woman have been, are, or will become victims of the malady from which she suffered.'

It is scarcely necessary to recall to your memory that the nervous disorder with which the name of Dr. George Huntington is associated, is notable because of a marked tendency to transmission from parent to offspring. It usually becomes manifest about the age of 30 or 35; it is characterized by involuntary and inco-ordinate muscular movements which have some resemblance to the movements of chorea; it very commonly leads to marked mental reduction, and Huntington and others have thought that suicide is disproportionately common amongst its victims.

The charts illustrate in a striking manner the tendency of this disease to be transmitted from parent to child. They also show, less completely, that if one generation escapes it, it does not reappear in succeeding generations.

In a general way, the cases of which I have fairly full information are well described in Huntington's original article. I have, however, not been able to learn that suicidal tendencies have been noted unusually often in the group under study. From several sources I have been informed that intemperance in alcohol characterizes so many members of the families included in the group that it is a lay belief that the disease is a result of alcoholism. Numerous choreic patients, however, have not been intemperate. The neuroses do not unduly afflict these people, although many of them are of a somewhat inferior type, lacking in ambition and

a ability. Mild motor manifestations, especially involuntary movements of the head and tremor about the mouth, are not infrequently seen in cases which do not become more definitely choreic. Such mild cases are not included in my charts.

Since this paper was read I have seen another case in the fifth generation, a second great great grandchild, making thirty-three descendants of Mary M-1 who have had the disease. The chart has been corrected to conform with this last observation.

HEREDITARY CHOREA (HUNTINGTON'S). BY BEATRICE A. STEVENSON, M. D., AND H. D. PURDUM, M. D., Assistant Physicians, Northern Michigan Asylum, Traverse City, Michigan.

This case has been selected, from a comparatively large number admitted to this institution, as one to satisfactorily demonstrate practically all of the cardinal features of this most interesting and obscure disease, Huntington's chorea.

A. W., female, was admitted to the Northern Michigan Asylum, January 15, 1903, and died May 26, 1908.

The abstract of the history is as follows: Father and mother were natives of England, were not related and were, respectively, 23 and 21 years of age at the time of the patient's birth. No nervous peculiarities were recorded in reference to the paternal side of the family.

The maternal records revealed the following: Maternal grandfather, two aunts, three uncles, ten cousins, mother and two sisters had, or now have, this disease. Two brothers have been sentenced for arson and theft and a son of the patient is now in a reformatory.

The patient was born in the State of Michigan, in 1860. The developmental period was uneventful. During her early adult life she enjoyed fair physical health, though she was considered to be of a nervous temperament and was subject to attacks of fainting, palpitation and vasomotor irritability. She married at the age of 24 and had seven children. Her married life was an unhappy one and was attended by hard work and mental stress.

The first choreiform movements were noted at the age of 36. These were soon followed by gradual progressive mental deterioration with heightened emotional feelings. Nine years after the first choreic movements were observed the patient became depressed, entertained fears of becoming insane, had delusions of persecution and grandeur, together with auditory and visual hallucinations. Later on she became irritable, quarrelsome and aggressive, and demonstrated complete loss of self-control by violent outbursts of passion.

On being admitted to the hospital, she was emaciated, weak and in a much neglected condition. Her lips and teeth were covered with sordes, tongue was coated and breath offensive. Temperature was 99.6; pulse, 110. Respirations could not be satisfactorily counted because of the more or less constant choreic spasms which involved the face, trunk and extremities. Patient was unable to stand, walk or sit in a chair without support on account of her generally weakened state and incessant spasmodic movements. A thorough physical examination of the internal organs failed to reveal any evidence of disease. Deep reflexes were mark