Moral treatment is of the utmost importance. The child is, as a rule, weakened and demoralised by the new conditions in which she finds her self, and much may be done by kindness, firmness, and vigilant attention to her wants to restore the balance of her mind. At first she should be amused as much as possible, and endeavours should be made to anticipate her wishes, so that she may be spared the constant sense of failure. When the symptoms begin to improve, the child may be allowed to leave her bed ; and games which involve rhythmical movement, such as the skipping rope, should be encouraged. Benedikt recommends a weak constant cur rent along the spine. The child should stand up during the application, and the current should be just strong enough to be distinctly felt.
With regard to drugs, the whole pharmacopoeia has been ransacked for remedies for this complaint. The disorder has been attacked with anti rheumatic remedies, on account of its connection with rheumatism ; with iron, cod-liver oil, and tonics generally, on account of the weakness and pallor with which it is usually associated ; with phosphorus and other nervine tonics and stimulants, to strengthen the nervous system ; and with the whole long list of antispasmodics, sedatives, and narcotics, to reduce nervous excitement. Where there is great anaemia iron is very useful, and should be always given. In these cases, too, alcohol is of great service, and the child should take a wine-glassful of sound claret, diluted with an equal quantity of water, with her dinner. Of all the drugs which have been recommended as specifics in this complaint the only one from which I have ever seen any decided benefit has been arsenic, and with this only in large doses. Children bear arsenic well. I have been in the habit of prescribing for a child of five or six years of age ten drops of Fowler's solution of arsenic, directly after meals, three times a day. In this dose it is rarely found to disagree. If the child complain of discomfort at the epigastrium, and vomit a short time after taking the remedy—and these are the only unpleasant symptoms I have known the medicine to produce— it can be given for a time twice a day or in smaller doses. In every case the dose should be as large a one as can be borne without discomfort, and given thus immediate benefit will usually ensue. In cases where arsenic is ill borne by the stomach, or where it has been given without producing benefit, the drug may be administered hypodermically. Dr. W. A. Hammond, of New York, speaks in high praise of this manner of treating the disease, and states that thus administered the remedy can be tolerated by the system in doses considerably larger than if it were given by the mouth. Dr. Hammond directs that the injection should be made slowly at a spot where the skin is loose, such as the front of the forearm ; that care should be taken to conduct the fluid into the subcutaneous tissue and not into the skin or underlying muscles ; and that Fowler's solution should be used diluted with an equal proportion of glycerine. The injection should be made once in the twenty-four hours, beginning with ten or twelve drops of the solution, and increasing the quantity by one drop each day.
Almost every writer on this subject has his favourite remedy. Trousseau advocates the claims of morphia and strychnia ; Sir Thomas Watson speaks in high praise of turpentine. Sulphate of zinc is said to be a specific by
some ; others prefer bromide of potassium or chloral. Without going through the list of drugs specially recommended, it may be sufficient to say that it is now generally held that the bromides are most useful in cases where the movements are violent and exhausting, especially if there be any reason to suspect ovarian excitement ; that zinc should be preferred for florid children and the more acute cases, iron for the pallid subjects weakened by chronic illness, and that arsenic given by the mourn effects its most rapid cures in the simpler forms of the disease where the muscular disturbance is not extreme. In cases of acute chorea dependent upon meningitis or medullary congestion or inflammation, and accompanied by a high temperature, Dr. Jacoby recommends the liquid extract of ergot, given in half-drachm doses to a child five years of age, three or four times a day, and continued for many weeks in succession.
In very bad cases, where the movements are violent and incessant, where the child cannot sleep, and takes food with the utmost difficulty, the best plan is to put the patient under chloroform at stated intervals and feed her through an elastic catheter passed down the gullet. In such cases a sufficient quantity of stimulant should be supplied with each meal At night-time; in order to insure sleep, a full dose of morphia should be given hypodermically. Much benefit is sometimes derived from Jaccould's plan of spraying with ether the whole length of the spine twice a day. Dr. Anstie records the case of a boy, aged six years, who had been reduced by the violence of the disease into an almost hopeless condition. At length the ether spray was begun. The boy at once began to improve,- and in a fortnight the disease was at an end.
Obstinate cases of chorea may be sometimes cured by the plan originated by Dr. Weir Mitchell and ably practised by Dr. Playfair in cases of aggravated hysteria in women. The plan consists in vigorous shampooing or "massage " of the muscles, so as to excite excessive muscular waste, and in supplying the waste so induced by regular and excessive feeding. The shampooing must be carried out energetically. It consists in kneading the muscles and making passive movements of the joints. This should be done several times daily for half an hour on each occasion. At the same time the patient is fed with large quantities of milk, meat, eggs, and other nourishing food. By this means all the more violent movements are quickly controlled, the extremities become warm, the child sleeps soundly and rapidly puts on flesh.
In every case where the movements are violent care should be taken that the patient receives no injury from knocking or bruising or chafing the skin. The sides of the cot should be padded ; and the child should be confined to the bed by a folded sheet passed over the chest and tied underneath the cot.
When the disease has passed off, means must be taken to discipline the mind by a judicious system of education, both moral and intellectual, and the child should be encouraged to take part in active games and out-of door exercises. A change to the sea-side is often useful to complete the cure.