In Ingleby's case, (the fifth of Mosler,) the disease reached its maximum in five days, premature labor occurred, and the patient died twenty-four hours later. In some cases the disease ceased before labor.
On the other hand, in the cases of Barnes: Death occurred seventeen times in the days following delivery, the next day or the one following that. Twice mania occurred and once eclampsia. Among the seventeen cases, there were only six primiparte against eleven multiparte.
Among sixty-eight cases collected by Fehling, there were nineteen deaths. Among these, that of Senhouse Kirke is one of the most curious. A patient attacked with chore,a at fourteen years had two mis carriages and one labor at term. In a fourth pregnancy she was attacked with severe chorea four days before her confinement, and died four days after labor.
When chorea develops late, it seems to be more severe as well as when it occurs in a second or third labor or when it relapses. When, on the other' hand, it begins from the third to the fifth month or before, it rarely persists up to the ninth month. In these cases there is either abor tion or premature labor and a cure generally results.
Chorea is more serious in multiparazi than in primiparte. Spiegelberg, who among sixty-nine cases noted twenty deaths, saw pregnancy go to full term in only twenty-nine cases. Death of the child, however, does not always precede the interruption of pregnancy, even in cases of abor tion. The child is often born alive and has never been seen affected with chorea. The disease has no influence on the postpartum state.
Mosler and Barnes find the causes of death in the complications, not in the chorea itself. Fehling has noted intestinal ulcerations and cardiac affections five times, albuminuria once, and cerebral affections (mania and eclampsia) ten times. Cerebral complications ought not to occasion sur
prise, if one accepts Barnes' opinion, which locates the disease in the cor pora,striata.
In his remarkable study on chorea, Germain St.e states that it has not been positively shown that chorea is more common with pregnant women than in others, but he considers gestation as more or less favorable to the development of nervous, choreic phenomena. Among the fourteen cases which he collected, he finds thirteen primiparre. The chorea began three times within the first two months, seven times from the third to the fifth, three times from the fifth to the ninth. But he thinks that pregnancy is not the real cause, and that it acts only through the usual causes, the production of which it favors. In his view, the chorea of pregnancy de pends on no cause save choreic antecedents. Five of his patients had al ready had chorea in their youth, and only relapsed during their preg nancy. With the others chorea was only secondary t,o rheumatism, chloro sis, chronic dysmenorrhcea, hysteria or hydrremia, which so often attend both chorea and pregnancy. The chorea of pregnancy is more stubborn than ordinary chorea, and if it is improved by labor, the cure is not gen erally effected for aome days, or even for more than a month. Chorea does not produce abortion itself, nor does it demand artificial premature delivery.
Treatment.—This should embrace general tonic measures, narcotics, quinine, bromide of potassium, and particularly, chloral. Spiegelberg, in cases where the chorea gets worse and resists all treatment, advises artifi cial premature labor and even abortion. Ile especially recommends early interferene,e.