Chorea.

S. G. ARNOLD, M. D.

In the July number of the THERAPEUTIST I notice a paper on Chorea with treatment by N. M. Dewees. I recently had occasion to treat a case which had been pronounced incurable by the other physicians of my town. After they had used arsenic to its full physiologic effect.

The parents stated when they called me that they hoped because I was of a different school of practice that perhaps I could do something for the child. Up to that time all that had been accomplished was to produce quiet and rest by the use of the bromides and morphin.

The patient was a little girl of five years. She had had rheumatism which left her with a heart complication. Six months later she became afflicted with chorea. The case presented the typical symptoms in every particular as recorded in the books. I will not therefore go into detail as to symptomatology.

The treatment was as follows: Specific macrotys two drams, specific passiflora one and one-half drams, water sufficient to make two ounces. Of this mixture I gave one dram every two hours during the day, and when awake during the night, but not oftener than once in three hours. The effect of this treatment gave us complete control of the erratic movements within three days. Even the muscular twitching of the voluntary muscles disappeared. The appetite improved, the sleep became natural, and in three weeks the patient was pronounced cured.

Another case was that of a girl age 16 years, who for some time had had recurrent attacks. She came to my office and asked for some Fowler's solution, with directions how to take it, stating that she had been previously cured by that remedy, after taking it for perhaps three months. I found here a severe tachycardia with 160 pulsations per minute. The irregular muscular movements were constant and very severe. I gave this patient the following prescription:

Specific macrotys, one-half of an ounce, specific cactus, one and one-half drams, water sufficient to make four ounces. Of this, a teaspoonful four times a day. There was a marked benefit from the treatment, apparent after three weeks, and within four weeks the cure was complete. After the cessation of the irregular muscular movements, I gave two drops of specific cactus every three hours for its influence upon the heart.

COMMENT: It will be observed in nearly all of the articles we are publishing at the present time on the use of macrotys in the treatment of chorea, that the dose is larger than usually advised. In most of the cases from three to ten drops is the dose. This is a marked contrast to the advice given by most of our writers to drop from ten to twenty drops in a glass of water and of this to give a dram every three or four hours. As I have said before I believe our failures come from an insufficient dose. Furthermore, there are in nearly every case one or more other conditions that could be met at the same time. Neither is there proper attention paid to the diet and its digestion, and to rest. The severe cases should be kept in bed for a sufficient period and should be fed on the most nutritious food, which must be readily digested.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.