148 PRACTICE OF MEDICINE. 



female than the male, the proportion being, according to the best 

 authorities, three of the former to one of the latter. It most fre- 

 quently appears between the age of seven and fifteen. 



The nature of the disease is but very little understood ; by several 

 writers it is attributed to inflammatory action of some part of the 

 cerebro-spinal axis ; and Dr. Hamilton ascribed it to the disordered 

 functions of the bowels affecting the muscular actions sympa- 

 thetically. 



The seat of this disease is quite as obscure as its nature. M. 

 Serres considers the corpora quadrigemina to be the seat of chorea, 

 while MM. Bouillaud and Magendie conceive that it is seated in the 

 cerebellum^ the functions which they ascribe to this organ being 

 those chiefly affected in this disease ; it is, however, much more 

 probable that the affection depends on disturbed function of the 

 nerves arising from the spinal marrow. 



Treatment. — This consists in removing morbid secretions and 

 fsecal accumulations ; in subduing, when evidently present, excited 

 action of the vessels of the spinal cord or brain ; and, finally, in 

 rousing the energy of the organic nervous system. Purgative me- 

 dicines have been prescribed with the best effects in this disease ; a 

 full dose of calomel should be given at first, and in a few hours 

 after a brisk cathartic ought to be exhibited. Calomel and jalap are 

 a common combination in this disease ; and Dr. Hamilton recom- 

 mends aloetic pills on the days when these are not employed. The 

 compound infusions of gentian and senna, with a little sulphate of 

 magnesia, may be given in the morning occasionally. The oil of 

 turpentine also forms an excellent medicine in chorea, and is parti- . 

 cularly indicated where the presence of worms is suspected. The 

 diet should be light and nourishing; every indigestible substance 

 should be carefully avoided. Dr. Wood recommends the use of 

 black-snakeroot, having frequently found it of itself adequate to the 

 cure of the disease. 



If there be evidence of cerebro-spinal irritation, our attention 

 must necessarily be directed to its removal ; this is best efl^ected by 

 cupping, leeches, and powerful counter-irritation, over the parts par- 

 ticularly implicated. Attention to the mental emotions, warm woollen 

 clothing on the lower extremities, cold afflision on the head or on 

 the spine, or the shower-bath, constitute important parts of the 

 treatment. 



Boys are said to be more easily cured than girls. In obstinate 

 cases, tonics must be employed, and those generally used in this 

 disease are, bark, disulphate of quinine, arsenical solution, nitrate 

 of silver, sulphate of zinc, the preparations of iron, and the ammo- 

 nio-sulphate of copper; of the efficacy of the last substance. Dr. 

 Burns speaks highly. The experiments of M. Baudelocque, at the 



