Lectures on diseases of children ... / by Edward Henoch.

  • Henoch, Eduard Heinrich, 1820-1900.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on diseases of children ... / by Edward Henoch. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    Child, aged four weeks, moderate diarrhoea for a week, a few days ago sudden spasm of face and trunk muscles, together with loud laughter. The paroxysms lasted about five miuutes, and occurred three or four times a day. Infus. ipecac, and tinct. theb. removed the symptoms in a week. V. St. Vitus' Dance, Chorea Minor. This disease is the most frequent neurosis afifectini^ children from the second dentition to the age of puberty. In fully developed cases, the en- tire body of the child is in continuous motion, the limbs being almost always most affected. The arms and hands are scarcely' kept quiet for a moment, the shoulders are raised and depressed, the head drawn down to one side and more or less rotated. The e3'es are alternately opened and closed, the forehead wrinkled and rapidly smoothed again, the angles of the mouth drawn to one or the other side. The lower limbs may be still able to carry the body, but their movements are often so severe as to im- pede motion and the children fiequently stumble and fall. In more severe cases, even sitting is rendered impossible. If we direct that the tongue be protruded, this is often done with great suddenness and then as rap- idl}' restored; even when it can be protruded for a few secoiids, distinct twitching of its muscular bundles is noticeable. The speech becomes in- distinct and may be entirely abolished, but recovery from this condition always takes place. Numerous deviations from this symptomatology may be observed. Very often the twitchings are comparatively feeble during the whole course of the disease, and certain muscular regions may entirely escape. There are numerous gradations between this mild form and the most se- vere cases, in which almost all the muscles of the body are in constant motion, and throw the body in various directions, and may thus produce contusions in many places. I have seen such children covered with black and blue spots, and even thrown out of bed. Deglutition may also be in^ terfcred with. But even in the most severe cases, the ocular muscles, with the exception of the orbicularis palpebr.nerum, are almost always spared. In very many cases, the movements are much more severe on one-half of the bod}^ or may even be entirely confined to this side (hemichorea). This restriction is either manifested onlv at the beginning' of the disease or continues throughout its course. The tongue, however, presents dis^ tinct movements on both sides in hemichorea, and this is readily explained by the numerous anastomoses of its muscular fibres. In general, I do not attach any more serious significance to unilateral than to bilateral chorea. The movements are rarely uniform, but vary in intensity from day to day and from hour to hour. They are always increased on volitional ef- fort. The children are, therefore, incapable of any occupation which re- quires the use of the fingers, such as writing, sewing, etc. In severe cases, even an attempt to speak or to sit, causes a great increase in their severity. ]\Iany patients are unable to eat alone and must be fed. Em- barrassment or the consciousness of being watched often intensifies the movements, while others control themselves better under these circum- stances. Quiet sleep almost always induces complete cessation, and in only a few cases have I observed the movements continue mildly during sleep. If the sleep is not quiet and profound, the movements may continue, and this fact furnishes the therapeutic indication to cause the children to ob-