More Vocal Hygiene

Vocal hygiene is a specific system based upon well-regulated principles

for a specific purpose and applying to a specific class in the family

of nations. But there is the difference that, whereas the laws governing

the general health of the community have legislative sanction and are

strenuously enforced by official authority, the laws of vocal hygiene bear

no seal of state or municipal power, save in the broadly general sense

indicated, but rely for enforcement upon the individual who is most

nearly involved, and who must pay swift penalty for any infringement,

however slight and however innocently committed.

While this is a truism, yet it cannot be too strongly emphasized nor too

often reiterated; for with all their notable precautions, singers are

often taken unawares and fall when most they desire to stand. Why? They

are simply paying the penalty of a broken law, and it does not help them

with a disappointed club committee, or in framing a telegram of regret,

accompanied by a physician's certificate, to say that they have erred

through ignorance. The aphorism that ignorance of the law is no excuse

is just as valid in the court of the hygienic judge as in any common law

court between the oceans.

It is the prevalent practice to use the physician as the court of last

resort. But it would be vastly better and far more sensible if the

singer could be made to act with swift authority as an agent of

prevention over the weaknesses of his or her own nature. The subject,

thereby, would be vastly simplified. It would not be so profitable to

the specialist; but I can vouch for it that he would not only forgive,

but praise the discretion of his patient, and lend all possible aid to

educate him along a new scientific path--that of prevention. Not a

new path, either, for in its last analysis what is hygiene but the

science of prevention? Preservation of health means the prevention

of disease. This answers the cry of every artist's heart, especially

that of the vocal artist, teacher and student: How can I prevent

disease and weakness of the vocal machinery? Briefly and plainly: How

can I keep well?

In this important matter of vocal hygiene a prominent part is played

by the mucous membrane. What is the mucous membrane? It is the membrane

which in this special sense covers or lines the respiratory tract from

the very outlet of the nose to the terminal bronchi; in fact, to the

very air-cells of the lungs themselves. Its function is that of

supplying the involved passages with moisture, and it secretes a glairy

or watery substance called mucus. Now, mark this well. The entire area

of the respiratory tract, from the nose to the bifurcation of the

bronchi, it is said on good authority equals one square foot of exposed

surface, and the amount of secretion per day equals about sixteen fluid

ounces, or a pint, which must be secreted by a person in the normal

condition of health. It also has the power of absorption of certain

diverse substances, such as alkaloids, fluids of all kinds, hence the

danger of alcoholic indulgence to the singer. Alcohol coagulates. It

causes the epithelium to contract and to become so disintegrated as to

be utterly incapable of performing its functions until such time as the

underlying tissue shall have created new cells to take the place of

those which have been destroyed. To illustrate briefly the varied

functions of this membrane: Whereas alcoholic stimulant destroys it,

another powerful drug, cocaine, is absorbed, often to such an extent

that the patient is prostrated by the poison introduced into the system

by this means, and yet without impairing the membrane to any extent

except through persistent indulgence.

The mucous membrane is the telltale of conditions. If a man's tongue

is coated with detritus--which, anglicized, is nothing more than the

products of decomposition, a coating formed by over-stimulation of the

glands lying at the base of the tongue--and this has been previously

superinduced by a disordered stomach, we know that the cause is

indigestion. If the follicles in the back part of the pharynx or throat

appear distended, and even the tonsils themselves are affected--and

these again are part and parcel of this same mucous membrane--we can say

this is due to one of several causes: either to a reflex condition from

the stomach, due to over-eating or over-indulgence of some other equally

deleterious sort, or to inactivity of the bowels, or to suppressed

perspiration, or to improper or undue use of the vocal organs.

Again, let us glance for a moment at what a good many people deem a

superfluous appendage, the uvula. A patient comes into my office with a

badly swollen uvula. The upper tones of the voice are gone. He has no

complicating quinsy, and in that case I can say without hesitation that

he has outrageously misused his voice. I ask him where he was the

previous afternoon, and find he was jubilantly "rooting" for the New

York Giants in an exciting baseball contest. Now, it in nowise lessens

the force of my illustration that this patient was not a singer and did

not acquire, if you please, his swollen uvula in orthodox fashion. It is

only a short time ago that a man came to me with a pronounced case of

oedematous uvula, or swollen soft palate. He announced to me that he

was no longer a tenor singer, although he had sung tenor for three

years; that lately he had been persuaded that his voice was baritone;

and, indeed, he had been singing, up to the time of coming to me, a

baritone part in opera. It was this which brought him under my hand

as a patient. He had changed his teacher, who had insisted that he was

a tenor, within two months, and since that time had been under the

instruction of the master who had declared that he was a baritone. I had

known him for some time, and the only perceptible change to me in the

voice was a decided tendency to cover and sombre the upper tones. Upon

examination, the only thing abnormal was the condition of the soft

palate and the surrounding tissue extending down both pharyngeal

pillars. The soft palate was swollen to nearly three times its original

size and hung down upon the tongue. The symptoms he complained of were

inability to sing above F, and all high tones were husky. The production

of the upper tones was accompanied with considerable pain. An emollient

gargle was given and, soon after, astringent applications; but in vain.

It was necessary three weeks afterward to amputate the uvula. Within

three weeks more the operation was demonstrated a success in that the

upper tones were fully restored; but I leave the question with the

teachers whether this operation would have been necessary had not this

young tenor been drawn aside on the purely theoretical issue as to

whether he was not a baritone instead.

In the case of one of New York's most experienced singers, it required

two years of persistent effort on the part of both patient and physician

to overcome the habits of a lifetime. The case is of general importance

for the reason that the habits he had formed are more or less common to

all of us, though perhaps not to such an aggravated degree. He was an

inveterate smoker and a confirmed coffee drinker. These habits reflected

themselves upon the poor, defenceless mucous membrane, whose function

was perverted as shown in the constantly congested appearance of the

respiratory tract. I have seen this artist with congested vocal cords

rehearse an oratorio in the afternoon at a public rehearsal and sing the

same work in the evening at the regular concert performance, when, to

use his own words, "I feel as if every note will be my last. I have no

grip on my voice." It was a clear case of indomitable will and sheer

physical strength carrying the singer over obstacles that even to my

mind seemed well-nigh insurmountable. A cure was effected in this

obstinate case simply by insisting upon observance of hygienic law.

There is no better instance of efficacy of vocal hygiene than in the

case of this man. The gradual reassertion of nature, as indicated by the

clearing up of the inflamed mucous membrane of the nose, the thickened

condition of the pharynx and the chronically congested cords, was an

all-sufficient reward for anxious thought spent upon an important

subject. You may ask what was the remedy in this case. It was simply

advice given and heeded, together with needed incidental treatment. I

cut off his coffee and cigars, not immediately but gradually. He had

sufficient force of character to aid me by heeding the counsel. The

result was a diminution of secretion of the mucous membrane and a return

to normal conditions.

Right here there is another phase of the situation to which I desire to

call particular attention, not alone because of its vital importance

to the singer, but also because of the danger to the unschooled student

of neglect of what we ordinarily term a cold in the head in its first

stages. By the first stage of the cold I mean that condition which

obtains before the stage of secretion is arrived at, where the mucous

membrane is being congested, where it is almost impossible to

distinguish what is the highest point of normal stimulation under which

the membrane may be expected to do its best work. This point may be

aptly illustrated by comparison with a singer under perfectly normal

conditions. Then, as is well known, it is the mental impulse that

stimulates nerve, muscle and membrane to do their best work. But in the

other condition this result is attained without the mental impulse, as

we have the mucous membrane and the blood-vessels carried to a temporary

climax of effectiveness due to the systemic disturbance. By this I wish

to make clear my point, that artists have often noticed an unusual

brilliancy of voice under circumstances which were all the more

mysterious because of the sudden collapse of the vocal organ under

stress of use, and the alarming suddenness of the catastrophe which

overtakes them and leaves them totally incapacitated. Then they say, "I

have a cold;" whereas it requires from twenty-four to thirty-six hours

for the fulfilment of these conditions. They should have reached this

sensible conclusion just two days before. I take issue with those

physicians who urge that certain exercises should be given to the artist

when the vocal cords are in a state of congestion, for the reason that

it requires a period of from ten to fourteen days for the complete

relief of this inflammation. During that period, the blood-vessels are

fully employed absorbing the products of the inflammation, and any

attempt to interfere with this necessary process of nature can end only

in disaster or in a prolongation of the difficulty. This is the law of

pathology, unalterable and not to be evaded. Physicians at times resort

to soothing and astringent applications in an emergency, to carry the

artist through a performance; but the lack of edge to the voice for

weeks following is an all-sufficient indication of the revenge nature

takes for this trespass upon her domain.

The cause of the sudden disaster to the voice which I have described is

not far to seek. The cold has caused over-stimulation of the mucous

membrane of the larynx, and a consequent loss of voice. This cold begins

in the head, and on the third day, perhaps before, it has attacked the

larynx. Why? Because the mucous membrane has become so swollen that the

nasal passages are obstructed and the mucous membrane of the larynx has

to perform a double function, that of heating the air as it is brought

to the lungs in the process of respiration, as well as carrying out its

own obligation to the scheme of nature. By a strange coincidence, this

membrane of the larynx is supplied with sensation by the same nerve

that conveys motion to one of its tensor muscles. This is the superior

laryngeal nerve. By the thickening of the mucous membrane, all the

intrinsic muscles of the larynx are interfered with, and, consequently,

total extinction of the voice follows swiftly upon excessive

inflammation. There you have it in a nutshell. The mucous membrane of

the larynx and the bronchial tubes, to enlarge upon its duty for a

moment, is endowed with very fine, hair-like processes called cilia,

whose action is to waft secretions from the interior of the lungs

outward. Hence the danger of promiscuous spraying with all sorts of

everyday nostrums, or of anything which may interfere with the activity

of these minute bodies or the media in which they operate.

This intimate relation of nerve and muscle and mucous membrane is best

illustrated by the sneeze. The explanation of this is an over-stimulation

of a part of the mucous membrane of the nose called the Schneiderian

membrane. If we analyze the sneeze, we find that it simply consists of a

spasm of the pharynx, larynx and diaphragm through the reflex action of

this membrane. The over-stimulation of the membrane, in the case of the

singer especially, may generally be set down to an incipient cold; but

any inflammation of this part of the mucous membrane of the nose alone

may give rise in reflex action to vocal disability.

There are some peculiarly interesting isolated instances of disturbance

of the vocal mechanism, which are unique in that, while apparently

harmless and uninteresting from the standpoint of even the specialist,

they have, on occasions, developed most alarming influence over the

voice. They have no precedent; experience alone can determine their

influence for evil. They are not a matter of record, they are simply

etudes, interesting studies in the bypaths of vocal hygiene, and must

be dealt with as they appear. An exceptional example was one wherein

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.