54. AFFECTIONS OF TUB LARYNX. 



advisable to substitute a clyster of asafoetida. (Asafoetid. 3 ss i, 

 vitell. ov. no. j. m f. emulsio. c. infus. valerian. f ss iv. S. for 

 two clysters.) 



CHAPTER XI. 



PALSY OF THE MUSCLES OF THE GLOTTIS DYSPHONIA AND APHO- 

 NIA PARALYTICA. 



[OuR knowledge of palsy of the vocal chords begins, as is well 

 known, with the laryngoscopic era. Prior to this time, a few 

 forms only of this affection, due to pressure .upon the nervus 

 vagus or upon the recurrent nerve, were understood, and these but 

 imperfectly. Tumors of the mediastinum, thickening or degener- 

 ation of the bronchial glands, cancroids of the oesophagus, compres- 

 sion of the left recurrent nerve by thoracic aneurisms, compression 

 of the right by pleuritic adhesions about the apex of a phthisical 

 lung, are the chief sources of pressure in such cases. By means of 

 the laryngoscope, however, we have found that a series of other 

 symptoms, some of them of daily occurrence, are due to a paralysis 

 of the vocal chords. 



First among these is the alteration of the voice due to catching 

 cold, which formerly was ascribed off-hand to the catarrh ; and in 

 fact catarrh and paresis often do coexist ; and then the latter might 

 be ascribed solely to an inflammatory oedema of the laryngeal mus- 

 cles, had we not ascertained that the palsy is often very serious 

 while the catarrh may be very slight or even be entirely wanting. 

 A further cause is a nervous temperament with hysteria. These 

 disorders play an important part among females after the age of 

 puberty, so that in a nervous woman any slight cold, mental shock, 

 or fatigue of the vocal apparatus may suffice to induce aphonia. 

 More rarely, palsy of the chords has for its cause an organic disease 

 of the brain, medulla, or spinal cord, or of their membranes, or 

 diphtheria of the pharynx, or poisoning by lead, arsenic, or atropine. 



We must premise that the vibratory and motor derangements of 

 the vocal chords result in a great diversity of phenomena, both 

 laryngoscopic and acoustic. Many circumstances combine to modi- 

 fy these phenomena : 1. The degree, which in slight cases may be a 

 mere laxity or want of tone of the muscles, or in grave ones may 

 amount to a complete loss of all motor power. 2. It depends upon 

 the function of the muscles affected upon whether it be the glottis- 

 closers or -openers, or both at once. 3. It is of importance to know 

 whether both sides of the larynx or one only is affected. 



