Competition for prizes and any other excess in school-work should be for bidden, and the child encouraged to spend as much time as possible out-of doors, in healthy games and play. Drop ping back a year in classes will, by di minishing amount of intellectual effort required, often prove of decided benefit, only- for the time being, but in all after-life. An epidemic of chorea-like hysterical spasm was observed in a girls' school by Laquer.
Three cases of arhythmic hysterical chorea in which the hysteria showed all the features of Sydenham's chorea, thus confirming the facts previously advanced by Debove, Merklen, Chantemesse, Jof fray, S6glas, Reque, and Perret. B. Ouche (Le Progres Med., Dec. 5, '91).
Chorea never arises in healthy children from imitation, but in all cases of so called epidemics we have to do with an hysterical affection. In weak and poorly nourished children chorea is often devel oped in the schools from overwork. Koerner (Dent. med. Woch., Apr. 2, '91).
The co-existence of chorea and hysteria admitted in a certain number of cases, but more often common chorea, does not arise from hysteria, but hysteria is capable of simulating it. Dettling (These de Paris, '92).
Mental disturbances appearing in chorea divided into groups: 1. Cases of degenerative disturbance the exacerba tions of which are often accompanied by choreic or amulsive anomalies of move ment. 2. Lymphatic posthemiplegic chorea with distinct focal brain disease. 3. Imitative chorea or anomalous move ments evoked primarily by psychical or traumatic indignity; these are mainly hysterical. 4. Cases of Huntington's chorea, which is analogous to paralytic dementia. 5. Senile chorea. G. Syden ham's chorea, which may be character ized by elementary psychical disturb ances, fleeting, light delirium, the symp toms of profound neurasthenia, stupor and dementia, or by complicating psy choses of the severest form. Von Krafft Piing (Wiener klin. Pundschau, July 20, 1900).
Should any indication of chorea ap pear, the child should be removed from school at once and placed in as good hygienic circumstances as possible. The child's attention should not be directed toward the disease, and the nervous ifestations should not be openly noticed nor commented upon by others, since self-consciousness and suggestion play an important part in exaggerating the choreic symptoms. Removal of the pa tient from home, relatives, and familiar surroundings will go far toward relieving the condition. A trip to the country or
to the sea-shore when possible is always beneficial. 'Massage and hydrotherapeu tic measures are almost always indicated, and do especial good in the cases in which amemia and general debility are present.
Hydrotherapy; wet pack best method, —sheet dipped in water at 50° to 54° F., then lightly wrung out, spread over mat tress with oil-cloth; then closely wrapped around patient; latter rubbed from head to foot and placed with sheet in woolen blanket and returned to bed. Charyeux (Revue de Therapentique Medico-Chin, Oct. 1, '95).
In severe cases rest in bed for a few days or even for weeks is advisable, and in the severest cases is made necessary by the violence of the contortions, which may entirely prevent the child from walking or standing. 'With these non medicinal restorative measures the pa tient will usually recover within a month or two, but in most cases there can be little doubt that restoration is hastened by proper medicinal treatment. The drugs which experience has shown to be most useful are arsenic, strychnine, the zinc salts, silver nitrate, potassium iodide, and cimicifuga.
No rontine treatment can be followed. The first indication is to remove every thing that may be an irritating cause. The patient should be taken from school; if the prepuce is too long, it should be cut off; if there is evidence of worms they should be got rid of, etc. The per centage of hypermetropia. usually latent, he believes is extremely large, perhaps fully 70 per cent.: and an investigation for latent heterophoria shonld always be made with the greatest care and patience. The relief of marked heterophoria should be finally attained only by graduated tenotomies upon the nmseles exhibiting abnormal tension or by advancement of the tendons exhibiting defective power. Prismatic glasses are not curative and should not be given for constant use. Choreic subjects arc usually rapidly cured by eye-treatment alone; the eye problems encountered, however, are not. ns a rule, so complicated and difficult to solve as those of epileptics. Sodium bro mides employed with Fowler's solution of arsenic, and, if there is a chance of malaria being a factor in the trouble, quinine also. Tompkins (Amer. Jour. Obst., Mar., '97).