Mental and physical rest and maxi mum doses of antipyrine and arsenic recommended in the same way as sug gested by Grancher. Treatment com pleted by the use of some hypnotic. and during convalescence gymnastics and sul phur-baths prescribed. Malian (Revue Men. des -Mal. de l'Enfance, Aug., '97).
Sedatives are of value combined with arsenic, the latter being given in the form of Fowler's solution or as a solution of arsenous acid in doses which are rapidly raised to twice or even three times what is usually accepted as thc maximum. At the same time sodium or potassium bromide and antipyrine are given in large doses, while the relation ship between rheumatism, endocarditis, and chorea is a sufficient indication for the routine use of the salicylates in con junction with the other remedies. W. von Beehterew (Centralb. f. Nervenheilk. u. Psychiatrie, Aug., 1000).
Study of 1400 cases of chorea. Arsenic, pushed to the physiological limit, and then reduced slightly. is the best drug in the treatment, and antipyrine is sec ond; exalgin. phenacctin. bromide, chlo ral. and paraldehyde produced little effect. Better than any medicine is a change of air. M. Allen Starr (".Tacobi Festschrift"; Phila. Med. Jour., May 26, 1900).
Several cases of neuritis which super vened after the cure of chorea by arsenic. In these cases l0 drops of liquor arscni calls had been given thrice daily for three or four weeks, by which time the patients had taken an equivalent of from 6 to 8 grains of arsenous acid. None of the cases gave any warning of the ad vent of the neuritis during the adminis tration of the arsenic, but the symptoms developed after an interval of froni a week to a fortnight subsequent to its discontinuance. .No dose amounting in the aggregate to more than 4 grains of arsenous acid should be administered to a child suffering from an attack of chorea. Rai1ton (Med. Chron., Feb., 1900).
Experiments performed in 1879 by Chapuis have shown that arsenic when combined with butter appears infinitely less toxic than when given in solution. These investig,ations, personally repeated, show that the amount of butter should be invariably fixed to 10 grammes what ever the quantity of active principle in corporated with it. To prepare the mixt ure a known qnantity of arsenous acid is taken according to the dose to be ad ministered. To this is added sodium
chloride in such proportion that 0.1 gramme corresponds to 0.005 of arsenous acid. This mixture of sodium chloride and arsenic is triturated with 10 grammes of fresh butter, and this amount is g,iven spread on bread: a form of medication which is extremely pala table to children. The drug, must never be administered while fasting,. The whole dose should be given at a time, but two doses a day seem to be sufficient. Under this method of treatment it is not necessary to confine the patient to bed or to put him on a milk diet. A more liberal diet gives better results. Levy (Thil‘se de Lyon, 1900).
Three cases of chorea. treated with sodium cacodylate instead of arsenic. The former drug given hypodermically, first in doses of 2/3 grain, then of 2/3 grain. The patients recovered in from one to three weeks. In all the ordinary treatment had previously been tried without benefit. Lannois (Revue de Aled. lxviii. No. 5, 1901). The treatment of ehorea with arsenic is inadvisable in very acute eases with coma or paralyses, in those that have been treated for some time with small doses of arsenic, in those in which there is reason to siippose that the rheu matic process is going, on in the acute form, and in cases of advanced cardiac disease. The writer gives the following principles for the administration of ar senic in the treatment of chorea: See that the tongue is clear before com mencing treatment, and, if not, give a mild mercurial, purge and a stomachic mixture for forty-eight hours. Put the patient on a bland and easily digested diet. Give the drug in a much diluted form and in the same dilution 'through out. Do not discontinue on the first attack of vomiting-, which may be due to accidental causes. Increase the dose daily. Keep the patient in bed through out the treatment. If the vomiting per sists, discontinue the drug for t\venty four hours and then give the same dose as the last. Examine the patient very carefully daily for any sign of toxic action. What must be aimed at is a form of shock action on the nerve-tis sues, and this may explain why long continued treatment with small doses fails. On discontinuing the arsenic, the writer usually gives a mixture contain ing iron for a few days. F. M. Pope (Brit. Med. Jour., Oct. IS, 1902).