Chorea.
C. W. BEAMAN, M.D., CINCINNATI, O.
For the purpose of this paper, it does not seem necessary to go into detail concerning the etiology, symptomatology or pathology of this disease. Tremendously interesting and important is the knowledge of the symptom-complex of chorea, and the incidental pathology, which gives rise not alone to bizarre muscular movements, but often to serious degenerations in the heart and the central nervous system. The cardiac disturbance may come with startling and tragic suddenness, turning an apparently satisfactory convalescence into an unexpected fatality. Once the central nervous system has been severely impressed, one may look for recurrences, especially if the focus of infection has not been eliminated. Recurrences are not to be looked upon lightly, as experience has taught me.
I hope these statements will cause those of you who, perchance, have had little experience with this disease, or who have met only the milder cases, to give more serious thought to the study of this condition, fraught with such grave possibilities. Having passed through the various stages myself, first of seeing the disease infrequently in my early practice, then having excellent success with mild types, and finally discovering by sad experience just how severe and uncertain chorea can be, it is my desire to stimulate such study. It is my aim in this paper to call attention to some of the therapeutic agents of special value in chorea, especially those which with pardonable pride can be considered as Eclectic in their specific application.
Here it may be interesting to inject a bit of personal history which concerns my introduction to one of the most valuable and reliable agents in this respect. While still a medical student in Cincinnati, it was my good fortune to meet a physician of the old school, Dr. A. J. Miles, who had rounded out more than fifty years of practice at that time. Possessed of a brilliant mind, a courtly and genteel manner, he kept abreast of the times, and had earned the respect of all who knew him. He was one of the foremost internists in Cincinnati some twenty-five to fifty years ago. In one of our enjoyable and always profitable chats, he told me of an experience he had with chorea. While on one of his trips to Europe many years before, one of the famous house of Rothschild had a child seriously ill with this disease, which had failed to yield to the treatment of some of the most noted medical men of the continent. Dr. Miles was known by reputation even abroad, and was called in consultation by some one who knew he was traveling in southern France. He saw the child and prescribed macrotys, or cimicifuga, as it was better known. None could be found in the apothecaries of continental Europe, but the wealth and station of the family made it possible to carry the search quickly and thoroughly until a supply of the powdered drug was located in England. It was dispatched with utmost speed to the bedside of the little sufferer, who was by this time all but given up to die. Improvement was soon noted and a cure was eventually recorded. All this was told me with no desire or effort to exaggerate the doctor's skill, but to impress me with the value of this drug, which later, in far more elegant preparation, became one of my most prized agents. Only a few years ago our late and much beloved Dr. Felter, in a splendid paper on "Macrotys," before a joint meeting of the Homeopathic and the Cincinnati Eclectic Societies, emphasized the value of this drug in this disease.
The specific indications are no doubt familiar to you all, i. e., muscular soreness, tensive deep-seated pain, sense of painful muscular contracture, bruised feeling, feeble heart action associated with the above type of discomfort. There is little doubt but its use is broader than the specific symptoms mentioned. Dr. Felter states in his "Eclectic Materia Medica:" "Macrotys has a powerful influence over the nervous system, and has long been favorably known and accepted as the best single remedy in chorea." While this statement may be a little sweeping, the writer feels that he is fortunate to have this drug at his command, and many cases of chorea will be found that will be most favorably influenced by its exhibition.
While I might not place conium maculatum next in importance to macrotys, it is appropriate to consider it as somewhat similar in action, though perhaps of less general utility. Excessive motility and nervous excitation call for its use. Certain cases respond to the drug where such symptoms predominate. It is a more dangerous remedy and should be used with care. It powerfully depresses the peripheral motor endings, and in cases where the incoordinate and incessant movements prevent rest it is one of our most reliable agents.
Gelsemium should not be overlooked, either alone or in combination with other drugs, where nervous excitement is associated with the special indications for this drug. Fever, flushed face, bright eyes, with tendency to convulsions, are not infrequently met in this disease, and here gelsemium will seldom disappoint. From my experience with this drug in encephalitis (chorea may be a form of encephalitis), I am tempted to believe that its action is not only sedative, but probably antitoxic, if not actually destructive to the organism responsible.
Arsenic in the form of Fowler's solution is mentioned because of its rather general use by our Allopathic brethren, and no doubt has found favor with many Eclectics. The statements in our literature that its value in chorea is due to a malarial or chloremic taint does not seem wholly tenable. The bactericidal action of arsenic would seemingly better account for its action. While largely used empirically, it can and should be used more specifically. General pallor, poor peripheral circulation, subacute forms showing anemic symptoms would, in the writer's opinion, seem a more appropriate field for its exhibition. There is little question that it is valuable in this disease, but whether it should be carried always to its toxic reactions is debatable. My own experience leaves me still in doubt on this point.
No doubt there are many other agents of value, but to mention more might be confusing, and I shall leave the field to others whose individual experience may add to my short but dependable list.
