"You will verify the fact for yourself, as I am fortunate enough to be able to place under your observation this patient. We are thus enabled to make you touch with the finger, as it were, the most interesting peculiarities connected with rhythmical chorea. The disease in question seems to be most frequently allied to hysteria, or to be even of hysterical origin; although it may exist in some cases by itself, independent of all phenomena indicative of hysteria.
The patient had both spontaneous attacks and such as were provoked. The former usually come on after a meal, and are as it were a sort of relic of the original hysterical attacks of the ordinary type. The patient experiences pain and palpitation in the epigastrium combined with a feeling of repletion. Then the right upper extremity begins to move, and is soon followed by the left, and then by the lower extremities. Then you witness a succession of various and very complex acts, in which you recognise the characteristics of rhythm, or cadence, and of a perfect imitation of certain voluntary purposive movements. When it is started spontaneously, the attack begins without any other aura than a blinking of the right eyelid. The induced attacks can be obtained by pulling on the left arm, or by striking a hammer on one or other patella tendon such as I am now doing. When you have excited the attack by means of pulling the left arm, that arm immediately commences performing rappid rhythmical movements in which the patient seems to be whipping eggs. Then she bends her fingers, applying the tips to the thumb; and raising her arm, makes the gesticulation of an orator who is demonstrating. From time to time the whole of the upper extremity performs extensive movements of circumduction. The lower extremities are also affected by movements in their turn, and if the patient is in the erect position, she dances alternately on each foot, very nearly imitating the dance of the Tsiganes, or of the Zingari of Andalusia. During the whole time of the attack the patient is perfectly conscious; and strange to say, when anyone is placed close to her when she is executing some of these violent movements, which would have the result of violently striking the person near her, she warns them to take care before the commencement of the gesture. It would appear then, and this is an important feature from a psychological point of view, that the act is preceded by a mental representation which warns the patient of what is about to happen. You can question her during the attack and she will reply that she does not suffer; that she is simply fatigued, and inconvenienced by violent palpitations. After awhile she stops and rests for a minute; you think that the attack is past; but no, soon it recommences, and the same phases are reproduced. The total duration of an attack varies from one to two hours. She then lies down and it is all finished. When she gets up she feels a bit tired.
The patient may now retire. We shall be able to relate
more fully, in
her absence, the other peculiarities of her history."