CHOREA.
Till the exact pathology of chorea he demonstrated specific treatment is not to be expected. Only three or our of the host of remedies recom mended from time to time for the treatment of chorea are of real value. A disease so liable to get well in many cases if left to itself is certain to have scores of specifics, and whatever drug the observer had chanced to give, he is liable to attribute the spontaneous cure to its influence. Whilst many cases of chorea will recover if left alone without any medicine what ever, it is equally certain that many will go on from bad to worse if not treated. It is also certain that we have drugs which, if judiciously admin istered, possess considerable power over the duration of the disease.
Rest, suitable clothing, ventilation, tepid sponging, good food and abundance of it carefully administered, will go a great way to effect re Absolute rest in bed and freedom from all excitement is essential in bad cases.
Anemia is often associated with it and when this is remedied the chorea passes off. f t will be %vise, when a mild rase comes before the physician for the first time, at the very commencement of the symptoms to attend to rest and feeding, and abstain from very active drugging. A small quantity of Tincture of Iron, with Cod-Liver Oil, cannot fail to improve the general health when associated with a few mild doses of a saline purga tive. If-the movements, however, have lasted for any time—a week or more--the patient should at once be placed upon a course of Arsenic.
This drug is the best routine remedy for the disease, and the writer is convinced from large experience in a children's hospital that when failures result these may be accepted as a general rule as caused by improper dosage, the error being nearly always made of prescribing arsenic in too minute amounts. The ordinary rules for appropriating dosage according to age should be discarded in the case of the treatment of chorea by arsenic, since choreic children bear larger doses of this drug than would, at first sight, seem possible. These large doses are also necessary to produce
an effect upon the disease. In the ordinary doses, say of 1. min. of Fowler's Solution for a child 3 or 4 years old, or of 2 to 3 mins. for a child of 6 or 7, arsenic probably produces little or no benefit, and the writer has seen several cases where the drug was said to have failed which have rapidly improved when the proper dose was administered. Something very like this was seen in the treatment of anemia and chlorosis with small doses of iron. It is a well-established fact that these affections may be for a long time treated by ordinary doses of some iron preparation without any appreciable benefit, but almost immediate improvement is noticed after the administration of large doses—doses much larger than can possibly be assimilated. The same fact is constantly observed in the treatment of tertiary syphilis by iodides. Seguin gives up to 25 or 27 drops of Liquor Arsenicalis after each meal in a large tumblerful of Alkaline Water in divided drinks during the hour following the meals, but such colossal dosage is seldom required. Gordon Sharp's dosage more nearly reaches the limits of safety ; he begins with io mins. thrice daily for children between 8 and 15 years, and increases the dose to 121- mins. after the end of a week if improvement is not manifest. Where the stomach is irritable the drug may be given hypodermically. Rarely have any evils been recorded from these large doses, but the physician should be on the watch for pigmentation and signs of neuritis.
Liq. Arsenicalis for a child of 7 years old may be commenced in doses of 3 mins. three times a day, and the dose may in a week be brought up to io mins. thrice daily without producing any untoward symptoms, and this close can be taken for many weeks. Iron may be combined with it, but not in doses proportionately large, and it should always be given after a full meal. The following is a good working formula: Liq. Arsenicalis Hydrochlor. 3iiss. Tincturce Ferri Perchlor. 3ij.