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THREE KINDS of fidgetiness are commonly met with in general practice: fidgetiness of anxious excitement, tics, and chorea. As the last, which is less common than the other two, carries with it a liability to rheumatic fever and heart disease, the differential diagnosis between one kind of fidgetiness and another is a matter of importance. A mistake may mean either that a child who is not liable to heart disease is kept in bed when he would be better up and about, or else that a child with chorea is punished at school for fidgetiness that is not under voluntary control, and made to do drill and play games just when the heart should be allowed the maximum rest. Either mistake is deplorable.
Fortunately each kind of fidgetiness has its distinguishing features, so that, assuming reasonable care, only seldom need there be any doubt as to diagnosis.
Common fidgetiness has no physical basis, is quite unrelated to chorea, and consequently to rheumatic heart disease, and is usually best left untreated, and as far as possible unnoticed.
Usually this common fidgetiness does not appear as a new thing, but is, so to speak, part of the child's nature, and for this reason can be distinguished from chorea on the history alone.
Sometimes there is a history of onset following some event that was so exciting or so productive of anxiety that the child could not deal with it, the idea behind the event producing feelings that the child found intolerable. Such an event might be too sudden and unexpected, as when a sudden gale blows open the window, and the door bangs, and all is in confusion; or too great fear or