-AN ESSAY 
ON 
CHOREA SANCTI VIII. 
SUBMITTED AS AN 
INAUGURAL THESIS, 
TO THE EXAMINATION OF THE 
Reverend JOHN ANDREWS, D. D. Provost 
(Pro tempore), 
THE TRUSTEES AND MEDICAL FACULTY 
OF THE 
UNIVERSITY OF PENSILVANIA, 
ON THE ' 
FIFTH X3YANT OIF JTT3STE, 1805. 
FOR THE 
DEGREE OF DOCTOR OF MEDICINE. 
By FELIX ROBERTSON, of Tennessee, 
Member of the Philadelphia Medical Society. 
PHILADEDPHIA: 
PRINTED FOR THE AUTHOR, BY JOSEPH RAKESTRAW, 
No. 84 North Front-street. 
1805. A. 1ST ESSAY 
ON 
CHOREA SANCTI YITI. 
SUBMITTED AS AN 
INAUGURAL THESIS, 
TO THE EXAMINATION OP THE 
Reverend JOHN ANDREWS, D. D. Provost 
(Pro tempore), 
THE TRUSTEES AND MEDICAL FACULTY 
OF THE 
UNIVERSITY OF PENSYL VANIA, 
ON THE 
FIFTH DAY OIF tTTJTsTE 3 1806. 
FOR THE 
A C:c 
DEGREE OF DOCTOR OF MEDICINE. 
Br FELIX ROBERTSON, of Tennessee, 
Member of the Philadelphia Medical Society. 
PHILADEDPHIA: ' 
PRINTED FOR THE AUTHOR, BY JOSEPH RAKESTRAW, 
No. 84 North Front-street. 
1805. TO 
DOCTORS JOSEPH HAYS, 
AND 
THOMAS AUGUSTIN CLAIBORNE, 
OF 
NASHVILLE, TENNESSEE, 
THIS ESSAY1 
IS RESPECTFULLY DEDICATED 
BY THEIR MUCH OBLIGED PUPIL, 
The Author. AN ESSAY 
ON 
CHOREA S ANCTI VITI. 
The subject of the following pages is an inquiry into the 
affection denominated Chorea St, Viti, or the dance of St. Yitus; 
and although my principal design is to give a history of the 
epidemic chorea, at present prevailing in the States of Kentucky, 
Tennessee and Virginia, I shall also transcribe the substance of 
what has heretofore been written on the subject; generally using 
the language of each author. 
The first account we have of this disease is by Horstius, who 
says that “ certain virgins yearly visited the chapel of St. Vitus 
near Ulm, who on those occasions exercised themselves day and 
night in dancing, being disordered in their minds; at length 
falling down in ecstacy, and were thus relieved until the next 
spring, when they were again affected in the same manner; 
which always returned at that season of the year afterward.” 
And hence the very appropriate name of Chorea St. Viti. Dr. 
Mead considers it a paralytic disease, and speaks of it as follows: 
“ I look on chorea as a paralytic affection, arising from a relax - 
tion of the muscles, which being unable to perform their functions 
in moving the limbs, shake them irregularly by jerks. Is for 
the most part a slight evil, and commonly attacks weak habits 
of body ;• girls more frequently than boys, and seldom adults. 
Wherefore I never found it difficult to be cured by cold-bath 
and chalybeates.” 
Dr. Sydenham says, “It is a kind of convulsion, manifesting 
itself by a halting or unsteadiness of one of the legs, and at the 
same time the arm of that side being affected by convulsive 
contractions.” He treated it by bleeding, purging,'etc., and this Robertson or, Chorea Saudi Yiti. 
practice he repeated for several springs, at the season it first 
appeared, with the view to prevent its return. 
He seems to have thought it very nearly allied to epilepsy, 
differing principally from it in attacking only children, whereas 
epilepsy commonly affects adults; and concludes that it is 
probable the same treatment would be successful in that disease. 
Hr. Cullen denominates it a convulsive disease, and adds, “with 
very few exceptions it attacks boys and girls from the age of 
ten to fourteen yearsthat “it comes on always before the age 
of puberty, and rarely continues beyond that period.'’ After 
describing it nearly in Dr. Sydenham’s words, he continues, “it 
appears to me that the will often yields to the convulsive motions, 
as to a propensity, and thereby the}7 are often increased while 
the patient seemed to be pleased with increasing the surprise and 
amusement which his motions occasion in the by-standers. In 
this disease the mind is often affected with some degree of fatuity, 
and often shows the same varied, desultory and causeless emo- 
tions which occur in hysteria.” He adds, “and there have been 
instances of this disease consisting of such convulsive motions, 
appearing as an epidemic in a certain corner of the country. In 
such instances persons of different ages are affected, and may 
seem to make (he might have said do actually make,) an excep- 
tion to the general rule above laid down; but still the persons 
are for the most part the young of both sexes, and of the more 
manifestly movable constitutions.” In some plethoric habits he 
found small bleedings and mild purgings of service; but, in 
general, extensive evacuations, especially by bleeding, were 
very injurious. It sometimes resisted every remedy for many 
months, but often readily yielded to tonics: Peruvian bark 
and chalybeates. One case, which had long resisted many 
remedies, he cured by repeated electrical shocks. Dr. DeHean 
also cured several persons by this remedy. 
Dr. Darwin says, “ in Chorea St. Yiti the patient can, at any 
time, lie still in bed, which shows the motions not to be con- 
vulsive ; and he can at different times voluntarily exert every 
muscle of the body, which evinces that they are hot paralytic. Robertson on Chorea Sancti Viti. 
This disease is frequentl}’ left after the itch has been too hastily 
cured. A girl about eighteen, after wearing a mercurial girdle 
to cure the itch, acquired the Chorea St. Viti in so general a 
manner that her speech became affected as well as her limbs, and 
there was evidently a disunion of the common train of ideas-; 
as the itch was still among the children of the family, she was 
advised to take her sister as a bed-fellow, and thus received the 
itch again, and the dance of St. Vitus gradually ceased.” lie 
advises the use of calomel for some time, steel, bark, warm bath, 
cold bath, opium, venesection (once at the beginning of the 
disease), and electricity. Perpetual, slow and repeated efforts to 
move the limbs in the designed direction. - 
The chorea which is more particularly the subject of this 
dissertation, made its appearance during the summer of 1803, 
in the neighborhood of Maryville, (Tennessee,) in the form of 
an epidemic. Previously to entering on its history, I think it 
necessary to premise a few cursory remarks on the mode of life 
of those amongst whom it originated, for some time before the 
appearance of the disease. 
I suppose there are but few individuals in the United States 
who have not at least heard of the unparallelled blaze of enthu- 
siastic religion which burst forth in the 'western country about 
the year 1800; but it is perhaps impossible to have a competent 
idea of its effects, without personal observation. This religious 
enthusiasm traveled, like electricity, with astonishing velocity, 
and was felt almost instantaneously, in every part of the States 
of Tennessee and Kentucky. It often proved so powerful a 
stimulus that every other entirely lost its effect, or was but 
feebly felt. Hence that general neglect of earthly things which 
was observed, and the almost perpetual attendance at places of 
public worship. Their churches are in general small and every 
way uncomfortable; the concourse of people on days of worship, 
particularly of extraordinary meetings, was very numerous, and 
hundreds who lived at too great a distance to return home every 
evening, came supplied with provisions, tents, etc., for their 
sustenance and accommodation during the continuance of the 6 
Robertson o-n Chorea Sancti Viti. 
meeting, which commonly lasted from three to five days. They 
as well as many others, remained on the spot day and night, 
the whole or greater part of this time worshipping their Maker 
almost incessantly. The outward expressions of their worship 
consisted chiefly in alternate crying, laughing, singing and 
shouting, and at the same time performing that great variety of 
gesticulation which the muscular system is capable of producing. 
It was under these circumstances that some found themselves 
unable by voluntary efforts to suppress the contraction of their 
muscles, and to their own astonishment and the diversion of 
many of the spectators, they continued to act from necessity the 
curious character which they had commenced from choice. 
The disease no sooner appeared, than it spread with rapidity 
through the medium of the principle of imitation; thus it was 
not uncommon for an affected person to communicate it to the 
greater part of a crowd, who, from curiosity or other motives, 
had collected around him. It is at this time in almost every 
part of Tennessee and Kentucky, and in various parts of Virginia, 
but it is said not to be so contagious (or readily communicated) 
as at its commencement. It attacks both sexes and every con- 
stitution, but evidently more readily those who are enthusiasts 
in religion, such as those above described, and females, children 
of six years of age, and adults of sixty have been known to 
have it, but a great majority of those affected are from fifteen to 
twenty-five. The muscles generally affected are those of the 
trunk, particularly those of the neck, sometimes those of the 
superior extremities, but very rarely, if ever, those of the inferior. 
The contractions are sudden and violent, such as are denominated 
convulsive, being sometimes so powerful when in the muscles of 
the back that the patient is thrown to the ground, where for 
some time his motions more resemble those of a live fish when 
thrown on land, than any thing else to which I can compare 
them. 
This, however, does not often occur, and never, I believe, 
except at the commencement of the disease. The patients in 
general are capable of standing and walking, and many after it RoBERTSON on Chorea Saudi Viti. 
7 
has continued a short time, can attend to their business, provided 
it is not of a nature requiring much, steadiness of body. They 
are incapable of conversing with any degree of satisfaction to 
themselves, or company, being continually interrupted by those 
irregular contractions of their muscles, each causing a grunt, or 
forcible expiration; but the organs of speech do not appear to 
be affected, nor has it the least influence on the mind. They 
have no command over their actions by any effort of volition, 
nor does lying in bed prevent them, but they always cease during 
sleep.* The disease has remissions and exacerbations, which, 
however, observe no regularity in their occurrence or length of 
duration. During the intermission a paroxysm is often excited 
at the sight of a person affected, but more frequently by the 
common salute of shaking hands. The sensations of the patients 
in a paroxysm are generally agreeable, which the enthusiastic 
class often endeavor to express by laughing, shouting, dancing, 
etc., etc. 
It has not proved mortal in a single instance within my know 
ledge, but becomes lighter by degrees, and finally disappears. 
In some instances, however, of long duration, it is attended with 
some degree of melancholia, which seems to arise entirely from 
the patient’s reflections, and not directly from the disease. The 
state of the atmosphere has no influence over it, as it rages with 
equal violence in summer and winter, in moist and in dry air. 
Having adduced various passages containing the substance of 
what has been written on affections receiving the name of 
Chorea St. Viti, and given a history of the American Chorea, I 
think it unnecessary to occupy room in making comparisons of 
them for the purpose of deciding whether or not they are the 
same. I shall, therefore, leave the reader to determine this point 
* I have lately been informed that some have been known to have them 
during sleep, but have not been ablo to learn whether or not, previous to 
having the disease they were subject to muscular motions during this period. 
I think it is very probable they were. 
f Some who took the disease in 1803, have not yet entirely got rid of it, 
but these instances of its long continuance are very few. Robertson on Chorea Sancti Viti. 
for himself. As theory or speculation has of late become a 
principal part of the science of medicine (as indeed of every 
other science), I fear it would be deemed an unpardonable 
omission were I to omit it entirely. From this consideration, 
and a conviction of the universality of the laws of nature, I 
shall in as few words as possible, give the outlines of the theory 
I have adopted to explain the phenomena of the epidemic above 
described. It is not only unnecessary but impracticable, within 
the bounds allotted to this essay, to enter into an examination of 
every metaphysical and physiological point which is connected 
with the present subject; but there being a sufficient number for 
my purpose which have been examined and by many determined 
upon, I shall take the liberty of assuming them as data. 
First, I take as granted that the frame and nerves, constitu- 
ting the nervous system, are so organized that when acted upon 
by external bodies, denominated stimuli, they are capable of 
taking on perhaps an infinite variety of motions which constitute 
our ideas of matter and its properties. 
Secondly, That this organization enables the brain to repeat 
any series of motions in the same order in which they had pre- 
viously been performed, whenever any one of such train of 
motions by an exciting cause is produced. 
Thirdly, That the muscles are caused to contract through the 
medium of the nerves, by sympathy of motion, and not as the 
ingenious Dr. Darwin supposes, by secreted sensorial power. 
And, finally, that every phenomena of the animal (and vegeta- 
ble) creation, results from motion produced by the operation of 
one portion of matter upon another. 
These positions being granted, it will then follow that the 
brain and nerves cannot act without the aid of stimuli; that 
unless the brain perform its functions the muscles mnst be qui- 
escent, and of consequence all the phenomena of life, as thought, 
muscular motion, etc., if they previously existed, must now 
cease. Or, in the language of the ingenious but unfortunate 
Dr. Brown, I believe life to be a forced state. Some motion of 
the brain accidentally causing the contraction of a muscle. Hobertsox on Chorea Sancti Yiii 
9 
becomes associated with it and ever afterward causes it to take 
on action. Thus each muscle of the body becomes associated 
with some motion of the brain, for those actions which at first 
from accident took place in succession or rotation, from a law of 
the brain above mentioned, always occur in the same order, so 
that if at any time one of such motions be produced, the others 
follow as necessarily as-the sinking of a heavier solid in a lighter 
fluid, unless interrupted by some more firmly established train. 
It appears that the facility with which these trains of associate 
motions are produced, depends entirely on the state of the brain, 
and on the degree of stimuli which produced them. That is, 
that when the brain is most excitable, and the stimuli applied 
most powerfully, the trains of motion will be performed with 
the greatest energy, and afterward the more readily occur. 
This disease then, I believe is not produced, as Dr. Darwin 
supposed, by dissevered associate motions of sensation, but by 
the firm establishment of those associations rendering them more 
easily performed by the brain than any other, which of course 
continue to take place without being interrupted, proceed again 
when an exciting cause is applied. Nothing more happens here 
than when the trains of associate motions which took place on 
the death of a beloved relation or bosom friend, in spite of every 
.effort to repel them, continually harass us. The circumstances 
under which the disease took place, render this explanation, in 
my opinion, the least exceptionable of the two. I have shown 
the muscular system to have been in a state highly irritable, and 
the brain, from the alternate hope and fear of future reward and 
punishment,* must have been highly stimulated; the result 
must of necessity have been powerful action and a firm estab- 
lishment of such trains of motion as was then performed. The 
muscles of the trunk being more readily affected than those 'of 
*With due deference to the opinions of Drs. Cullen, Rush, &c., I must 
acknowledge that to me, fear appears to rank amongst the most powerful 
stimuli, and like every other produces a sedative effect only when in excess. 
Thus it causes great muscular excretion, extreme debility, and even death, 
according to its extreme force. Like opium, digitalis, etc,, it has, from its 
sudden and violent, effects, been generally thought a sedative. 10 
Robertson on Chorea Sancti Yiti. 
the extremities, also tend to strengthen the theory; for the 
former must be much more irritable than the latter, being subject 
to less frequent and less violent contractions. The disease thus 
produced in some, was excited in others by the principle of 
imitation, a phenomenon which I shall not attempt to explain 
farther than it has been done in the above theory. Facts 
which confirm the existence of such a law or principle in the 
animal economy, are almost daily presented to our observation. 
The aptitude of persons to become affected by those motions 
generally denominated tricks, who spend much of their time 
with those who have them, is well known. And there is scarcely 
a school boy who has not observed, that if, in a large company, 
one person gapes or yawns, it is often produced in most of those 
present. In the Pennsylvania Hospital, there occurred a few 
years since a still more remarkable instance of its existence. 
An epileptic patient was brought into the house and was seized 
iii the long room with a tit, and a number of convalescents 
having collected around him, several of them were in like 
manner seized with convulsions. In this way we are able to 
account for a very curious fact—which I have not observed 
noticed by any writer—which is the resemblance that often 
takes place between man and wife, a resemblance which before 
their marriage did not exist. I have no doubt that those who 
have not been in the habit of attending to such trifles, will con- 
sider this fact as the chimera of a theorizing brain; but this does 
not render it the less true. 
From some superstitious motives which were entertained by 
the common people respecting the epidemic disease, medical aid 
has been sought for but by few, and until very lately was 
obtained by none. Those who have been cured of it were 
heated by rubefacients to the whole body, at the same time 
taking internally stimulant medicines. Some have been known 
to prevent a paroxysm by taking at its commencement large 
quantities of ardent spirits, but they received no permanent 
benefits from this practice. The plan of treatment, best accord- 
in cr with the theory I have delivered, would be to remove the Robertson on Chorea Sancti Viti. 
11 
patient from among those who have the disease, to keep his mind 
occupied on new and agreeable subjects as much as possible, 
which would be best done by traveling with an agreeable com- 
panion through a highly cultivated or wild mountain country, 
visiting natural and artificial curiosities, particularly of the more 
sublime kind. By these means new trains of associate motions 
would be produced, which from their novelty, etc., might at 
length overcome those which produced the disease, and the 
excitability of the brain w'ould thus be expended. The cure by 
rubefacients is also agreeable to this theory. 
Having now finished the consideration of the subject of this 
dissertation, it only remains for me to express my grateful 
acknowledgments to the medical professors of this university, 
for the polite and friendly attention with which they have 
individually honored me. 
[finis.] 
I have caused the Inaugural Thesis of my old friend, Dr. 
Felix Robertson, to be transcribed, have collated it carefully 
with the transcript, corrected all the discrepancies I discovered, 
and believe the foregoing to be a true copy. Witness my hand, 
at West Chester, Pennsylvania, this 18th day of January, 1859 
WM. DARLINGTON, M.D.