If nausea, vomiting or diarrhffia develop, the arsenic, is withdrawn for a day or two.
In one of Cornby's cases an ascending paralysis, with incontinence of urine and Mu's, loss of the tendon reflexes and sensation, ending slowly in recovery', occurred four weeks after the arsenic had been stop ped; and, as the paralysis could not be ascribed to anything else but the arsenic, Filatow advises that the close be made only half as large. With Comby, lie contends that by this treatment not only the choreic motor disturbances are diminished in intensity, but that the duration of the entire disease is shortened to a. few weeks. They admit, however, that this treatment with forced doses of arsenic must be instituted early. The method does not as yet appear to have found any imitators in Germany.
Of other remedies the bromides, chloral and opiates, particularly morphine, may be temporarily used when there is much restlessness.
Baecelli and others recommend camphor monobromate (camphors bromata) 1.0-1.4 Gm. (15-20 gr.) for children about six years old; and 1.2-1.S Gm. (1S-30 gr.) for children about the age of ten.
In the Breslau Children's Hospital we have sometimes seen excellent hypnotic results when there was severe muscular unrest, interfering with sleep, from the use of hyoscine hydrobromate in daily doses of one-half to one milligram, while in other cases the drug failed even when employed in twice as large a dose. At all events, if chloral proves inadequate in severe cases of this kind, scopolamin injections are quite justifiable.
We refrain from mentioning a number of other drugs which have been recommended in the treatment of chorea, because they have not been sufficiently tested.
The most important curative factors in the treatment of chorea, however, are not drugs, but physical methods of treatment. The necessity of absolute rest and avoidance of any excitement has been mentioned. For this reason choreic patients should be confined to their beds, at least as long as there is any pronounced disturbance of the static functions; but to keep them in bed until the complete disappear ance of choreic twitching, as most authors recommend, does not seem to me proper in view of the duration of the disease, which may be pro tracted for months. As yet, however, it is impossible to formulate any positive rules in this respect.
Wet packs of several hours' duration, and warm baths, 32° to 36° C. :89.6° to 94.S° F.) possibly followed by light massage, almost regularly produce an excellent sedative effect. These measures may, if necessary, be repeated several times a day, but the patients must be under careful and constant supervision, even if they are comfortably and securely supported on a sheet in the bath-tub.
It is hardly necessary- to state that if the child is very restless it should be protected against injury by padding the sides of the bed, and that clue attention must be paid to feeding, cleanliness, the evacuation of the bowels, etc.
Rheumatic and cardiac affections occurring in the course of chorea require the same treatment as under ordinary circumstances; for this, the reader is referred to the corresponding chapters in this book.
During convalescence the child must be kept under careful super vision and not be allowed to take up its, work again too soon. Several weeks should elapse before the child is permitted to go back to school.