundings for periods of varying duration. At such times his left eye would wink frequently. His work was always well done and nothing irrational was noticed. He frequently complained of headache, and claimed to have had a similar attack ten years previously.

Dr. Gunther was first called on Sept. 8,1893, when he found the patient in bed, rather stupid; complaining of severe general headache, vertigo and numbness of all extremities. His temperature was 97


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