Hoarseness and Loss of Voice

In the term "hoarseness" I include not only those coarse changes in the voice which render it rough and husky, but also those finer ones, by which it is altered in pitch as well as in clearness. Owing to these changes, a person who normally sings tenor songs is unable any longer to do so, because the highest notes first lose their clearness, and then are lost altogether, the compass being thereby lessened ; along with this, it is found that all the notes that are left have lost their clearness and tone, and fatigue of voice very soon ensues, after an attempt is made to sing. Now, although there is this most noticeable interference with the power and range of the singing voice, there may be nothing abnormal in the speaking voice, except that, perhaps, it is slightly deepened; it is not, in other words, hoarse, in the ordinary acceptation of that term. It is, however, most important not to overlook this alteration of vocal power, as grave disease, quite unsus-pected by the patient, and for which he therefore does not come for medical advice, may be present, and may be the cause of the change.