19 Nervous Diseases, p. 490.
SYMPTOMS.—An attack of chorea is usually preceded by more or less failure of the general health and evidences of some mental disturbance. It is quite common to be told by the parents of a child suffering from chorea that the little patient had seemed unwell for some time previous to the attack; that the appetite had failed, and that the child had looked pale; that he had been irritable or excitable, and at school the teacher had complained of restlessness or inattention in the pupil. In a little girl who was brought to me recently with her second attack of chorea her mother stated that for several days before the outbreak the child had been in excessive spirits, and that she had been singing loudly and in a peculiar manner. The same symptoms had preceded the first attack. Sometimes nothing is observed until it is found by the parents or teacher that there are abnormal twitchings and movements of the limbs.
At first there is a general restlessness and fidgetiness. The child may be punished at school for not keeping still or for dropping things. Soon irregular movements of groups of muscles are seen. The shoulder is shrugged or the fingers move spasmodically. At first the patient is aware of the movements and tries to control them, but before long the twitching and jerking are constant, and extend to most of the voluntary muscles of the body. He is then unable to control them for any length of time.
The sudden jerk of a limb followed by an odd grimace, the quick protrusion of the tongue, and the rolling of the eyes or snapping of the lids give a characteristic picture which can hardly be mistaken.
The extent of the movements varies in different cases. In some they are slight and affect only certain muscles. Often the disorder is confined to one lateral half of the body. In other cases the movements involve all the limbs and the trunk, and are so violent and constant that the patient does not seem to have a moment's rest. The trunk may be suddenly drawn backward, then the arms are extended or thrown up, and the legs flexed and tossed about with great quickness. Sometimes the patient is thrown off the bed or from the chair on which he may be to the floor.
The speech is often affected. The patient speaks in a thick or jerky manner, as if the tongue were too large for the mouth, and saliva usually flows in great quantities. Sometimes in bad cases there are involuntary utterances made at frequent intervals.
The features undergo contortions continually, and when at rest relapse into a condition of vacancy which makes the patient look almost idiotic. The expression of a child with chorea is so peculiar that the disease may almost be diagnosticated by this.
During sleep the movements usually cease, but generally the patient is restless while asleep, and in some instances the irregular movements continue even at this time.
The mental condition commonly shows some change. The child is irritable and peevish, cries and laughs readily, or is sullen and morose. Sometimes he is violent to those about him, but this is rare. Intellectually the patient suffers somewhat. He is not able to study as before, and the memory may be impaired. Sometimes there is a mild form of dementia.