Eserine, Curara, Picrotoxin, Lobelia, Tartar Emetic, and other powerful antispasmodic drugs have fallen into disuse, since their action cannot safely be kept up save for very brief periods.
A spray of Ether or Methyl Chloride or an ice-bag along the spine has sometimes aided in controlling the movements and inducing sleep. High frequency currents and other forms of electrical treatment have not given encouraging results.
Chloralamide, Sulphonal, Trional and Verona' are inferior to the bromide and chloral hydrate combination. Antipyrine has often been useful, and some authorities push the drug till too grs. have been given daily—a practice open to serious objection. Lumbar Puncture has successfully been resorted to in this severe type of the disease.
Forced restraint by bandaging the upper limbs to the trunk and the leg to its fellow seldom can be tolerated, but it may be tried, and if well borne may be persisted in; the bony prominences should he protected by cotton-wool.
In the grave form of chorea occurring during pregnancy absolute rest in bed and the avoidance of all excitement must be insisted upon. The best results are obtainable from full doses of Chloral Hydrate (3o grs.) combined with Go-gr. doses of Sodium Bromide. Abortion should not be induced unless as a last resource; overfeeding or even forced feeding may have to be resorted to.
A course of Arsenic is indicated in all severe cases of chorea after the violence of the movements has been controlled by sedatives.
Alternating with the arsenic treatment, or taking its place when for any reason arsenic cannot be tolerated, Zinc salts have been advocated. 3 to 5 grs. Sulphate or Oxide may be given thrice daily after food to children of 5 to 8 years old. The Phosphide gr.), Valerianate (-k- gr.) and Bromide (1- gr.) may be employed. Silver, Gold and Copper salts have also been advocated. Little can he said for Wood's Quinine treat
ment and Strychnine (Trousseau's remedy) has fallen into disuse, though the latter drug may be employed with advantage in the grave forms of the disease when heart failure threatens, and it may be given with Chloral Hydrate in order to counteract the depressing influence of the latter drug on the cardiac muscle.
In the convalescent stage generous feeding to the fullest extent com patible with the digestive powers, an open-air life and abstention from all school lessons, games and excitement of every kind and a change to a bracing seaside resort are all most desirable or necessary. Where weak ness of the muscles or local wasting supervenes, a course of massage and Swedish movements is clearly indicated, but electricity, if empitlyed, must be in the form of the mildest constant currents, else the movements are apt to return through the excitement produced by painful shocks. In some chronic cases where through habit or the loss of co-ordinating power some purposeless movements continue, the child must be daily taught to use the affected muscles, as in the treatment of ataxia, by graduated exercises short of inducing fatigue. Every source of reflex irritation should he carefully sought for in such patients, adenoids, errors of refrac tion, round-worms and dental caries being removed by suitable treatment. Frights must be sedulously guarded against.
In the hopeless form of congenital or Huntington's chorea, drugs arc of no avail in combating the fatal issue, though occasionally some relief may be obtained by the administration of Hyoscine. In senile chorea first appearing after the age of so where there is no mental deterioration or hereditary history occasionally Arsenic has been found efficacious.