Some time ago Dr. Thomas suggested to me that it might be of interest to analyze the records of the cases of chorea which had been treated in his department in the Johns Hopkins Hospital Dispensary with reference to the cardio-vascular manifestations. For the most part these cases have been rather carefully studied, each patient, as far as possible, having been sent to the medical department for special notes on the heart. Last fall, accordingly, I undertook this task, which was particularly

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... eresting to me in view of the fact that many of the special notes had been made by myself. I have added to these cases those which have been treated in the hospital wards during the same period, the majority of which I have also been able to study. My plan was somewhat similar to that which was adopted a few years ago in the study of the cardio-vascular complications and sequels of typhoid fever. It involved: 1. A study of the records of these cases while under treatment. 2. A study of the pathological observations in the fatal cases. 3. An investigation into the present condition of all old patients with whom it was possible to enter into communication. The amount of time required to go over so large a number of cases made it impossible for me to finish this whole undertaking in time for this session. That which I present consists of a brief summary of the first part of the work, namely, a study of the records of 808 cases of chorea treated in the Johns Hopkins Hospital and Dispensary, with special reference to the condition of heart and vessels. Number of Cases.-The material amounted to 808 cases, of which 698 were treated in the dispensary and 110 in the wards of the hospital. Race.--Of these cases, 783, or 96.9 per cent., were white; 25, or 3 per cent, only, were colored. As the proportion of colored patients treated for all diseases in the medical department of the hospital and dispensary amounts to about 12 per cent., it may be seen that these figures go to support the observations of Weir Mitchell and others that chorea is relatively rare in the negro. Sex.-Two hundred and thirty-two, or 28.7 per cent., of these cases were in males; 576, or 71.2 per cent., were in females; about the usual proportion. Age.--The following table, arranged by hemi-decades, will show the incidence of chorea according to age: TABLE SHOWING INCIDENCE OP CHOREA ACCORDING TO AGE. years. Cases. It may thus be seen that 84.5 per cent, of the cases were between the age of 5 and 15. Number of Attacks.-The frequency of relapses and recurrent attacks of chorea is well recognized. these 808 cases good records could be obtained as to the number of attacks. In 499, or 62.4 per cent., the patient was seen in the first attack alone. In 163, or 20.4 per cent., there was a history of two attacks. In 137, or 17.1 per cent., there was a history of three or more attacks. Incidence of Rheumatism.-A point of special importance, particularly with regard to the occurrence of cardio-vaseular manifestations, is the frequency with which rheumatism was observed, or distinctly noted in the history. The atj-pical and mild character of acute rheumatism in children is familiar. Considering the histories given by the patients or their parents, it was deemed wise for our present purposes, to classify arbitrarily, as acute rheumatism, all those cases in which there was a clear, definite history of pain and tenderness in joints. The patients and their parents and friends were always carefully questioned on this point. Out of 789 cases in which there was a record as to the previous history of the patient, in 171, or 21.6 per cent., a history of rheumatism was obtained.1 In 618, or 78.3 per cent., there was no history of rheumatism. Fever.-Observations on the temperature, important though they undoubtedly are, were unfortunately not made in many of the dispensary cases. A discussion of the temperature records in the hospital cases is reserved for the section treating of organic heart lesions. Heart.-In 118 cases in the dispensary, and in one case in the hospital no note on the heart was recorded. Of the remaining 689 cases, cardiac murmurs were detected in 235, or 40.5 per cent.; they were absent in 345, or 59.4 per cent. In about one-quarter of the instances with abnormal heart sounds, the murmurs were soft systolic souffles, heard at the base alone, or over the whole cardiac area, and unassociated with other modifications of the size or functions of the heart, such as might justify the diagnosis of organic lesion. In 175, or 25.4 per cent., of the cases in which an examination of the heart was recorded, conditions justifying the diagnosis of organic cardiac disease were found. In 16 more instances the signs were sufficient to warrant a reasonable suspicion that such changes were present. Including these, the proportion of cases with possible organic change would be raised to 27.7 per cent. Character of the Cardiac Lesions.-The cases in which the diagnosis of organic cardiac disease was made have been divided into three classes, one in which the condition was certain; another in which the existence of organic change was regarded as probable; a third, which has been already mentioned, including 16 cases in which organic lesions were suspected. Taking into consideration those cases only in which organic lesions were deemed probable, 175 in number, there were: Cases of mitral insufficiency .Ill Cases of mitral stenosis . 7 Cases of mitral stenosis and insufficiency . 39 Cases of mitral and aortic insufficiency . 10 Cases of mitral stenosis and aortic insufficiency . 1 Cases of double mitral disease and aortic insufficiency. 1 Cases of acute endocarditis, probably mitral in character. 6 In 20 instances with definitely recognized organic lesions an acute endocarditis was also present. There were 3 cases of acute pericarditis. In 2 instances a diagnosis of adherent pericardium was made in a relapse. Fatal Cases.-There were 4 fatal cases of chorea insaniens, and one case in which the patient died during an attack of acute rheumatism which had been associated with a choreic attack. Of the 4 cases of chorea 1. In some of these cases rheumatic symptoms were observed while the patient was under treatment.