It is always to be kept in mind that chorea is a symptom, in many instances, of some general bodily enfeeblement or disease; a thorough and searching phys ical examination, should invariably be niade.
Chorea is usually started by some re flex irritation, such as eye-strain, nasal irritation, tight prepuce, a bound-down clitoris, or lumbricoid worms; and sec ondary attacks may not always be true chorea. The patients can be divided into two classes: those that tend to get \veil under almost any, or even without treat ment, and those who fail to obtain relief from medicine. In the latter the percent age of hyperinetropia, usually latent, is extremely large, apparently about 70 per cent.; and an investigation of latent heteroplioria should always be made, in choreic subjects, with the greatest care and patience. Filially, the spasmodic movements which aceompany and indi cate organic lesions of the brain—as, for example, those of leptomeningitis—exist in hut a small proportion of choreic sub jects, and are usually associated with other evidences of disease. Tompkins (Amer. Jour. Obst., Mar., '97).
Especial attention should be given the intestinal tract and stomach, renal dis order, or any state of autogenous poison ing, anwmia, malarial poisoning, the presence of intestinal parasites, etc.
The use of morphia, chloral, chloro form or other sedative for the suppres sion of the muscular movements is of questionable propriety in any case, and will usually prove injurious.
Antipyrine in large doses: 4, S. or 15 grains, according to age, repeated 2, 3, or 5 times a day; may be continued weeks without ill effect. Comby (La France Med. et Paris med., Sept. 6, '95).
Antipyrine had a beneficial effect in 40 out of GO cases, but in three-fifths of these cases the affection recurred. Where the drug failed the failure was due to intolerance or cutaneous eruption, but in a few- cases it seemed to have no effect. It was found necessary to give large doses; doses from 1/, to 11/2 drachms were well tolerated for some weeks. Le roux (Revue Mens. des Mal. de l'Enfance, June, '91).
When the usual remedies fail, gel semium in 2- to 5-drop doses four thnes a day should be tried. H. H. Nottage (,Tour. Amer. Med. Assoc., May 28, '98).
Severe typical case of Sydenharn's chorea rapidly cured with camphor bro mide, increasing from V, to 2V., drachms a, day during twelve days, again decreas ing to 1/2 during next fifteen days. Bourneville and Katz (Progres MOd.,
July 16, '98).
Satisfactory results from antipyrine given according to Eskridge's method. The drug is given in increasing doses, beginning with 1 grain for each year of the child's age, and increasing 1 grain each day. In the mildest cases the child is allowed to sit up a part of a day, and the antipyrine is only given in the even ing, but in severe eases absolute rest in bed is necessary, the dose of antipyrine being given three times a day. The drug is stopped as soon as the choreic move nlents cease or greatly diminish. Fow ler's solution and iron are given until two or three weeks after the cure ap pears to be complete. In giving such doses of antipyrine (20 grains three times a day to a child S years old) the child /nust be kept in bed and carefully watched; should there be heart disease or any fever, it is not given. Rapid cures were obtained in nineteen cases so treated. S. D. Hopkins (Philadelphia Med. Jour., Aug. 19, '9g).
Physostigma (Calabar bean) used in two extremely violent cases of chorea. Results were better than those usually obtained by the treatment with arsenic. Extract of physostigma was given in doses of 1/,6 grain, three times a day. J. W. Russell (Birmingham Med. Re view, Sept., 1900).
Very many of these cases are habit cases, induced by some trivial local source of irritation or reflex influence not of central origin. In such, static electricity plays a double role, and is uniformly successful if applied early. (1) It lessens the irritability and (2) acts as a powerful sugg,,estive influence when systematically employed.
Most cases of central origin are not due to any traceable organic defect, but are induced by functional derangement. Such are capable of being cured if not of too long standing.. For treatment, a metal electrode covering the affected muscles is applied and held in position with the hand, and the wave-current is employed with as long a spark-gap as can be used without causin,g painful muscular contractions. Sparks to the region will also Tender the results more effective in some cases. If the condition is suspected to be of central origin. a large electrode to the back or abdomen should be used, as in epilepsy, for an additional fifteen minutes for its general effect. Under this r(gime there are few cases of not more than two years' stand ing that will not yield. W. B. Snow (Journal of Electrotherapeutics, Dec., 1901).