In hyperemesis gravidarum, as elsewhere, therapeutic abortion is never permissible, under any circumstances, if the child is not viable. If the mother cannot be saved without emptying the uterus, the mother must die; there is no way out of the difficulty. The proof that this doctrine is correct has been given in the introductory chapter on Homicide and when considering abortion in general. CHAPTER XVI CHOREA GRAVIDARUM AND HYSTERIA Recurring, permanent, localized spasms of facial or other groups of muscles, which are often called chorea, are tics,--convulsive tic, painful tic, accessorius spasm, and so on. Chorea is also characterized by various recurrent spasmodic movements, but the origin of the disease is commonly an infectious endocarditis, rheumatism, tonsillitis, or the like disease. This is Chorea Minor, St. Vitus's Dance, or Infectious Chorea. There is also a common chorea, which is not from an infection but from some nervous irritation, usually eye-strain, and disappears with the removal of the irritation. The chorea of pregnancy is often an infectious chorea, and then it is an extremely dangerous condition: the mortality in some collections of toxic cases is as high as 22 per cent. We meet, too, in pregnancy hysterical chorea, and a form which is partly hysterical and partly infectious in origin. Primigravidae are more susceptible to infectious chorea in pregnancy than multigravidae. If a woman has not had true rheumatism she very rarely gets chorea after the first gestation. Rheumatism in the patient or in her immediate ancestors, epilepsy, fright and other emotions, and anemia are predisposing causes. The patients are all very neurotic; and if they had chorea in childhood, the condition is likely to recur in pregnancy. Mild cases may be cured without damage to the woman or fetus, but many cases go on to abortion and death in coma and fever. Some severe cases result in a mania which may last for months; again, there is paralysis and delirium. The earlier in pregnancy the attack, the greater the danger to the fetus. It is very important to differentiate infectious chorea from hysterical chorea--the latter may or may not be dangerous; chorea always is dangerous. In hysterical chorea the movements are sudden, isolated, and sometimes rhythmical, especially in the fingers; there are zones of anesthesia, and the perversity of the hysteric soon manifests itself. The movements in hysteria are never so intense as to exhaust the patient. In true chorea the movements are irregular, spasmodic, and increased by motion and voluntary effort, especially if the effort is sustained; they exhaust the patient.