! ! COLUMBIA LIBRARIES OFFSITE HFAimsr;!! tIM '•'■'AMUAH J HX641 47371 RC736 .W21 Singers' throat trou bmg^^ Throat Troubles yHEiR Cause and Cure Course of Lectures delivered at the Grand Conservatory of Music, during the season 1883-84. BY WHITFIELD WARD, A. M. M. D, Physician to the Metropolitan Throat Hospital; author of " The Throat in Relation to Singing," etc. PUBLISHED BY THE GRAND CONSERVATORY PUBLISHING CO. 46 West 23d Street, New York lS8q :.»?»■* T.v^- -1 r=i - \\c i^ ^ VJZ\ intiitCitpofikttigork College of ^fjpsficianfi anb ^urgeonjs Hifararp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/singersthroattroOOward Singers' rhroat Troubles "JTheir Cause and Cure Course of Lectures delivered at the Grand Conservatory of Music, during the season 1883-84. BY WHITFIELD AVARD, A. M. M. D. Physician to the Metropolitan Throat Hospital ; author of " The Throat in Relation to Singing," etc. PUBLISHED BY THE GKAXD CONSERVATORY PUBLISHING CO. 46 West 23d Street, New York \\/A\ Copyright by E. Eberhari>, 1885. PRESS OF WILLIAM S. GOTTSBERGER, 11 Murray St., New York. PREFACE. In this little work which is intended as a companion to "The Throcit in Relation to Singing," I have en- deavored to present a series of pictures of the most prominent ailments peculiar to the vocal organs of singers. Believing that many voices are annually lost through ignorance and mismanagement, 1 have, for the express purpose of remedying this evil, undertaken in the fol- lowing pages to give the vocalist an insight into many of these difficulties. THE AUTHOR, 208 West 25th Street, New York City. SlN(;p:kS' IMIKOAT TRD IJ p. Lies THEIR CAIISI-: AND CURE. CHAl'TKR I. The Causes of Throal Troubles iiu7 mucous into llic Ijuck of I lie luoulii. VVIkmi tliu sufferer from nasal catarri) is unable to expcll I Ik- mm oiis which is being constantly pourerl forth from the deceased mcuihranc, the ravities of the nose, after a short time become completely blocked n|i. There arc two reasons for this accumulation. FIRST, The mucous hcinL; thick and tenacious becomes firmly attached, or, as it were, joined to the parts, and is therefore capable of resisting all ordinary efforts of expulsion. SECOND, The niucous membrane being diseased is unable to perform its natural function, namely, the expulsion of the secretion accumulating on its surface. Pain as a general thing is not a prominent sympton of this affection. In some cases, however, it is well marked and the occasion of a great deal of worriment. Its most frequent seat is generally immediately beneath the eyes at the most depressed portion of the nose. Deafness and impairments of the sense of smell oftentimes result from neglected cases of nasal catarrh. The first manifestation is due to the extension of the disease through the ear ducts into the cavity of the ear itself, while the second is owing to the deadening of the nasal mucous membrane. Nasal catarrh in a vast number of cases is caused by frequent and repeated attacks of " cold in the head." Quite frequently the disease commences in a slow and insidious manner, and is present in the parts several months before the sufferer is conscious of its existence. The influence of this disease upon the singing voice is at all times most marked, and may be either immediate or remote. The immediate effect of an attack of catarrhal inflammation will be the utter impossi- bility of rendering certain portions of the vocal register. The tones most affected will be those which in their journey from the body issue solely from tlie nasal cavities. Those tones which issue partly from the nose and partly from the mouth will, of a necessitv, be only partially affected by the above state of affairs. This interference to vocal sounds is due to the thickening of the mucous membrane lining the nasal canals. In order that the thickening of the mucous membrane characteriz- ing nasal catarrh be removed, it is necessary to undergo a series of treatments by the skilled physician which consists simply in the thorough and repeated applications of medicines to the diseased parts. The remote effect of nasal catarrh upon the voice is of the most pronounced character. When the vocalist thus affected begins to find out that certain tones are being poorly rendered, unless he thoroughly under- stands the cause, he is apt to strain every nerve to regain his lost power. By so doing he brings more force to bear upon those delicate bands, the vocal cords. For a time this metliod of singing improves the tones. i8 SINGERS' THROAT TROUBLES, but at a heavy price, namely, injury to the vocal cords. Why ? Because the extra forces invoked are the stronger muscles outside the larynx — bodies which ordinarily have nothing to do with singing. What does this method of vocalization lead to ? Strain of the voice which is greater or less according to the amount of nasal obstruction, and the length of time the extra forces are employed. 'I'his result I have seen very many times, in fact, scarcely a day. passes but that a singer consults me who has been endeavoring to render tones whicii could not be made properly on account of obstructions existing in the nasal passages, the direct cause of catarrhal swelling. Aside from its effect upon the vocal apparatus nasal catarrh is pro- ductive of much harm, and is a direct cause of many other throat com- plaints. Why ? Because to a greater or less extent it compels the afflicted person to breathe through the mouth. The nose is the only channel through which air should pass into the bo'ly during ordinary acts of breathing, the mouth being intended only as an accessory breathing agent when on certain occasions — as for instance running — the lungs demand a rapid and increased supply of air. The air in passing through the nostrils is warmed and sifted of its harmful ingredients and thus prepared for its reception into the delicate structures below. If it goes directly into the mouth without the above preparation, it will frequently cause irritation and inflammation of the mucous membrane lining of the mouth and throat by being, in the first place too cold, and in the second place, by containing irritating particles of dust and other matter. We will now pass on to a consideration of that part of this subject which the singer, in all probability, will consider of the most importance, namely, can nasal catarrh be cured ? My answer to this query is, cer- tainly if the proper treatment be employed in the proper manner. The inquiring mind will immediately ask, why then do so many people, and among them many physicians, constantly assert that this affection is incurable ? Simply because they have not properly investigated the subject. You must remember that the science of laryngology is still in its infancy, and that but a few years ago little or nothing was known concerning the cause and treatment of the many ailments peculiar to the throat, in fact, not until the discovery of the beautiful instruments by which we are enabled to see the hidden recesses of the throat and nose. Since the employment of this apparatus, diseases, which were hitherto not at all understood, have been investigated and their cause thoroughly made out. To none of these affections do the foregoing remarks apply more forcibly than to nasal catarrh, concerning the cure of which science has done so much during the past decade. The treatment of this most distressing affection must be of the mo.st thorough nature. Til KIR CAUSK AND CIJKK. '9 Iwery portion ollhc nas.il ihikoii^ incinbranc must be treated with the proper apphcations and no pari, no matter how remote, must 1;e allowed to go untouched. The necessary applications are made through the agency of a special set of instruments which are mani[)ulatcd under the brilliant light of the laryngoscope. The most important and useful of the instruments u.sed for this purpose is the compressed air apparatus. Viy means of this contrivance a most powerful liquid spray can be forced into the nasal cavities both in front and behind and the medicines thoroughly applied thereby. Of late years owing no doubt to the great prevalence of nasal catarrh, very many quack nostrums and patented appliances have been extensively advertised as specifics for the cure of this disagreeable affection. Each one of the above are always accompanied by an unlimited number of signed certificates which testify as to the inestimable value of the article in question and are thus calculated to attract the eye and the pocket of the unwary victim. 1 could, were I so disposed, fill a book with narra- tives concerning the effect of many of these articles upon the delicate mucous membrane lining the nose, but I shall content myself with the statement that the best of them are only palliative and not in any man- ner curative while the remainder are extremely injurious. Many of the nostrums contain ingredients the employment of which will not only increase the inflammatory action, but will also if persevered 'in, excite ulceration in the delicate nasal membranes. It stands to reason that no remedy, no matter how meritorious it may be, can effect a cure in a number of cases, since there are very many forms of nasal catarrh, and in order to differentiate between them it is necessary that a thorough examination be made by a skilled physician. Generally speaking that drug which may be most serviceable in one case may be extremely harmful in another. This assertion is not true only in the nasal organs but holds good with reference to ailments located in any other portion of the body. Some persons spend more money, and to no purpose, on quacks than the legitimate cure of their affection would cost in the hands of the regular physician. It is only necessary in this age of pro- gress for the quack to prepare some nostrum, no matter how worthless it may be, and proi)erly advertise it, and he is certain to reap a rich harvest gleaned tVom the pockets of the gullable public. CHAPTER III. PHARYNGITIS. Phariiygilis or ordinary sore throat is simply an inflammation of the mucous membrane lining the pharynx or l)ack wall of the cavity of 20 SINGERS' THROAT TROUBLES, the mouth. This disease may present itself in two forms, namely an acute and a chronic. In the ACUTE or recent form of inllammation the affected tissues are found, upon laryngeal examination, to be greatly swollen and congested the mucous membrane lining the parts presenting a deep red color. The sensations experience by the j^atient are peculiar, and characteristic of the disease. The principal symjjtoms are pain in swallowing, dryness of the mouth a harsh and rasping cough, and later on in the attack, a copious expectoration of frothy mucous. The most frequent cause of this form of throat trouble is exposure to cold when the body is unprepared to withstand it. Although very many cases of this disease are produced by the carelessness of the affected persons many more are caused by some unforeseen and unavoidable circumstance. Very many persons take cold in passing from a heated theatre or concert hall to the cooler street beyond. No matter how high the temperature may be outside it is generally from ten to twenty- five degrees warmer inside, hence the sudden transition will oftentimes produce quite a serious attack of sore throat unless, forsooth, the exposed party be provided with extra garments. In the chronic or long-stand- ing form of sore throat the affected tissues are not nearly as red or con- gested as in the acute form, the symptoms, however, experienced by the patient are more numerous and more cleasly defined. There is apt to be more or less difficulty in swallowing, the mucous membrane lining this portion of the throat being thickened and covered with a thick and pasty mucous. There is always present a sharp dry cough which is caused by the efforts of the patient to expel the mucous. There is also apt to be present a peculiar feeling as if the parts were covered with some foreign substance. The effect upon the voice of a chronic sore throat is sometimes quite marked. When the inflammation is great and there is much swelling of the tissues, there is a certain amount of huskiness and thickening of the voice with also a lack 'of vocal control and a tendency to tire easily. Among the causes for this disagreeable affection, there are two which deserve special consideration, namely : THE IMMODERATE USE OF TOBACCO, AND THE ABUSE OF ALCOHOLIC LIQUORS. It is an undisputed fact that the smoke arising from tobacco is an irritant to the delicate mucous membrane lining the air passages. This effect is more especially noticeable in persons afflicted with delicate throats. It has been asserted as an argument in favor of the use of tobacco, " That the mucous membrane of the throat becomes, after the lapse of a certain period of time, hardened and inured." This is merely a possible result and should not induce the singer, especially if he have any throat trouble, to persevere in the use of tobacco. The vocalist THEIR CAUSE AND CURE. 21 who wishes to preserve liis voice sliouUl not smoke, Init if lie must use the weed, let him remember that smoking immediately after singing is harmful, because the vocal organs are then in a congested state and easily acted upon by any irritant. There is another fact with relation to this subject and which should always be born in mind I)y those indulging in the excessive use of tobacco, and tliat is that the constant absorption of nicotine, which, as we all know, is deadly poison, is not only injurious to the system at large, but also to the delicate tissues of the mouth. I cannot too forcibly impress it upon the mind of the singer, if he wishes to retain his voice in its natural purity, to abstain entirely from the use of tobacco, even though for the time being it may seemingly produce no ill effect. If the employment of tobacco is harmful to the vocal organs the use of alcoholic stimulants is ten-fold more so. Alcohol is an irritant to all mucous membranes, especially to that lining the air passages, and if used to any extent will assuredly in time create inflammatory action in these parts. If the drinking habits are persevered in sufficiendy long permanent injury will undoubtedly be done to the vocal apparatus. Some artists, prompted no doubt by bad advice, are in the habit of imbibing alcoholic stimulants immediately previous to vocalizing. I wish particularly to warn singers against this pernicious habit which, if persisted in, cannot fail to be productive of serious consequences. The treatment of the two forms of sore throat depicted above must be chiefly of a local nature ; that is to say the medicines employed must be applied direcriy upon the diseased surfaces. The most valuable agent in the treatment of these ailments is the compressed air apparatus already incidentally alluded to. By means of this appliance the medi- cated solutions can be thoroughly distributed over the diseased tissues in the form ot a fine and powerful spray. Camel's hair brushes attached to a long and slender handle can also be often used to advantage in making applications in this species of throat trouble, but their employment, except in some special cases, is neither as agreeable nor as efiicacious as the compressed air spray. The other forms of treatment generally employed in this class of diseases are gargles and medicated troches. These agents are in no manner cura- tive, they are simply pallative. They are beneficial in two ways, namely : By keeping the parts free from mucous and by soothing the inflamed tissues. 22 SINGERS' THROAT TROUBLES, C H A FT K K 1 \ . LARYNc;rris. Laryngitis is an inflammation of the mucous membrane lining the larynx or voice-box. It presents itself like the affection just considered, in two forms, namely : An acute and a chronic. The acute or recent form is generally superinduced by exposure to cold or rapid changes of temperature. Upon inspection of the parts with the valuable assistance of the laryngoscope, the larynx presents a characteristic appearance, being very red and swollen, a direct eftect ol' the inflammatory process. These manifestations are generally most noticeable in the vocal cords the sound-producing reeds of the voice-box. these bands, being very highly colored, thus offering quite a contrast to their natural appearance, namely : A pearly wliite. Tlie most prominent symptom, however, is impairment of the voice both in talking and singmg. The talking voice is husky or hoarse in direct proportion to the severity of the attack. When the voice is thus affected talking in a loud tone, even for a short lime, will invariable increase the hoarseness. The singing voice is always greatly affected; proper vocahzation being out of the question. The reason why the voice is affected by this form of laryngitis is easily demonstrated. The vocal cords, in order to perform their function properly, must be in a healthy condition, tliat is to say they must possess their natural i)roportions. When they are the seat of inflamma- tory action they become thickened and congested, which not only des- troys their vibratory power, but also to a greater or less extent obliter- ates the chink of the glottis, the opening between tlie two cords which is for the purpose of allowing the air to escape through the laryngeal tube. This closure of the chink of the glottis is a prominent cause of vocal impairment because the air, which passes through the voice-box in a healthy condition, is the motor power which causes the vocal bodies to vibrate. Cough is also a prominent symptom and is caused in two ways: First, by a constant tickling of the throat, and second, by the copious secretion of a thin mucous. The cause of acute laryngitis is, like most of the other inflammatory affections of the throat, exposure to cold and dampness. It is sometimes surprising what a slight exposure will produce this affection, the afflicted one being oftentimes totally unaware of having exposed himself. The phenomena of taking cold is decidedly interest- ing and should in a measure be understood by everybody, especially those constantly using their voices. When the body is overheated, its surface is covered throughout Its entirety with profuse perspiration. Now if wliile in this condition it THEIR CAUSE AND CURK. 23 be subjected to cold, all tlic minute sweat pores whicli abound on its surface and through which the perspiratory fluid oozes, will be instantly closed, which in turn will cause an instantaneous checking of perspira- tion. When the cutaneous secretion is checked in the above manner on any portion of the frame, all the blood is driven from the surface to the organ or organs immediately subjacent, which causes them to be sup- plied with a much greater amount of sanguinious fluid than is necessary, producing congestion, the precursor of inflammation. If the system is in prime order it will generally be able to combat successfully this con- gestion and prevent its development into inflammation, but if it is weak and run down, inflammatory action is a foregone conclusion. The reasons why the larynx, and the other organs in its immediate vicinity, are so frequently attacked by cold are two-fold : First, they are very near the external surface of the body, being covered in lean persons by the skin and a few ribbon-like muscles; second, they are situated in that part of the frame which is, as a rule; unclothed. There is a time when the singer is especially liable to take cold, and that is when he proceeds from a warm apartment into the colder atmosphere beyond immediately after acts of vocalization. The larynx when at work requires a greater amount of blood than during rest, this causes it for the time being to be in a congested state, which congestion, however, is perfectly natural. When the larynx has accomplished its task and is quiescent, the above natural congestion gradually subsides, until the vocal organs contain only their^ normal quantity of blood. Now, if the vocalist should expose himself to the cold street air before this congestion has entirely subsided, he is almost sure to suffer from his indiscretionary act. The manner of dressing has a great deal to do with the health of the vocalist. The body should be clothed sufficiently for warmth and comfort. Too much clothing is as bad as too little because it produces an overheating of*the body which in time causes a free perspiration, a state of affairs, as we have seen, extremely favorable for the reception of a cold. The overbundling of any portion of the body, particularly the chest and neck, with wraps, mufflers, &c., renders the wearer peculiarly liable to colds because it produces an extra sensi- tiveness of the parts. The minute a person thinks he has taken cold he piles on chest protectors, extra wraps, &c., not forgetting to encircle his neck many times with red flannel. This procedure can do no pos- sible good but the greatest amount of harm for the several reasons cited above. A very prevalent way of taking cold is the tarrying in over- heated apartments with heavy clothing on. This habit is especially noticeable among the ladies during their numerous shopping excursions. They will remain sometimes an hour or more in a store heated to a temperature of from 80° to 100'' without removing their sacks and then, while their bodies are bathed in perspiration, proceed immediatelv to 24 SINGERS' THROAT TROUBLES, the cold street beyond. These remarks are especially applicable to those wearing seal skin sacks, which have a special tendency to the overheating of the body. Singers, more especially those iiaving delicate throats, should take care to keep the feet warm and dry. Some i)eople are so sensitive that a welting of the feet, no matter how slight, will invariably be followed by a cold. CHRONIC LARYNGITIS. This form of laryngitis is an inllaninuition of the mucous membrane lining the larynx, of a mild type and chronic character. This, of all the laryngeal aftections, is the most prevalent amongst singers. The most prominent symptoms are a feeling of tickling or irritation referable to the larynx and impairments of the voice either of the singing, or of the talking, or of both. There is generally an irritating cough with a constant desire to clear the throat. Upon inspecting the parts with the laryngoscope, the entire mucous membrane lining the larynx will be seen to be congested and considerably thickened in certain localities. The vocal cords themselves will be found much thicker than normal and reddened instead of being pearly white as in health. The characteristic redness is apt to manifest itself in spots or streaks on the vocal bodies. A quantity of frothy mucous is nearly always present on the diseased tissues. In singers and professional speakers chronic laryngitis is apt to be localized in certain portions of the larynx the vocal cords being the chief point of attack. There is one condition quite often seen in the throats of vocalists affected with this disease, and that is a relaxation or giving way of the cords from over-exertion or strain of these bands. Chronic laryngitis frequently occurs, as a result of a cold, or more properly speaking, a series of colds. Among singers, however, this atTection has several special causes, the jirincipal of which are: 1. Improper training. 2. Injudicious singing. 3. False singing. 4. Strain of the voice. 4. Other throat affections. IMPROPER TRAlxNlNG. We cannot over-estimate the evil eflects produced on the delicate structures of the larynx by bad training of the voice. I have frequently seen a lar\ nx which was perfectly well prior to teaching become utterly destroyed in a course of vocal lessons extending over a period of from two to three months. One of the chief ways in which chronic inflam- mation of the larynx is produced in singers, is the practice in vogue with a certain class of teachers, of striving by rapid methods to develop the Tt[Krk CAiiSK AND ciJki':. 25 voice in ;i slioii iiiii<'. 'I'lic (IcvcldiiUMjiii o( Uic voice, as every good instructor fully knows, is ;i tedious affair and can only be accomplished after years of study. I know that rapid advancement is the tendency of the age, and that by developing a voice in a short time the teacher will cater not only to the pupil but also to his friends; but still the fact must never be lost sight of, lluit by endeavoring to develop the vocal appara- tus rapidly, permanent injury is apt to follow. How does over-training produce chronic larynx ? By making use of the stronger laryngeal muscles, bodies which ordinarily iiave nothing to do with vocalization. Why is the aid of these external laryngeal muscles invoked ? Because the delicate vocal muscles not having had time to develop sufficiently to perform the duties imposed u])on them, outside help is sought. The direct effect of the use of these stronger musculnr bodies manifests itself in the vocal cords. In the first place, these bodies are congested, that is to say a large amount of blood is drawn to the parts by the extra force used. The next steji in the process is the production of swelling in the parts especially in the neighborhood of the cords and finally after the lapse of a varying period of time, which depends upon the exertions of the teacher and the susceptibilities of the pupil, this congestion and swelling becomes a chronic inflammation and thickening. The mistak- ing the register of the pupil will oftentimes produce a chronic laryngitis in a manner somewhat similar to that described above. Unskilled teachers will frequently attempt to develop a tenor voice from one which nature intended to be a baritone or produce a soprano where there are only the qualities of a mezzo-soprano. This is also often done by un- scrupulous masters in their endeavors to please a certain class of people who judge a voice by the height to which its possessor can go. It is in the rendition of the higher notes of the register that the efforts of the singer will produce the species of inflammation under consideration. Why ? Because in the rendition of these notes a greater muscular action will have to be brought to bear on the vocal cords because the latter bands are not of the proper conformity to produce the desired tones with the unaided eftbrts of the delicate vocal muscles. Generally speaking the higher the voice the tliinner or finer will be the vocal cords. This state of aifairs is to allow of a greater velocity in the vibration of these little bands, for the greater the number of vibrations in a specified time the higher will be the resulting tone. Now when the cords are thicker as in a mezzo-soprano in the female, or a baritone in the male, in order to be made thin enough to produce tones that properly belong to the soprano or tenor, the cords will have to be stretched more than the delicate vocal muscles are able to do, hence the stronger or outside laryngeal muscles are made use of, the action of which bodies produce the same diseased conditions enumerated with reference to over-training. The following case clipped from my note-book will serve as a good 26 SINGERS' THROAT TROUBLES, illustration of this subject. Mr. G , a young gentleman aged about twenty, consulted me in January, '82, to ascertain if* possible the reason of his inability to sing. Upon laryngeal examination both vocal cords were seen to be congested and thickened, and tlie tissues in the imme- diate vicinity considerably inflamed. There was likewise visible in the larynx a large amount of mucous, which, as I afterwards ascertained, occasioned a great deal of annoyance from cough. These symptoms, as we have already seen, are those of chronic laryngitis and such was my diagnosis. Upon making inquiry, with a view of ascertaing in the cause of the trouble I elicted the following facts. About six months prior to his consulting me, my patient had placed himself under the tuition of a singing master of considerable repute in this city. Upon a cursory examination of his pupil's voice, the teacher set him down as a tenor and forthwith proceeded to train him as such. After the taking of a few lessons, the pupil noticing that it was exceed- ingly difficult for him to render certain tones, so informed his teacher, who in response told him that it was of no consequence, but that if he persevered all would turn out right in the end. My patient being of a persevering and enthusiastic nature, kept on in his endeavors, his master all the time compelling him to render tones which he was totally inca- pable of making without forcing the voice. Matters kept on in this wav for a time, the pupil gradually losing his vocal powers, until fortu- nately the voice broke down altogether rendering further tuition impos- sible. Such was the condition of aftairs when the sufferer applied to me for advice. After listening to the above narrative and informing my patient as to the cause of his trouble, he placed himself in my hands for treatment. His disease yielding readily to treatment, I discharged him cured, ■after the lapse of several weeks, with the strictest injunction not to use his vocal organs for at least six months. I did not see the gentleman again until the following December, when he called to have his vocal apparatus examined to see if everything was all right. Upon a thorough examination I found the parts perfectly healtliy in every particular, the vocal cords themselves being much stronger than when I last saw him. He then informed me that he had begun tuition again in September and that his teacher (not the former one) recognizing his voice as that of a baritone, was training it as such with very good results. INJUDICIOUS SINGING. Under this heading a great variety of causes may be arranged as producing chronic laryngitis, I shall, however, confine my remarks to the most interesting one of all, namely: the exercising of the voice when it is husky or hoarse. I think, nay, I am quite certain, that nine- tenths of the cases of chronic laryngitis among vocalists are produced 'IK I'll K CAIJSK AND ( (IRK. 27 in this manner. When the voice is husky or hoarse il is always a sign that tlie vocal cords are more or less congested. Now, as I have already stated elsewhere, when these bodies are to any degree inflamed, in order that such inflammation shall subside, it is necessary that the [)arts be kept quiet. As we all lns an; inarkf.-d in the nasal passages is conductive to the aljove form of laryngeal trouble in almost the same manner as enlarged tonsils, that is by offering an obstacle to the escape of certain tones, those traversing the nasal canals. What will eventually be the result if chronic laryngitis is allowed to remain ? Why an entire destruction and breaking uf) of the voice. The time for tl)is final giving out of the voice, will df|H.Tid entirely upon the manner in which the vocal apparatus is used. If il is treated barlly, a few weeks will be sufficient, but if, on the coiitr.irv. the voice is used carefully it may last for several months. The treatment of laryngitis as with the otlier forms of throat disease previously described, must be entirely of a local nature. The medicines used must be applied into the larynx itself through the agency of instru- ments especially designed for that purpose. There are three methods of making applications to the interior of the voice-box, namely: The compressed air spray method. The brush method, and finaly Insufflation. The spray treatment is essentially the same as that described when speaking of pharyngitis, with the single exception that the spray tube points downwards instead of forwards. The brusli method consists simply in the introduction of camel's hairbrushes attached to a long and curved handle into the interior of the laryngeal organ. Insufflation consists simply in the blowing into the larynx of medicated powders bv an instrument which is called an insufflater. Many singers have an idea that the direct application of medicines to the vocal apparatus is pi-oductive of great pain. This is a great mistake, for when the operation is performed by the skilled manipulator very little annoyance is occasioned and in some cases, particularly those of nasal catarrh, the treatment is rather agreeable than otherwise. Of course if a person who does not understand the throat attempts to treat it, much pain will result from his efforts Ji/sf, because of a lack of skill in handling the instrument, and second, on account of the medicines employed,, these persons generally using much too powerful remedies. CHAPTER V. PARALYSIS OF THE VOCAL CORDS. Paralysis of the vocal cords is by far the most interesting of all the types of laryngeal disease. In order to fully understand the description of the several paralytic affections to be shortly given, it will be abso- 30 SINGERS' THROAT TROUHLES, lutely necessary to stop foV a moment and look into the pliysiological action of the vocal cords. As I have fully treated of this subject in my work entitled •' The Throat in Relation to singing," I shall merely give a brief synopsis here. Vocal sounds are produced by the vibration of the vocal cords, which action is caused by the passage of the air-current through the chink 'of the glottis, the opening between the two vocal cords. W'hat does this vibratory action on the part of the vocal bodies do ? Why it divides the current of air into a large number of little currents which are then known as tone-waves. These tone-waves passing up into the mouth are formed into articulate speech by the action of the tongue and other organs contained in the mouth. The vocal cords are merely two thin elastic bands of tissue running across the larynx from before backwards, attached firmly in front to the inside of the voice-box immediately behind the prominence known as the " apple," and behind to two bones which are called the arytenoid carti- liges. The vocal cords together with their points of attachment to the larynx are beautifully displayed in the subjoined cut. P'igure I. Horizontal section of the Laryn.x. I. Outer framework of larynx. 3. Arytenoid cartilages, the bones to which the vocal cords are attached behind. 5. Vocal cords. 7. The point of attachment of vocal cords in front. In this drawing the cords are represented as being oj^en as during inhalation ; when they are brought together the passage between them which is then called the chink of the glottis, may be represented by a single dark line. The bones to which the cords are attached behind the arytenoid cartilages, are of the greatest importance since it is mainly by their action that the cords perform those movements, so characteris- tic of them and upon which vocalization principally depends. Since the princijially movements of the vocal bodies are dependent upon the action of the arytenoids it follows of a necessity, the muscles which preside over the vocal movements, must be attached to these cartilages. This indeed is true with a single exception which shall be presently alluded to. When the cords are separated as during respiration and it is desired to use the voice these bodies are brought together. This Til KIR CAIJSK AND CUKK. 31 action is known as adduction and is produced as you may easily imagine by simply drawing together the twtj arytenoid cartilages. This action is performed by a muscle whicli rinis from one arytenoid to the other, and is attached to both bones, 'i his Ijody, winch is rlisj^Iayed in figure 2, is called, from the effect whif;h its acti(;n has on the vocal cords the adductor muscle, a derivation from two Latin words, ad and ducto^ meaning to lead to. I. Epiglottis, or guardsman of larynx ; 4. cricoid cartilage, the body on which the arytenoids revolve; 5 arytenoid cartilages. T. transverse laryngeal muscle the adductor of the vocal cords P. abductor muscle or separator of vocal cords. Whenever it is necessary to take a breath during vocalization the cords must fly back or separate. This action is called abduction which term is a derivation from two Latin words ab and ducto meaning to lead from. This action is brought about through the agency of a single muscle, fig. 2. P.) which is attached as plainly shown in cut to the lower part of the ary- tenoid and the back of the cricoid cartilage. This muscle separates or abducts the cords by simply revolving the arytenoids outwards. In the above drawing the left muscle is only depicted, their being a similar muscular body on the opposide side. There are two other actions of the vocal cords, making four in all, which remain to be described, namely : tension and relaxation. TENSION is performed by a single muscular body called the ten- sor muscle. It is attached to the front of the voice box on the outside and tenses the cords by drawing the front of the larynx directly down- wards which increases the distance between the two points of attach- ment of the vocal cords in front and behind and stretches these banes. RELAXATION is performed by two muscles style the relaxors and which are attached to the same bones as the vocal cords. There is one of these muscular bodies for each vocal cord and they relax these bands by drawing together the two portions of the voice-box to which they are attached. PARALYTIC AFFECTIONS of the vocal cords may be most conveniently divided into four varieties, each one of which shall corres- Framework of the larynx seen from behind. 32 SINGERS' THROAT TROUHLKS, pond to one of the four movements desrribed above as characteristic ol the vocal bodies. These forms enumerated in their resi^eclive order are : 1. Paralvsis of adduction. 2. Paralysis of abduction. 3. Paralysis of Tension. 4. Paralysis of Relaxation. PAR.M>YSIS OF ADDUCTION is a lack of power in the ad- ductor muscles to draw together tlie arytenoids and thus adduct the cords. In this variety of paralysis which is shown below the vocal cords are permanently sejjarated from inahilit) on the part of the ad- ductor muscles to approximate them. a, a, the two arytenoids, h, back wall of larynx s, s, points of attachment of cords to arytenoids, c, opening between the cords, k, attachment of two cords to front of larynx. The annexed illustration, which is simply an outline drawing, will give a pretty good idea of this variety of laryngeal paralysis. When an attempt at vocalization is made the vocal cords instead of approximating or coming together, as they naturally would in a healthy larynx remain permanently fixed at the sides of the voice-box. Why ? because the transverse muscle (see fig. 2) which presides over abduction, being par- lyzed, is unable to perform its duty, namely, the drawing together of the arytenoids and with thcin the vocal cords. What will be the effect of this form of laryngeal disease upon the voice ? A complete loss thereof, both in speaking and singing ; because the cords not being able to come together there can be no vibration in them. This, which is the most prominent symptom of par- alysis of adduction, is called aphonia. The only other symptoms liable to manifest themselves in this affection are a slight cough and irritation due to a congestion of the parts. PARALYSIS OF ABDUCTION is simply an inability on the part of the abductor muscles or separators of the vocal cords, to abduct or separate these bodies. In this variety of paralysis the two cords remain jjermanently fixed in the middle of tiie larynix as shown in l''ig. 4. Paralysis of adduction of vocal cords. THEIR CAUSK AND CURK. 33 Paralysis of abduction of vocal cords. A. A. arytenoid cartilages ; I!. I'., paralyzed cords ; C. front wall of larynx; D, back wall of larynx. The cords occupy the above position because the adfluclor muscles, acting properly, bring together the cords, but the abductor muscles being inactive on account of paralysis are unable to bring the vocal bodies back to the sides of the larynx. The two sets of muscles, the abductors and the adductors, when healthy are antagonistic to each other, conse- quently when either set is paralyzed, there being no opposing forces brought to bear against the healthy set it acts continuously, thus when the abductors are paralyzed, the adductors keep the vocal bodies permanently united. The muscle involved in paralysis of abduction is depicted in fig. 2. (P). It, as we have seen, abducts the cords by revolving outward the arytenoid cartilages. In order that air shall pass through the larynx in its journey to the lungs, it is absolutely necessary that the vocal cords be widely apart. If this condition be not permitted and the cords are drawn close together, no matter how slight may be the degree of such approximation, the proper performance of respiration is interfered with. The most prominent symptom of this form of laryngeal paralysis is a great difficulty in breathing or dyspnoea as it is technically called. When the paralysis is complete, that is to say, wlien the cords are in direct opposition, the above interference to respiration is marked, and the occasion of the greatest suffering, all the air that enters the lungs having to pass through the narrow opening known as the chink of the glottis. The voice is not apt to be much interfered with, because the vibratory power of the cords is not destroyed, and because these bodies are approximated in the proper manner to produce tone. The difficulty of breathing above described comes on in spasms, as it Avere, during each of which the life of the sufferer is seemingly in great danger. Aftera Avhile inflammatory action is set up in the larynx which, on account of the accompanying swelling, greatly increases the suliterings of the patient. The above symptoms increase until finally, unless relief is afforded by surgical interference, the sufferer must die. Fortunately paralysis of abduction, as depicted above is an extremely rare affection, this disease being generally of a partial nature, and its symptoms therefore some- what modified. Upon inspecting the larynx in a severe case of paralysis of abduc- tion, the picture presented upon the laryngoscopic miiTor will be most striking. The vocal chords will be seen drawn together and lying almost 34 SIJJGERS' THROAT TROUBLES, motionless in the centre of the larynx, and the opening between these bodies, the chink of the glottis will be clearly defined and about a line in extent. The larynx will also be seen to be the seat of inflammatory action, the mucous membrane being quite red and somewhat swollen. PARALYSIS OF TENSION is an inability on the part of the tensor muscles to stretch the vocal cords. In this variety of laryngeal paralysis the vocal cords, when adducted. jn-csent a relaxed condition from a lack of action in the muscular body presiding over tension. Ad- duction and abduction are in no wMse interfered with, the vocal cords being approximated and separated in a perfectly normal manner. Upon laryngeal inspection the picture presented in this afteclion is somewhat like the subjoined cut. A A, arytenoids ; B B, relaxed cords ; C, front wall of the larynx ; D, back wall of larnyx ; E, ellipitical opening between cords. In order to thoroughly understand this form of laryngeal paralysis, as well as the variety next to be described, it will be necessary to glance for a mo- ment at the effect exerted upon the singing voice by the two vocal movements called tension and relaxation. When the two cords are brought to- gether by the phonatory act, a tone located about the middle of the vocal register can be rendered without much action on the tensor or relaxor mus- cles. If, however, a higher note be demanded, in order that the vocal bodies shall make the required number of vibrations they must be made tensor. This duty is performed by the tensor muscles, which bodies stretch the cords as we have already seen, by pulling the front part of the larynx downwards. The higher the note is placed in the scale the more will it be necessary to tense the cords. Now, supposing when the cords are brought together a lower instead of a higher note is required what then must transpire? Why the cords must be relaxed, for the reason that the number of vibrations necessary to produce a lower tone is less, and that in order to diminish the number of vibrations in any giving period of time, the aid of the relaxor muscles must be invoked. The lower the note the slower must be the vibrations, and consequently the greater must be the relaxation of the vocal bodies. When, therefore, the tensor muscle is paralyzed and unable to perform its function, that is the tightening of the vocal cords it will be impossible for the affected person to render, in any degree, the higher notes of the register. PARALYSIS OF RELAXATION is an inabihty on the part of the relaxor muscles to perform their function, namely the relaxation or THEIR ClAliSK ANF) CUKK. 35 loosening of the vocal cords. In lliis species of vocal paralysis, wliile the cords can be broiiglil to^rcther and separated in a perfectly normal manner it will be inip()ssil)lc to relax them. 'I'he relaxor muscles, which are called the vocal muscles par-excellence, relax the cords by drawing together the two points of attachment of the vocal corrls, which action of course loosens these bodies. In the above movement, the relaxor muscles are directly antagonistic to the tensor muscles. Now supposing from paralysis or other cause, the relaxor muscles are unable to relax or loosen the cords what will hap[)en ? Why the tensors having no oppos- ing forces to contend against will keep the cords in a perpetual state of tension. As you have undoubtedly already suspected the effect upon the voice by the variety of laryngeal paralysis under consideration will be an inability to render the lower notes of the register; because the vocal cords cannot be relaxed enough to allow of a sufficiently slow vibration for the production of these tones. I had, several years ago, a remarkable and instructive case of this form of laryngeal paralysis which I think will be interesting to the singer. Mr. H., aged about 35, consulted me October 16, 1879, at the sug- gestion of his vocal teacher, to obtain an opinion regarding a peculiar defect in his voice. Upon interrogation I learned the following history. About two years previous, after an attack of cold, Mr. H. noticed that in talking the tone of his voice had altogether changed; that while previous to his " taking cold " he could talk in the ordinary tones of an adult male, he was subsequently unable to lower his voice, but was compelled to speak in his upper register ; in other words, his voice was the fac-siml/e of a. hoy's prior to the change which occurs at about the age of fourteen. The singing voice was likewise similarly affected, it being impossible for him to render any of the notes above the middle register. Thinking that time would mitigate the difficulty, my patient pursued no course of treatment other than an attempt to regain his lost powers by vocalatory exercises. This latter procedure being entirely void of good result, he was induced to seek medical advice. At the time of seeing Mr H., the difficulty above described was so manifest that were I to have conversed with him a dark room I would most cer- tainly have pronounced him a boy of about twelve or thirteen. Upon laryngeal examination I found the larynx comparatively healthy, there being but a slight amount of congestion in the tissues adjacent to the cords. Upon requesting the patient to phonate I noticed that although adduction was performed perfectly, the vocal chords were both in a state of great tension — such a condition in fact as one would expect to find during the rendition of the higher notes of the register. Again and again I repeated the experiment, requesting the patient to render certain musical tones, with a similar result, each successive examination confirm- ^6 SINGERS^ THROAT TROUBLES, ing its predecessor. The most ciiriovis circumstance connected with the whole case was the following: by pressmg on the front of the larynx in the neighborhood of Adam's apple, the voice suddenly assumed a natural cliaracter, drojjping from the tones of a boy to those of an adult male. As long as this pressure was kept up Mr. H. talked quite easily in what would naturally have been his voice, were not his larynx the seat of the paralysis of the relaxor muscles, but the moment the hand was removed from the throat, the voice assumed its former unnatural condition. The reason of the dropping of the voice when pressure was exerted on the voice-box, was that this action took the place of the paralyzed muscles and relaxed the cords by diminishing the distance between the points of attachment of the vocal bodies. The causes of the several forms of paralysis enumerated above are oftentimes involved in obscurity. Mental emotion will sometimes produce them ; instances of sudden loss of voice through fright being quite common. The variety of laryngeal paralysis described under the head of paralysis of ai^duction, and which is characterized by great interference with respiration, is gen- erally caused by pressure on the laryngeal nerve which thus interferes with or shuts oft" the nervous supply to the larynx. Overwork is a fre- quent cause of laryngeal paralysis in the vocalist. Many great singers have lost their voices at some time or another by this practice. The immense price sometimes paid to these artists stimulates them to sing through a long season and many times when they are utterly unfit to per- form. 1 know of several artists now very popular, who are doing too much vocal work, and which will end up by an entire destruction of their voices unless they take the much-needed rest. Since the reign of comic opera many have risen and fallen, and this will continue to be the case as long as the singer is compelled to vocalize six nights a week and two Biatinees. No artist who has a good voice should endanger it by such continuous action ; it is too much to expect of the delicate vocal cords, and it will assuredly tell upon them in the long run ; it is simply a matter of time. STRAIN OF THE VOICE is another frequent cause of vocal paralysis. This is often the result of vocalizing with the cords at too high a tension, or in other words attempting to sing entirely outside of the normal register. Some forms of vocal paralysis, especially that type described under the heading of paralysis of abduction, are exceedingly difficult to cure. Those varieties, however, which are so often found in the throats of singers, as a direct result of abuse of the voice, are amenable to treat- ment and oftentimes speedily cured. As in paralytic affections of other parts of the body, electricity forms the sheet anchor of hope in the treating of laryngeal paralysis. THEIR CAUSE AND fJURR. 37 The inetluxl of its .-ulmiiiistration is most iiniijiic, .-ukI simply f:f>ri- sists in the introduction into the huynx itself of wh;it is known as a larngeal electrode. Fig. 6. Instrument for the introduction of electricity into the larynx. This instrument is connected to an electric battery by means of a fine wire which is attached to the little ring on the under surface of the handle. When inserted into the air tube, the spring located on the upper surface of the handle is depressed, which allows the electricity to travel through the instrument and into the larynx. By this method of treatment the electric current is brought into direct contact with the paralyzed cords. This is a great improvement upon the old method of application, which simply consisted in the electrization of the outside of the throat through the agency of sponges. I have frequently seen cases of paralysis of the vocal cords subside after a few direct applications of the laryngeal electrode when persistent treatment externally with the electric sponges have failed to give any relief whatever. Dr. WHITFIELD WARD. 208 West 25th Street. Singers' Throat Troubles T HEIR Lause and Lure BY AATHITFIELD ^A^ARD, A. M. M. D. Physician to the Metropolitan Throat Hospital ; author of " The Throat in Relation to Singing," etc. PUBLISHED BY THE GRAND CONSERVATORY OF MUSIC PUBLISHING CO. 46 West 23d Street, New York 1885 Date Due ' f) h