Spasmodic dysphonia is a rare voice disorder that makes the voice sound strained or strangled. Some people with the condition are almost inaudible. Kate Quarry, who has this problem, scoured Wellcome Collection archives for fellow sufferers and treatments from the past.
My search for a stronger voice
Words by Kate Quarry
- In pictures
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When I was in my late twenties, I noticed something odd was happening to my voice. It had begun creaking, cracking and cutting out unpredictably. This was embarrassing, as it made me sound as though I was upset or had a cold most of the time. As other people made comments, it began to dawn on me that a person’s voice is an important part of their identity: for example, I would sometimes be mistaken for an elderly woman over the phone.
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I started trying to find out what the problem was, first by visiting the GP. Had I been alive during Anglo-Saxon times, I might have been recommended this treatment, which appears in ‘Lacnunga’, a collection of ancient remedies, for a woman struck dumb: “Take pulegium and grind to dust and wrap up in wool. Lay it under the woman. Soon she will be better.” Pulegium, also known as pennyroyal, a minty-smelling plant, was more commonly used to induce abortion or menstruation, and wool was seen as having ‘loosening’ properties, hence releasing the voice.
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The GP referred me to an ear, nose and throat (ENT) specialist. I’m grateful that I wasn’t subject to the ministrations of Dr James Mackness, whose 1848 book ‘Dysphonia clericorum’ focuses on voice problems in clergymen. Having explored treatments from leeches to the poisonous emetic croton oil and the opiate laudanum, which was a popular cough suppressant at the time, its writer plumps for more common-sense solutions. These included “the application of a handkerchief dipped in cold water to the throat” and “a light diet, regular hours, and as much as possible horse-exercise”.
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Another of the treatments Dr Mackness suggests is “galvanism” – electric-shock treatment. Dr Morell Mackenzie’s book on “hoarseness & loss of voice” describes treating dysphonia with galvanism with, apparently, great success. Mackenzie, a pioneer of laryngology, is on the far right of this drawing. He was one of the specialists consulted over the treatment of Friedrich III, who was married to Queen Victoria’s daughter Princess Victoria. Friedrich was briefly King of Prussia and died from complications of laryngeal cancer in 1888.
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Before I developed a voice problem, I was a keen amateur singer, but now this became fraught with difficulty as my voice faded and wavered. The choir leader suggested that I simply had stage fright. Today beta blockers are sometimes prescribed for this sort of anxiety, but the Victorians had different ideas. In those days singers struck by nervousness might drink wine fortified by coca leaves – cocaine, in other words. This popular concoction, Vin Mariani, is suggested in the 1886 book ‘Voice, Song and Speech’. The authors’ caveat is that it should only be taken “under medical advice”.
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The ENT clinic told me there was nothing physically wrong with me: it was psychological. I was referred to a speech therapist. Speech and language therapy has its origins in elocution, which was very popular in the 1800s and began to mutate into a true science in the second half of the century. But there were plenty of quacks in this field. One, Dr Carter Moffatt, surmised that Italian air was responsible for the country’s great singers. His 1886 ammoniaphone “reproduced” Italian air using chemicals (including ammonia) and delivered it in measured doses to help with “voice cultivation” – and to “cure” tuberculosis too. Of course it didn’t work.
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Speech therapy was interesting, but didn’t make my voice any better. By this stage I had small children, and reading bedtime stories or singing nursery rhymes was extremely difficult – and trying to make the effort was painful. I was recommended an osteopath who specialised in voice problems. The osteopath manipulated my larynx and said he thought I had spasmodic dysphonia, an uncommon neurological disorder – cause unknown – that makes the vocal folds go into spasm.
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Dysphonia is from the Greek word meaning “roughness of voice” and was first used in English in the early 18th century. Spasmodic dysphonia is a movement disorder: it may be caused by disruption in the basal ganglia of the brain, which control movement. It is more common in women. Possible causes were suggested: had I suffered a severe shock or bereavement, for example, around the time of onset? It was decided that it might have been triggered by a couple of chest infections that I failed to get treated when travelling in places with scant access to a doctor.
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I went through the referral process again and saw another ENT specialist, who used a tiny fibre-optic camera to see what the problem might be and definitively diagnose me. Proper inspection of the larynx was made possible by the invention of the laryngoscope, which originally used the sun reflected in mirrors to see inside the throat. The discovery and use of electricity transformed the development of this tool. The laryngoscope in the image is of the ‘Czermak’ type, referring to the 19th-century doctor credited with making important adaptations to the instrument’s design.
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I was treated with injections of Botox into the vocal folds, which provides a temporary improvement, but needs to be repeated every four months. Botox is measured in ‘mouse units’ (MU): 1MU of a toxin kills a 20g mouse in 15 minutes. A few weeks after the first injection I was able to sing ‘Happy Birthday’ on my twins’ seventh birthday – which hadn’t been possible for years. Unfortunately, after a time I found that each Botox treatment became less effective, while the side effects became worse, so I stopped having the injections. Now I just live with – and mainly try to ignore – my creaky voice. It’s just part of me.
About the author
Kate Quarry
Kate Quarry is a freelance subeditor working with Wellcome Collection’s Digital Editorial team.