the voice of the singer was perfectly even except as to the G sharp in the medium, which was entirely wanting—as though it had never existed.
The singer in question came to me after an Easter rehearsal. I tried her voice with the E-scale before using the laryngeal mirror, and to my utter surprise found the medium G sharp missing, while all the rest of her scale was perfect even to the G sharp above. This experiment was tried repeatedly with the vowels a, e, i, o, and u, and with consonants prefixed, but invariably with the same result. Upon examination, no deviation from the normal anatomy was found, save in the left anterior nostril. Here a sharp spur of bone projected from the septum into the turbinated tissue. This condition had remained in this singer for four years, according to my previous observation, without causing her any inconvenience. A similar condition was seen by me in the case of Mr. Santley, the famous English baritone, when I made an examination, and he declared that he was not aware of its producing even discomfort—such a capital illustration of the necessity for non-interference until the laws of reflexes are disturbed, that I cannot refrain from alluding to it.
In my patient, however, in addition to her nasal trouble,
I found an enlarged follicle about the size of a pea back of the posterior pillar of the pharynx, at the junction of posterior pillar and pharynx. This follicle was removed by a simple process, when, as if by magic, the G sharp responded and has since remained unimpaired. My explanation of this case is simply one of reflex action; that is, by a singular complication this follicle fell in the track of the glosso-pharyngeal, the pharyngeal-plexus, the external-laryngeal and the recurrent laryngeal nerves, which, as it were, sounded the alarm for retreat of the phonating muscles whose harmonious action was necessary to produce the medium G sharp.
There are numerous instances of affections of the vocal cords that might be cited, all superinduced by straining the voice from various causes, but especially by using the voice under improper physical conditions or of singing in rooms filled with foul atmosphere.
CHAPTER XII
NODES AND THEIR CURE
I use the scale of E as a means of revealing to the ear points wherein the voice shows signs of failure. I use this scale because within it lie all the principal resonances involved in voice-production. By this I mean that somewhere between the interval G# to C# an oral resonance is developed in the majority of voices. This seems to be coincident with the action of the lips, the tongue and the soft palate, and the other muscles that go to increase or to decrease the size of the oral cavity. From C# to E above middle C the principal changes occur which contribute to the development of the nasal resonance. Some rare voices, however, continue their oral resonance as high as F# before changing. It has occurred to me so often in the course of my practice that a peculiarly apt reason exists for making E the foundation-note of the test-scale employed in the operating room, that I lay particular stress upon it. It has seemed the most easeful note for the patient to sound, whatever his vocal condition, and I have been tempted to call it the "nature tone,"