After recovery from chorea especial care should be exercised in the education and bringing up of the child. A display of good judgment and the intelligent di rection of conduct and development will be well repaid in increased stability and safety from relapse or from tbe subse quent occurrence of some other and more serious neurosis.
The treatment of chorea insaniens is practically the same as that of an ont burst of acute mania. Active measures —eliminants and nerve-sedatives—are indicated.
Anomalous Varieties of Chorea.
The other conditions described under the name of chorea are:— Endemic chorea, or epidemic chorea, a form of acute chorea with hysterical symptoms which develops in a number of persons at or about the same time in the same school or community. Sug gestion plays au important part in its etiology.
Hysterical chorea: Closely allied to the above, but with the characteristic symptoms of hysteria superathled. The so-called "chorea major" is a purely hys terical phenomenon, and is not a chorea at all.
Electrical chorea is the name given to certain forms of acute chorea in which the movements are sudden and light ning-like in onset, and also to a state in which sudden rhythmical muscular con tractions °emir, simulating a "tic co ordine." The tern) is loosely employed, and is used in a different sense by differ ent authors.
Procursive chorea, or "chorea festi nans," is a form of chorea with hys terical accompaniments in which rhyth mical dancing and procursive movements are prominent, vertigo being often pres ent at the same time.
Saltatory spasm is a choreoid affection sometimes occurring in epidemics, and characterized by peculiar jumping and dancing movements, which are executed when the patient is startled in any way. It is closely related to the forms of mus cular clonic spasm affecting a few or many groups of muscles of the body to which the name "tic convulsif" is given. It is also spoken of as "lata." It occurs in degenerates of hysterical tendencies, is often accompanied by the .uncon scions and involuntary repetition of words and phrases and actions seen or heard, and by the involuntary repetition of obscure words.
Oscillatory or nodding spasm, spasm nutans, is chara.cterized by rhythmical wao-o-in, or noddinu movements of the ,b head occurring in paroxysms or continu ing for hours, or even during the entire time the patient is awake. It occurs in extreme degenerates, and may be com plicated with epilepsy or other neurosis, or may accompany a hemiplegia or other secondary degeneration. It shades im perceptibly into "habit chorea." Tic or habit chorea, consists in the involuntary occurrence of tricks of speech or gesture—a twist of the head, shrug of the shonlder, etc. It is some times a result of an early attack of acute chorea, but occurs also as a primary affection, and inay be inherited.
Post-hemiplegic chorea is a name given to the irregular rhythmical or arhyth inical jerky movements sometimes seen in hemiplegic limbs. Similar move
ments may occur as a result of infantile cerebral palsies.
Chronic adult chorea is characterized by choreic movements associated with spastic symptoms and progressive mental deterioration. There is always marked degeneration in cortical cells and in pyramidal tracts. If there is a history of chorea in ancestry this "chronic adult chorea"' is called "Huntington's" or "hereditary chorea." The affection was described fifty years ago in America, but has obtained general recognition only since Huntington called attention to it in 1872. In typical cases the disease de velops insidiously, slowly progresses, and terminates in marked spastic paralysis with advanced dementia, or in death. It is closely' related, in etiology, pathology, and clinical features, to general paresis, into which it probably shades by insen sible degrees.
Careful pathological study made of case of Huntington's chorea,. Investiga tion of family history showed that nine members, beginning with patient's grand father, had been affected. The changes consisted in a chronic parenchymatous degeneration of the cortex, with consecu tive changes in the interstices and vascu lar system. The belief expressed that the cells are originally properly formed, but that they are not endowed with their normal longevity.
In Huntington's chorea, drugs, if given at all, must be administered in the largest possible, almost toxic, doses, for a long period of time. The marriage of persons with a heritage of Huntington's chorea should be discouraged. Joseph Collins (Amer. Jour. Med. Sciences, Sept., '98).
Case in which the essential lesion con sisted in the diminntion in size of nerv ous elements generally, an increase in pigment content of the nerve-cells, espe cially in those of the cerebellum; an overg,Towth of nenroglia tissue, — the relation of which to the nervous ele ments seems to be passive and possibly accounted for by the so-called "tissue tensiou,"—a shrinkage of the cells in the dorsal root ganglia with the analogous proliferation of the endothelial cells of their capsules, a pigmentary degenera tion of the neuroglia, and a degeneration of the white matter about the periphery of the cord. G. Y. Rusk (Amer. Jour. of Insanity, July, 1902).
These forms of choreic movements with degenerations in brain and cord are, of course, incurable.
It will be seen that the term chorea has been applied to numerous and widely-clifferent affections, insuring some confusion, as previously remarked. It is unfortunate that the name of "chorea" cannot be entirely restricted to mean the acute or Sydenham's chorea, since this is a tolerably-well-defined group of clini cal symptoms, with a definite course and character. The other varieties of chorea are symptoms of hysteria and extreme degeneracy or of chronic degeneration in motor cells and tracts, and should pref erably be relegated to their proper noso logical place.