CHOREA. 383 



liously given, can do no harm. This is especially true of the prepara- 

 tions of zinc, particularly of the oxide. The sulphate, the valerianate, 

 and the hydrocyanate of zinc, are less innocent, but not more to be 

 relied upon, nor are the ammonio-sulphate. of copper and nitrate of 

 silver. Romberg's valuable opinion is in favor of arsenic ; and, indeed, 

 where we have determined to employ the metallic nervines, Fowler's 

 solution (gtt. iij gtt. v t. d.) is to be preferred to all others. The 

 narcotics may be dispensed with, as a rule, in treatment of chorea, and, 

 moreover, are apt to be so ill-borne that we often have regretted the 

 administration of an evening dose of Dover's powder or morphine to 

 insure the rest of the patient. My experience as to the action of 

 opiates is, however, in opposition to that of one of our great authori- 

 ties. Trousseau urgently recommends the administration of large 

 doses of morphine, and claims, too, that they are remarkably well 

 borne. Strychnine, another medicine for chorea, strongly recommended 

 by Trousseau, and which has been given, as directed by him, at first 

 in very small doses, afterward in larger ones, until slight signs of 

 poisoning set in, has met with little approval in Germany. Their in- 

 troducer's own experience, which by no means resulted in sudden or 

 even in rapid cures, offers no encouragement to make use of these 

 noxious remedies. This is also true of the proposed hypodermic in- 

 jection of curare. With this article the certainty of benefit is by no 

 means proportionate to the dangers incidental to an overdose. When- 

 ever the vertebrae are sensitive to pressure, a few leeches or cups may 

 be applied by the side of the spine, to be followed by counter-irritants 

 to the skin. Care should be taken, however, not unnecessarily to dis- 

 figure the necks of young girls by scars ; hence we should avoid the 

 use of tartar-emetic ointment. Cold affusion upon the back, which is 

 probably the best method of producing determination to the skin, 

 seems to be of decided benefit in some cases, especially in cases of 

 long standing, although it sometimes aggravates the disease. The in- 

 halation of chloroform is an excellent palliative for the severer forms 

 of the chorea ; but further experience only can determine whether the 

 repeated and long-continued exhibition of this article, pushed to the 

 point of complete narcotism, has the effect of abbreviating it. A more 

 careful trial will be requisite ere the general adoption can be sanctioned 

 of the practice of forcibly holding or tying patients, a practice which 

 has been proposed by several authorities. Benedikt declares that, 

 ".out of more than twenty cases of chorea, treated by him by the con- 

 stant galvanic current, not one has failed to recover." The current 

 which he employs is just strong enough for the patient to feel it dis- 

 tinctly, and he applies it along the spine, the patient standing erect. 

 Painful currents aggravate the symptoms. During convalescence we 



