382 GENERAL NEUROSES, 01 UNKNOWN ANATOMICAL ORIGIN. 



times swollen and painful from the constant strain and motion. Un 

 less there be some complication, there is no fever, although the pulse 

 usually is accelerated. The appetite, digestion, secretion, and excre- 

 tion do not present any constant peculiarity. When the disease has 

 been of long duration, the nutrition of the patient suffers in conse- 

 quence of the loss of rest, and he becomes anaemic and thin. 



The course of chorea is chronic. It rarely terminates before the 

 end of six or eight weeks, and it often continues for three or four 

 months. In rare instances it becomes habitual, and lasts throughout life. 

 Its course either is marked by remissions and exacerbations, or else the 

 malady increases constantly to its acme ; then remains stationary for 

 a while, after which it gradually abates. Recovery is the most usual 

 termination of the complaint. The cases are exceptional in which 

 chorea becomes habitual ; but it often happens that, in certain of the 

 patient's motions, a trace of the former disease remains for years, as 

 well as a tendency to relapse. Permanent mental derangement is 

 also rare. Death scarcely ever occurs, unless through complications. 

 There are, however, a few instances on record where it has been the 

 result of the disease itself. In these cases the muscular contractions 

 rapidly become extremely violent and general. This was followed by 

 collapse and coma, in which the patient perished. 



TREATMENT. Our scant knowledge as to the causes of chorea 

 puts a fulfilment of the causal indication almost out of the question. 

 When the disease has been preceded by symptoms of anaemia and 

 hydraemia, the ferruginous preparations are to be selected from the 

 long list of reputed remedies against chorea. We do not attempt to 

 say whether carbonates of iron (gr. v gr. x pro dosi), or ferr. hydro- 

 cyanic (gr. ij gr. iij pro dosi), which are the favorites, possess any 

 real advantage over the other preparations. When the patient has 

 suffered from rheumatism, the sulphur-baths (as recommended by 

 Baudeloque), an ounce of sulphuret of potassium to twelve gallons of 

 water, in which the patient is to spend an hour at a time, are as much 

 to be recommended as are the chalybeates, when there is anaemia. 

 Where worms are known to exist in the intestine, the treatment may 

 be commenced by a dose of santonin or other anthelmintic. 



The number of remedies proposed for the cure of the disease itself 

 is very large. As, however, the disease usually subsides spontaneous- 

 ly, hi the course of six or eight weeks, and as it very rarely is possible 

 to cut the malady short in a less period of time, we are very apt, it 

 quite candid and circumspect in measuring our success in special in- 

 stances, to be in doubt as to whether the chorea abated in consequence 

 of a six weeks' administration of the medicine prescribed, or whether 

 it " got well of itself." Fortunately most of these remedies, if cau- 



