On chorea and choreiform affections / by William Osler.

Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: On chorea and choreiform affections / by William Osler. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    age incidence seems to be somewhat earlier in the United States than in Great Britain. In the report of the Collective Investigation Committee of the British Medical Association/ by Stephen Mac- kenzie, of the 439 cases analyzed, the largest proportion occurred in the third hemi-decade. Practically the disease is rare under the fourth year. The Infirmary records include two cases which are stated to be congenital, but I believe that such are in all instances associated with definite cerebral changes, and belong to an entirely different disease. It would be extremely difficult to distinguish between the jerky, irregular movements of an infant, and those seen in infants with meningeal htemorrhage, or the subsequent changes induced thereby. The ratio of cases at the Infirmary to other diseases was i to 180. Station in Life.—The disease affects children of all grades of society. It is, however, more common among the artisan and lower classes. Our clinical information about the disease has been drawn almost exclusively from hospital work. In the Collective Investiga- tion Report, already referred to, the returns which were furnished chiefly by general practitioners show 72-27 per cent, of cases belonging to the lower classes. Race.—Chorea is rare in the negro, as shown by the inquiries instituted by Weir Mitchell some years ago among physicians in the Southern States. Sinkler, who has also written on this question, has seen but one case in the full-blooded negro. The records of the Infirmary show that no negro child of full blood has been under treatment, and only four or five cases in mulatto children are noted. As the proportion of coloured to white is in Philadelphia as i to 25, it would have been reasonable to expect a larger proportion of coloured patients, if chorea was as common in them as in the whites. Of 175 cases at the Johns Hopkins Hospital there were five in the negro race. The disease is also rare among the Indians. I have made inquiries at the Indian schools, and of a number of physicians who have practised for years in the American and Canadian North-west territories. There were several references made to its occurrence in half-breeds, but not one of my correspondents mentioned a case in the full-blooded Indian. Dr. Waldron, of the Hampton Normal and Agricultural Institute, Hampton, Va., writes that he has never seen a case in an Indian, and that there had not been any in the ' British Medical Journal, 1887, I.