imation of the cords, as in tumours
and certain forms of paralysis. Huskiness of voice occurring in a
middle-aged person, lasting for a considerable period, and unattended
by any other local or constitutional symptom, should always arouse
suspicion of malignant disease, and calls for an examination of the
larynx. Should this reveal a congested condition of one vocal cord,
associated with some infiltration, and should the mobility of the cord
be impaired, suspicion of the malignant character of the affection is
still further increased. The hoarseness in these cases is sometimes
greater than the local appearances would seem to account for.

_Aphonia_, or loss of voice, sudden in origin, and sometimes
transient, occurs more often in women, and is usually functional or
hysterical in nature. Although the patient is unable to speak, she is
quite able to cough. In these cases there is a bilateral paralysis of
the adductor muscles, so that the cords do not approximate on
attempted phonation; or the internal tensors may be paretic, leaving
an elliptical space between the cords on attempted phonation. If the
arytenoideus muscle alone is paralysed, a triangular interval is left
between the cords posteriorly. There is no inflammation or other
evidence of local disease.

The _treatment_ of functional aphonia should be general and local;
tonics such as strychnin, iron, and arsenic should be administered;
the intra-laryngeal application of electricity usually effects a
sudden cure. In obstinate cases the use of the shower-bath and cold
douching, the administration of chloroform, and even hypnotism may be
tried.

An examination of the lungs should be made in all cases of adductor
paralysis, as this functional condition may be met with in early
pulmonary tuberculosis.

#Dysphagia.#--Pain on swallowing, due to causes originating in the
larynx, is usually associated with ulceration of the mucous membrane
covering the epiglottis, ary-epiglottic folds, or arytenoid
cartilages, that is, in connection with those parts with which the
food is brought into direct contact.

The most frequent causes of such ulceration are tuberculosis,
syphilis, and malignant disease. The differential diagnosis is often
difficult from local inspection alone. The Wasserman test, the
previous history, the state of the lungs and sputum, and the results
of anti-syphilitic treatment may clear it up.

The _treatment_ of dysphagia, apart from that of the disease