CHOREA, or SAINT VITUS' DANCE, is a disease of the central nervous system characterized by disturbances of spontaneous and co-ordinating movements. It occurs usually in the later years of childhood or less frequently the earlier years of adolescence and is more common in girls than in boys. The motor symptoms vary from slight unrest and irritabil ity to matked disturbances. In mild cases the choreic movements are limited to the face and to single muscles, in more severe ones the en tire body musculature may be involved. The movements in the incipient stage are often scarcely noticed. There are at first slight, irregular, jerky movements with a tendency to drop articles, due to a relaxation of grasp oc curring simultaneously with the muscular jerk. There are also premonitory symptoms of list lessness, depression, nervous irritability, loss of appetite and sometimes anemia. Psychic mani festations may accompany the development of the chorea in the form of night terrors, transi tory hallucinations, all of which are only tem, porary and belong to the less severe forms. Distinct delirium, stupor and acute dementia belong only to the severer form for which the prognosis is unfavorable. The usual course of chorea is from 6 to 10 weeks, but not in frequently it extends over three or four months, or the movements may persist for many months due to the nervous condition of the child. Recurrent attacks are also frequent. All of this points to a broader view of the causation than is usually accepted. There is funda mentally present, probably, an inferior or slowly developing psychomotor-cerebellar integration, which is inadequate to the grade of motor adaptation demanded by the rapidly growing body. Chorea is therefore a fatigue symptom arising from a slight degree of infection or even from mere excess of motor activity. Rheumatic and other infections aid in reducing the physiological efficiency, but probably have not the specific etiological value that has been as
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signed to them. Ancestral syphilis, by inter fering with the normal development of the ner vous system, is a causative factor in certain choreas.
The best treatment for chorea is rest in bed during course of the active symptoms. Excite ment of all kinds, play or intellectual effort should be avoided. There should be full nourishing diet and during convalescence gentle exercise in the open air. Arsenic is of distinct value, but its administration should be very carefully supervised. Neosalvarsan may be used intravenously in some cases with advan tage. In chronic chorea much can be done in overcoming the persistent motor disturbance by judicious training through passive and vol untary movements under guidance. The vol untary movements are very simple at first and gradually become more complex, thereby assist ing in establishing once more freedom and pre cision of movement through co-ordination.
There are also habit choreas which may be hysterical imitation or may be milder forms of convulsive tics, from which, however, true chorea can be differentiated. There are also choreas appearing in adults. The most serious of these is the chorea of pregnancy. It usually occurs with the first pregnancy and may recur with succeeding pregnancies. It soon ceases after the termination of the pregnancy. (For hereditary chorea see HUNTINGTON'S DISEASE). The name Saint Vitus' Dance was acquired from a dancing mania common at one time in Germany and which was said to be cured by pilgrimages to the shrine of Saint Vitus. The name has been retained although chorea is an entirely different affection from those out breaks of mental and physical excitement. Con sult Jelliffe and White; 'Diseases of the Ner vous System> (2d ed., 1917).