Chorea is nothing else but one of the numerous manifestations of rheumatism, for the followimg reasons: It affects the same geographic distribution; like rheu matism, it is most frequent in cold coun tries; it shows its preference for damp seasons; besides, if choreic patients are examined with care, it will be found that cardiac affections are frequent, even though they may not have had rheu matic antecedents. One of the argu ments against a, rheumatic origin is that the disease is not modified by sodium salicylate, but this same drug is equally ineffective as regards endocarditis, cu taneous eruptions, etc. Simon (Med. Press and Circular, Apr. 7, '97).
Histories of 1400 ea.es of chorea seen in Vanderbilt Clinic shows proportion of females affected compared with males was almost 2 to 1; the disease is more common in the poorer classes. I1eredity and infectious diseases seemed to bear no definite relation to the disease, the most constant element being malnutri tion. Fright immediately before onset was noted in 2S5 cases, and 290 had dis tinct history of true rheumatism. Or ganic heart-murmiirs were present in 175 eases, functional in 123, and none in 871. Nine hundred and nineteen cases oc curred between the ag,es of seven and fourteen years; of 1129 cases, 707 came on between March and August. Recur rences present in one-fourth of the cases, were most common in the spring. Cho reic movements were general in 951 cases, unilateral in 449, the right side being affected slightly more than the left. Mental irritability was noted in 827 and speech was affected in 556. M. Allen Starr ("Abraham jacobi Fest schrift"; Phila. Med. Jour., May 26, 1900).
The theory of the infective genesis of chorea (rheumatic) points out that a, negative bacteriological result need not exclude micro-organisms as a cause, for this may re.sult from several causes: for example, spontaneous attenuation of the micro-organisms, germicidal action of organic fluids, plasmolysis, irregular distribution of the bacilli, occlusion (in flammatory) of the communicating chan nel between the internal cavities of the brain and the perimedullary spaces, stratification of the bacilli in different layers of the fluid, or insufficiency of material taken for test purposes. Any one of these causes account for a negative result in testing for bacilli, and taken together they may explain the cases of rheumatic chorea where germs have not been discovered. And since every day seeins to show more clearly an association between rheuma tism and the various pyogenic organ isms, it is these that one looks for in chorea. The non-rheumatic choreas may be due to germs not easily cultivated.
Mirco (Oazz. degli Osped., Nov. 23, 1902).
.1Ieasles, whooping-cough, influenza, diphtheria, scarlet fever, endocarditis, malaria, urinary abnormalities, aggra vated constipation, etc., are also impor tant factors.
Query whether chorea should be con sidered a sequel of scarlet fever or not. Cheadle recognizes it as such, but quali fies the opinion by adding that, in 1S94 and 1596, S360 cases of scarlet fever were under treatment at the Northeastern Hospital, and of these 5355 were com pleted there. Thirteen cases of chorea were observed, or 1 in 412 completed cases. Osler found 1 case of chorea to every ISO patients. Hence it would ap pear that chorea is less frequent among scarlet-fever patients than among, pa tients in general. Of Osler's 13 cases, 5 bad rheumatic manifestations, which, in each instance, immediately preceded, or appeared shuultaneously with, the chorea. Rheumatism or joint-affection which occurs as a complication of scarlet fever sets iu toward the end of the first yveek; but in these cases it was consid erably later, indicating a difference in the nature of the joint-affection. Priest ley (Brit. Med. Jour., Sept. 25, '97).
A ease of paralysis and chorea as a sequel to scarlet fever. That the scarlat inal attack bore a causative relation to the growth of the nervous condition there can be no doubt. Cornell (Medicine, Jan., '9S).
From a study of 239 cases of chorea gravidarum it was found that the chorea frequently appears in a patient who has suffered from the ordinary form on some previous occasion. Chorea gravidarum may come on gradually or suddenly, and in the latter case is not infrequently due to a sudden fright or emotion. The onset of the chorea may be accompanied by globus and other symptoms. Many of these cases show extreme constipation. Mastier (These de Lyon, '99).
In over 71 per cent. an infectious etiology could be obtained in chorea. Not only are endoearclitis and articular rheumatism frequently mentioned in the past history, but often some catarrhal condition of the respiratory tract, as angina. bronchitis, laryngitis. or influ enza, seems to be the precursor, alone or in various combinations. Of the non infectious eases, the majority of patients possessed a neuropathie tendency and were considerably run down, through rapid growth, overexertion, or insuf ficient nourishment, and frequently showed the stigmata of a past rachitis or scrofulosis. Here the most fre quently mentioned cause seemed to be fright, and often hysteria played an im portant part. G. Koster (Miinchener med. Wochen., Aug. 12, 1902).