Chorea is a subject much too lightly treated in the ordinary systematic works on medicine. Not to mention the occasional fatal acute cases which occur in every hospital, I have observed a large amount of suffering and disaster to health of which chorea has either been the direct cause or at least the prophetic forerunner. I know of few things which would more incline me to think gravely of the future of a family than the fact that I found it much invaded by chorea, and there are few things which would more disincline me to think well of the healthy chances of an individual than the fact that he had suffered severely from chorea, unless, indeed, there were certain accidental causes, of which we must now speak, at work in its production.

Insufficient food and chorea

Of these accidental causes, which (from their facility of removal) enable us to look at the chorea which is their result with a favourable prognosis, the most regular in its operation is insufficient food.

Where this has been the main cause of the chorea, or the chief reason why the chorea is severe, we may hope everything from the effects of copious and generous nutrition. The fact itself is of course well known, but it is not often that one gets such a forcible illustration of it as in a case that was recently seen by me.

A girl was admitted to the Westminster Hospital who was one of the most pitiable objects one could see. She was more than fifteen years old, and had already menstruated for two years; nevertheless, she was diminutive in size and exceedingly emaciated, and with a development, both of body and mind, which corresponded rather with the tenth than with the sixteenth year of life.

She had extremely violent choreic movements; and as the case was one of those occurring in connection with a somewhat premature and over-profuse menstruation, I expected bromide of potassium to do much good, as it often does. But neither this nor anything else seemed to have any influence, and I was really afraid that she would either become exhausted and die, or else her mind would altogether pass into abeyance – in fact, into idiocy.

The effect of steady and nutritious diet with moderate stimulation, however, told upon this child in a very unmistakable manner, and soon, instead of looking like a hunted animal, she assumed a rational expression, and the movements nearly ceased.

The above is an example of what is commonly enough observed. We must remember, however, that though it may be easy enough to restore such patients to health for the time, a comparatively short course of their old habits of semi-starvation may reinduce the disease in a severe form, or lead (with or without chorea) to one or other of those more formidable nervous affections which are closely akin to it.

And in respect to this latter possibility I wish to mention a case which has not long since been under my care, that of a young woman who had been choreic as a child of twelve years, with considerable mental disturbance. As starvation had had much to do with the precipitation, at least, of the chorea, so did generous food in hospital very quickly produce an impression both upon the choreic state and upon the mental condition.

But she went back to her poverty-stricken home for two years, and at the end of that time was prematurely forced into the slavish toil of a maid-of-all-work in a small tradesman’s family. The consequence was very remarkable: she was observed to become somewhat fidgety in her movements and sly and furtive in her gestures; and before she was sixteen she had passed (without any full re-development of the choreic affection) successively through the stages of prostitution and of religious melancholia, in which latter she settled down: the youngest of such patients that I have seen.

It is certain, however, that where we can permanently raise the scale of nutrition of a patient who has been brought into chorea chiefly by starvation, we may often save his nervous health, once and for all.