CHOREA

JOHN H. RICHARDS
1914 Journal of the American Medical Association  
with symptoms of intestinal occlusion. Operation dis¬ closed an obstructing hair-ball in the ileum. Four weeks later symptoms of pyloric stenosis supervened and the material vomited contained hair. Gastrotomy was per¬ formed and a hair-ball was found impacted in the pylorus. Eecovery ensued. In both these cases of multiple hair-balls involving the stomach and intestine, the presence of another mass was unsuspected at the first operation. These experi¬ ences, together with mine, indicate that a
more » ... e, indicate that a thorough examination of the entire gastro-intestinal tract should be made before closure of the abdomen in every opera¬ tion for hair-ball. The other cases reported in the literature are nearlv all taken from necropsy records, death having ensued from inanition, perforation or obstruction, the diag¬ nosis being made post mortem. "With increasing famil¬ iarity with this class of tumors should come an earlier recognition of an operable condition and a steady decrease in such a heavy mortality. Ever since Roger in 1866 classed rheumatism, chorea and endocarditis as manifestations of the same pathologic entity there has been much controversy as to the etiology. A review of the literature leaves no doubt that there is a relationship between these diseases. Sturges, Peacock, many others have written on this relationship, and have given statistics showing a relationship in from 15 to 80 per cent. of all cases. There are those who conclude that no definite relationship can be established, and at the other extreme there are those who, like Roger, assert that acute rheumatism, chorea and endocarditis are but different manifestations of the same underlying disease. Of late Butler, Hoskins, Anderson and MacAlister have published studies on this relationship. In the main this relationship is based on clinical findings, such as the very frequent association of rheumatism, chorea and endocarditis. Of late years more attention has been paid to the bacteriology of chorea. To quote from Church : Dana found a coccus in a case of chorea in which there was a leptomeningitis of the brain and of the upper part of the cord. In a severe case of chorea and rheumatic endocarditis Triboulet found Achalme's bacillus. In two cases Apert found Triboulet's coccus. Westphall, Wassermann, and Malkoff found a coccus in the brain of one patient. Poynton and Paine isolated a similar coccus in several cases of chorea. In three cases Beaton and Walker found the same coccus. Camisa and Guervier have independently reported the finding of cocci in the blood of chorea patients. In their reports the cultural characteristics are not fully given, but so far as given there is no difference between their findings and those of Fovnton
doi:10.1001/jama.1914.02560270026008 fatcat:fxjkthxaardqfgjtyxgb7nuw7y