Saint Vitus's Dance. Chorea.
This disease is chiefly confined to children and youth between the ages of eight and fourteen. But few cases occur after puberty.
Symptoms. The complaint affects mostly the muscles and the limbs. It excites curious antics, such as we should suppose would occur if a part of the muscles of voluntary motion had hatched a mimic rebellion, broken away from the control of the will, and in sheer mischief and wantonness, were tripping their fellow muscles, and playing tricks with the patient. A few of the muscles of the face or limbs begin their mischievous pranks by slight twitches, which, by degrees, become more energetic, and spread to other parts. The face is twisted into all kinds of ridiculous contortions, as if the patient were making mouths at somebody. The bands and arms do not remain in one position for a moment. In attempting to carry food to the mouth, the hand goes part way, and is jerked back, starts again, and darts to one side, then to the other, then mouth ward again; and each movement is so quick, and nervous, and darting, and diddling, that ten to one the food drops into the lap. If the attempt be made to run out the tongue, it is snatched back with the quickness of a serpent's, and the jaws snap together like a fly trap. The lower limbs are in a state of perpetual diddle; the feet shuffle with wonderful diligence upon the floor, as if inspired with a ceaseless desire to dance.
It is supposed by some that the disease consists in a partial palsy of a part of the muscles. The will in that case not being able to control the palsied muscles, when it commands the others to move, their action is not balanced, and they twitch the face and limbs into all the capricious and fantastic shapes we witness.
Others, and probably with more truth, hold that the seat of the disease is in the cerebellum or little brain. It is supposed to be one of the functions of the is organ to preside over and regulate the locomotion, that it holds the office of chief engineer, and that its duties are to keep the muscles in subjection to the will. The combined and consenting action of several muscles is needed for every movement. It is the business of the cerebellum to maintain this oneness of purpose and action to see that no muscle flinches so as to disturb the harmony of the movement. When the cerebellum is diseased, all is confusion, just as the locomotive runs from the track when the engineer is smitten with palsy.
The disease is not dangerous, but when it continues for many years it is apt to weaken the mind, and it sometimes very nearly destroys it.
Causes. Whatever excites and weakens the nervous system, as powerful emotions of the mind, overworking the mind, reading exciting novels, eating too much meat, f7ight, striking in of eruptions, self pollution, etc.
Treatment. In the first place, remove all causes of excitement. Take the patient from school, and require some sort of cheerful outdoor exercise, daily. Take away all books, and be careful not to do anything to occasion anger or fear, or any kind of injurious excitement. Apply spinal ice bags gradually and regularly.
In the second place regulate the diet making it more animal and stimulating if it has been too low, and more vegetable and cooling if it has been too high.
In the third place, if the above changes have not been sufficient for the purpose, open and regulate the bowels with some gentle physic (30), (34) for a few days.
Iron in the form of tincture of the chloride of iron, 10 drops in water taken through a tube after meals, and arsenic in the form of Fowler's solution must be used for the anemia, which is so often present. This latter drug is a strong solution of arsenic and must be used with great care, given in a dose for a young child 2 or 3 drops well diluted with water three times a day, gradually increasing a drop a day up to 8 to 10 drops three times a day, which is the maximum amount; it is not safe to increase more. The danger of poisoning must be looked for, such as a puffiness about the eyes and nose, or pains and cramps in the stomach. They show that the patient is getting a little more than is sufficient. The drug should then be cut down about half and continued at the last amount or entirely stopped. If there is a rheumatic history the salicylate of soda in 5 to 10 grain doses three times a day must be used. Next to arsenic, sedatives, such as bromide of soda or hyoseyamus or better than all the fluid extract of cimicifuga in the doses of half a teaspoonful diluted with water twice a day often proves a help.
To these remedies should be added the shower bath, beginning with tepid water, and making it a little colder every day. If the shower bath frightens the patient, or is not otherwise well borne, take the sponge bath.
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