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JAMA 100 Years Ago
April 1, 2009

Chorea of Emotion

JAMA. 2009;301(13):1390. doi:10.1001/jama.2009.353

SOCIETY PROCEEDINGS

PHILADELPHIA NEUROLOGICAL SOCIETY

The President, DR. T. H. WEISENBURG, in the Chair

DR. S. WEIR MITCHELL: The affection which I call emotional chorea is perhaps more interesting than important. The terms emotional temporary ataxia would equally describe it. The patient whose case I report is a busy man of 45, whose general physical condition is excellent. He has always been healthy but inclined to be nervous. He worked hard for many years without holidays, with few pleasures, but no excess of alcohol or tobacco. His memory was so good that in his business of real estate transactions and building, he, for some years, trusted alone to his memory and kept no books. . . . His muscular power is good; he has no ataxia, sensation is perfect, knee-jerks are absent until reinforced, which has been the case with him at least for twenty years. Gait, station and eyes are good. His writing is distinct, clear and without tremor, while he is untroubled, but for the last twelve years he finds himself unable to write when people are overlooking him, as in a hotel register, for example; the first letters of his name are correctly penned, then there is abruptness and irregularity of the signature and his hand flies off, at times across the page. On the other occasions the effort to sign his name results in wild immediate movements of an ataxic character and in a signature which is practically unreadable. At times he is compelled to leave the dinner table since, when with strangers, it is almost impossible for him to feed himself, and as he then becomes almost helpless, requiring both hands to get a cup of coffee or glass of water to his mouth. When alone this rarely occurs unless something strikingly reminds him of his failure. Under extreme excitement he is quite steady, and a single glass of whisky or a glass or two of wine puts an end to his choreic difficulty. . . . Strenuous efforts to overcome his choreic trouble usually end in making him “nervous.” . . . I have known persons whom no one would have described as nervous, who always disliked to be under observation while signing their name. A man, twice mayor of Philadelphia, who had to write hundreds of signatures, sedulously avoided having any one near while writing, lest the effect on distinctness of his sign manual would be such that some one would say: “He is failing.” A glass or two of wine entirely abolished it and it always does so. Failing powers bring self-consciousness so that what has been almost automatic becomes a distinctly impaired act by being the subject of attentive volition. A short time ago four out of six men, two of them scientific, confessed that they did not like to be watched while making a signature. Recently a physician who has this infirmity told me that, if in a letter he had to express himself as being annoyed, his handwriting at once became so ataxic that he had to stop and determine to wait, and then he would take up the pen again quietly.

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