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this, for fear of injury to the vocal apparatus. He had never yet uttered a complete sentence in other than his present squeaking, puerile voice. He felt sure that his voice was of higher pitch than previous to puberty.

There existed a partial, not a literal, exception to this latter assertion. Direct questioning elicited the important and instructive fact that, in laughing, the voice was of low pitch, as in other men. He had quite given up hope of relief, inasmuch as a specialist of repute at his own home, having unsuccessfully treated him during several months, had then called in consultation a veteran and distinguished laryngologist from another city, who could, however, suggest no other therapeutic measure than the one already chiefly employed, namely, electricity. He had further consulted another laryngologist in a large Eastern city without avail. He was told uniformly that the trouble was of a paralytic nature, and given an unfavorable prognosis.

Instrumental examination revealed a condition, crudely speaking, of perfect health of the upper air-passages. He was in all other respects a normal individual, including his genital organs. It is a matter of common knowledge that boys who have been castratad—the eunuchs of the East — maintain their puerile voices after the age of puberty, and it has been written that as late as the last century choir boys with fine voices suffered castration that their high tenor or falsetto voices might remain unchanged after puberty to serve in the choirs of cloistered orders of monks. The general public, acquainted with these facts, is prone to consider that a full-grown man with a falsetto voice must be lacking in genital development. One of my patients insisted on proving to me that he was not deficient in this respect. I need not say that the public is entirely wrong in the suspicion."

Observation with the laryngoscope proved in the patient in question that, far from there being any paretic candition present, the true and false cords during phonation approximated more closely than they should have done; an observation proven by comparison in the same individual a few moments later, when his falsetto voice had given way to a normal baritone. It could then be readily seen that the vocal chink was now much larger; that the whole larynx was lacking in the element of muscular tenseness which had characterized the vocal attitude of the falsetto voice. The patient was told with an air of confident authority, after

1 Nature asserted itself, but was promptly suppressed.

* The matter is embarrassing to the patient, who is conscious that the public suspect him to be a eunuch.

careful and prolonged laryngoscopic examination, that his vocal apparatus was in a condition of perfect health; that the error was purely physiological, and consisted in the faulty use of his voice, and that he would leave the consulting room cured of his falsetto tones. This infor

mation was given in this confident manner that it might carry conviction; that it might stimulate the nerve element involved to a correct performance of function.

The chin of the patient was now depressed on the sternum, this being done for its mental effect rather than to relax tension or depress the larynx; and whilst in this position I uttered a low guttural, and asked the patient to imitate me, which he at once did. His attention was then drawn to the fact that he could utter low tones. His head again depressed, he at once readily imitated my low tones in counting. A conversation ensued, his confidence was established, and the cure almost accomplished. The patient must, however, be assured that his newly acquired voice is proper to him, for at first he can scarcely believe that the unfamiliar tones form his normal voice.

In a word, the remedy consists in telling the patient that he has a normal voice, and, by some device, proving it to him. For the first few days, unless the patient fixes his attention on each vocal effort, he is apt to commence a sentence in his former falsetto key.

My patient was, therefore, requested to remain at his lodgings for two days to escape business diversions, and concentrate his attention on his voice; to practice speaking and reading aloud. At the end of this time he found that, even when his mind was diverted from his voice, he spoke quite naturally. At the end of three months, on being requested to speak in his former falsetto key, he found himself utterly unable to do so.

I have thus far had three cases, their history and cure being similar. In my first case, occuring fourteen years ago, I noticed that the individual spoke in falsetto tones, but laughed in quite natural ones, and it was the clue to my successful theory and treatment. It occurred to me that laughing was a natural act, articulated speech an artificial one, the product of imitation and training. It therefore suggested itself to me that the artificial tone of speech could be trained to imitate the natural one of laughter.

The muscles at physiological fault are undoubtedly the thyro-aryte noids, from the physiological fact that they are the internal tensors of the larynx, and from the clinical fact that in my cases the ellipse between the

cords during vocalization was much larger after restoration of the normal voice.

This belief is further strengthened by laryngoscopic observations in a totally opposite class of cases, to which also, indeed, little if any attention has been made by authors, namely, paralysis of the thyro-arytenoids in adults, caused by excessive use of the high pitch before puberty.

I have been consulted by two gentlemen for voice troubles whose history was identical. In both, direct questioning drew forth the history that there had been habitual excessive use of the high register for two or three years before puberty; in the one case in singing, and in the other in elocution. At puberty both found their voices changed, to become husky, very deep, rough, incapable of maintaining so long a sentence, without inspiring, as before puberty, so aptly termed phonative waste of breath, and both unable, with any effort, to reach a note higher than the middle register of a baritone.

Their ages at the time of observation were, respectively, twentyseven and thirty-two. Their voices had undergone no change from the one into which they passed at puberty. In both the vocal ellipse was very large, the sickle shape of the cords during phonation being well marked. There existed the well-known clinical picture of paralysis of the thyro-arytenoidei.

My purpose in mentioning this class of cases is to offer the conclusion that if, in the one, the subjective and objective signs collectively be the exact antithesis of those in the other, and it be admitted that in the one paralysis of the thyro-arytenoids be the exact diagnosis, hypertension of the same muscles must be chiefly concerned in the emission of the falsetto voice.

THE TREATMENT OF HYPERTRICHOSIS. (Arthur Jamison, M. D., C. M., London, in Practitioner.)—The removal of superfluous hair from the face is often a matter of great difficulty, and not infrequently very unsuccessful. The hair will grow again in a provokingly persistent manner, and if too energetic treatment be adopted, a permanent disfigurement remains to remind the practitioner of his too great diligence. I wish therefore to suggest a plan of treatment which I have found very successful in suitable cases for the removal of hypertrichosis, and I will briefly give details of an extreme case.

The first illustration, from a photograph, shows my little patient, three months old, before treatment.

The whole right side of her fore

head was covered, closely covered, with an overgrowth of long dark hair; some of the hairs being fully an inch long. The adventitious hair grew over the right eye brow and eyelid, extending thence across the nose to the margin of the left eyebrow, and, upwards, a little to the left of the middle line, to the margin of the hairy scalp. On the outer side it grew in a line from the external angle of the right eye to a little above the meatus of the right ear. The child's appearance was, as far as that side of her face was concerned, exactly like that of a Skye terrier. deferred doing anything till the child was three months old, and in the interval thought over a good many of the plans advised to remove superfluous hair from the skin. I thought them all inapplicable in this case, and finally ventured to risk the trial of the one I now venture to suggest.

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When applying Sodium Ethylate for the removal of nevi, I had noticed that when the nevus was near the hairy portion of the scalp, if any of it were let to run around the base, the effect was a loss of hair where the ethylate had touched. I tried the effect of the ethylate on several small hairy moles, and finding the results to have been very satisfactory, I determined to try it in this instance. Accordingly the child was put very fully under the influence of chloroform, the long hair cut short in a vertical line down the forehead for the width of an inch, and sodium ethylate rubbed over the surface very freely and thoroughly, till the skin had an orange appearance. By the time the child had slept off the effects of the chloroform, the pain of the application had ceased, so that the child was fairly comfortable. A little cold cream was then applied.

At the end of a fortnight the result of the first operation was seen, and most satisfactory it was. The hair-follicles over the greater part of where the application had been made seemed destroyed, and a whitish skin remained. Curiously enough here and there some long hairs remained uninjured. At the end of a month I tried again, but this time I attacked the surface of the forehead from the eyebrow upwards, leaving the hair of the eyebrow alone. The result was the same. Next time I applied the caustic from the margin of the eyebrow to the ear. Then I waited some time to see the result. When the child was a year old the forehead was fairly clear of hair; but the eyebrow and eyelid were still covered with long hair, and that from the eyelid was growing over the eye. I now very carefully applied the ethylate over the eyelid. There was, as might have been anticipated, a good deal of sub

cords during vocalization was much larger after restoration of the normal voice.

This belief is further strengthened by laryngoscopic observations in a totally opposite class of cases, to which also, indeed, little if any attention has been made by authors, namely, paralysis of the thyro-arytenoids in adults, caused by excessive use of the high pitch before puberty.

I have been consulted by two gentlemen for voice troubles whose history was identical. In both, direct questioning drew forth the history that there had been habitual excessive use of the high register for two or three years before puberty; in the one case in singing, and in the other in elocution. At puberty both found their voices changed, to become husky, very deep, rough, incapable of maintaining so long a sentence, without inspiring, as before puberty, so aptly termed phonative waste of breath, and both unable, with any effort, to reach a note higher than the middle register of a baritone.

Their ages at the time of observation were, respectively, twentyseven and thirty-two. Their voices had undergone no change from the one into which they passed at puberty. In both the vocal ellipse was very large, the sickle shape of the cords during phonation being well marked. There existed the well-known clinical picture of paralysis of the thyro-arytenoidei.

My purpose in mentioning this class of cases is to offer the conclusion that if, in the one, the subjective and objective signs collectively be the exact antithesis of those in the other, and it be admitted that in the one paralysis of the thyro-arytenoids be the exact diagnosis, hypertension of the same muscles must be chiefly concerned in the emission of the falsetto voice.

THE TREATMENT OF HYPERTRICHOSIS. (Arthur Jamison, M. D., C. M., London, in Practitioner.)-The removal of superfluous hair from the face is often a matter of great difficulty, and not infrequently very unsuccessful. The hair will grow again in a provokingly persistent manner, and if too energetic treatment be adopted, a permanent disfigurement remains to remind the practitioner of his too great diligence. I wish therefore to suggest a plan of treatment which I have found very successful in suitable cases for the removal of hypertrichosis, and I will riefly give details of an extreme case.

The first illustration, from a photograph, shows my little patient, three months old, before treatment.

The whole right side of her fore