APHONIA.
This comes under the eye of the physician commonly as a manifestation of hysteria, and its cure is rapid and satisfactory. A strong induced current is the remedy for this affection. One wire of the battery is attached to a flat electrode, which is made to rest upon the outer surface of the larynx, whilst the other wire is attached to a laryngeal electrode mounted on a handle, containing a small contact-breaker. This electrode is inserted into the space between the cords, and the current turned on by pressing the button in the handle so as to produce a painful and a severe shock. At the same moment the patient should be commanded to pro nounce some word, which she frequently accomplishes in a loud cry. Occasionally the application of the shock must be repeated. The con tinuous current is useless, and so also is a weak induced current. Some times the passing of a smart induced or interrupted current across the larynx, by applying a pole to each side of the external surface of the larynx, is enough to restore voice. Often all that is necessary is to introduce a laryngeal mirror into the pharynx, and firmly command the patient to utter a particular word, the " suggestion " being sufficient to arouse the dormant will-power, but relapses are more likely to follow this plan of treatment.
The treatment of hysterical aphonia by intoxicating doses of Alcohol is a most objectionable and unjustifiable proceeding. Atropine and Bella donna, pushed to the extent of producing their physiological actions, have been employed, but Electricity fulfils every indication. Strong solution of Nitrate of Silver, r dr. tor oz., has been applied with a brush to the larynx with rapid improvement. Hunt recommends the training and systematic exercise of the vocal cords by singing the vowels and numerals. Crouch states that in relapsing and very chronic cases of aphonia, isolation of the patient should be insisted upon, after which exercises in singing the musical scale should be practised, commencing with some high note, which may be elicited by making her attempt to phonate. Afterwards the intonation of words and of poetry, and finally the reading aloud of prose and frequent use of the voice in singing, are to be daily practised. The aphonia following shell-shock yields to time after removal from the scene of war. The aphonia resulting from laryn geal lesions can only be met by appropriate local measures.