From New England Journal of Medicine, 1940 – article by Simon Stone, of New Hampshire, USA [behind a pay wall, unfortunately].

Besides streptococcus, other factors likely to be responsible for SC are “emotional strain and a basically unstable nervous system”!

Quotes from Sydenham’s original description (translated from the Latin) – “If a cup of drink be put into his hand, he represents a thousand gestures like Jugglers, before he brings it to his mouth; for whereas he cannot carry it to his mouth in a right line, his hand being drawn hither and thither by the convulsion, he turns it often about for sometime, till at length happily reaching his lips, he flings it suddenly into his mouth, and drinks it greedily, as if the poor wretch designed only to make sport…”

Sydenham recommended bleeding and purging, which remained popular because of course most cases improved by themselves.  In the 19th century, water baths and massage became popular.  Other recommendations included strychnine and cannabis.

In this paper, Stone describes treating 7 “very severe” cases with 6-7 fever treatments, every 3-4 days, where body temperature is increased to 104 degrees Fahrenheit by use of electric current applied to the skin by an electrode jacket, under a rubber sheet and blankets, for about 2 hours. Results were “excellent… movements have disappeared completely” by the end of treatment.

He treated one “extremely severe” case and one chronic case (symptoms had already been present for 3 years) with intravenous and oral vitamin B, with good results.

The reason for thinking vitamin B deficiency might be part of the problem appears to have been the recent discovery that various neurological symptoms in chronic alcoholics could be explained by vitamin B deficiency.

Fever therapy had been used for arthritis and asthma, but considered risky when fever was induced with injections of milk or typhoid vaccine, or hot baths.

The fact that most of these children would just have improved regardless is not discussed, and is the reason any treatment suggested for Sydenham’s chorea should be evaluated through a randomized controlled trial, and not just assumed to work on the basis of case reports.

The paper finishes with the observation that improvements in behavioural problems accompanied the improvement in physical symptoms, which therefore supports the theory that behavioural problems are part of the illness.