THE RADICAL OPERATION FOR EMPYEMA OF THE FRONTAL SINUS.
Authors: W. FREUDENTHAL
Journal: JAMA (1905)

modic form.It must be remembered, too, that there are many diverse causee of chorea.Some cases of Sydenham's chorea may be of infectious origin, but they are not by any means all of infectious origin.One could not for a moment believe that cases of chorea induced by fright, as many are, could be due to infection, nor can the numerous cases due to an overstrain of study or school be of infectious origin.There are also met with several types of Sydenham'e chorea in which the symptoms vary to a marked extent, so it seems important that in the study of chorea and of choreiform affections one should discriminate more fully between the different forms of the disease whieh are met with.Dr. J. A. Hodges, Richmond, Va., emphasized the causal re¬ lation of rheumatism and chorea.Having been impressed as a student with the theory that this disease is almost inseparably connected with rheumatism as a causal factor, Dr. Hodges expected to find it in a great majority of his cases; however, during an experience of ten years he has not seen a single case of chorea associated with rheumatism.Likewise, he has only seen two cases suffering with heart lesions and only two that were supposedly due to toxins, though he is not ab¬ solutely positive about these, as neither case died and he did not have the opportunity of extending his investigations into the definite cause of the disease.Many neurasthenic condi¬ tions, he believes, may be the cause of this disease. ,Dr.Hodges referred to the calmative effect of iron on muscular tissues.In a number of cases in which neither small nor large doees of arsenic would control the spasmodic mani¬ festations, iron caused marked improvement.Db. Albert E. Sterne, Indianapolis, stated that a great many cases of tic of the convulsive sort have absolutely failed to be benefited by any method that he hag ever em¬ ployed.The older the patient is the poorer the prognosis becomes.The prognosis is very much better in children and decreases as the patients advance in age.There must be a fundamental weakness for the manifestations exhibited in chorea, because the same elements which produce chorea in these individuals have absolutely no effect on persons not predisposed to the condition through fundamental nervous weakness.He believes that there is a very distinct relation¬ ship, in a large percentage of cases, between Sydenham's chorea and acute arthritis.It is perfectly natural in a pre¬ disposed case that there be a joint manifestation which is frequently overlooked.He has seen many cases beginning in chorea which have developed heart disease only, or arth¬ ritis and endocarditis, successively.Chorea may be either the first or the last in the trinity of diseases.In the case of a child which had injured itself by cutting with a piece of tin, the wound would not heal, but remained open, and the child successively developed arthritis, endocarditis and cho¬ rea; all disappeared under treatment, but again she devel¬ oped arthritis, endocarditis and chorea, and died.Dr. Sterne could not recall a single case where tuberculosis was asso¬ ciated with chorea.