* I mean exclusively the usual chorea (chorea minor), whether single or double-sided, and not the prominent motor symptoms, known as chorea major, present in marked psychoses, hysteria, simulation, etc.

The majority of my readers have probably frequently thought that the number of methods in use in treatment of a disease is in inverse ratio to the effect of these methods. A great part of the pharmacopoeia, and many methods which would otherwise be foreign to medicine, have been used in the treatment of chorea. +

+ On the whole, mechano-therapy has been comparatively successful. In 1799 Erasmus Darwin suggested mechanical treatment for chorea. Swedish gymnastics, under the elder Ling, was also used in its treatment. Southam of London deserves to be honourably mentioned; he suggested in 1841 immobilisation alternately with passive movements and after-treatment by gentle gymnastics. In 1850 the treatment of chorea by massage and gymnastics came into vogue in France through See, Blache, Laisne, Bequerel, and others. Mechanical, along with other treatment, is now commonly used.

It is still far from easy to decide to what degree each part of the mechanical treatment contributes in relieving and shortening the duration of this erratic disorder, which may last weeks or years, may entirely disappear or recur, without satisfactory answers as to the cause of the disease, whether it is combined with endarteritis or with rheumatism, with chlorosis, hysteria or pregnancy, and whether it arises, as usual, at the beginning of the second decade of life or later.

The mechanical treatment consists of immobilisation, massage and gymnastics, and I personally consider that the value of these three therapeutic methods is in the above order.

I would specially point out that immobilisation must so far be considered the best (Nebel, Monahan, Nonnchen, and others). It may be brought about by means of a plaster jacket and by plaster bandages on the extremities, which are later changed to movable splints and taken off once or oftener daily to allow of massage.

Massage is indicated, when immobilisation is used, to counteract its effects, and also to act upon the pathological-anatomical changes which are to be found, whether they result from or are the cause of the muscular excitability, and which Elischer describes as hyperaemia in the vasa nutrientia of the nerves, hypertrophy of the interstitial neurilemma, flattening of the contour of the myelin sheath and axis cylinder, and a decidedly abnormal macroscopic appearance of the nerve fibres ("verschmachtigt, abgeplattet und abnorm derb, von schmutzig grauer Farbe").

As regards gymnastics, many hold Ziemssen's opinion that it really belongs to the stage of recovery, at least in severe cases. It ought certainly to consist of passive movements and of progressive self-resisted movements, during which without doubt the movements are most easily performed under the control of the will; other active movements should be kept for the more advanced stage of convalescence.

Along with immobilisation and massage, chiefly effleurage and self-resisted movements, the anodal* galvanic current should be used on the spinal cord and peripheral nerves, the physical and mental diet should be controlled, and for the rest the aetiology of the case (chlorosis, peripheral irritation of one kind or another) must decide.

It was in Charcot's clinic that Vigouroux in 1878 first succeeded in treating hemianaesthesia and contracture in hysteria successfully by vibrations. Insomnia also in these cases was improved by vibrations on the head (Buccola). After what has been said in the general part of the chapter there is little to add concerning the massage for hysteria. From what has been said above it is easy to see how sensory, motor, and other symptoms may be treated in this way, which naturally can never be more than an accessory to other treatment. Owing to the nature and character of the disease itself, as well as to the absence of pure therapeutic experiments with massage, no one is in a position to estimate its value with certainty, although it appears to have the same influence upon the special symptoms as it has in those neuroses of which the pathological anatomy is known.

* I would remind the reader of the observations by Legros and Onimus upon choreic does on the diminution of the movements with an anodal current and increase of the same with a kathodal current.