PARALYSIS OF THE LATERAL CRICO ARYTENOTD MUSCLES.—ThiS variety of paralysis is that generally termed "hys terical aphonia," owing to its prevalence among the female sex and the association it so often presents with disorders pecul iar to them, neurotic and uterine. It usually comes on suddenly, the aphonia being generally total, including even, sometimes, the power to whisper. Some cases are able to sing, however, and the voice may also appear during laughter, sneezing, coughing, etc.; indeed, in every act involving vocal resonance, except talking. The vocal cords upon laryngo scopical examination are wide apart and fail to approximate when the patient is told to sound her voice, the formation of sound-waves being impossible. The mu cosa in true cases of hysterical aphonia is pale. It is usually due to a shock or fright; sometimes no external cause can be found. There is, as a rule, a history
of previous attacks.
Treatment.—In true hysterical aphonia the voice may return as suddenly as it disappeared without treatment. But therapeutic measures are required in the majority of cases, since prolonged paresis of the muscles is liable to promote their atrophy. The cases should be carefully examined and any abnormal condition corrected. Strychnine is always indi cated. The voice can usually be brought back, by local applications of electricity, one pole, using Mackenzie's electrode, being inserted behind the larynx and the other, the negative pole, externally over the thyroid cartilage. A weak current is sufficient—indeed, at times, no current at all—to cure a case, the psychical effect being the main factor.