Sée and Roget consider the causal relation between the two diseases so close as to make their connection almost a pathological law.
On the other hand, Steiner made quite opposite observations in Prague. He saw among 252 cases of chorea only four which originated during the course of acute articular rheumatism.9 This statement does not prove the absence of a relation between chorea and rheumatism, for Steiner does not say what proportion of cases occurred after an attack of rheumatism which had taken place some time previous. Hammond10 believes “that the influence of rheumatism upon chorea is not greater than that of a depressing agent to the organism.”
9 Ziemssen's Cyclopædia, loc. cit., p. 427.
10 Dis. of the Nervous System, p. 715.
Octavius Sturges, physician to the Hospital for Sick Children, Ormond St., London, says that in two years 219 cases of chorea have been treated at that institution: 20 per cent. of them were connected with rheumatism, but he does not believe in the rheumatic origin of the disease, because 15 per cent. of all children have rheumatism.11
11 Lancet, Sept. 20, 1884.
The following cases illustrate the direct sequence of chorea upon acute rheumatism:
Case II.—Kate S——, æt. 17 years, came under my care in May, 1877, with an attack of acute rheumatism which lasted for two weeks. She regained strength slowly, and about June 11th, not more than two weeks after the subsidence of the rheumatic symptoms, choreic movements were noticed in the right arm. The movements were constant, and were worse when she was conscious of being observed. She often dropped things. The right leg jerked often and gave away under her in walking. Under the use of liq. arsenici bromidi the patient was entirely well in one month. A sister had had chorea.
Case III.—Rudolph C——, æt. 5 years, was placed under my care May 12, 1883. He has had scarlatina, and in Dec., 1882, he had an attack of inflammatory rheumatism, accompanied with slight choreic movements, from which he recovered in a short time. Three or four weeks before coming under my charge he had a return of rheumatism from getting his feet wet, and at the same time choreic trouble began again. He rapidly became worse, and in a short time was utterly helpless. On examination he is found unable to sit up or make any voluntary movements. He is unable to move the legs on account of the intense pain in the knees and ankles from the rheumatism. These joints are swollen and red. The right arm is in constant and violent motion, swinging about or thrashing up and down. The left arm lies motionless, and, although painless, he seems unable to move it. The fingers are clenched, and they are continually and rhythmically being pressed against the palm. He cries if an attempt is made to open the fingers. The facial muscles are contorted all the time, and there is a peculiar vermicular movement of the upper lip. He cannot speak a word nor can he protrude the tongue. He sleeps but little, and during sleep the movements are occasionally seen. He is very fretful and irritable, but is perfectly intelligent. The appetite is poor. Bowels regular; urine phosphatic and contains no albumen. There is a loud but not harsh cardiac murmur heard at the apex, replacing the first sound of the heart. Temperature, May 12, evening, 100°; May 13, morning, 1002/5°. Pulse, 140. He was ordered sodii salicylat., gr. v. q. q. h., and inunctions of cod-liver oil.