A nervous twitching of the muscles of the arms, sometimes of the legs and sometimes of both, including a jerking of the head. Before the disease has developed into its severe form there is a period of warning, running over from six months to a year. The parents will notice that the child is very nervous, restless, and hard to keep still. The child is quite excitable. Many times it will be very irritable, and easily thrown into tears by a slight reprimand. There may be such symptoms as frequent urination. A quite young child may wet the bed frequently at night.

When chorea proper starts, the child loses control over its hands--will drop dishes, playthings, or books. At first the parents may think it is carelessness, and scold the child or mildly punish it for being so careless. But the symptoms become worse. A physician is consulted; and then the parents learn for the first time that the cause of the child's nervousness is functional paralysis.

In severe cases the child cannot stand and cannot walk without someone being near to take hold of its hand or arm. Indeed, two people may be required in attempting to help the child to walk. When children get in this state, they have no inclination to walk.

Only children of neurotic temperament develop chorea. When such children are allowed to eat at any time, have no regular time for feeding, and are permitted to eat any and all kinds of foods, taking milk and bread, or mixing protein and starch, eating rich cooking--custards, pies, cakes, cookies, etc.--they bring on such a state of deranged digestion that they develop such diseases. Fear of parents and teachers aggravates the disease. Fear and improper feeding enervate, and are the principal causes.

Many children will cultivate the drinking habit--drinking frequently between meals. Every drink taken between meals, or while digestion is on, checks digestion, will bring on acute indigestion, and hasten the development of such diseases as chorea, petit mat, and epilepsy.

Treatment

Such children, when they have developed a state of chorea, should be put to bed, and kept there until all shaking and twitching of the muscles have entirely disappeared. Eating must be very light. A glass of milk in the morning; orange juice and water, or a little fresh fruit, at noon; and in the evening a pear and a few grapes, with milk. The child will improve very much faster if it can be persuaded to go without food for a week, and then given the food as suggested above. As the muscle-twitching disappears, the feeding may be increased.

Such a patient should have a daily warm sponge-bath, followed with gentle rubbing. It should have abdominal massage daily, and the massaging should be more over the stomach, just beneath the ribs and breast-bone. The entire abdomen needs rubbing, but the region of the stomach needs more attention than the rest.

If the bowels are constipated, a small enema of warm water may be used to secure a movement about every other day.

The child should be kept as quiet as possible. Playmates should be excluded from the bedroom entirely. There must not be any excitement whatsoever. The parents should be gentle and firm, and avoid exciting the child by scolding. This is not the time for punishing a child for peevishness. Many of these children are quite impatient and irritable and want to dominate everybody. This must be overlooked, and at the same time parents must be firm, not allowing such children to be out of bed nor to have company. Picture-books for entertaining can be allowed, or such reading as the child may desire. Where children are kept very quiet and continuously in bed, with a very light diet, the disease will be controlled in a very reasonable time from two to four weeks.