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LOSS OF VOICE (APHONIA) HOARSENESS. 385 



muscles and other tissues of the larynx. The functional variety is the more common, 

 and is that to which we shall especially devote our attention. It is as a rule 

 associated with and probably dependent on that peculiar condition which we recog- 

 nise by the term hysteria. It occurs chiefly in women, and more especially in 

 women in whom there is some disturbance or derangement of the functions of the 

 womb. Sometimes the periods are deficient in quantity, but more frequently they 

 are excessive. In some cases there is marked anaemia or even chlorosis. The 

 patient sometimes completely loses her voice without any very apparent cause, and 

 at others she speaks quite in a whisper, possibly for days together. In a fashionable 

 school, where the studies were principally devoted to the so-called accomplishments, 

 three out of the eight pupils suffered from occasional attacks of aphonia. In two of 

 the cases the disease was hysterical, but in the third the affection was simply feigned, 

 the young lady being capricious and wayward, though in good health. Galvanism, 

 moral influence, and a course of iron cured all three patients. Such cases unfortu- 

 nately are common enough, and are met with not only among the upper classes of 

 society, but not unfrequently in the out-patient rooms of our hospitals. 



In men aphonia has been known to result from a sudden shock to the nervous 

 system. The case is recorded of a soldier who, in a charge of his regiment, received 

 a severe bullet wound. He instantly and completely lost his voice, and for nearly 

 two years was unable to articulate a word. He suddenly recovered his speech while 

 in a state of excitement during an altercation in a public-house. In some cases 

 aphonia is due to the pressure of a tumour on the nerves which govern the muscles 

 of the larynx. It is then usually accompanied by marked shortness of breath^ 



There can be no difficulty in recognising the condition of which we have spoken 

 under the term aphonia. It can never be confounded, even by the least observant, 

 with that failure of articulate language which is the consequence of disease of the 

 cerebral hemisphere the seat of the mind. 



The treatment of complete aphonia must, of course, vary with the cause. When 

 it is dependent simply on some morbid condition of the larynx, the treatment 

 recommended for relaxed sore throat and clergyman's sore throat may be resorted to 

 with advantage. Benefit may be anticipated from the use of the astringent spray 

 preparations. Every means must, of course, be taken to improve the condition of 

 the general health. The direct application of galvanism to the interior of the larynx 

 is sometimes followed by the most astonishing results. We on one occasion 

 witnessed the instantaneous restoration of the voice by this means in a young 

 woman who, we were assured, had not spoken a word for nearly a year. 



In obstinate cases, phytolacca both given internally and used in the form of 

 spray is deserving of a patient trial. The dose of the tincture is three drops every 

 three hours, and the spray solution is made by mixing twenty-five drops with a 

 quarter of a pint of water. Should this fail the internal administration of phos- 

 phorus may be tried (Pr. 53 or 54). 



When there is only partial aphonia, and the patient is suffering from mere 

 hoarseness, far less difficulty will be experienced in effecting a cure. In very many 

 cases hoarseness is simply due to a cold, and the best treatment for it is the Turkish 



bath. When in the hot chamber the voice generally becomes quite clear and natural, 

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