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 hara.s.sing 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 cla.s.s, 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.

Paralysis of the vocal cords const.i.tutes a second form of vocal catastrophe. It should need no definition. In reality, however, the paralysis does not lie in the cords themselves, but in the leading muscles that control in phonation. There are many forms of this particular example of vocal catastrophe, though I am now dealing only with those which are liable to attack a singer, and which are most frequent in my own experience.

With the singer one form is common, viz.: paralysis of the left adductor muscles, or those which inspire the arytenoid cartilage in drawing the left vocal cord forward to meet its fellow for the production of tone.

No one can ever forget the sight presented by the left cord in its helpless condition: the arytenoid, tipped with its cartilage of Santorini, extending far over the median line of the glottis and drawing after it the right vocal cord in a vain endeavor to put it in position where it can aid its injured mate.

The paralysis may, of course, occur on both sides, and then it is that, on the side which is most exercised, there is felt a sense of distress, of pain and sudden fatigue. This condition generally arises from prolonged singing, and many of the cases I have seen have been the result of overwork during Easter and Christmas; and all of the cases which have come under my observation were a.s.sociated with rheumatic const.i.tutions. Fortunately for these singers, when the conditions were made known to them, they were in a position, or at least were perfectly willing, to rest, because of the fear that a knowledge of their condition instilled. Indeed, the situation is always one to cause serious alarm. The beautiful symmetry of the arytenoids is impaired and the agility of the voice is destroyed. If the singer persists in his vocation, total disability results. As a rule, complete rest is enforced by reason of inability to sing at all. If the voice is continued in use, the affection becomes permanent and there is one more case of irremediable vocal collapse. The remedy is rest, and that, too, before the disease has pa.s.sed recoverable ground. If the singer experiences pain on either side of the thyroid cartilage, or on either side of the Adam's apple, then let him by all means have a care, for those are the symptoms of this peculiarly menacing form of paralysis. In the voice a palpable hoa.r.s.eness is manifest. The voice becomes "fuzzy" throughout its entire compa.s.s. A p.r.o.nounced disability to make a _crescendo_ arises, and when the effort is made (for in the described circ.u.mstances use of the voice is attended with undue effort), the tone becomes coa.r.s.e and uncontrollable. The range of the voice is lessened and the singer finds difficulty in reaching the upper tones. In the general debilitation the singer tries, or rather is compelled through weakness, to poise the voice from the cords themselves and not from the diaphragm.

Of the other forms of vocal-cord paralysis there is one of great interest, known as hysterical paralysis. It is usually only temporary, and is sometimes produced in singers whose nervous condition grows upon itself until the system pa.s.ses into the trying disturbance diagnosed by the rudely critical public as "stage-fright." Artists of marked pretension have been compelled to abandon a public career because of this affliction. There are other examples of it even more difficult to understand. I have in mind a case of a singing-teacher in a conventual school, who was under a peculiar strain of preparation for the commencement exercises of the school and of her own cla.s.s and their appearance in public. She brought her cla.s.s up to the appearing-point.

Then her nervous system gave way, and when she came to me she was absolutely voiceless. Sometimes in coughing her vocal cords could be seen to move. With rest she recovered, but she has a recurrent tendency to the same trouble every year. The case would seem to ill.u.s.trate the uselessness of all effort on the part of the person so affected permanently to overcome it. The remedy is at hand, however, in numerous cases, in resort to a careful and uninterrupted upbuilding of the nervous system.

I will mention some other cases of vocal disorder and cure. An operatic tenor came to me with a tendency to break in scale-sounding, and with a nasal or catarrhal color to all his tones above E. I found attached above and back of the soft palate a ma.s.s as large as a hickory nut and completely blocking up the dome of the pharynx. A little cocaine was applied, and with a single sweep of the curette he was minus an adenoid on the third tonsil, a tonsil of Luscha. Within ten days his voice was completely restored.

Sometimes the physician is obliged to seek far for the cause of catastrophe to the voice. A fine and thoroughly well-trained tenor singer came to me with a singular tremor in his voice. The entire scale was tremulous. I found nothing the matter with any part of his vocal tract save that, on closely studying the condition of his mouth, there was a rapid muscular contraction of the soft palate and surrounding tissues. This led me to examine him from head to foot for possible nervous disorder, of which, however, I found no trace. Then, satisfied that there must be a more remote physical cause, I pushed the examination further and discovered traces of kidney affection. He was successfully treated for this and, with its cure, his voice also was restored. This case shows the close relationship between parts of the physical const.i.tution and the voice, and ill.u.s.trates the importance to the singer of a generally healthy physical condition.

Another case ill.u.s.trates a further and somewhat peculiar phase of the subject. From the posterior nasal pa.s.sage of a singer I removed nine large adenoid tumors. He was a tenor, and within a few days his upper tones were perceptibly freer and fuller. He had recently changed his instructor; and subsequently I found that he was attributing to this teacher the marked improvement in his voice. The physician was receiving no credit as a voice-builder whatsoever from either of them--which shows that in addition to a keen knife, the specialist should also possess a keen sense of humor.