Diseases of the Nervous System: Chorea
This is an irregular reception or distribution of nervous power — a convulsive involuntary twitching of some muscle or set of muscles. It is an occasional consequence of distemper that has been unusually severe or imperfectly treated, and sometimes it is seen even after that disease has existed in its mildest form.
This nervous affection, more commonly known as St. Vitus' dance, is not a rare disease, and we doubt not that examples of it have been seen by most of our readers, more particularly in young dogs affected with distemper.
This malady is characterized by sudden involuntary twitchings of the different muscles of the body, the disease being sometimes confined to one limb, sometimes to two, and frequently pervades the whole system, giving the dog a distressing and painful appearance. These involuntary motions, it is very true, are generally restricted during sleep, although in old chronic cases of long standing they often continue in full activity without any remission whatever. The disease is not attended with fever, and all the functions generally remain for a considerable time unimpaired. — L.
It first appears in one leg or shoulder, and is long, or perhaps entirely, confined to that limb. There is a singular spasmodic jerking action of the limb. It looks like a series of pulsations, and averages from forty to sixty in a minute. Oftener, perhaps, than otherwise, both legs are similarly affected. When the animal is lying down, the legs are convulsed in the way that I have described, and when he stands there is a pulsating depressing or sinking of the head and neck. In some cases, the muscles of the neck are the principal seat of the disease, or some muscle of the face; the temporal muscle beating like an artery; the masseter opening and closing the mouth, the muscles of the eyelid, and, in a few cases, those of the eye itself being affected. These convulsive movements generally, yet not uniformly, cease during sleep, but that sleep is often very much disturbed. If the case is neglected, and the dog is in a debilitated state, this spasmodic action steals over the whole frame, and he lies extended with every limb in constant and spasmodic action.
the majority of cases, such an expenditure of nervous and muscular power slowly destroys the strength of the animal, and he dies a mere skeleton; or the disease assumes the character of epilepsy, or it quiets down into true palsy.
In the most favourable cases, no curative means having been used, the dog regains his flesh and general strength; but the chorea continues, the spasmodic action, however, being much lessened. At other times, it seems to have disappeared; but it is ready to return when the animal is excited or attacked by other disease. In a variety of instances, there is the irritable temper which accompanies chorea in the human being, and most certainly when the disease has been extensive and confirmed.
Chorea, neglected or improperly treated, or too frequently pursuing its natural course, degenerates into
paralysis agitans
. There is a tremulous or violent motion of almost every limb. The spasms are not relaxed, but are even increased during sleep, and when the animal awakes, he rises wilh agitation and alarm. There is not a limb under the perfect control of the will; there is not a moment's respite; the constitution soon sinks, and the animal dies. No person should be induced to undertake the cure of such a case: the owner should be persuaded to permit a speedy termination to a life which no skill can render comfortable.
Chorea is oftenest observed in young dogs, and especially after distemper; and it seems to depend on a certain degree of primary or sympathetic inflammatory affection of the brain.
Chorea is often very plainly a consequence of debility: either the distribution of nervous power is irregular, or the muscles have lost their power of being readily acted upon, or have acquired a state of morbid irritability. The latter is the most frequent state. Their action is irregular and spasmodic, and it resembles the struggles of expiring nature far more than the great and uniform action of health. It is not the chorea that used to be described, in which there was an irresistible impulse to excessive action, and which was best combated by complete muscular exhaustion; but the foundation of this disease is palpable debility.
Rickets, bad feeding, cold and damp housing, worms in the alimentary canal, mange, and other chronic affections, are all forerunners of this malady. — L.
In the treatment of chorea there must be no bleeding, no excessive purgation, but aperients or alteratives, merely sufficient to keep the fæces in a pultaceous state, so as to carry off any source of irritation to the intestinal canal, and particularly some species of worms, too frequent sources of irritation there. To these should be added nutritious food, gentle exercise, tonic medicines, and general comforts. Counter-irritants may be applied — such as blisters over the head, and setons, extending from poll to poll — the application of turpentine, or the tincture of cantharides; but all of these will frequently be of no effect, and occasionally a rapid and fearful increase of irritability will ensue: antispasmodics are in this case of no use, and narcotics are altogether powerless. As for tonics, iron and gentian have been serviceable to a certain extent, but they have never cured the complaint.
nitrate of silver will be the sheet-anchor of the practitioner, and if early used will seldom deceive him. It should be combined with ginger, and given morning and night, in doses varying from one-sixth to one-third of a grain, according to the size of the dog.
The condition and strength of the dog, and the season of the year, will be our best guides. If the patient has not lost much flesh,
and is not losing it
at the time that we have to do with him, and has few symptoms of general debility, and spring or summer are approaching we may with tolerable confidence predict a cure; but, if he has been rapidly losing ground, and is doing so still, and staggers about and falls, there is no medicine that will restore him.
5th October, 1840
. — A
, eighteen months old, had had the distemper, but not severely, and was apparently recovering when he suddenly lost all voluntary power over his limbs. He was unable to get up, and his legs were in constant, rapid, and violent motion. This continued three days, during which he had refused all food, when, the dog being in the country, my advice was asked. I ordered a strong emetic to be given to him, and after that a dose of Epsom salts, the insertion of a seton, and, in addition to this, our usual tonic was to be given twice every day. His food to consist chiefly of good strong soup, which was to be forced upon him in a sufficient quantity.
In two days he was able to get up and stagger about, although frequently falling. His appetite returned. He continued to improve, and most rapidly gained strength and especially flesh. A very peculiar, high-lifting, clambering, and uncertain motion of the legs remained, with an apparent defect of sight, for he ran against almost everything.
In six weeks the seton was removed, and the dog remained in the same state until the 7th of December. The uncertain clambering motion was now increasing, and likewise the defect of sight. He ran against almost every person and every thing. The cornea was transparent, the iris contracted, there was no opacity of the lens, or pink tint of the retina, but a peculiar glassy appearance, as unconscious of everything around it. An emetic was given, and, after that, an ounce of sulphate of magnesia.
8th.
He was dreadfully ill after taking the salts; perhaps they were not genuine. For two days he panted sadly, refused his food, and vomited that which was forced upon him. His muzzle was hot; he could scarcely stand; he lost flesh very rapidly. An emetic was given immediately, and a distemper-ball daily.
16th.
He soon began rapidly to recover, until he was in nearly the same state as before, except that the sight was apparently more deficient. The sulphate of magnesia was given every fourth day, and another seton inserted.
21st.
He continued the medicine, and evidently improved, the sight returning, and the spasms being considerably less. The distemper-ball was continued.
4th January, 1841.
— The spasms were better; but the vision did not improve. In the afternoon he fell into a momentary fit. He almost immediately rose again, and proceeded as if nothing had happened. An ounce of Epson salts was given, and then the tonic balls as before.
22d
. The spasms were lessened, the clambering gait nearly ceased, but the vision was not improved. The seton was removed, and only an additional dose of salts given.
27th
. The spasms suddenly and very considerably increased. The left side appeared now to be particularly affected. The left leg before and behind were most spasmed, the right scarcely at all so. The vision of the left eye was quite gone. The dog had been taken to Mr. Alexander's, the oculist, who attributed the affection of the eye and the general spasmodic disease to some pressure on the brain, and recommended the trial of copious and repeated bleeding.
28th
. The dog was dull; the spasms appeared to have somewhat increased and decidedly to affect the left side. Fever-balls were ordered to be given.
29th
. Considerable change took place. At three o'clock this morning I was disturbed by a noise in the hospital. The poor fellow was in a violent fit. Water was dashed in his face, and a strong emetic given; but it was not until seven o'clock that the fit had ceased; he lay until eleven o'clock, when the involuntary spasms were almost suspended. When he was placed on his feet, he immediately fell; he then gradually revived and staggered about. His master brought a physician to see him, who adopted Mr. Alexander's idea and urged bleeding. Ten ounces of blood were immediately taken; the dog refused to eat.
1st February
. — The strength of the animal was not impaired, but the spasms were more violent, and he lay or wandered about stupid and almost unconscious. I subtracted eight ounces more of blood.
2d
. The spasms were fully as violent, and no amendment in the vision. Eight ounces more of blood were subtracted without benefit. A fever-ball was ordered to be given.
3d
. No amendment; but the bleeding having been carried to its full extent, I again resorted to the tonic balls, which were given morning and night. The dog was well fed and the seton replaced.
5th
. A very considerable amendment is evident.
9th
. The spasms rapidly subsided and almost disappeared. Vision was not perfectly restored; but the dog evidently saw with his left eye. He was taken away, and tonic balls sent with him and ordered to be continued.
6th March
. — The dog had improved in strength and no spasmodic affection remained; he likewise evidently saw with his left eye. The tonic-balls had been discontinued for a week, and his master hoped that all would turn out well, when suddenly, while at home, he was seized with a fit that lasted ten minutes. A strong emetic was given, which brought up a vast quantity of undigested food. A strong purging-ball was given to him in the evening.
13th.
The dog had lain slightly spasmed for two or three days, when they all at once ceased, and the animal appeared as well as before. Suddenly he was taken with another fit, and again a vast quantity of food was vomited. These spasms remained two days, but on the 21st the fit returned with the same discharge of food. Courses of purgatives were then determined on. A strong dose of sulphate of magnesia was given every third day. After four doses had been given, it was impossible to force any more upon him. The syrup of buckthorn was tried, but the fourth dose of that it was impossible to give. The dog was then sent into the country; no fit occurred, but there were occasional spasms.
23d September.
— He was brought back to town, and I saw him. During the last month he had had many fits. His owner at length consented that the actual cautery should be applied to his head. The searing-iron for doctoring was used, and applied red-hot to the centre of the head. It was exceedingly difficult so to confine the dog as to make the application effectual, without destroying the skin.
Under the influence of the sudden violent pain, he wandered about for more than two hours, and then the spasms returned with greater force than usual. He refused all food.
We determined to try the cautery to its full extent. We chained him up in the morning, and penetrated through the skin with the budding-iron. The spasms were dreadfully violent, and he was scarcely able to walk or to stand. This gradually subsided, and then he began to run round and round, and that increased to an extraordinary velocity: he would then lie for a while with every limb in action. The owner then yielded to all our wishes, and he was destroyed with prussic acid. No morbid appearance presented itself in the brain; but, on the inner plate of the right parietal bone, near the sagittal suture, were two projections, one-sixth of an inch in length, and armed with numerous minute spicula. There was no peculiar inflammation or vascularity of any other part of the brain.
We [once] cured a case quite accidentally, by throwing a pup into a cold stream of water, and making him swim ashore; we do not recommend the plan, although we should be willing to try it again with one of our own dogs. The animal should be forced to swim till nearly exhausted, and wrapped up in blankets on coming out of the water. The intense alarm created in the pup, together with the violent struggle and coldness of the water, all act as revulsives to the disease, which, if purely nervous, may be overcome by these powerful agents.
If the dog be weak, and the stomach deranged, the following tonic balls will answer a good purpose:
[Symbol: Rx]: Carbonate of Iron;
Ground Ginger, ââ, grs. X, made into two pills, one given morning and evening, or more frequently according to the age or size of the animal. — L.
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