896 entirely to an inability to properly guide the delicate movements of the fingers, although there may possibly have been in addition some degree of mental impairment. This group may be contrasted with the second, in which as soon as the choreic movements were controlled the patients were FIG. 11. able to write with ease and in which therefore the element of incoördination must have been entirely, or almost entirely, absent. I believe, however, that incoordination plays a considerable part in

more »

... the disorder of many of the cases included in the first group. 5. The fifth group contains two cases only and in these there was either complete or almost complete inability to write at all, although the choreic movements were of very moderate severity. This inability arose, I am inclined to think, mainly from intellectual defect. In the first of the two cases the attempt to write resulted in the production of nothing more than a few meaningless scratches on the paper, yet the choreic movements were by no means severe. It is interesting to note that the power of speech was in this case almost abolished, "yes" " being the only word spoken, and that with much difficulty and after long hesitation. As far as I could judge from this one word, the articulation was not greatly at fault. The second case was that of a boy who succeeded with the utmost difficulty in writing the first two letters of his name and appeared then to lose all idea as to what was to come next. His movements were also slight. Speech was a mere unintelligible jargon of considerable volubility. In conclusion, I must refer to a question which may be raised with regard to my cases-namely, whether they are all cases of true chorea. I am well aware that it has been maintained by some observers that the power of controlling choreic movements during voluntary action is met with only in cases of hysterical chorea ; but my own experience directly contradicts this belief. I have carefully watched my cases from this point of view and have moreover kept nearly all the patients under observation during their illness, and I can positively say that all the cases upon which my paper is based were, so far as I am capable of forming an opinion, instances of true chorea, and ran the ordinary course of that complaint. On the other hand, I give one more illustration (Fig. 12) , namely, the autograph of a girl who was obviously suffering from hysterical chorea, and here it will be seen that even the slight power of control exercised temporarily by the cases in the first group is entirely wanting, and that the individual lines of the letters possess in consequence a jerky irregularity which is not seen in any of the other specimens. To sum up, the cases belonging to the five groups may be described as follows: (1) little or no power of control over the movements, incoördination probably present in at least many of the cases; (2) power of control practically complete, no incoordination; (3) no choreiform movements or movements very slight, much incoordination ; (4) control over choreic movements perfect, great incoördination ; and (5) movements moderate, much central defect, writing impossible.