AFFECTIONS OF VOICE AND SPEECH.
The voice may be affected in various ways. It may be weakened, that is, its force dimin ished, by any disease which reduces the general strength, or the extent of the move ments of the vocal cords may be voluntarily lessened because of the pain any vigorous move ment would call forth. Its pitch is variously affected, not only by the condition of the cords themselves, but also by the state of the air tubes above them. The cords may be thickened by swelling, the result of catarrh, or the mu cous membrane may be relaxed, so that the usual rapidity of vibration or stretching of the cords cannot be produced, and the pitch will be lowered. But the larynx and throat may be similarly thickened and relaxed so as to be unable to resound to sounds of the same pitch as formerly. Singers and public speakers ought to observe that enlarged tonsils (p. 217) act in this way, and markedly lower the pitch of the singing voice, or cause a painful sense of straining when singing or speaking for any time. Some celebrated singers, who have had enlarged tonsils removed, found with delight that after the operation they were capable of taking notes fully half an octave higher than formerly. The quality of voice is also affected iu various ways, the most marked alteration being when hoarseness or huskiness is produced.
Hoarseness is due to irregular and imper fect bringing together of the vocal cords, and is most frequently due to swelling of the mucous membrane of the cords, to thickening, and to excessive secretion of mucus in their neighbourhood, such as common cold will readily induce. Various other reasons may exist to account for it, such as inflammation, ulceration, contraction, &c., of the cords or in their immediate neighbourhood. Most ob stinate hoarseness is produced by syphilitic thickening and ulceration, and by tubercular ulceration, such as often occurs in the progress of consumption. Paralysis of the cords, owing to pressure on the nerves supplying the muscles of voice, or other nervous- disease, is also a cause.
Treatment, to be of value, must have regard to the condition of the cords and larynx, and the condition can only be properly ascertained by examination with the laryngoscope (p. 356). The hoarseness that comes ou quickly with pain on any attempt to speak, as a result of ordinary cold, should be treated with soothing remedies, the inhalation of the steam of boiling water, warm poultices to the neck, &c. Later, when all pain has passed away, and only the hoarseness remains, the sprays recommended for clergyman's sore throat are useful.
Clergyman's Sore Throat (LW/Ionia deni corum). —This is an affection to which not clergymen only, but teachers, lecturers, and all public speakers generally are liable. It consists of a chronic thickening of the mucous mem brane of the throat and larynx. The mem brane is thickened and relaxed, and pours out an excessive quantity of thickened mucus, which is brought away with difficulty. There is a feeling of great discomfort in the throat, especially after speaking. The person feels as if a veil had been drawr over his speaking apparatus, as if something were present which by coughing or hawking he could dislodge, and he dislodges it only to find it again collect. It is the mucus that gives this impression.
Treatment is difficult, since the most vital part of it would be absolute rest for some time, and that is generally impossible. The person should always try to avoid straining the voice, and specially if he is affected with the slightest cold, as loss of voice lasting for some days might thereby quickly arise. His general health should be maintained as well as possible by stomach, bowels, skin, and kidneys being kept in good order, and by the use of sonic tonic medicine such as quinine and iron, or phosphorus quinine and iron (p. 169) if neces sary. For the throat local applications are needful. Weak alum or chlorate of potash gargles are useful (see PRESCRIPTIONS); but these never get down to the vocal cords. For the medicine to reach the cords it must be drawn in with the breath in the form of spray. To effect this atomizers or spray-producers (see INHALERS AND ATOMIZERS, Plate XLVII.) are employed, by which the liquid is dispersed in a cloud of small particles by a strong current of air. The point of the atomizer is held within a few inches of the mouth. The mouth is widely opened, the tongue being kept down as much as the person can, and when a full stream of spray is directed into the mouth the person draws a long deep breath and thereby intro duces the material into the larynx and wind pipe. Various dregs may be used, of various strengths, with the spray producer. In the appendix on PazscanmoNs—Gaaca.Es, &c., some are mentioned. A useful one consists of tincture of steel, 2 fluid drachms, glycerine, ounce, rose water, Ij ounce, and . water to 4 ounces. This is put into the bottle of the atomizer full strength, or diluted with water if necessary. If required it way be made stronger by the addition of one or more drachms of the tincture of steel.