On Some Constitutional Aspects of Chorea and on Its Sequelæ.

Abstract

IF one sees many cases of chorea and investigates them in detail, one cannot help thinking that constitution plays a part of some importance in its setiology. In textbooks one finds remarks to the effect that the patients had already exhibited neurotic traits before the onset of the disease. Furthermore, among relatives cases of chorea and other mental and nervous diseases and abnormal personalities are observed with some frequency, as far as a general impression goes. Kehrer has proposed to name the abnormal types in choreic families 'choreopathic personalities.' In doing so he took as his starting point Huntington families, but he expressly extended his idea to families with Sydenham's chorea. The definition of the choreopathic personality is not exact as yet, on either physical or psychical side, nor do we know whether the postchoreic personality which will be discussed later on is identical with the choreopathic personality or even similar to it. It may be mentioned that the schizoid personality has been conceived along similar lines, viz. as a premorbid personality, as postschizophrenic defect and as a constitutional anomaly in schizophrenic families. There is moreover some constitutional relationship between chorea and schizophrenia. Looking through the families of some choreic patients I found some frequency of catatonic psychoses among their relatives. B. Schulz has confirmed these observations in material which was relatively small but elaborated on strict genetic lines. He found that the proportion of schizophrenics in the families of choreic patients is nearly twice as high as in the average population. Krauss also found in the families of 24 cases of chorea eight certain and three doubtful cases of schizophrenia. This author was the first to investigate systematically the postchoreic personality, earlier writers having been interested only in the neurological sequelae of this disease, and that to a limited degree. Looking through the textbooks of neurology with regard to the prognosis of chorea one generally finds it stated that only a small proportion of the patients die, and that death in these cases is due to endocarditis or heart failure, the prognosis of severe cases generally depending on the