In this disease, there are involuntary muscular contractions without loss of consciousness, and without a complete loss of the power of the will. The contractions are somewhat peculiar, not being rigid like those of Tetanus, nor so quick and jerking as those of ordinary convulsions, but rather resembling voluntary movements, for which they may be easily mistaken. The name of the disease is said to have arisen from the custom, formerly prevalent, for those afflicted with the disease, to journey to the shrine of St. Vitus, near Ulm, in France, where they were supposed to be miraculously healed.

The complaint usually comes on gradually, and is often preceded by symptoms of derangement of the digestive organs, such as irregular appetite, constipation, swollen abdomen, etc, which are also sometimes accompanied by depression of spirits, and oilier signs of nervous disorders. The first unusual movements noticed are frequently in some particular part of the body, as the face, the shoulder, or the hands; the patient making ludicrous grimaces, or shrugging his shoulders, or incessantly working with the fingers, and perhaps incurring blame for behaving rudely, or acting absurdly, as if the motions were voluntary. But they are soon found to be beyond the control of the will. These irregular muscular actions increase, and at length the whole body becomes involved. Head, trunk, and extremities are in almost constant motion. The features undergo various whimsical distortions, as if the patient were making faces for the amusement of the spectators. The head is moved grotesquely upon the neck; the limbs appear to be twitched about, and the muscles of the trunk pull it first one way and then another, making the patient appear exceedingly fidgety, without greatly altering his position.

If any voluntary movement is attempted, there is a curious and often ludicrous mixture of the regular and irregular actions of the muscles, which seem to be influenced by two opposite forces; but unless the disease be very violent, or the object aimed at requires some nicety or steadiness of movement, the will is generally successful in the end. Thus patients cannot use the hand in writing or sewing, but they can usually convey objects to the mouth, or move from one place to another, though in accomplishing the former object, the arm is jerked about in various opposite directions before it reaches the point aimed at, and in attempting the latter, the body often goes through numerous zig-zag operations, advances with a sort of hitching gait, and as if one foot were dragged after the other, and the patient frequently falls.

The inner muscles of the mouth and fauces sometimes participate in the disturbed action; the tongue is rolled out occasionally between the lips; the patient stammers or hesitates in speaking, and sometimes even has a difficulty in swallowing.

In very bad cases, the patient loses the power of maintaining a standing, or even a sitting posture, and is compelled to lie in bed. One side is sometimes much more affected than the other. Usually these involuntary motions cease during sleep, but not always. It has been noticed that the patient is generally worse when conscious that others are noticing him.

St. Vitus's Dance is sometimes attended with headache; the bowels are generally confined, and the discharges often unhealthy. The appetite is changeable; there is no fever. It is a singular fact that there is much less sense of fatigue from the incessant muscular action than would result from an equal amount of exercise under the direction of the will. The temper is not unfrequently affected; it is more capricious, excitable, or apprehensive than in health. The patient often weeps without apparent cause, or is gloomy or apathetic. The disease is not unfrequently associated with hysteria, when it attacks females about or beyond the age of puberty. The mental disturbance sometimes amounts to delirium. Neuralgic affections are not uncommon in patients who have been labouring under chorea, and some authors have noticed a connection between the latter complaint and rheumatism.

The course of the disease is not by any means regular. Under proper treatment, it may continue only a few days, or it may run on tor months or years. There is reason to believe that when it commences young, a patient may eventually outgrow it, even without medical assistance, but it is thought, when long continued, to weaken the mental powers, and it is even accused of producing imbecility, epilepsy, and paralysis, but the probability is that these diseases, when they occur, are due to the same original cause as the chorea, and are not the results of the latter.

Chorea is sometimes confined to a single part, as the face, an arm, or a leg; and the patient, although well in other respects, is unable to prevent himself from making uncouth or ridiculous movements of this part, which subject him occasionally to inconvenience or mortification. This partial chorea is more difficult to cure than the general, and frequently continues during life.

An unsteady, excitable state of the system is supposed to predispose to chorea, but in many cases it has appeared suddenly in persons previously healthy. A predisposition to the disease is said to be sometimes inherited. No particular age is exempt from the disease, but it seldom attacks infants or old people; the most liable are those between the ages of six and fifteen. Females are more liable to the disease than males.

The exciting causes are strong and disturbing emotions, especially terror; excessive excitements of all kinds, whether mental or bodily, and consequent over-exertion of the faculties; various irritations, as those of dentition, decayed teeth, disordered stomach and bowels, derangement of the liver, worms, uterine disease, suppression of regular discharges, the driving in of cutaneous eruptions, anything tending to weaken the constitution, and various organic affections of the brain and spinal marrow.

Pure Chorea is very seldom fatal; still, instances have occurred where the system has been worn out by its violent and incessant agitations, or in which some vital function has been interrupted sufficiently long to occasion death. In complicated cases, it is not the Chorea, but the accompanying disease, whatever it may be, that is dangerous. When taken in time and properly treated, the disease usually yields in a short time; some few cases, however, are intractable, and will run on for years.

Treatment

In the first place we have to remove any disease we find to exist independent of the involuntary movements, and secondly to improve the health, and give vigour to the nervous system. Where the strength of the patient will bear it, most writers recommend a course of brisk purgatives, repeated every second or third day, and certainly much benefit has resulted from the practice. Powdered Jalap and Cream of Tartaric a very good medicine in these cases. For a child of ten years old, Ten grains of Jalap and ten grains of Cream of Tartar may be given for a dose; and in proportion for older or younger ages; or the Cathartic Powder, No. 3, may be given. Senna Tea, or a mixture of Senna and Epsom Salts is also good.

Acidity in the stomach may be counteracted by Carbonate of Magnesia. Where the patient is debilitated, Rhubarb and Magnesia may be substituted for the Jalap. But different persons are differently acted on by the same medicine, and I have known a mild dose of Rhubarb and Magnesia produce a violent attack of Diarrhoea; and I have known a dose of Quinine produce the same effect.

In giving purgatives, as a general rule, some aromatic should be mixed with the purgative to prevent griping. If the dose consists of Senna Tea, a little Bitter Orange Peel, or a few bruised Cloves, or a little sliced Ginger, should be mixed with the Senna, before the boiling water is poured thereon; or, after the infusion is made, a little Compound Tincture of Cardamoms, or Tincture of Orange Peel may be added. If the purgative given is in powder, such as Jalap, a few drops of Essential Oil of Carraway, or a drop or two of Oil of Cinnamon may be added. For young children, I generally prefer Carraway. Care should be taken not to give the purgatives to such an extent as to debilitate the patient.

As soon as the bowels are in a healthy state, we must commence with Tonics. The infusion of Gentian, or Camarilla or Calumba, (made by pouring one pint of boiling water on half an ounce of the root or bark,) either together or separate, are valuable tonics. To these may be added Acetate of Iron and Quinine. Valerian has been much employed, and is sometimes beneficial; Assafaetida has also been found of service.

Dr. Ceo. B. Wood, of Philadelphia, strongly recommends Black Snakeroot; which he says he has "in repeated instances, found of itself adequate to the cure of the disease. From half a dram to a dram of the powder, from one to two fluid ounces of the decoction, or one or two fluid drams of a saturated tincture should be given three or four times a day, and continued for several weeks; the dose being gradually increased till it produces some sensible effect such as nausea, headache, giddiness, or disordered vision. It is important that the root should be selected of good quality. The fresher it can be obtained the better." Dr. Bardsley, of Manchester, England, tried a great number of distinct remedies, and different plans, in the treatment of Chorea, and came at last to the conclusion, that purgatives followed by antispasmodics were the most effectual. He gave purgatives till the discharges became healthy, and then administered musk and camphor, in doses of four grains of each every four or five hours, with an enema of assafaetida, or a little laudanum at bed-time.

When the weather is not too cold, the cold or shower bath will sometimes produce very beneficial effects, and sea-bathing is a very valuable remedy. Fresh, pure air, and moderate exercise, as soon as the patient can bear it, are also useful. Great attention should be paid to the diet, which should be light and nourishing; and the patient should be amused as much as possible, and his mind kept in a cheerful state.