The paralysis may, of course, occur on both sides, and then it is that, on the side which is most exercised, there is felt a sense of distress, of pain and sudden fatigue. This condition generally arises from prolonged singing, and many of the cases I have seen have been the result of overwork during Easter and Christmas; and all of the cases which have come under my observation were associated with rheumatic constitutions. Fortunately for these singers, when the conditions were made known to them, they were in a position, or at least were perfectly willing, to rest, because of the fear that a knowledge of their condition instilled. Indeed, the situation is always one to cause serious alarm. The beautiful symmetry of the arytenoids is impaired and the agility of the voice is destroyed. If the singer persists in his vocation, total disability results. As a rule, complete rest is enforced by reason of inability to sing at all. If the voice is continued in use, the affection becomes permanent and there is one more case of irremediable vocal collapse. The remedy is rest, and that, too, before the disease has passed recoverable ground. If the singer experiences pain on either side of the thyroid cartilage, or on either side of the Adam's apple, then let him by all means have a care, for those are the symptoms of this peculiarly menacing form of paralysis. In the voice a palpable hoarseness is manifest. The voice becomes "fuzzy" throughout its entire compass. A pronounced disability to make a _crescendo_ arises, and when the effort is made (for in the described circumstances use of the voice is attended with undue effort), the tone becomes coarse and uncontrollable. The range of the voice is lessened and the singer finds difficulty in reaching the upper tones. In the general debilitation the singer tries, or rather is compelled through weakness, to poise the voice from the cords themselves and not from the diaphragm.