A treatise upon the diseases and hygiene of the organs of the voice

Front matter

• f UNITED SJATES UF AMERICA. I

TREATISE

DISEASES AND HYGIENE

Table Of Contents

Translator's Preface, , . ix

Description of Frontispiece, xiii

Description of the Vocal Instrument, 1-11

Chapter I. Description Of The Vocal Instrument

Art can never imitate the mechanism and sounds of the vocal instrument, and man will in vain seek to communicate to mechanical instruments the principles of the animal organization, because he will never have at his disposal the elements of vital action.

The organs, which by their union contribute to form and modify the vocal sounds, are the following : 1. The lungs, the reservoirs of the air; 2. The muscles of respiration and the chest, which act like the bellows ; 3. The trachea and bronchi, constituting a windpipe bifurcated inferiorly ; 4. The larynx proper, which acts as an elastic and movable mouthpiece ; 5. The glottis, 1

% THE VOICE.

the vocal cords of which are well represented by the lips of a musician playing upon the horn; 6. Finally, the pharynx or back part of the mouth, the veil of the palate, the uvula, the tonsils, the epiglottis, the palatine arch, the nasal cavities, the maxillary sinuses, the lips, the cheeks, etc., equally contribute to the formation of the voice, and play an important part in the intensity and modulation of the sounds.

To render this work complete, a detailed description of all the parts mentioned ought, perhaps, to be given ; but as I have nothing new to add with regard to their anatomy, and as such details would enlarge too much a work intended for the general reader, a few words with regard to the form and structure of the larynx are all that seem necessary to me.

The larynx, from the Greek XagvyS, a whistle, the principal organ of the voice, is a kind of cartilaginous box, v/hich, taken as a whole, has the general form of a hollow and reversed cone, with its base turned upwards towards the tongue in the shape of an expanded triangle opening into the pharynx, and its summit, united inferiorly to the trachea, is continuous with that canal by a rounded opening.

The superior orifice of the larynx is an oval

THE VOCAL INSTRUMENT.

Fig. I.«

space, bounded in front by the epiglottis, behind

* The right wing of the thyroid cartilage has heen cut away in this plate, in order to expose the muscles connected with the edge of the glottis. No. 1. The large horn of the thyroid cartilage. 2. The interior surface of its left wing. 3. The surface of the incision made to remove the right wing. 4. The right arytenoid cartilage. 5. Part of the arytenoid muscle. 6. The thyro-arytenoid muscle. 7. The lateral crico-arytenoid muscle. 8. The posterior cricoarytenoid muscle. 9. The right side of the cricoid cartilage. 10. The first ring of the trachea.

by the arytenoid cartilages, and upon the sides by the folds of the mucous membrane. This superior orifice of the larynx is always open, and passive as regards the formation of the voice and respiration.*

The walls of the larynx are chiefly formed by the union of several cartilages, called the thyroid, arytenoid, cricoid, and the epiglottis, which is a jibro- cartilage.

Fig. 2.

The thyroid or scutiform cartilage, from the Greek <9-vQsog, a buckler, and sidos, form, is the largest of all the cartilages of the larynx. It

* Those who have never seen, or who have badly studied the larynx, always confound the superior opening of this organ with the glottis, which is below. The name of epiglottis contributes to perpetuate this error, because the inference is that the epiglottis immediately covers the glottis.

THE VOCAL INSTRUMENT. O

forms the anterior wall of this organ, and the projection in the neck, which is called AdarrCs apple, marked 1 in the figure ; 2 indicates the square sides of this cartilage ; 3 its upper, and 4 the smaller, horns.

Fig. 3.

The two arytenoid cartilages (2,) from the Greek aovzcuva, a ladle, and £idog,form, united by their anterior edges to the posterior borders of the preceding are situated at the posterior and superior part of the organ.

The cricoid cartilage, (1, Fig. 3,) from the Greek v.qivog, a ring, and eidog,form, circular, as its name indicates, is situated at the inferior part of the larynx, and united by its superior borders, through the intervention of a membrane, to the inferior borders of the three cartilages just mentioned ; below, it corresponds to the first ring of the trachea of which it is a continuation. 1*

O THE VOICE.

There now remain four cartilages, which are the two corniculated cartilages, called, also, the tubercles of Santorini, and the cuneiform or cartilages of Meckel ; but as these cartilages have been less studied, and as their functions are but little known, the mention of them will be sufficient.

Finally, the epiglottis* a vigilant sentinel, is placed at the superior part of the larynx, and fixed to the upper border of the thyroid cartilage, behind the base of the tongue. It is a fibro-cartilage ; its shape has been compared to that of a leaf of parsley ; its use is to prevent the introduction of articles of food into the air-passages, and, probably, to modify the sounds as they issue from the glottis.

From what has been said, it will be seen that the arytenoid cartilages are by their situation, at the posterior and superior part of the larynx, opposed to the thyroid, which forms the anterior and superior part of this organ. The connections maintained by these three cartilages with regard to each other, are of the highest importance in the formation of the vocal sound. In fact, two ligaments, formed of elastic and parallel fibres, enclosed in a fold of the mucous membrane,

* Vide Frontispiece.

THE VOCAL INSTRUMENT. 35 slender and about two lines in width, are inserted behind into an anterior projection at the base of the arytenoid cartilages, and passed forwards to be fixed in front to the middle of the angle on the interior of the thyroid. These two ligaments, which I call the lips of the larynx, were named by Ferrein the vocal cords, and are called by

*In this plate is represented a view of the larynx from above, G E H the thyroid cartilage, enclosing the ring of the cricoid, r u x w, and turning upon the axis x z, passing through the lower horns, 4, Fig 2;NF,NF, the arytenoid cartilages connected by the transverse arytenoid muscle ; T V, T V, the vocal ligaments ; N X, the right lateral crico-arytenoid ;vkf, the left thyro-arytenoid j N 1, N 1, the posterior cricoarytenoids j B B, the crico-arytenoid ligaments.

anatomists of the present day the inferior ligaments of the glottis, or the thyro-arytenoidean. The interval between them forms the glottis, an oblong fissure, from ten to eleven lines in length in the adult male, and from two to three broad in its widest part, varying, however, and more considerable behind than before, where the two vocal cords approximate each other, so as to touch at the point of their insertion into the thyroid cartilage.

These ligaments, covered by the fleshy fibres of the thy ro- arytenoid muscles, to which they adhere, and which they separate from the lateral crico-arytenoid muscles, are enveloped by the mucous membrane of the larynx through the remainder of their extent. Their superior face, directed outwardly, constitutes the lower wall of a depression named the ventricle of the larynx, the upper wall of which is formed by the superior ligaments of the vocal instrument, which are situated more externally, about the middle of the anterior face of the arytenoid cartilage. These ligaments, which are merely a fold of the mucous membrane of the larynx, are not fibrous, are less elastic than the inferior, and represent superiorly another kind of glottis, which is separated from the true glottis by the ventricular cavities just mentioned.

THE VOCAL INSTRUMENT. y

The larynx, as well as the trachea, is lined by a mucous membrane, but it is more sensitive than that of the trachea, and the contact of the smallest foreign body causes in it an excessive irritation, the severity of which strikingly contrasts with the small extent and apparently slight importance of the organ. It is in consequence of these irritations, increased, too, by painful and prolonged movements in the exercise of certain professions, that we often meet with alterations, which, although but slightly visible in the autopsy, have occasioned such mournful results as even to have hastened the hour of death.

The larynx is much more developed and prominent in man than in woman, in whom this organ has but two thirds and even the half of the volume of that of man. In the latter, the retreating angle of the thyroid cartilage is acute, while it is rounded in woman, in whom the central slope of the superior border of the same cartilage is less deep, and the epiglottis less large, less thick, and less prominent than in man.

Less striking differences are to be observed in the foetus and the infant ; only the larynx is not so much developed as it will be at a later period, proportionally in either sex, but especially in ours. It is very remarkable, that this increase is not progressive, like that of the other organs, but, on the contrary, develops itself almost at once at the period of puberty, and the energy of its functions makes itself apparent at the same time with that of the generative organs. It is this rapid increase, corresponding with the change in the voice, which furnishes us with the most certain signs of puberty. After this period, the larynx experiences no remarkable change, its edges simply become more decidedly developed, its cartilages become hardened and in part ossified in old men, with the exception of the glottis, in which I am not aware that any rudiment of ossification has ever been discovered. In eunuchs this organ is as small as in woman ; and the removal of the testicles at an early period, by arresting the development of the larynx, perpetuates in males the clear and feminine voice of adolescence, and even destroys the timbre of that already formed, when the operation has been resorted to soon after the period of puberty.

Finally, to terminate all these dry and lengthy anatomical details, I will add, that several muscles are inserted into the larynx. Some of these muscles are external, and intended to move the entire organ, as to lower or elevate it, to carry it backwards or forwards, or, finally, to hold it steady. The other muscles are internal, and

THE VOCAL INSTRUMENT. 11

have for their object to change the relation of its parts, as to enlarge or contract the glottis, to stretch and relax the vocal cords. The external muscles, which attach the larynx to the neighboring parts, are, the ster no -thyroids, the constrictors of the pharynx, and all the muscles of the hyoid region, etc. The internal muscles, which impart all their motions to the cartilaginous pieces composing the organ, are, the crico -thyroids, the posterior crico- arytenoids, the lateral crico-arytenoids, the thyro- arytenoids, and the arytenoid, properly so called. I will add, also, that the larynx has several glands, the uses of which are but little known ; these glands are, the epiglottic, the arytenoid, and the thyroid. The functions of the latter, especially, are entirely unknown ; those of the others seem to be to secrete a mucus, which lubricates the larynx and the epiglottis, keeps them supple and movable, and prevents them from being irritated by the continual passage of air during respiration, singing, and speaking. Lastly, the nerves of the larynx, which are two on each side, have been named laryngeal for the superior, and recurrent for the inferior. I shall close by saying that the division of these nerves causes aphony, or loss of the voice, with which we shall be occupied in a future chapter.

Chapter II. The Voice And Its Formation

The voice, cpcovrj of the Greek, vox of the Latin, is an animal sound, living and articulate, of which the air is the material, the glottis the efficient cause ; finally, the determining cause of the voice is the necessity or state of the mind, to which its actual expression is to be referred.

This faculty of animals, of making themselves heard at considerable distances, is one of the most beautiful attributes of living nature, for without it they would be condemned during life to the silence of death.

Every animal has a voice peculiar to itself, and which is a kind of distinctive character of the species to which it belongs ; these great differences in the voice depend upon a peculiarity in the organization of the parts concerned in its formation.

Vicq 6? Azir, in an excellent memorial upon the voice, remarks that the structure of the larynx is extremely simple in animals with a sonorous and agreeable voice, like the lark and the nightingale ; while the organ is very complicated in those with a strong and disagreeable voice, as hogs, monkeys, etc. It would seem as if nature had been at more trouble to enable the horse to neigh, and the ass to bray, than to render the voice of man capable of imparting to us the most melodious sounds.

The voice presents remarkable differences depending upon the age. It is feeble and shrill in children, but grows strong at a later period ; in woman the vocal timbre changes much less than in man, and it almost always preserves the characteristics of infancy. Young animals have a shriller voice than those which have finished their growth. This is a general rule ; nevertheless, calves are an exception, for it has always been observed, that they have a graver voice than bulls and oxen. The cause of this peculiarity is without doubt in the larynx of these animals, which is larger and more movable when they are young, but gradually contracts as they approach the termination of their youth.

All organized beings, in whom the respiration is effected by the lungs, utter vocal sounds, because they are all provided with a glottis and 2 larynx.* But these organs present in all classes such multiplied varieties of form and structure, that it is not possible for us to point them out in this place.

The mammiferse, birds and reptiles, are then the only animals provided with a true vocal instrument, and which can consequently give utterance to a voice properly so called. For it is only necessary for this purpose that a certain quantity of air, accumulated in any receptacle whatever, be driven out with violence, and break against the edges of an orifice more or less narrow and sufficiently contracted. Fishes, which respire by the gills, cannot, for this reason, produce any vocal sound. The monotonous and insipid noises made by some insects, as certain grasshoppers, locusts, and most flies, must not be regarded as a true voice ; the noise produced by them does not come from the mouth, but is the result of the mechanical friction of certain elastic membranes put in rapid agitation. These sonorous organs are sometimes the elytra and wings of the insects, sometimes a kind of membrane in the form of a drum, or, finally, a sort of scraping

* The male duck has scarcely any voice, on account of a dilatation of tjie trachea, in which the expired air is swallowed up, produced by the movements of the posterior thighs, in the manner of the violin- bow.

The vocal timbre can be changed and modified by the habits ; for instance, those engaged in noisy occupations, such as smiths, millers, etc., or those who inhabit, like sailors, the banks of the sea and great rivers, generally have a stronger voice, from the fact that being obliged in speaking almost always to cover noises often very intense, they exert more strongly their vocal organs.

The voice of man is strong in proportion to the development of the larynx, and the capacity of the chest. For this reason the vocal timbre seems much weaker after a meal, because the stomach, distended by food, diminishes the capacity of the chest by crowding up the diaphragm superiorly.

No sound goes more directly to the soul than the human voice ; therefore the instruments more nearly allied to it, such as the concert-horn, the bassoon, and the hautboy, have a more touching and melancholy expression, especially in the minor tones and solemn music. This organ, as admirable for its sweet harmony as for its great simplicity, is, I repeat, beyond all imitation, and not even the most skilful mechanic will ever devise an instrument to produce sounds as beautiful, and furnish in the same degree of perfection this melodious timbre, these varied tones, and these inflexions so manifold and agreeable.

The experiments of Ferrein, by means of which, as he himself said, he made the dead speak, are well known. The Dominican, Albert the Great, constructed a head, which, by peculiar mechanism, was enabled to pronounce some articulate sounds. The famous statue of Memnon, which sung, upon the authority of Pliny and of Strabo, is not less wonderful, although it uttered only inarticulate sounds. The history of this prodigy may furnish an idea of the others, and show how far art has always been from nature. " The Egyptians, to perpetuate the memory of Memnon, had erected in his honor, in the temple of the god Apis, upon the borders of the river Belus, a statue which had this peculiarity, that being lighted and struck by the rays of the rising sun, it sent forth a sound as melodious as that of a lyre, while in the evening the sound was mournful and deep, which might have been a very natural effect of the dilatation and condensation of the air. A reed had undoubtedly been adapted to the mouth of the statue ; in the morning the air, warmed by the rays of the sun, issued with a clear sound ; in the evening, when the sun retired, and the statue grew cold, the returning air caused a dull sound in its interior. In a word, the effect being external in the morning, and internal in the evening, the variation in the sounds is naturally explained. " *

Singing is a modification of the voice depending upon the passions, and especially that of love ; this is the reason, perhaps, why at that interesting period of life, when we experience for the first time this thirst for love, nature develops in so rapid a manner the vocal organs, and changes almost at once the timbre of the voice. In the season of spring, when the birds are accustomed to choose their mates, the singing of the nightingale is in all its beauty, while in the month of June, when it has young, its voice is so disagreeable and so much changed, that it is contemptible.

Of all the actions peculiar to man, singing is the most familiar to him ; there are no people, even the least civilized, among whom singing is not practised. The savages of America, the CafTres, the Esquimaux, and the Greenlanders, experience, as well as the Europeans, the desire for singing. Rousseau is therefore in the wrong

* Rouland.

2* when he says that singing is not natural to man ; and so, too, is that German author, Blumenlach, who has advanced the doctrine, that if whistling is peculiar to birds, singing belongs to man alone. These two opinions, which are paradoxes, are founded upon a puerile verbal distinction ; for singing does not require the application of words, these being but an explanation, of which the melody is the picture. It is, moreover, a common fact that certain mutes, without uttering any articulated notes, can sing and modulate sounds almost as agreeably as those who speak.*

To a delicate ear, the voice of the individual may teach many things with regard to his temperament, character, moral qualities and states of mind. It is certain, that the condition of the mind exerts a marked influence over the organ of the voice, which always varies according to circumstances. We may therefore say with Gretry, that if man can conceal himself in his

* I have now under my care a young man. thirteen years of age, to whom, a year since, I restored the poWer of speech. When I had succeeded in teaching him to listen and to hear, although he could not then articulate a single word, he repeated accurately and in time, all the airs that I sang or played to him upon the horn or violin. I have also seen an old soldier, whose tongue had been completely removed by a bullet, who sung in an extremely agreeable manner, and modulated with much taste and talent the most difficult airs of the French and Italian operas.

conversation, he has not yet learned to disguise his intonations. The immortal physiognomist of Switzerland, Lavater, said, that the voice and the countenance were very often associated.

In a work of Father Kircher, we read, that a strong and hoarse voice is that of a man avaricious, pusillanimous, insolent in prosperity, cowardly in misfortune ; such was Caligula, according to Tacitus. The voice which is grave at first, and terminates in faucette,* is that of a sad and irritable scold ; the sharp, feeble j and broken voice is that of an effeminate ; that which is sharp and strong indicates a man devoted to pleasure ; finally, the same author adds, that the grave, sonorous, heavy and precipitated voice denotes an individual enterprising, bold, and adapted to the execution of great things.

If the voice, in an ordinary condition of the mind, can discover to us the inclinations and moral qualities of the man, it will yet far more certainly expose the different passions with which he is agitated. Fear and languor lower the voice, astonishment cuts its off, admiration prolongs it, hope renders it sonorous and equal, anger makes it hoarse and interrupted, desire

* The reason will hereafter be given why this word should be written faucette, and not falsette.

hastens the words and causes the phrases to begin by long exclamations. Boldness renders the discourse laconical ; it always leaves something for thought to supply : quos ego Iff... Plato knew so well that the sound of the voice could, to a certain point, discover the moral state of men, that when he wished to know those who addressed him for the first time, he said to them, Speak, that I may know you.

The voice may also often instruct us in regard to the state of the body, on account of its admirable sympathetic relations with the nervous system in general, especially with the sexual parts. To this latter sympathy must be attributed the change of the voice, the faucette of eunuchs, the melodious singing of birds in the season of their loves, and, finally, the aphony (or loss of voice,) upon which we shall make some observations, arising in consequence of a chronic enlargement or acute inflammation of the testicles, and often, also, from a prolapsus of the womb, or a suppression of the menses, and even from child-bearing.

The sympathy of the voice with the whole nervous system is not less manifest ; in fact, in malignant fevers the voice presents a remarkable alteration; on the accession of acute diseases the patients often complain of pains in the throat, which, not being the result of any apparent inflammation, generally announce a grave affection, frequently accompanied by nervous accidents. It is the same with all affections complicated with delirium, and with all other nervous diseases, such as insanity, the cholera, etc., which are ranked in this class by most physicians. Finally, the inconvenient spasm experienced in the throat by hysterical females and hypochondriacal subjects, is a new proof in favor of this sympathy.

In the warm seasons the voice is more beautiful and more sharp ; in winter, on the contrary, it is more grave and hoarse. It is probably owing to the influence of the temperature, that the people of the south have in general a finer and more sonorous voice than the inhabitants of the cold countries. Foreigners acknowledge, that in France are found the greatest number of fine voices ; how far is this to be ascribed to the development of the chest, which in that country has in general a better conformation ? *

The idioms of the south, such as the Spanish

* Nature, according to the Abbe Expili, develops more fully certain parts of the body in one climate than in another. He considers, that a man would be perfect in his physical development, who had the legs of a Spaniard, the hand of a German, the head of an Englishman, the eyes of an Italian, the body, size, and gait of a Frenchman.

and Italian languages, the accents of which are more marked by the vocal inflexions and the frequent use of the vowels, are more favorable to music than the languages of the north, the pronunciation of which is very far from singing. In a language as harmonious as was anciently the Greek, there must have been without doubt very little difference between the speaking and the singing voice.

If the same musical phrase were to be sung in words translated into the principal languages of Europe, the difference to the ear in harmony and sweetness would be very striking. The Italian and the Dutch languages, taken as the two extremes of the comparison, would follow a progressive course, in the following order : Italian, modern Greek, Portuguese, Spanish, French, German, English, Dutch.

The people of the south greatly prefer the shrill voices ; those of temperate countries prefer the median ; finally, the inhabitants of the northern regions seem to give the preference to the base. The difference of climate probably exerts an influence over the taste of nations, as well as over the sweetness of the tongues. In Italy, the first male parts in the operas are filled by soprani ; in France, by tenors ; in Germany, by base.

The human voice is the most beautiful medium of execution possessed by the musical art. It will ever be in vain, therefore, for instruments to attempt to imitate it ; for, like slaves which precede or follow their master, they have only been invented to accompany and sustain the voice.

As each individual is distinguished from another by his physical features and form, so may he easily be by the nature and timbre of his voice. But there are some of these differences common to several persons, and which form so many different kinds of voice, each of which has received a particular denomination.

To carry the vocal system to the capacity of that of the great singers, which is often in three octaves, it has been agreed to divide it into six parts, which represent six kinds of voice :

1st. The first above, first soprano.

2d. The second above, second soprano.

3d. The contralto.

4th. The tenor.

5th. The baritone.

6th. The base.

It is not then from the timbre and volume of the voices, but rather from their extent in the musical scale, that this general distinctive character has been devised.

The grave voice is not usually met with in man till after puberty ; while acute voices are more frequently met with in women, children, eunuchs, and in most men who take the faucette in singing.

Voices are also known by other differences than those of the grave and acute. There are strong voices, in which the sounds are strong and brilliant; sweet voices, in which the sounds resemble the tones of the flute ; extensive voices, those which run through a large musical scale ; beautiful voices, the timbre of which is full, just and harmonious. There is also the contrary of all this ; for example, we meet with harsh, hoarse, unequal voices, those in which the beautiful sounds are unequally distributed, whether in the first, the second, or the third octave. An even voice, on the contrary, is one, in which the timbre is always the same through its whole extent ; finally, the voices, which pass without a harsh transition from the grave to the acute, are designated by the epithets of flexible and easily managed, — with unvarying sweetness and flexibility they run through all the modulations constituting musical and vocal harmony.

It has never been well determined in what the articulated sounds differ from the modulated ;

nevertheless, this difference could be perceived, even if there were wanting to the voice which forms the word merely that permanence of sounds, which constitutes the voice of the true singing. Besides, the true distinctive character of this latter species of voice is, to form harmonic and appreciable sounds, the unison of which may not only be taken and felt, but which may even be expressed by signs forming part of our system of music. In the spoken voice, on the other hand, the sounds are not sufficiently sustained to be appreciated, and the different inflexions, which separate them, present only inharmonic and immeasurable intervals.

Physicians and physiologists ought therefore to study the voice of man under different aspects ; they ought to study it, 1st, as a simple sound, such as the cry of infants, comprising in it the various intonations arising from the movements of the mind, the passions, pleasure, pain, disdain, anger, etc., etc. ; 2d, as an articulated sound, such as it is in ordinary conversation ; 3d, as a modulated sound, in singing, which adds to speech the variations in its tones ; 4th, finally, in declamation, which is, at the same time, a modification of the modulated and of the spoken voice, since it may be united to either, or withdrawn from them. We shall examine the human voice in these four aspects, after having been occupied with its formation and the various opinions which have been promulgated as to its mechanism.