56 AFFECTIONS OF THE LARYNX. 



during the acts of straining or coughing the false chords lie close 

 together, completely covering the true chords, the anterior ends of 

 which moreover are overlapped by the prominent pad of the epi- 

 glottis ; so that, besides the closure of the rima glottidis, there is 

 also a closure of the larynx above it. J3ose has shown that there 

 may be a palsy of these muscles also, especially in cases of unilateral 

 paralysis of the recurrent, while ordinary palsy of the glottis-closers 

 is not usually accompanied by palsy of the false chords. When the 

 glottis-closers alone are affected, we can see by means of the mirror 

 that during the act of coughing the closure of the larynx above is 

 not prevented (phonic palsy) ; but when the true and false chords 

 are both affected, not only phonation, but also cqughing, hawking, 

 and holding the breath, become impracticable. The patient cannot 

 cough, because for this purpose a momentary closure of the larynx 

 is required (respiratory palsy) ; hence he expectorates with difficul- 

 ty, and when he swallows, particles of food or drink easily fall into 

 the air-passages. 



The prognosis of palsy of the vocal chords is generally favor- 

 able, unless the affection depend upon incurable organic disease, 

 pressure of a tumor, glandular degeneration, or upon those central 

 paralyses which destroy the function of the cerebral apparatus of 

 voice. Nearly all cases recover which proceed from catching cold, 

 mental shock, over-use of the voice, hysteria, diphtheria, and the like. 

 True, the cure is not always a speedy one ; and, particularly in the 

 hysterical, we often meet with capricious and obstinate cases which 

 defy treatment for months, and then, under the influence of some 

 mental disturbance, suddenly get well. Aphonia in hysterical per- 

 sons also presents the peculiarity that, under psychical excitement 

 or during sleep, the voice not unfrequently returns for a while. 

 Intermitting palsy of the glottis-muscles has also been met with, in 

 which the usually sonorous voice was lost daily for some hours 

 ( Gerhardt, Levison). 



TREATMENT. In exceptional cases removal of the cause may 

 furnish the main object of treatment. A tumor may be resolved 

 by iodine or extirpated by the knife. Quinine or arsenic may be of 

 use in the intermittent cases ; or poisoning by lead, arsenic, or atro- 

 pine may be appropriately combated. It may further be advisable 

 to treat any coexisting catarrh, to prescribe tonics in anaemia, and 

 to use antihysterics in hysterical cases. 



Local treatment, however, either mechanical, medicinal, or elec- 

 tric, plays a more important part. Some benefit has been obtained 

 by means of the so-called " gymnastical treatment of the larynx," 

 that is, by the often-repeated effort to utter the sounds of the several 



