(A caetus saltantium ). St Vitus' dance. Also called viti saltus; by Paracelsus, lascivus. Horstius observes, that some women, who were disordered in mind, once every year paid a visit to the chapel of St. Vitus, near Ulm, and there exercised themselves day and night in dancing, till they were completely exhausted. Thus they were restored till the return of the following May, when they were again seized with a restlessness and disorderly motion of their limbs, in so great a degree as to be obliged, at the anniversary feast of St. Vitus, to repair again to the same chapel for the sake of dancing. From this tradition, a convulsion, to which girls are principally subject before the eruption of the menses, took its name. The disorder, however, above described by Horstius is different from what we call 67. Vitus' dance.
Mead and Pitcairn think this disorder paralytic; Sydenham considers it as convulsive; Dr. Cullen calls it chorea, and has, on account of the age at which it attacks, as well as the motions which it exhibits, established it as a genus, under the class neuroses, and order spasmi. He remarks, that it affects those of cither sex before the time of puberty, for the most part between the tenth and fourteenth years. It manifests itself by involuntary convulsive motions of some parts, commonly of one side, resembling the gestures of buf-foons, in the movement of the arms and hands; the patients, in walking, oftener drag one foot than raise it.
Sydenham thus describes it: "A kind of convulsion, which principally attacks children of both sexes from ten to fourteen years of age. It first shows itself by a lameness, or rather unsteadiness, of one of the legs, which the patient draws after him like an idiot, and afterwards affects the hand on the same side, which, being brought to the breast, or any other, part, can by no means be held in the same posture for a moment, but is distorted or snatched by a kind of convulsion into a different posture or place, notwithstanding all possible efforts to the contrary. If a glass of liquor be put into the hand to drink, before the patient can get it into his mouth, he uses a thousand odd gestures; for, not being able to carry it in a straight line thereto, because his hand is drawn different ways by the convulsion, as soon as it hath reached his lips, he throws it suddenly into his mouth, and drinks it very hastily, as if he only meant to divert the spectators."
This is, however, a very imperfect and inadequate view of the disease. We shall, therefore, transcribe that given by Dr. Hamilton, in his Treatise on the Utility of Purgatives.
"Chorea Sancti Viti attacks boys and girls indiscriminately; and those chiefly who are of a weak constitution, or whose natural good health and vigour have been impaired by confinement, or by the use of scanty or improper nourishment. It appears most commonly from the eighth to the fourteenth year. I saw it in two young women, who were from sixteen to eighteen years of age.
"The approaches of chorea are slow. A variable, and often a ravenous, appetite, loss of usual vivacity and playfulness, a swelling and hardness of the lower belly in most cases, in some a lank and soft belly, and, in general, a constipated state of the bowels, aggravated as the disease advances, and slight irregular involuntary motions of different muscles, particularly of those of the face, which are thought to be the effect of irritation, precede the more violent convulsive motions, which now attract the attention of the friends of the patient.
"These convulsive motions vary. The muscles of the extremities and of the face, those moving the lower jaw, the head, and the trunk of the body, are at different times, and in different instances, affected by it. In this state the patient does not walk steadily; his gait resembles a jumping or starting; he sometimes cannot walk, and seems palsied; he cannot perform the common and necessary motions with the affected arms.
"This convulsive motion is more or less violent, and is constant, except during sleep, when, in most instances, it ceases altogether. Although different muscles are sometimes successively convulsed, yet, in general, the muscles affected in the early part of the disease remain so during the course of it.
"Articulation is now impeded, and is frequently completely suspended. Deglutition is also occasionally performed with difficulty. The eye loses its lustre and intelligence; the countenance is pale, and expres-sive of vacancy and languor. These circumstances give the patient a fatuous appearance. Indeed, there is every reason to believe, that, when the complaint has subsisted for .some time, fatuity, to a certain extent, interrupts the exercise of the mental faculties.
"Fever, such as arises in marasmus, is not a necessary attendant on chorea; nevertheless, in the advanced periods of the disease, flaccidity and wasting of the muscular flesh take place, the consequences of constant irritation, of abating appetite, and impaired digestion, the common attendants of protracted chorea; and which, I doubt not, may, in some instances, although contrary to the opinion that chorea is not fatal, have been the forerunners of death."
This is a very faithful picture of the disease, and we can only add to it, that the belly seems often obstinately bound. We have seen it at every age, from seven to twenty-two; and, in one case, it occurred in a young woman of twenty, who had been married about three weeks.
What can have occasioned the apathy of practitioners respecting this frightful complaint, it is not easy to say. The description of Sydenham has been repeated in every author, and the usual tonics and antispasmodice indiscriminately and fruitlessly advised. The disease evidently depends on debility; but we can no more conquer this debility by tonics, than we can successfully combat that which arises from infarcted viscera by-bark. It seems to have escaped authors that, in every case of chorea, there is a load in the head, an obstructed discharge from the bowels, at a time when it is the object of nature to determine the fluids to the lower belly, viz. about the age of puberty. Many of the symptoms are those of apoplexy or palsy; but, as usual in cases of debility, the voluntary muscles lose their balance, and convulsions follow.
Those who have once suffered under this disease are very subject to a relapse. However violent the symptoms, they never are suddenly destructive. When recent in a young person, of an otherwise good constitution, there is hope of a speedy cure. If the menses are obstructed, their return will mitigate, if not cure, the disease. If the temperament is very sensible, the disease hereditary or habitual, the cure is difficult.
Nothing, in the records of medicine, is more trifling and indiscriminate, than the mode recommended of relieving chorea. The author of this article, more than twenty years since, catching the hint from Sydenham, gave purgatives; and found that this usually obstinate disease yielded not only soon, but with little danger of relapse; and, in this interval, he has had occasion to see more than sixty cases, three times Dr. Hamilton's boasted number, in one of which only he may have been styled unsuccessful. The violence of the disease, indeed, in that instance, was subdued; but slight irregular motions, especially on any sudden agitation, would not yield. The author's own illness obliged him to refer the patient to another physician, but every measure seems to have failed.
The choice of the purgative appears of little importance; but it must be active, for no other will produce the necessary discharge; and the saline purgatives are apparently less adapted to the complaint. The author knows no distinction but in their power. The most active are the most useful. In the Edinburgh Medical Journal, there are two cases of chorea in which purgatives succeeded; and, in Dr. Hamilton's volume, there are many instances of well conducted successful treatment by this plan. We have had no reason to follow the purgatives by tonics. The constitution has restored the general health with rapidity and effect. We may just add, that, in the woman newly married, the complaint yielded, within a fortnight, to the purgative course.
See Wallis's Sydenham, vol. ii. p. 327; Cullen's First Lines, vol. iii. edit. 4. Hamilton on Purgative. Medicines; Edinburgh Medical Journal, vol. i.