The medical diseases of children . ss of the palatal muscles. The most severe speech defect isthat of aphasia. This may remain absolute for many weeks or months,but invariably clears up entirely. It may persist for as long as ninemonths. It is usually associated with the severer atonic cases. CHOREA 163 Ocular symptoms are sometimes present. The pupils show varioussigns. Dr. Langmead has described rhythmical oscillatory movementsof the iris (hippus), and inequality and eccentricity of the pupils. Inmy experience, such changes as these are very common, particularlyduring the earlier stages of c
The medical diseases of children . ss of the palatal muscles. The most severe speech defect isthat of aphasia. This may remain absolute for many weeks or months,but invariably clears up entirely. It may persist for as long as ninemonths. It is usually associated with the severer atonic cases. CHOREA 163 Ocular symptoms are sometimes present. The pupils show varioussigns. Dr. Langmead has described rhythmical oscillatory movementsof the iris (hippus), and inequality and eccentricity of the pupils. Inmy experience, such changes as these are very common, particularlyduring the earlier stages of chorea. The displacement of the pupil, Ithink, is always upwards and inwards. The reaction to light andaccommodation is usually brisk but ill-sustained ; to the latter,however, it may be sluggish or apparently absent. The pupils arevery commonly dilated. Rarely, there is a departure from the normalcircular form of the pupil. I have seen a pupil remain oval in choreafor several weeks. Slight nystagmoid movements in the eyes are very. Fig. 33.—Chorea : Extreme Hyperextension of Fingers. common; but well-marked nystagmus is quite rare, although itcertainly does occur. I have watched it appear and disappear intwo attacks of chorea in the same child. The reflexes in chorea require mention. The tendon-jerks aredifficult to elicit, but are usually brisk when obtained. Some casesshow what is known as the choreic or sustained knee-jerk, in whichthe extensor muscle is thrown into spasm, and the response to thetap on the ligamentum patella? is unduly sustained. In other casesa double response is seen. Similar changes are found in the tendonreflexes in the arms and at the ankles. A suprapatellar jerk can notuncommonly be elicited. The knee-jerks are occasionally absent ;but the more patience that is exercised in examining these reflexes,the fewer will be the failures to elicit them. In some cases of thesevere atonic class, they appear to be quite absent. The abdominal 164 INFECTIVE DISEAS
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectpediatrics, bookyear1
