4 Medical and Surgical Reporter, April 13, 1872.
Some additional cases of hereditary chorea have been lately recorded by Peretti in No. 52 of the Berliner klin. Wochenschrift, 1885, and others by Clarence King in the New York Medical Journal, vol. i., 1885. The history of all these cases is strikingly like those of Huntington, and establishes without question a distinct form of chorea.
Mrs. N., one of Peretti's cases, had a mental affection with choreic movements, and there was a history of a similar condition in her parents and grandparents. Two of Mrs. N.'s four children, Mrs. A. and Anton N., had chorea in adult life; some of these became insane. Mrs. A. had five children; three of these became choreic; one had tremors and one became insane. Anton N. had ten children; of these six had chorea. In all of Peretti's cases the disease came on after the age of forty years, and persisted. In several members of the family insanity was associated with the chorea.
In the families where it occurs the nervous temperament predominates. It sometimes will be found that neither of the parents of the patient has had chorea or any other nervous disease, but that an uncle or an aunt has had St. Vitus's dance in childhood.
Chorea may occur at any period of life, from infancy to extreme old age. I have reported two cases in patients over eighty years of age5—one at eighty-two and the other at eighty-six—who had characteristic attacks of St. Vitus's dance. Robert Saundby has collected twelve cases of chorea in the aged. The two cases just referred to are included in the number. He considers the affection very rare in old persons.6 The following case is an example of congenital chorea, and I believe this to be very unusual. The movements of all infants are choreic, so that it is difficult to say when the chorea begins; still, it seems fair to infer that when a child has never had any but choreic movements it is a case of congenital chorea:
Case. I.—Jennie W——, aged nineteen years. Family history is good as regards nervous diseases. Her mother was frightened by seeing a case of chorea some time before the child was born. The movements were observed at birth, and have continued always. The patient was brought to my clinic at the Infirmary for Nervous Diseases, and her condition noted as follows: The movements are general and continuous; the arms and legs are in constant motion, and the mouth is perpetually grimacing; there is tremor of the tongue when it is protruded; volitional efforts increase the movements; during sleep they cease entirely; tendon reflexes are normal; there is no paralysis; heart-sounds are normal and the general health is good; menstruation is regular, and the choreic movements were not influenced in any way at the time of its first appearance.
5 Journal of Nervous and Mental Diseases, July, 1881.
6 Lancet, Nov. 24, 1884.
Chorea occurs most frequently during the period of approaching puberty. Sée in an examination of 531 cases found 453 between the ages of six and fifteen years.
I have examined the notes of 282 cases of chorea, most of which are in the case-books of the Infirmary for Nervous Diseases; the rest are from my own note-books. Of the 282 cases, 217 were between six and fifteen years. They were distributed as follows: