Besides the organic diseases of the nervous system, there are certain morbid conditions in which the nervous symptoms consist mainly of disturbances in the functions of certain organs, no doubt determined by disease, yet in which the diseased condition is of uncertain character. Of these, one of the most important is chorea. It is necessary merely to allude to the pathology of this condition, in which fresh interest has recently been aroused by the work of Drs. Poynton and Payne. Their conclusions would seem to point to the existence of a microbe of acute rheumatism. On this hypothesis the phenomena of chorea are traceable to the presence of those microbes in the cerebral vessels. Such a pathology would bring the most modern views as to chorea into line with the views of Hughlings Jackson, Broadbent, and others, according to whom chorea has, as its underlying morbid anatomy, the presence of occluded small vessels in the cerebrum. Whether this view be adopted, or the other, which would regard chorea as the result of some toxic condition of the blood acting upon cerebral structures, the disease is frequently so severe in its effects as to make the feeding of the patient a matter of both difficulty and importance. In discussing chorea in this relation, it must be understood that we are considering the disease as apart from any manifestations of actual acute rheumatism. Frequently, of course, cardiac disease is present, but so long as it is not in an active stage of endocarditis or pericarditis, the treatment of the condition is the treatment of the chorea. Where active rheumatic conditions are present, the dietetic treatment of the condition, as well as the treatment by drugs, is determined by the condition of the acute rheumatism present. Little need be said of the treatment of chorea by drugs. The use of arsenic and other tonic drugs in small doses is probably not without a certain amount of good influence. The use of arsenic in large doses is frequently harmful, and is never justifiable. Rest, seclusion, and abundant feeding are the essentials for the successful treatment of chorea. In an ordinary case it is sufficient to give a full diet suitable to the age of the patient, with one or two added pints of milk. In severe cases the food is to be entirely liquid, and it may have to be given by the nasal tube. In such a case, milk, eggs, and strong beef-tea are the chief articles of diet, and alcohol should always be added in considerable quantity, as much as an ounce, or even 2 oz., to each feed. This is especially important in those cases which are admitted into hospital actually in a state of starvation, because the violence of the movements has prevented proper feeding. In such cases it is important to give no sedatives, especially of the chloral class, at least until the patient has had a good meal, with added alcohol. In some cases in which this rule has been neglected, severe and even fatal collapse has followed the administration of the sedative : and indeed in those cases, if such a meal as has been indicated, of milk, eggs, or beef-tea, with 1 or 2 oz. of whisky or brandy, be given, the sedative will probably be unnecessary, as the food itself will induce a sleep at once more wholesome, more natural, and more refreshing than any kind of sedative.
The quantity to be given will depend upon the age of the patient, but if any error is to be made, it had better be made on the side of giving too much rather than too little. An adolescent male or female - and such are usually the subjects of the severer form of chorea - should have at least 4 pints of liquid, beef-tea or milk, with three or four eggs, and as much as 6 oz. of alcohol in twenty-four hours. For a younger patient, a smaller quantity will be sufficient. It is desirable, again, to insist upon the need for using alcohol in those cases, and upon the necessity of always feeding a patient suffering from chorea, after admission to a hospital before any sedative is administered. As has already been said, the administration of a good meal will often obviate the need for any sedative. The nasal tube will only be used if the patient cannot swallow, and if it has to be used, it must be discontinued at the earliest possible moment.