3T. VITL'S' DANCE. 39 



the chin is alternately protruded and retracted ; while the tongue can very often be 

 seen moving unsteadily and in a jerking manner within the mouth. The limbs, as 

 well as the face, generally suffer, and neither arms nor legs are quiet for an instant, 

 but tin- child's body is in one constant state of fidget. The degree of movement in 

 this disease varies immensely. It may be so slight as only to be observable occa- 

 sionally, and then only in a very small degree ; or it may be so excessive that the 

 child requires to be constantly held in its bed to prevent its being jerked out 

 upon the floor. These extreme cases are very terrible to see, and a child attacked 

 in this way not unfrequently dies from the exhaustion caused by the excessive 

 movement. Sometimes the choreic movement is limited to one side of the body. In 

 average cases the child is unable to walk steadily, to sit steadily at table, and feeds 

 itself with great difficulty. They are not to be trusted to carry any breakable 

 articles, since their grasp is necessarily very uncertain. The movements cease during 

 sleep, but in extreme cases the excessive amount of movement may prevent the child 

 from getting to sleep. 



There exists a curious relationship between this disease and rheumatism, and it 

 has been very frequently observed that chorea often follows or is followed by an 

 attack of rheumatism, or else that the families of children who suffer from chorea 

 are very subject to rheumatic affections. 



This disease is infectious ! Such a statement may seem startling, but is never- 

 theless true ; and it has been found again and again that if a child suffering from St. 

 Vitus' dance be allowed to associate with its fellows, other children are very apt 

 to become affected, and to acquire the trick of movement, as it were, by unconscious 

 imitation. There have been genuine epidemics of this disease. The most notable, 

 perhaps, is one which is recorded to have broken out at Strasburg in 1418, and as 

 the sufferers made pilgrimages to the shrine of St. Vitus to obtain relief, the name of 

 this saint has been given to the disorder. Although most common in childhood, 

 it does occasionally make its appearance (especially in women) at more advanced 

 periods of life, and we occasionally meet with cases of it at twenty years of age, 

 or even at more advanced ages. It occasionally happens that disease of the heart 

 accompanies the disorder of movement, and diligent search should be made by the 

 medical man in charge for the detection of the heart trouble, which can only be 

 done by means of the stethoscope. 



The treatment of this disease is simple, and happily it subsides, as a rule, 

 without being obliged to have recourse to any strong measures ; but occasionally it 

 proves very obstinate, resisting every attempt to alleviate it, and in some very few 

 instances it proves fatal by the exhaustion which it causes. The child's health must 

 be very carefully attended to, and search must be made for any source of irritation 

 which may help to keep up the trouble. The teeth must be looked to, the digestion 

 must receive attention, any errors in diet must be corrected, the bowels must be 

 regulated, and diligent search be made for any evidence of the presence of intestinal 

 worms, which are not unfrequently a cause of this disorder. The child should have a 

 bed to itself, and the bedroom should be airy ; but, and especially if the trouble havo 

 arisen from fright, an elder person should sleep in the same room, and a light should 

 be burnt. The lessons need not, except in the more severe cases, be abandoned, but 



