Clergyman's Sore Throat

PROVENANCE

prov·e·nance (prǒv´ ə nəns) n. Place of origin, source. [Lat. Provenire, to originate.]

Merriam-Webster dictionary declares Clergyman's Sore Throat (CST) is the "chronic inflammation of the pharynx often occurring in persons who habitually overstrain or misuse the voice (as in public speaking)."¹ The Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health defines CST as "loss of the voice from overuse, as by clergymen; called also dysphonia clericorum."² Wiktionary opines that CST is "chronic pharyngitis."³

I unearthed the topic of CST by happenstance while researching a different topic. That is not unusual; I often begin researching one topic, only to be sidetracked and become more curious about another, much as when I go to a department store to purchase one item and leave the store with a full basket. But with a term like CST, I had to know more.

I investigated with enthusiasm this nebulous topic thinking that I may have found the "holy grail" of stories. The more I looked, however, the more confused I became. Each source seemed to have its own interpretation. The only similarity was that this illness included overuse of the voice.

Thomas Whipham discussed how CST is an irritation that comes from overexerting the voice while the head is in an incorrect position (excessive tension).⁴ John Hullah suggested that it occurs in speakers that exclusively use the "weak" register of the voice.⁵ Charles Wesley Emerson asserted that CST "is caused by making too close a chamber of resonance in the pharynx while speaking. This is a confirmed habit with a very large number of persons; in fact, it might almost be said to be a prevailing difficulty, but it does not always cause a sore throat until the voice is more constantly used than it ordinarily is in private life."⁶

In magazines you could find "cures" for CTS in advertisements (Figure 1).⁷ Others consider CST to be associated with an inflammation of the follicles of the mucous membrane lining the pharynx and larynx. Homer M. Thomas stated, "It occurs in those who strain the voice or misuse it. It consists of the mucous membrane and muscles of the many of the minute glands which secrete fluids that keep the surfaces of the throat moist and pliable."⁸

In 1879, Jacob Solis Cohen offered the medical name of Chronic Folliculitis Sore Throat for CST.

It consists not only in disease of the mucous membrane, but, also, and especially, in disease of the glands (or follicles) which are imbedded in the mucous membrane.

Figure 1.

A magazine advertisement addressing CST.

Its prevalence among clergymen seems to be in part due to the inequalities of temperature to which they are often subjected in the performance of their duties, with bare head exposed to draughts from open windows or in the open air. It has often been stated that clergymen who preach extemporaneously or without manuscript, are less liable to the complaint; and this may be so, as far as the constrained position of reading from a desk interferes with the freedom of respiratory movement so essential to the favorable use of the voice without sensible effort. It occurs very often in wine-bibbers. It is not confined to the structures mentioned in connection with the simple catarrhal form of chronic sore throat, but is apt to involve the glands at the posterior portions of the nasal passages, the roof or vault of the pharynx, the glands in the base of the tongue and floor of the mouth, and those in the outer and inner mucous membrane of the larynx. It often occurs in scrofulous persons, in those subject to diseases of the skin, in those predisposed to consumption, gout, rheumatism, and other hereditary maladies, but is by no means confined to these classes of individuals. It is more frequent in the delicate than in the robust. City life seems to favor the development of this affection, the evil results being due to inhaling the dusts, chemicals, and decomposing emanations, and so on, in...