It is a matter of some difficulty to furnish an adequate description of the movements of the right arm. We note, first of all, that their activity depends on whether the arm is free or held in a fixed position. Voluntary movements are carried out stiffly, but are interrupted by sudden deviations, sometimes of rather a wide range, and highly irregular in distribution. Notwithstanding these breaks, the end to which the movement is directed is always attained with precision. While L. was an apprentice dressmaker, she occasionally used to make various contortions with her arm, though if her attention was diverted they did not occur, and as a matter of fact she did her work well enough. Once she became familiar with the mechanical act of sewing, the involuntary performances ceased. Before her disease asserted itself, she had commenced to learn the piano, and she continued to make unimpeded progress, as her teacher discovered a method of holding her elbow which checked all convulsive twitches. The involuntary movements of the right leg were so insignificant as to be almost negligible; they united to produce a sort of irregular tremor which became appreciable only when the patient was very tired or very annoyed. Sometimes a long walk was followed by a certain hesitation in putting the right foot to the ground, and by defective inhibition of the antagonists of the desired movement. Sometimes one foot was knocked against the other, and sometimes the right appeared to assume an equinovarus position. On the other hand, we have seen L. walking in the street with her father, when no anomaly could be detected in her gait. The distraction of any occupation such as dancing or playing a game has the effect, for the time being, of banishing the greater part, if not all, of the spasmodic phenomena. This is undoubtedly a case of Brissaud's variable chorea of a unilateral type, and a consideration of the symptoms confirms the intimate relationship between it and tic. Various intermediate forms have been noted. In one of Brissaud's cases, variable chorea and multiple tics co-existed. Féré[140] reports a case of variable chorea preceded by tic, and Bernard another in which starting, trembling, facial tic, variable chorea, etc., were associated. Tics of phonation are often superadded to the gesticulations of variable chorea. Brissaud refers to the case of a girl of sixteen in whom involuntary movements resembling those of this type of chorea were coincident with a sort of hiccough, and a more or less inarticulate cry; at a later stage the movements became very infrequent, the hiccough was more constant, and the cry developed into a coprolalic ejaculation.