The Birmingham age-herald., 1924-06-20
Aphojlr,a }
By H. ADDINGrON BRUCE

Stated &n few words the medical term aphonia, concerning which an inquiry has come to me, means simply loss of voice. It does not necessarily imply serious condition or disease, as some persons are inclined to assume when they hear it applied to them by physicians overfond of verbal impressive. ness. There are, undeniably, serious condi- tions of disease which have apbonia ss q symptom. But also aphonia may indicate nothing more serious than temporary dis turbances of the vocal organs by a cold in the head Almost everybody has had the experience of partial or complete loss of voice incidental to cold This is as truly case of aphonia as is loss of voice from any other cause. And the causes of aphonia are most numerous and varied.
 Among the graver causes are organic nerve disease and pressure from some humorous growth. Comparatively seldom, however, are these causes found present So, like wise' with aphonia caused by mineral pois- oning. f.@ =
 Of the minerals most likely to bring on aphonia, lead comes first. All workers with lead-painters, for example-who. experience gradual or sudden loss of voice. seemingly unaccountable, should bear in mind the pos sibility that this may be a sign of lead pois- oning. Aphonia may similarly be a sign of poisoning by copper antimony, or arsenic.
 But, as stated, aphonia sthus caused is un. common. Far more common, when it is a question of poisoning, is the aphonia due to- the disorganizing action of alcohol
 The so-called, whisky voice is a typical instance of partial aphonia. If the alcoholic poisoning is more severe the aphonia may approach completeness, so that it's victim is unable to speak above faint whisper.
 Already mention has been made of the commonest of all causes-a cold affecting the vocal apparatus, and especially the larynx. It is probably no exaggeration to say that 70 per cent of allseases of aphonia originate in colds. Many others are due to nothing but fatigue of the voice from over use.
 Then, a fairly common type we have aphonia as a sequel to some infectious dis ease, such as diphtheria, measles or typhoid fever. And, of course, aphonia may be brought on by accidental injuries involving the central nervous system or the vocal ma chinery itself
 Finally, aphonia may have no physical basis whatever but may be, in the language of the neurologists, purely ideogenic in origin. In such cases it is a symptom of hysteria.
 Hysterical aphonia may reasonably be sus- pected when the loss of voice follows pro- found emotional shock-such as a great fright or a sudden bereavement-or when the person to whom it occurs is one in whom circumstances have. induced prolonged emo tional conflict
 To illustrate, aphonia occasionally occurs to singers mistrustful of their ability to sing really well. Fear and ambition thus may 50 conflict as to cause an inner perturbation that interferes with free use of the voice and may provoke almost total aphonia
 When aphonia is hysterical, the cure sometimes is easy, sometimes exceedingly diff ficult. There are cases which may be cured by the mere suggestion, "You really can use your voice as you will" There are others re- sistive of all curative measures short of tedious psychological analysis to determine precisely the conflicting fears and desires re- sponsible for the loss of voice.