CHOREA. 243 
likely be disappointing. However, there can be no objection to uniting it with 
the arsenical treatment; and indeed it may be well to give it a trial if one 
course of the arsenic mixture advised has been administered without good effect 
and a second round is contemplated. 
The fluid extract is the best preparation of cimicifuga, and the dose for a 
pup over eight months old and of medium size breed is six drops; for largest 
breeds, nine drops; for fox terriers and the like, four drops; for toys, two drops. 
Each dose can be given with a dose of the mixture of Fowler’s solution and 
water, prepared as advised in the foregoing. 
When chorea is associated with debility it will be well to combine the citrate 
of iron and ammonia, or the compound syrup of hypophosphites, with the arsenic 
given; and in such event the druggist can have the proportions right if informed 
that the dose for a pup of medium size breed is about the same as the minimum 
dose for an adult. The largest breeds can take one-half more; pups of about 
the size of fox terriers, one-half less; and one-fourth the dose would be right 
for toys. 
Hemlock has been much used in chorea, and some think highly of it. 
Given alone it is not likely to have much effect, but in event the quinine 
treatment has been tried without good results it might be well to modify it 
somewhat and give it another trial after a week has elapsed. 
The modification may be to combine with the sulphate of quinine precisely 
as many grains of the extract of hemlock and as many grains of ginger. For 
example, assuming the pup to be of medium size, two grains of quinine have 
been recommended for him. As modified, the dose would be the same quantity 
of quinine, two grains of the extract of hemlock, and two grains of ginger. 
Each dose will therefore be six grains of the mixture, and made up of the 
three drugs, the quantity of each being the same — two grains. 
The druggist should make pills of the right dose, or use gelatin capsules, 
each to contain one dose. 
Modifications for the various breeds will be easy. Thus, one-half more for 
largest breeds; one-half less for fox terriers and the like; and one-fourth for 
toys. 
That mistake may not be possible, the dose for the latter is given as tollows: 
One-half a grain of quinine, the same quantity of the extract of hemlock, 
and the same of ginger. 
Hypodermic injections of hyoscyamus have had good effect in some cases, 
but manifestly this treatment must generally require the services of a physician. 
Could one be interested in a case and persuaded to administer a hypodermic 
injection daily, it would be well to give the treatment a trial, other methods 
having failed. 
Instead of using hyoscyamus, the alkaloid of it, hyoscine, would be better. 
And better still, perhaps, the hyoscine hydrobromate. 
