MUSICAL COU Ri È fi
.1
SINGERS’ NODULES, THEIR CAUSE AND CURE
By William A. G. Zerffi
Copyrighted, 1922, by The Musical Courier Company.
tion is always observed, but that these edges are clear, and this type of phona'tion cannot possibly produce nodules.
The Artificial Action of the Vocal Cords.
This type of tone production consists of inducing an artificial shortening of the vocal cords by means of the extrinsic throat muscles. The cords are forced together at the point indicated by 'the arrows in Fig. 3, which, however, causes the high tones to be sung with the posterior instead of anterior portion of the vocal cords. The acute irritation of the cords at the point of contact results in the formation of the nodules.
Cases Chosen from Actual Experience.
The following three cases chosen from the writer’s actual experience will serve to illustrate and furnish further testimony of the validity of the above contentions.
Case No. 1.—A young girl, possessed of a high soprano voice, suddenly experienced difficulty in singing the higher tones, and a laryngeal examination revealed the presence of two small nodules. It developed that upon the preceding day a contest had arisen between her and some of her student friends as to who could sing the highest tone. Throwing aside all caution they forced their voices beyond all normal limits for a considerable period of time, with the result as described above. Absolute silence was immediately prescribed, and in a comparatively short space of time all trace of nodular formation had disappeared. These nodules may be classed as produced by acute irritation.
Case No. 22.—A supervisor of music in the public schools who complained of hoarseness, was found to have con-treated a mild case of laryngitis. Rest and care were prescribed, and two weeks later she returned with the information that the hoarseness had left her after a few days’ rest, and that her voice was in excellent condition. She was in fact planning to sing publicly the following day. A slight difficulty experienced in vocalizing led to a laryngeal examination, and the presence of two nodules was discovered. This case illustrates very clearly the writer’s contention that the presence of nodules does not necessarily render singing impossible, for in this instance the singer had no realization of the fact that her chords were affected, and displayed considerable irritation when the verdict of “absolute silence” was rendered, and the engagement had to be cancelled. Two weeks later she returned with her cords absolutely normal. These nodules may be classed as produced by singing with the cords in an inflamed condition.
Fig. 3. Diagram of vocal cords shoioing “K” shaped condition due to artificial shortening i>y pressure of extrinsic muscles.
Case No. 3.—The case of a professional singer, with a highly successful career of ten years’ public singing before any vocal trouble developed. A laryngeal examination revealed the presence of a large, blood red nodule upon the left cord, situtated, however, upon the top of the cord, and not upon the free edge where the nodule is usually to be found. A zone of congestion surrounded the nodule extending to the edge of the cord, which also existed'־ to a lesser degree upon the right cord. The cords were in a “K” shaped condition as depicted in Fig. 3. The entire normal action of the vocal cords had been disturbed and the higher tones produced by the artificial shortening described above. In this case the pressure exerted by the extrinsic muscles had been so great as to cause the right cord to be pushed over to such an extent as to subject the upper surface to an intense and constant irritalion. It need hardly be said that it required months of1 careful work to straighten the cords and to re-establish a normal functioning of the vocal organ.
The Cure for Nodules.
Obviously, as Tilley says, the cure for nodules is rest, the cure can, however, not be considered complete without steps being taken to prevent their recurrence. Once the tendency to force the cords together with the help of the extrinsic muscles has been established, the nodules will return until this tendency has been absolutely destroyed. To accomplish this, to reeducate the neglected tensor muscles, and to re-establish a normal working of the larynx is a task which requires infinite care and patience, but it is the only lasting cure for the above conditions.
Organist Robert Recital Tonight
Tonight, June IS, at 8 o’clock, Louis Robert, distinguished Dutch concert organist, will play the following program in the Green Avenue Baptist Church, Brooklyn: Adagio and allegro (Handel), andante con moto (Boely), offertory (Wely), andante from sonata in G minor (Louis Robert) Gavotte (De Pamo), toccata (Hendricks, Jr.), “Serenade” (Pierne), “Finale” (Franck). Mr. Robert is endorsed by the highest authorities, such as Mengelberg, Schonberg and Mailly.
Heniot Levy to be Heard in London
Heniot Levy will appear in recital June 27, in Wigmore Hall, London, England. The program will be an elaborate one, Chopin being largely represented. Mr. Levy will later join his family, who are at present sojourning in Berlin. He will return in the fall to resume his work at the American Conservatory of Music, Chicago.
The word “nodules” has to the average singer a significance which is almost comparable to the dread which children often exhibit with regard to the “bogey-man.” While it is unfortunately only too true that there are cases where loss of voice is directly traceable to the presence of nodules upon the vocal cords, or to the result of an unsuccessful operation for their removal, the existence of nodules does by no means invariably mean any such disaster as permanent loss of voice.
It should hardly need to be emphasized that any knowledge of nodules can only be attained through the examination of the larynx by means of a laryngoscope. The writer is fully aware of the vast amount of prejudice extant as regards the advisibility of vocal teachers making laryngo-scopic examinations, but this prejudice exists chiefly among the laity, and certainly every throat specialist with whom the writer has discussed this point has expressed himself as heartily in sympathy with the opinion; that without the aid of the laryngoscope a teacher has not the ability to guard the interests of his pupils to the fullest extent. As a matter of fact, it is a strange prejudice which could hold lack of accurate knowledge as to the health of the organ upon which the singer depends for his livelihood, as preferable to an exact knowledge of its condition.
What Are "Singers’ Nodules”?
Quoting from Herbert Tilley’s “Diseases of the Nose and Throat,” the nodule is described as follows: “The nodule is usually seen as a small white and sometimes translucent swelling upon the free edge of the vocal cord, and situated at the junction of the anterior with the middle third of the cord; as a rule both cords are affected. According to the late Professor Kanthack’s observations, the nodules represent a local hyperplasia (swelling) of the epithelial and subepithelial tissues produced by chronic irritation rather Fig. 1. Diagram of	than inflammatory action. The chief
vocal cords showing	symptom is impairment of voice
nodules.	rather than actual hoarseness. A
singer finds it difficult to “strike” a note or hold it when once obtained, the voice may crack on certain notes, or it may be impossible to pass smoothly from one register to another. When the nodules are small and the symptoms of recent date, the prognosis is good if the patient will only submit to rational treatment. Neglect of the condition will almost invariably mean ruin of the voice in so far as it is necessary as a means of livelihood.” Then with regard to treatment he says: “In treating the nodules themselves it is obvious that rest of the voice is imperative. If the excrescences be small and of recent date the silence treatment maintained for three or four weeks may be all that will be necessary. When ׳the nodules are well developed and of long standing, the vocal rest cure may be so prolonged as to be out of the question and under such circumstances it may be necessary to consider the actual removal of the nodules.”
The reader will observe the continual insistence which Tilley places upon the importance of the nodules being “of recent date” when discussing the possibility of a cure. It is only when the nodules are “well developed and of long standing” that he suggests the necessity for actual removal. With an occasional laryngeal examination it is hard to imagine how it would ever be possible for a nodule to be “of sufficiently long standing” to make operative treatment necessary. He further speaks of “impairment of voice” rather than “actual hoarseness” which renders possible the condition described below as Case No. 2, which offers evidence of the fact that it is possible for a singer to be able to sing despite the existence of nodules.
What Causes Singers’ Nodules?
It is generally conceded that faulty voice production is the direct cause for the existence of nodules, but in view of the fact that there are so many conflicting views upon this subject, it can hardly be counted definite enough to afford a satisfactory explanation.
In making the following statements regarding the action of the vocal organ, the writer is aware that they may conflict with many of the accepted theories pertaining to voice production. He ־wishes, however, to make clear that they are the result of actual observation, and for this reason may rightfully claim to be of vastly greater value than any theoretical speculation. Furthermore, they may be proved “ad ocular demonstrandum” without the slightest difficulty.
The Normal Action of the Vocal Cords.
Upon phonation, the vocal cords are brought together to a practically parallel position across the wind pipe, and during the singing of low tones the cords do not touch at any point. As, however, the scale is ascended, the rear portion of the cords is gradually brought more and more closely together, until when singing the extreme high tones, almost half the length of the cords is pressed together. See Fig. 2. It will be noted that when singing thus, the cords do not touch at the points where the nodular forma-
Fig. 2. Diagram of vocal cords in their normal adjustment for the singing of high tones.
June 15, 1922
suite for seven solo instruments entitled “Conversations,” or the introduction of the human voice as an orchestral instrument in his “Rhapsody.” Bliss does not shun a veritable “jazz” turmoil for the wind-up of his “Mêlée Fantasque,” but he decidedly exceeds the limits drawn by the character of a concert hall in his storm music for Shakespeare’s “Tempest,” for even the hardened ear of a present-day musical critic is unable to cope with the deafening noise executed by an “orchestra” consisting of four tympani, three drums of various sizes, cymbal, gong, piano, trumpet, trombone^ and two screaming voices supposed to be those of human beings. He might as well have called his composition “A Sunday at Coney Island.” . . . ,
Of the two “A.B.’s” of modern English music, Arnold Bax is decidedly the more moderate. His symphonic poem, “November Woods,” is good-mannered music of the descriptive kind, but even he falls a victim to the syncopated fox-trot and jazz rhythms which seem to be the rule with young English composers nowadays. The older school of English contemporary music was represented in these concerts by Sir Edward Elgar and Dame Ethel Smyth.
“The English Singers.”
Amidst so many modern works of a more or less radical kind, we were glad to hear several of the beautiful old English madrigals executed by a company of three ladies and three gentlemen who termed themselves “English singers.” Comfortably seated around a small table and resembling a cheerful peace conference, they sang a number of a cappella gems by Thomas Morley, Thomas Weelkes and others, with inimitably airy pianissimo effects and with a perfection of ensemble which took the audience by storm.
“Thrift, Horatio. . . .”
Dawson Freer, an tsnglisn Baritone who was successful with a recital comprising mainly classical songs, had the ingenious idea of distributing programs with explanatory notes, free of charge. Now, it is a well known fact that many music lovers have to refuse even free tickets for concerts here nowadays on account of the many other incidental expenses connected with attending a recital. There is good common sense in Mr. Freer’s measure, therefore, both from an educational and from an economic point of view. His example will probably soon be followed by other artists, and in fact has already been surpassed by a certain cellist who recently announced through private channels that he was willing to refund the carfare (!) for anyone ready to accept and actually use a free ticket for his Vienna recital.
Old Lavender Music.
It was rather a queer experience we had at an orchestral concert arranged by Joseph Holbrooke, who had come all the way from London to perform some eight or ten of his own compositions for orchestra and for piano, with and without orchestral accompaniment. His productiveness, in fact, is his greatest asset, for, as the program told us, he has reached his opus 80 without, apparently, intending to stop very soon. Mr. Holbrooke’s industriousness is almost touching, and his entire personality seems to be surrounded by a faint scent of old lavender which is appealing if not convincing. Here is an idealist who, forgetting his time and age, goes on writing Wagnerian mythological trilogies, Schu-mannesque piano concertos and symphonic programs of a quaint “program music” sort. They are all scholarly compositions, but devoid of genuine inspiration, and on the whole they are the work of an earnest scientist who commands our respect but not our admiration.
Harold Henry Successful.
Harold Henry, the Chicago pianist, advocated the cause of American music by his excellent rendition of MacDow-ell’s fine Fourth Sonata and by two effective pieces of his own which pleased the audience immensely, besides playing Liszt’s “Dante” Sonata and several classic pieces in perfect style. There were many encores at the end, and finally the lights were turned out on a crowd of applauding enthusiasts who demanded still more “Zugaben.”
Sigrid Onegin Triumphs.
Following her success at the Staatsoper, Elisabeth Reth-berg from the Dresden Opera gave a song recital here and displayed her beautiful soprano voice to good advantage, particularly so in her lighter lyrical numbers. American audiences will soon have an opportunity of judging_ for themselves on her qualities. Speaking of America, Sigrid Onegin, whose first American tour is already announced for next season, completely captured Vienna at her second concert by her rich and powerful contralto. If her first recital had found her audience in a certain “Missouri” attitude as a result of over-advertising on the part of her zealous local manager, this spirit quickly gave way to genuine enthusiasm. Mme. Onegin’s operatic past still tells on her singing of Lieder sometimes, and occasionally she reverts to facial expression. Her dramatic singing of Hugo Wolf’s “Feuer-reiter,” which closed her program, fairly brought the audience to their feet, and there were many encores.
Interesting New Songs.
To Karl Roessel, baritone, we are indebted for an all-Wagner concert which substituted a number of all but unknown songs by the Bayreuth master for the customary operatic fragments. In another concert this singer presented, for the first time, songs by Hugo Kauder and Egon Lust-garten, Viennese composers both, and both striving for high aims. “The young composer” might have been the slogan for a song recital by Marie Gutheil-Schoder, soprano, of the Staatsoper, which was in the nature of a public rehearsal, as it were, for the coming Salzburg Festival, where she will repeat the majority of her program. Four strongly dramatic songs by Karl Horwitz and five “atmospheric” songs by Rudolf Réti were the most interesting among the novelties of the program, which included some older songs by Schonberg, as well as Zemlinsky and Franz Mittler. Mme. Gut-heil-Schoder has ever been a brave and valiant fighter for modernism, even in those days, a few years ago, when it was a hazardous undertaking to sing Schonberg or Mahler in a Vienna concert hall, and when grim conservatives used to carry whistles and canes with them on such occasions. Her voice? It is not always rich or beautiful, I suppose, though it commands all shades of human emotion. But who would not readily sacrifice sheer beauty of tone for this singer’s exquisitely musical phrasing, and for such rarely spiritual delivery of the innermost message of each individual song.
Paul Bechert.