The essentials, then, for a view of the interior of the larynx are: A source of illumination; a mirror to reflect the light reaching it from this source into the back of the throat and larynx; and a second mirror to reflect the light outward which is, in the first instance, reflected from below, from the interior of the larynx. The principles involved are few and simple, but their application to any particular case is not easy, and is sometimes well-nigh impossible.
The throat-mirror should be placed against that curtain suspended in the back of the mouth cavity known as the soft palate, so that it must be pushed back out of the line of view. But many persons find such a foreign object in the throat a sufficient cause of unpleasant sensations so that retching may be the result. Generally there is a tendency to raise the tongue behind in a way fatal to a view of the mirror and the picture reflected from it. These difficulties, however, can be overcome by a deft hand using the mirror brought to "blood heat" by placing it in warm water or holding it over some source of heat, as a small lamp, and directing the subject observed to breathe freely and through the mouth. This latter tends to quiet that unruly member, the tongue, and lead it to assume the flat position so important to an unobstructed view. It is for the same reason the author urges mouth breathing during speaking and singing. No other tends so well to put the tongue in the correct position.
The extent to which one feels the annoyance of a small mirror held gently in the throat depends really on the amount of attention directed to it, and the degree of determination with which he resolves to exercise self-control. The author has examined an entire class of students of voice-production and found only one person who did not succeed in at once giving him a view of the larynx. But it must be at once said that of all persons examined by the author during his experience as an investigator of voice-production and in special medical practice, none have been able to show their throats, the larynx included, so well as speakers and, above all, singers; which in itself indicates that speaking and singing do give control of the throat—that all its parts respond to the will of the observed person. The author must further, however, remark that he has found this control associated not so much with vocal power as with intelligent study. Intelligence tells in music a good deal more than many people have yet learned to believe; but on this point the reader will long since have learned the author's views—in fact, so deep are his convictions on this subject that he hopes he may be pardoned for frequent reference to them, in one form or another.
One anatomical fact may be so invincible that a view of the glottis cannot be obtained at all: the epiglottis may so overhang the opening to the larynx that a good view of its interior is absolutely impossible, in other cases only occasionally and under very favorable circumstances. Such cases are, however, of the rarest occurrence, while there are not a few persons in whom one may even see down the windpipe as far as its division into the two main bronchial tubes, and inflammation may thus often be traced from the vocal bands far down the mucous membrane common to the larynx, windpipe, etc.
As has been remarked previously, it is only by the use of the laryngoscope that one can see the vocal mechanism of the larynx in action, so that for investigation laryngoscopy is essential. Auto-laryngoscopy, or the use of the laryngoscope by the subject to observe his own larynx, has its special difficulties and advantages, the greatest of the latter being, perhaps, that the observer may use himself as often and as long as he will, while he would hesitate to make observations on others at great length or with frequent repetition. There are no new principles involved in auto-laryngoscopy. The observer must simply see that a good light is reflected into his own throat, and that the picture in his throat-mirror is reflected into another into which he may gaze, an ordinary small hand-glass usually sufficing.
Only rarely is the individual met who can himself so control his tongue that assistance from the observing laryngologist is unnecessary. In by far the greater number of instances the tongue, after being protruded, must be gently held by the left hand of the observer, a small napkin covering the tip of the organ. The auto-laryngologist must, of course, control his own tongue, and better if without any hand contact.
It is scarcely necessary to say that before placing the mirror in the mouth its temperature must be tested by touching it for a moment against the back of the hand.
Nearly all the facts of importance in phonation, several of which have already been referred to, or will be mentioned in the "Summary and Review" below, could only have been discovered by the use of the laryngoscope. The difference in the larynx in the two sexes and in different types of singers and speakers, though open to ordinary observation, dissection, etc., are still better brought out by the use of the instrument now under consideration.
One naturally expects any organ to be larger and heavier in the male than in the female, and to this the larynx is no exception; and individual differences are equally pronounced. There may be almost if not quite as much difference between the larynx of a barytone and of a tenor as between that of an ordinary man who is not a public voice-user and the larynx of the ordinary woman. The larynx of the contralto may in its size and general development remind one of the same organ in the male. The vocal bands of the bass singer may be to those of a soprano as are the strings of a violoncello to those of a violin—using these examples, it will be understood, merely as rough illustrations.
The change in the size of the larynx produced by even a few months' judicious practice may be astonishing. As already hinted, it is important that in bringing about this development exclusive attention should not be given, as is sometimes done, especially in the case of speakers, to the lower tones, though it is not so important for them as for singers to have an even development up to the highest range.