The Voice: Its Production, Care and Preservation

by Frank E. Miller

Another cause of the node is a lack of cordal coördination. Were the human form perfect, both cords would be equally strong. As a matter of fact, in my own experience, I have found that the major portion of nodal formations appear on the left cord,

indicating that it is the weaker. The fact that one cord is slightly lax while the other vibrates at full tension along its face causes trouble. Another source of difficulty is subglottic, owing to inflammation of the mucous membrane in the trachea, which extends upward and involves the cords. The inflammation, passing upward, may easily affect the voice. Such inflammation is discovered by a tickling sensation in the trachea, causing a dry, harsh cough about the third day after a cold has found lodgment "in the head," as the phrase goes.

The node has been the cause of vocal catastrophe from opera houses to concert halls, yet a reasonable amount of precaution will minimize the chances of attack. Singing in a room where there is smoking is a prolific source of node formation. Breathing dust-laden air, continued effort to carry on conversation on the cars or amid street noises, are fruitful causes of vocal disorder.

The mucous membrane of the vocal cords obeys natural laws in restoration. A node may disappear in three days, if not teased with effort. More often, however, it requires from seven to ten days for it to disappear without treatment. If the singer foolishly persists in using the voice, the node will extend into the cord tissues, and result in a most unfortunate

condition. The cord loses its elasticity. It refuses to respond. It will neither act nor will it consent to be acted upon. It is in a state of collapse, and the voice for singing purposes has gone, never to return.

Let me illustrate what rest will do for a node. A singer came to me with a node of three months' standing, on the left cord. She had been singing with her teacher in the regular course of her lessons at an unfortunate time, when, too, she was vocally weak. In singing up the scale, and at the C (as nearly as she could remember), she became hoarse, and, as she described it to me, "the voice had a hole in it." Throughout the remainder of the lesson, unless she exercised great care, she would always break at the point named. Her nose seemed stuffy, and she compared her nose and throat to a cornet lined with velvet. After the break, and for the remainder of the lesson, her voice was husky. Her teacher advised her to seek expert advice. Previously, the voice had been clear, though she was a novice in singing. After remaining away from her lessons for two weeks or more and finding that recovery was not rapid, she came to me. The node could be plainly seen on the left cord. Before examining her, I tried the voice with the

E scale, wrote down the diagnosis and handed it to her to read. My written conclusions were verified with the laryngeal mirror. I found no trouble except with the left vocal cord, the node being in the anterior middle third. On the summit of the node the mucous membrane appeared very red, budded, and almost warty. I cocainized the cord, and immediately applied pure alum in solution to the node itself, but to no purpose. This treatment was continued for two weeks, without any perceptible change for the better. Then I ordered the patient to remain quietly in a closed room; she was to see no one, she was not to talk at all, she was not to laugh. As harassing as was the experience, she faithfully observed the directions, and on the fourth day every vestige of redness had disappeared. Only a slight elevation remained on the cord where the node had been. The treatment was continued three days longer. At the expiration of that period no trace of the node could be seen. Now no one would suspect that a node had once affected her voice. Experiences like this indicate why I counsel against use of the voice under diseased conditions.

As a general proposition, all throat spraying is dangerous. A New York singer, suffering while on

a concert-tour from a case of sub-acute laryngitis, sought advice from a physician who honestly tried to aid him, but shot wide of the mark through injudicious use of a spray, in which he used menthol and eucalyptus, a combination much affected by a certain well-meaning class, and which for a time gives to the throat a delightful sense of coolness. The singer became afflicted with a violent, explosive cough, which caused the formation of a node. He gave up singing, losing nearly $1,000 in engagements. He went to his own room and to bed. He remained in his room for three weeks. The temperature was carefully watched. He did not expose himself in the slightest degree, nor did he use his voice. The result was a perfect cure.

Another case is that of a church singer whose throat during a religious festival service became filled with the smoke of incense. The irritation caused a troublesome cough, and she lost her voice entirely above the top F#. It required fourteen days to effect a cure. She stopped singing for six days and then sang in church, with the result that the difficulty returned, augmented. She sensibly rested the succeeding week and perfected a cure. Rest did far more than any amount of medicine, however it might have been administered.