Chorea and Athetosis

The words "chorea" and "athetosis" have been used rather loosely in the literature to refer both to clinical symptoms and to disease entities. For this reason, and because of the fact that neither the disease nor the symptoms are understood, the great mass of material written on the subject has served chiefly to increase the confusion which now masks the problem. In this paper an attempt will be made to present, after a short historical summary, the different views as to the pathogenesis of these movements and the centers and fiber tracts involved, a short clinical discussion, and, finally, a case report. In discussing "chorea" and choreiform movements it is necessary and important to keep clearly in mind the fact that choreiform movements , usually recorded in case histories as "chorea", may be manifestations of a great number of disorders of the nervous system. It is unnecessary to present a complete discussion of all the diseases in which choreiform movements have been described, hence this paper will be limited to the more important conditions in which the movements comprise the predominant clinical symptom, including Sydenham's chorea, Huntington's chorea, and double athetosis. Our first records of the susceptibility of man to what was later called, more or less correctly, "chorea" extend back to the time of the Phrygian bacchantes who, in their wild worship, were affected with violent, uncontrolled movements and with disturbances of consciousness. Somewhat later, shortly after the origin of Moham-medanism, we read that a similar condition of wild excitement with dancing, convulsions, and bizarre muscular spasms was exhibited by the sect of the Sufi, in Persia, during their sacred ceremonies. This sect was able to continue in existence for some time, and we find that about the year IOOO they had numerous followers and imitators throughout Asia Minor, Persia, Egypt, and Greece. In western Europe, in the Christian countries, the so-called "Dance of St. John" was already an established custom at the time of the Crusades. In 14I8, the term "St. Vitus' dance" or "Dance of St. Veit" came into general use as the result of an incident during an outbreak of