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1885 Boston Medical and Surgical Journal  
normal, the appetite is good, and the bowels slightly constipated. The movements are increased if spoken of in her presence. The possibility of any reflex irritation owing to intestinal worms was dispelled by the administration of male fern, chenopodium, and injections of turpentine and sweet oil. There is no history of masturbation or other genital irritation of any kind. No history of fright or chorea prior to the scarlatinous attack. No anaemia. The girl would generally be considered strong
more » ... considered strong and sturdy and does not appear to be of a markedly nervous temperament. The hand and arm affected (the right) were wanner than the left. This difference was only appreciable by the touch, since the thermometer in the axillae marked the same number of degrees in both cases. The right hand was hot, dry, and feverish, although the weather was cold and the child had come some distance. This case also recovered under the use of arsenic, the red hue of the hand and arm gradually disappearing as the patient's condition improved. Case IV. George N., aged thirteen, came to the Dispensary of the University Hospital suffering from an irregular form of chorea, which, at times, affects the whole body, but which is constantly present to a slight degree in the right arm, from which point the movements extend when he is suddenly frightened or greatly excited, as by the sight of a runaway horse or something of a similar character. The arm does not appear to be much warmer than normal unless the movements are about to extend to the rest of the body, when the boy will say to bis parents, " It'scorning, my hand is getting hot," and within the next few minutes the general attack comes on.2 That this attack is not epileptic is shown by the fact that there is never loss of consciousness or frothing at the mouth. He keeps on saving what he wishes to say as if nothing was occurring, although his mother tells me that his words are not articulated clearly, owing to the movements affecting the muscles of his mouth. He never falls down during an attack and goes on with his work (sewing rag carpet) after the attack passes off as if nothing had occurred, although he is entirely conscious of his having had one. If asked a question during an attack he will invariably give a clear and lucid answer. The beginning of this trouble dates back six years. At that time, while at Atlantic City, he was forced by his parents to take a surf-bath although he was much averse to it, owing to fright. He no sooner reached the water than his kicking and screaming was replaced by rigidity. This alarmed the parents and they immediaely took him out and dressed him. After a few hours the child seemed perfectly well. In the course of the next few weeks the mother noticed a slight twitching of the eyelids, chiefly affecting the left side. This was so slight that the father denied its presence. This, however, passed away at the approach of winter. The following spring the movements appeared in the right arm, and from this point have annually made further inroads on the rest of the system till the present condition has been reached. During the summer, when he is out of town, he becomes almost -The mother says that the hand feels hot to the touch and that the boy knows the approach of the attack, nut by any change of feeling in the affected arm, but by the feeling which is conveyed to the normal hand of increased heat when the affected hand la grasped. entirely well. Sometimes the attacks come on without apparent cause, generally in such cases following several days of unusual quietude. One of the frequent causes of a general attack is an imperative eall, on the part of his father, to get up in the morning. The boy has improved slightly under the use of arsenic and tonics. He, however, is in every way, but that mentioned, healthy, strong, wellgrown, and the possessor of a good digestion and appetite. This case, although not that of an ordinary chorea, is very interesting, as showing the change of temperature which takes place just before and during the movements of the arm, which seems to be the focus of each attack. Case V. Robert P., aged nine. Came to the Dispensary suffering from a constant and incessant chronic movement of the eyelids.3 To all appearance he is a strong, healthy boy and not of a neurotic temperament. He is only a little pale and would not be regarded as anaemic. His mother states that last fall he had an attack of scarlet fever and this trouble came on during convalescence. The closest questioning fails to elicit any history of paralysis, or of this disease in any form prior to the attack of scarlet fever just mentioned. There are no abnormalities about the heart and there is no history of rheumatism. The appetite is good and so is digestion. The bowels are in good order. The eyelids, particularly the upper lids, are infected, redder than normal, hot and feverish to the touch. The boy also states that his " eyes feel hot," referring to the lids. There is no change in the eyes themselves, either in the manner of moving the ball or change of the pupil. Unfortunately the actual temperature could not be taken owing to the exposed position of the parts. The treatment of this case consisted in the administration of Fowler's solution, the child recovering in about three weeks. remarked that the reader was especially to be congratulated on his success in the last case mentioned. For other operators had found the mortality very high in this class of cases, that is, cases where the tumor grows more or less from the cervix and extends into the broad ligament. Dr. llomans's conclusions in regard to the intraperitoneal treatment of the stump were of interest because they were opposed to the conclusions one would draw from the statistics of other operators. In ovariotomy the pedicle was at first treated by 8 This case is hardly one of mono-chorea, and is mentioned here merely because the movements were localized and accompanied by increase of temperature.
doi:10.1056/nejm188504021121403 fatcat:2ztjp762jrbf7brcl3dzgfuozu