influence of the growth, was restored immediately, and the cough disappeared a few days later,
A still more serious injury to the vocal cords is due to ulceration which has destroyed some part of the vocal cord. A defect of this kind is irreparable. When an arm is diseased, no matter how seriously, there is always a possibility of saving it, but when the arm is cut off, its usefulness is ended. This is also the case with the vocal cords. By means of training, the voice may to some extent be improved, but it will always be more or less affected when there has been a loss of substance.
Paralytic conditions also have a marked effect on the voice. As already explained, in the production of sound the edges of the vocal cords are brought together. In cases of paralysis, if one or both vocal cords can not be brought to the middle line, the space is too large to resist the column of air from the lungs for setting the vocal cords in vibration, and there is no voice. In some cases, where the paralysis is on one side and not too great, the remaining vocal cord may be gradually trained to be brought over to the other side, and in this case the voice may be recovered, otherwise it will be simply a whisper. Some cases of paralysis involve only the muscles which contract the vocal cords, thus preventing tension and causing hoarseness. As there is no loss of substance in paralysis, the prospects for recovery of the voice, except in certain cases, is good.
As we have already explained, the principal parts concerned in the modification of speech are the lips, teeth, tongue, palate and nostrils, and any defect in these will influence voice production. Some defects are easily recognized, as for instance the tie-tongue, in which the band, which connects the tip of the tongue with the floor of the mouth, is too short and prevents the tongue from being brought forward in certain sounds, thus giving rise to the defect characteristic of this condition. This defect is easily rectified by a slight operation, and, unless the muscles of the tongue are otherwise defective, restoration of normal speech eventually ensues.
It must be remembered, however, that in children who have for years been accustomed to this defective method of speech, the muscles have adapted themselves to the changed condition, and a complete correction of the defective speech is a question of time. I remember an occasion, for instance, when a mother returned to me after this simple operation had been done, and complained that it had been a total failure, giving as her reason that the child's speech was just as defective as before the operation. I explained to her what I have just said, and instructed her to teach the child to use its tongue in its normal position, and this exercise was followed in a few months by an entire correction of the defect.
