It is often seen that a patient becomes worse during the first few days that the arsenic is taken, but improvement generally begins after a week of the arsenical treatment, and is well marked after two weeks.
In obstinate cases it is of marked advantage to give the arsenic hypodermically. Cases which do not yield to the drug when given by the mouth often improve at once when it is given hypodermically. Chronic cases which have resisted all forms of medication sometimes are cured by hypodermic injections of arsenic. For giving arsenic in this way it is best to use Fowler's solution, made without the compound spirit of lavender. It is less likely to cause abscess to form at the point of puncture.
Other remedies enjoy a reputation in the treatment of chorea. Sulphate of zinc is relied upon by many, and it is the means which Ross recommends. It should be given in increasing doses like arsenic, and very large doses may often be taken without disturbing the stomach. Trousseau, Hammond, and Hamilton favor strychnia, but I have had no experience in its use.
Cimicifuga and conium are both often beneficial in their effects. I have seen the former do good when arsenic had failed. Conium to be efficacious must be given in large doses. Eserine and hyoscyamine have both been successfully employed, the former by Bouchut, and the latter by Oulmont and Laurent. Recently, DaCosta33 has reported, in a clinical lecture at the Pennsylvania Hospital, a case of very severe chorea successfully treated with hyoscyamine. The patient was a boy of eleven years, and the disorder had followed an attack of acute rheumatism. He was given 1/100 gr. of hyoscyamine three times a day.
33 Philada. Med. Times, Jan. 23, 1886.
Ziegler34 has recorded several cases which recovered under the use of nitrite of amyl. The bromides and chloral are useful adjuncts to treatment in case of sleeplessness or mental irritability. Cases of cure by the use of chloral alone have been reported. Bouchut gave a girl of fourteen and a half years, with chorea and dementia, 45 grains of chloral a day for twenty-seven days. She slept most of the time, but improvement was seen on the fifth day, and cure was completed on the twenty-eighth day of the use of the chloral. Electricity has been efficient in the hands of many writers. I have found galvanization of the spine to produce a quieting effect in some cases.
34 Ibid., vol. vi. p. 486.
Iron is always of use in chorea; it may be given during the course of the disease, and is generally necessary in convalescence. Cod-liver oil or malt extract should be given in feeble persons.
It is scarcely necessary to mention the other remedies which have been recommended. DaCosta has used the bromide of iron. H. C. Wood has used a preparation of skunk cabbage, and there are a great number of other remedies which have been found of value.
Next to the internal means come external applications. Baths and frictions are useful in their effect on the general health. The ether spray to the spine or the application of an ice-bag for ten minutes once or twice daily is sometimes found to assist the other means. Cold douches have been advised by some, but they may do harm. The care of the general health of the patient is of first importance, and his surroundings should be as quiet as possible.