les, or those which inspire the arytenoid cartilage in drawing the
left vocal cord forward to meet its fellow for the production of tone.
No one can ever forget the sight presented by the left cord in its
helpless condition: the arytenoid, tipped with its cartilage of
Santorini, extending far over the median line of the glottis and drawing
after it the right vocal cord in a vain endeavor to put it in position
where it can aid its injured mate.

The paralysis may, of course, occur on both sides, and then it is that,
on the side which is most exercised, there is felt a sense of distress,
of pain and sudden fatigue. This condition generally arises from
prolonged singing, and many of the cases I have seen have been the
result of overwork during Easter and Christmas; and all of the cases
which have come under my observation were associated with rheumatic
constitutions. Fortunately for these singers, when the conditions were
made known to them, they were in a position, or at least were perfectly
willing, to rest, because of the fear that a knowledge of their
condition instilled. Indeed, the situation is always one to cause
serious alarm. The beautiful symmetry of the arytenoids is impaired and
the agility of the voice is destroyed. If the singer persists in his
vocation, total disability results. As a rule, complete rest is enforced
by reason of inability to sing at all. If the voice is continued in use,
the affection becomes permanent and there is one more case of
irremediable vocal collapse. The remedy is rest, and that, too, before
the disease has passed recoverable ground. If the singer experiences
pain on either side of the thyroid cartilage, or on either side of the
Adam's apple, then let him by all means have a care, for those are the
symptoms of this peculiarly menacing form of paralysis. In the voice a
palpable hoarseness is manifest. The voice becomes "fuzzy" throughout
its entire compass. A pronounced disability to make a _crescendo_
arises, and when the effort is made (for in the described circumstances
use of the voice is attended with undue effort), the tone becomes coarse
and uncontrollable. The range of the voice is lessened and the singer
finds difficulty in reaching the upper tones. In the general
debilitation the singer tries, or rather is compelled through weakness,
to poise the voice from the cords themselves and not from the diaphragm.

Of the other forms of vocal-cord paralysis there is one of great
in