Paralysis of the vocal cords constitutes a second form of vocal catastrophe. It should need no definition. In reality, however, the paralysis does not lie in the cords themselves, but in the leading muscles that control in phonation. There are many forms of this particular example of vocal catastrophe, though I am now dealing only with those which are liable to attack a singer, and which are most frequent in my own experience.
With the singer one form is common, viz.: paralysis of the left adductor muscles, or those which inspire the arytenoid cartilage in drawing the left vocal cord forward to meet its fellow for the production of tone. No one can ever forget the sight presented by the left cord in its helpless condition: the arytenoid, tipped with its cartilage of Santorini, extending far over the median line of the glottis and drawing after it the right vocal cord in a vain endeavor to put it in position where it can aid its injured mate.
The paralysis may, of course, occur on both sides, and then it is that, on the side which is most exercised, there is felt a sense of distress, of pain and sudden fatigue. This condition generally arises from prolonged singing, and many of the cases I have seen have been the result of overwork during
Easter and Christmas; and all of the cases which have come under my observation were associated with rheumatic constitutions. Fortunately for these singers, when the conditions were made known to them, they were in a position, or at least were perfectly willing, to rest, because of the fear that a knowledge of their condition instilled. Indeed, the situation is always one to cause serious alarm. The beautiful symmetry of the arytenoids is impaired and the agility of the voice is destroyed. If the singer persists in his vocation, total disability results. As a rule, complete rest is enforced by reason of inability to sing at all. If the voice is continued in use, the affection becomes permanent and there is one more case of irremediable vocal collapse. The remedy is rest, and that, too, before the disease has passed recoverable ground. If the singer experiences pain on either side of the thyroid cartilage, or on either side of the Adam's apple, then let him by all means have a care, for those are the symptoms of this peculiarly menacing form of paralysis. In the voice a palpable hoarseness is manifest. The voice becomes "fuzzy" throughout its entire compass. A pronounced disability to make a crescendo arises, and when the effort is made (for in the described circumstances use
of the voice is attended with undue effort), the tone becomes coarse and uncontrollable. The range of the voice is lessened and the singer finds difficulty in reaching the upper tones. In the general debilitation the singer tries, or rather is compelled through weakness, to poise the voice from the cords themselves and not from the diaphragm.
Of the other forms of vocal-cord paralysis there is one of great interest, known as hysterical paralysis. It is usually only temporary, and is sometimes produced in singers whose nervous condition grows upon itself until the system passes into the trying disturbance diagnosed by the rudely critical public as "stage-fright." Artists of marked pretension have been compelled to abandon a public career because of this affliction. There are other examples of it even more difficult to understand. I have in mind a case of a singing-teacher in a conventual school, who was under a peculiar strain of preparation for the commencement exercises of the school and of her own class and their appearance in public. She brought her class up to the appearing-point. Then her nervous system gave way, and when she came to me she was absolutely voiceless. Sometimes in coughing her vocal cords could be seen to move. With rest she recovered, but she has a recurrent
tendency to the same trouble every year. The case would seem to illustrate the uselessness of all effort on the part of the person so affected permanently to overcome it. The remedy is at hand, however, in numerous cases, in resort to a careful and uninterrupted upbuilding of the nervous system.
I will mention some other cases of vocal disorder and cure. An operatic tenor came to me with a tendency to break in scale-sounding, and with a nasal or catarrhal color to all his tones above E. I found attached above and back of the soft palate a mass as large as a hickory nut and completely blocking up the dome of the pharynx. A little cocaine was applied, and with a single sweep of the curette he was minus an adenoid on the third tonsil, a tonsil of Luscha. Within ten days his voice was completely restored.
Sometimes the physician is obliged to seek far for the cause of catastrophe to the voice. A fine and thoroughly well-trained tenor singer came to me with a singular tremor in his voice. The entire scale was tremulous. I found nothing the matter with any part of his vocal tract save that, on closely studying the condition of his mouth, there was a rapid muscular contraction of the soft palate and surrounding