Chorea in the adult as seen among the insane / by Theodore Diller.

  • Diller, Theodore.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Chorea in the adult as seen among the insane / by Theodore Diller. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    18/22 page 346
    as shown by the table, being about four years. Why should not a person become insane who is subject to this distressing affliction ? The embar- rassments, the feelings of helplessness and despair, the constant attention to self—the constant dwelling of the mind on the affection—ever pre- sent—these, together with the feeling of despondency in the knowl- edge that his usefulness in life is over, and that he is only an object of pity, charity, and care for his friends would seem to me to be potent factors in bringing about gradually a certain mental impairment or enfeeblement of the mind which would progressively increase, and finally end in dementia. In cases of post hemiplegic chorea, it would seem most plausible to account for the movements, as well as the mental symptoms, on the hypothesis that there is a coarse irritation or destruction of some portion of the motor area of the brain or the motor tracts, proceeding from that region. In cases where the choreic movements are localized, and con- fined to the side or the single limb which had been paralyzed at the time of the apoplexy, this, I believe, to be the only conclusion which can be supported logically. W. Bevan Lewis's careful report of a case of localized paresis with choreiform movements is of great interest in this connection. The finding of local cortical disease post-mortem made his record complete. I believe, however, that in all cases of chorea an organic lesion of the brain (and in some cases, perhaps, of the cord also) exists. This lesion may be gross or fine, and would in some cases be easily demonstrated post-mortem, while in other cases it might defy detection by our present means of investigation. Of course, only careful post-mortem investiga- tions can establish the truth or the falsity of this theory. In my first paper I expressed my adherence to the view which, I think, is now commonly accepted, that chorea is a disease of the brain, and essentially of the motor apparatus—whether of the ganglia or the associated nerve-tracts. However, if a general sclerosis of brain and cord should in a given case be the particular lesion present, it would not be unreasonable to believe that the same diseased process operating on the analogous parts of the cord would intensify or exaggerate, in a measure, the choreic movements above what they would have been had the brain alone been the seat of disease. That the cord is primarily or essentially the seat of disease does not, in the light of our present knowl- edge of the subject, seem to be a view which can be consistently upheld. The evidence upon which rests the theory that the lesion is primarily in the motor apparatus of the brain is ingenious, but cannot well be dis- cussed in this place. In the causation of insanity among choreics it would appear, gener- ally, that two causes operate principally, namely, the psychical causes I have enumerated, plus some organic lesion—coarse or fine—of the brain.
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