[Reprinted from THE MEDICAL NEWS, October 6, 1888.] 
CANTATORY PARESIS. 
J. SOLIS COHEN, M.D., 
OF PHILADELPHIA. 
Cantatory paresis is a variety of vocal disability 
experienced only in singing ; the voice remaining 
good in all portions of the register utilized in ordi- 
nary conversation. 
Clinical History.—After some unusual vocal 
effort or after some ordinary vocal effort during a 
period of debility, a singer’s voice will begin to fail 
at some special note of the register. In some in- 
stances failure is limited to a single portion of the 
register. As determined by the researches of Lang- 
maid (The Medical Record, May 26, 1883, P- 5 76) 
this will most likely occur at the ninth note in the 
scale in the key of C, for tenor and soprano voices; 
and at the seventh for base and contralto voices. In 
other instances all tones are uncertain above the one 
at which the break begins. 
Pathology and Morbid Anatomy.—ln some in- 
stances no pathological condition can be detected. 
In most cases there is a slight congestion of one or 
both vocal bands, which becomes more and more 
pronounced as the defective tone is approached in 2 
CANTATORY PARESIS. 
singing the scale from below upward. In marked 
instances there may be a lack of due longitudinal 
tension of the vocal bands, so that the glottic 
orifice remains elliptic in its entire extent and does 
not close posteriorly as the voice rises in pitch. 
This is due to failure in the proper contraction of 
the thyro - arytenoid, lateral crico-arytenoid, and 
crico-thyroid muscles. 
It is possible that undue strain may stretch, or 
tear, or otherwise impair some of the delicate mus- 
cular fibrillse of the thyro-arytenoid muscles, so as 
to interfere with the adjustment of the vocal bands 
necessary to produce the tones at which failure 
occurs. This failure throws undue effort upon other 
muscles in the endeavor to secure the tension neces- 
sary for cantation; and this effort fatigues the 
muscles and produces atony with irregularity in 
contraction, and consequently in phonal vibration 
of the vocal bands. 
Symptomatology.—There is a lack in the pre- 
cision of the tone as the point of failure in the scale 
is reached; and this is sometimes associated with an 
involuntary slide or a tremble. . Prolonged effort, as 
in singing, is quite fatiguing and sometimes painful. 
The conversational voice remains unimpaired. ' 
Etiology.—The most frequent cause is over- 
fatigue of the intrinsic muscles of phonation, from 
undue exercise in forced efforts beyond those re- 
quired in the ordinary adjustments of the vocal 
bands for the natural emission of the tones made. 
This may be due to prolonged effort under ordinary 
conditions of health, or to customary efforts made CANTATORY PARESIS, 
3 
during impaired conditions, whether physical or 
mental, or both. Faulty respiration in singing 
(Mandl, Paris, 1855) is, perhaps, the next most fre- 
quent cause. 
Diagnosis.—There is usually a lack of longitud- 
inal tension of the vocal bands, and, in some in- 
stances, the bands are more or less undulatory 
in outline on their horizontal surfaces. The vocal 
bands are usually somewhat congested, in some in- 
stances with a pearlish translucence. In the absence 
of positive laryngoscopic evidence of atony, the 
character of the voice and the history of vocal 
fatigue remain the sole features in diagnosis. 
Prognosis.—The prognosis is good, provided that 
the voice be given proper rest and that suitable 
therapeutic measures be instituted. Should these 
precautions be neglected and the voice be continued 
in use, permanent injury may be sustained and the 
voice, for many months or even for a year or longer, 
may be rendered useless for singing purposes. 
Treatment.—The first element in treatment is 
absolute rest of the singing voice and comparative 
rest of the conversational voice; that is to say, 
avoidance of all unnecessary use of the voice. The 
next point is attention to any impairment of the gen- 
eral health. Strychnine, quinine, and cocaine are the 
special medicinal agents most likely to be directly 
beneficial to the impaired muscles. Finally, sys- 
tematic vocal exercises, limited to the unimpaired 
portion of the register, and daily percutaneous ap- 
plications of currents of induction from one side of 
the larynx to the other will assist materially in over- 4 
CANTATORY PARESIS. 
coming the muscular atony, and thus hasten restora- 
tion of the vocal powers. Great care should be ex- 
ercised in resuming prolonged vocal efforts for a 
year or two after apparent cure has been effected, 
lest the condition recur in an aggravated form. 
In cases of moderate disability it is possible so to 
arrange the music as to avoid using the tones in 
which the voice shows impairment (Langmaid).