Laryngoscope

“ The laryngoscope should not, in fact, leave the hands of the physician. Invaluable for the detection of diseases of the throat which impair the voice and which have to be cured either by treatment or operation before the voice can be restored to its original potency or charm, its value in studying the physiology of voice-production and the functions of the vocal organs is doubtful. ”

“ Like all very sensitive areas of the human body, the organ of the voice is sometimes invaded by special symptoms, notably in hysterical patients.
When the laryngoscope became a speciality, a young lady who for two whole years had lost all power of articulation was brought up to London by her mother for advice and treatment. ”

“ The bare fact that the voice is produced in the larynx is ascertainable by anybody through the medium of the laryngoscope, but to arrive only thus far the throat has to be forced into a position directly antagonistic to the production of those very qualities of tone that form the subject of desired investigation. Open chest voice, there is every reason to believe, is in great part produced by the drawing down of the larynx by means of the sterno-thyroid muscles, so that it becomes part of a compact mass of bone, tissue, and cartilage all vibrating together. ”

“ By the use of a laryngoscope and a cocaine spray the most irritable throat can now be made tolerant of the presence of the small mirror, and thus the medical man is enabled to make a prolonged and thorough examination of the interior of the larynx and even to perform delicate operations upon it. Foreign bodies which have become caught in the larynx can thus be seen and extracted, and small growths can be satisfactorily removed even from the vocal cords themselves. ”

“ We are indebted to modern science, aided by the laryngoscope, for many facts concerning the action of the larynx, and more especially the vocal cords in tone-production. While the early discoveries regarding the mechanism of the voice were hopefully believed to have solved all problems concerning its cultivation, experience has shown the futility of attempting to formulate a set of rules for voice-culture based alone upon the incomplete data furnished by the laryngoscope. ”

“ The best of us learn to use the ophthalmoscope to look into the eye, to use the laryngoscope for the larynx, and can at need examine the urine and the blood, but the men must be rare who are as competent to use each and all of these means as persons who devote themselves to single branches of our work. ”

“ The laryngoscope would be a great aid in diagnosis if it could be used during the distress of a membranous laryngitis. Still, it has been employed by Ziemssen, Rauchfuss, and others. But the opportunities are rare.
TREATMENT.—The objects of treatment differ with the various stages of the disease. The inflammatory symptoms of the commencement, the completed exudation, the maceration and disintegration, and also the expectoration of the pseudo-membranes, and, finally, the asphyctic stage, have each their own indications. If there is anything which must not be recommended, it is depletion. ”

“ There is at times great difficulty of breathing, and, finally, the effort becomes so great that the patient becomes alarmed. Upon examination with the laryngoscope the vocal cords are seen in close proximity to each other even during the inspiratory effort. In fact, they are, by the pressure of the air upon their upper surfaces, brought closer together during inspiration than during expiration. They seem to act as valves which are closed by the weight of the atmosphere upon their wide, flat upper surfaces, pressing them against each other. Hence the inspiratory stridor and dyspnoea. ”

“ In the condition known as nervous aphonia, which occurs mostly in women of hysterical habit or in circumstances of enfeebled health, the voice becomes reduced to a whisper, but there is seldom any affection of the breathing, or cough, and the laryngoscope reveals a perfectly healthy state of the parts. ”

“ No great force should be used, because if the bronchoscope does not go through readily, either the tube is too large a size or it is not correctly placed (Fig. 60) . Normally, however, there is some slight resistance, which in cases of subglottic laryngitis may be considerable. The trained laryngologist will readily determine by sense of touch the degree of pressure necessary to overcome it. When the bronchoscope has been inserted to about the second or third tracheal ring, the heavy laryngoscope is removed by rotating the handle to the left, removing the slide, and withdrawing the instrument. ”

“ It is easily demonstrable by the laryngoscope that the forced and strained action of the vocal ligaments, and of other laryngeal and throatal muscular action, exercises an injurious influence upon the voice. The endeavour to sing notes beyond the extreme of the compass, or notes which do not naturally lie within any one register—particularly the chest register—causes great fatigue of the tensor muscles of the vocal [139] ligaments, and serious congestion, extending to the windpipe and pharynx has, in many cases, followed this practice. ”

“ The speculum must pass sufficiently far below the tip of the epiglottis so that the latter will not slip. 6. Too deep insertion must be avoided, as in this case the speculum goes posterior to the cricoid, and the cricoid is lifted, exposing the mouth of the esophagus, which is bewildering until sufficient education of the eye enables the operator to recognize the landmarks. 7. The patient's head is lifted off the table by the spatular tip of the laryngoscope. Actual lifting of the head will not be necessary if the patient is fully relaxed ”

“ I have examined with the laryngoscope many ladies who had the habit of singing the chest-tones too high, and, without exception, I have found their throats in a more or less diseased condition. Laryngitis, either alone or complicated with pharyngitis, relaxation of the vocal ligaments, and sometimes paralysis of one of them, are the most frequent results of this bad habit. If a singer is afflicted with catarrhal trouble, it is always aggravated by this abominable method of singing. ”

“ The Larynx. The larynx is the enlarged upper end of the air-passage which leads from the pharynx to the lungs. It is a box composed of pieces of cartilage connected by ligaments and moved by muscles, and it is lined by mucous membrane. At the root of the tongue about one centimeter caudad of the body of the hyoid bone is the triangular leaf-like epiglottis (Fig. 95, e, page 227) . When food is taken this closes the opening into the larynx, and the food passes over it into the œsophagus. It is so curved that its apex is directed craniad. ”

“ The interior muscles of the larynx vary the position of its walls, thus regulating the proximity and tension of the vocal cords. The male larynx is the larger and shows the Adam's apple. In both sexes the larynx of the low voice, alto or bass, is larger than that of the high voice, soprano or tenor. The larynx and tongue should not rise with the pitch of the voice, but drop naturally with the lower jaw as the mouth opens in ascending the scale. The proper position of the tongue will insure a proper position for the larynx. The less attention the larynx receives the better. ”

“ If we remember that the larynx, which is the cavity in the throat behind the tongue, is capable of considerable flexibility, as well as the trachea or windpipe, we have good materials for ventriloquial effect; thus the mouth and tongue have really, but not apparently, a great deal to do with the modifications of the assumed voice. A clever ventriloquist recommends the mouth to be kept closed, and the tongue rolled back, so as to regulate, as it were, the sound which is formed in the larynx. This may be done by strengthening the abdominal muscles ”

“ In all cases, without regard to stature, the larynx is smaller in women than in men. Its angles are less salient, its muscles weaker, its cartilages thinner, and more supple: the sharp notes of the instrument are the evidences of these peculiarities of conformation. Though our general knowledge of the vocal organs is very positive, nevertheless we are unable to determine the characters of the voice by simply examining the larynx, for it is impossible to compare in all their details those instruments whose good or bad qualities are known. ”

“ The technic of laryngoscopy in the human subject is best perfected by a routine direct examination of the larynx of anesthetized patients after such an operation as, for instance, tonsillectomy, to see that the larynx and laryngopharynx are free of clots. ”

“ Instruments for Direct Laryngoscopy.—In undertaking direct laryngoscopy one must always be prepared for bronchoscopy, esophagoscopy, and tracheotomy, as well. Preparations for bronchoscopy are necessary because the pathological condition may not be found in the larynx, and further search of the trachea or bronchi may be required. A foreign body in the larynx may be aspirated to a deeper location and could only be followed with the bronchoscope. ”

“ It is impossible to produce good tone with a high larynx. When the larynx rises, the throat closes and you must always have your throat open. Don’t forget, your throat must be open and you can get it open only by keeping the larynx low.” He tries again with the same result and awaits further instructions. I take another tack and say to him, “Your tongue rises every time you sing and impairs the form of the vocal cavity. Keep it down below the level of the teeth, otherwise your vowels will be imperfect. You should practice a half hour each day grooving your tongue.” ”

“ Beattie, in defining the human voice, says, it is air sent out from the lungs, and so agitated, or modified, in its passage through the windpipe and larynx, as to become distinctly audible. The windpipe conveys air into the lungs for the purpose of respiration and speech; the top or upper part of which is called the larynx, 388 consisting of four or five cartilages, that may be expanded or brought together, by the agency of certain muscles which operate all at the same time. ”

“ Before the larynx, the apparatus that produces sound-vibrations, can be effectively employed, the source of power, the bellows, must be developed. To some Nature has been generous—they have large chests; to others she has given a smaller wind-chest, but has perhaps compensated by providing an especially fine voice-box. Happy are they who have both, and thrice happy those who have all three requirements: a fine chest, a well-constructed larynx, and beautifully formed resonance-chambers. ”

“ 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. ”

“ When the breath has been taken in, it is to be gently withheld,—not given up too freely,—and the tone is formed on the top, so to speak, of this body of breath, chiefly, of course, in the mouth and head. For the stronger and larger voice the breath is not driven out and dissipated, but the tone is intensified and given completer resonance within—within the nasal or head cavities, somewhat within the pharynx and chest. This body of breath, easily held in good control, by the lower breathing muscles, forms what is called the vocal "support." ”

“ The symptoms of a foreign body in the larynx are characteristic and consists in the very sudden appearance of the attacks and also in the severity of the symptoms. There will be a history of something having been in the child’s mouth, or the possibility of the child having placed some object in his mouth. A metallic body can always be located by means of the X-ray. ”

“ An artificial larynx may be made by using elastic bands to represent the vocal cords, and by placing above them chambers which by their resonance will produce the same effect as the cavities lying above the larynx. ”

“ In the larynx are the two true vocal cords, the vibration of which produces voice; and this voice, passing into the mouth, is moulded into speech by the organs of articulation.
Control of the breath. There are muscles that act on the lungs and regulate the entrance of air and the exit of breath. The muscles are: pectoral, dorsal, costal, intercostal, abdominal, and the diaphragm. The pectoral [p. 124] muscles hold up the chest and thus allow the air to enter the upper lobes of the lungs. ”

“ The elasticity of the ribs and the contraction of the abdominal muscles diminish the cavity of the chest, and the air, in consequence, is pressed from the air-cells into the bronchial tubes and trachea. It then rushes by the vocal cords, and causes a peculiar vibration, which produces sound.
Observations. 1st. Experiments have satisfactorily shown that the vocal cords are the principal agents in the formation of the voice. The tongue, which many have supposed to be the most important organ in speaking, is not essential to sound. ”

“ Let it be stated here that the peculiar role played by the larynx in hearing, already referred to by us in Chapter XVI, is one of the symptoms which tells of the participation of the muscular system in the internal acoustic process.
Psychologically, the difference between ear and eye is that aural perceptions work much more directly on the human will - that is, on the part of our astral organization connected with the limb system. Whereas eye-impressions stimulate us in the first place to think, ear-impressions stimulate us to ... ”