Occupation - ex-munitions worker. Diagnosis: Chorea? Father 50+, good health, stone dyker. Mother has had heart trouble.

This girl gives a history of rheumatism four years ago with pains which started in the right hip joint and moved to shoulders, knees and wrists. She was kept in bed for six months and has since had pain in the right hip and a limp. This latter, which was felt to be largely functional, was the reason for her referral.

On examination she adopted a very hypotonic decubitus, slouching in her chair wearily. On extending her hands the wrists adopted the hypotonic position. There were constant slight, but to my mind, quite definite choreifomr movements of fingers, limbs, trunk and face. She tells of frequent rows at home lately for dropping crockery. Muscular weakness and atony is great.

I admit that the residual hip complaint after rheumatic fever is unusual and that the background makes it possible, even likely, that that has been hysterical. Reluctant however as one is to multiply diagnosis it seems possible that she is now suffering form a mild Sydenham's chorea and that that so obscures the picture that it is impossible to be definite about the other conditions. Would you consider taking her into your wards for observation?