Music Trade Review

THE MUSICAL CRITIC AND TRADE REVIEW.
THE THROAT IN ITS RELATIONS TO SINGING.
A SERIES OF POPULAR PAPERS BY WHITFIELD WARD, A.M., M.D., PHYSICIAN
TO THE METROPOLITAN THKOAT HOSPITAL.
ni.
THE INSTRUMENTS USED IN THE EXPLOHATION OP THE THROAT.
THE ILLUMINATOR OR LIGHT CONDENSER.
F the several styles of instruments for the condensation of light, which
have been from time to time invented or designed, the one that is most
O
nuiversally used is that displayed below.
January 5th, i 8 8 \ .
of an elastic band, which encircles the forehead. The mirror may be
arranged in two positions, namely, over the brow, or in front of either eye.
The former position is the easiest of acquirement, but the latter is to be pre-
ferred, because the image obtained thereby is the best—the eye, as will be
seen farther on, being directly in the line of vision.
THE ADJUSTMENT OF THE ILLUMINATOR.—The illuminator or light con-
centrator is placed on a table or stand, immediately at the side of the chair
to be occupied by the person submitting to examination, in such a manner
that the portion of the apparatus from whence the light issues shall be even
with and on a line with the ear of the subject, and shall point to the face of
the examining party (occupying a chair exactly to that of the opposite person
being examined). The above relationship, not only of the illuminator and
head mirror, but also of the subject and the examiner, will be instantly
understood by a glance at the accompanying cut-
Fig. 1 represents Mackenzie's illuminator or
light condenser. This instrument consists simply
of a hollow tube of brass to which is affixed at
right angles a shorter tube provided with a
powerful condensing lens, the latter portion of the
apparatus is located opposite the jet of flame. The
appliance as portrayed alone is constructed so as
to fit an ordinary argand burner, and resembles
somewhat an ordinary bulls-eye lantern. The stand
to which it is generally attached consists of a movable
cross-piece which plays up and down an ordinary stem
or rod, the illuminator being fixed to the cross-
piece (Fig. 1). The reason why the arm or cross-piece
is constructed so as to move up and down, is to allow
of the light being elevated or loAvered at will, a neces-
sity as will be seen further on in making laryngeal
examinations. In some parts of Europe the flame
1 proceeding from an ordinary gas burner is the only
illuminator used. The light derived from the latter
source differs from that obtained from the instrument
depicted above, in that it is diffused throughout the
Fig. 1.—Light Condenser, entire apartment and not concentrated within a cer-
tain area of space.
THE HEAD MIRROR.
This instrument is a simple
concave mirror of circular
form, perforated in the middle,
and set in a strong metal frame,
It is provided with an elastic-
band, which circumvents the
forehead, by which means the
mirror is held in situ.
An excellent picture of this
useful instrument is here
shown.
There are several sizes of
head mirrors manufactured.
They are arranged according
to their diameters, that of the
smallest being 3 inches, and
that of the largest 4 1-2 inches.
The 4-inch mirror is the one
most generally employed.
THE MOUTH MIRROR.
The mouth mirror consists
Fig. i— The Head Mirror.
of a circular piece of looking-
glass set into a metal frame, attached to a stout shank.
The shank is set into a handle, generally made of bone or
ivory.
The cheapest of these instruments are firmly set in the
handle, whilst the more expensive (see Fig. 3) are attached
to the handle by means of a thumb-screw for regulating the
distance of the mirror from it.
There are five sizes of mouth mirrors on sale in the in-
strument stores, but the one displayed in Fig. 3 will be the
one most generally serviceable for exploring the hidden
recesses of the vocal organs.
There are several other instruments sometimes necessary
as aids to a laryngeal examination, but as they properly be-
long to the domains of medicine, their description will have
to be omitted here.
How TO EXAMINE THE THROAT.
Fig, i.
In the picture, as you see, the head mirror is placed in front of the eye,
the second of the two positions already referred to ; also that the bull's eye
portion of the light condenser is turned so as to point to the head mirror,
and likewise the close proximity of the faces of the two individuals.
I should particularly recommend to those gentlemen of the musical pro-
fession who desire to perfect themselves in the art of laryngoscopy, that is
the examination of the larynx during life, to first master the casting of the
reflected light into the open mouth of the subject under examination ;
for in fact, it will be impossible to succeed further, namely, in the intro-
duction of the mouth mirror, until the above feat can be properly done.
The arrangement of the illuminator is simple enough, only requiring to be
placed in the position illustrated above, but the next step, the posing of the
head mirror is fraught with considerable annoyance, oftentimes requiring
the expenditure of a great amount of patience on the part of the examiner.
To obtain a perfect image the explorer must look through the little aperture
to be found in the centre of the reflecting mirror. To be certain that such
a course is being pursued, it is only necessary to close the opposite optic.
As it will necessarily be exceedingly annoying to the person under examina-
tion to be the object of a prolonged course of experimentation, the learner
had better practice on a dummy, any object, as for instance, the examiner's
hand, or a spot on the adjoining wall, placed in the locality occupied by the
head of the subject as illustrated in fig. 4, serving the purpose admirably.
THE INTRODUCTION OF THE MOUTH MIRROR.
If the casting of the light into the mouth is difficult, the introduction of
The examination of the vocal organs during life is not
the small mirror of the laryngoscope to its proper place is tenfold more so.
nearly so difficult as one would naturally suppose upon first
In the performance of this part of the operation both hands are necessary—
inspecting the instruments necessary to its performance.
one to hold the mirror, and the other to hold the tongue of the subject under
Before undertaking to explore the throat, I would tender a
examination. The tongue is withdrawn in order to pull forward the larynx,
word of advice regarding the kind of subject that should be
as the latter tube is firmly attached to the organ of speech. Having grasped
chosen by a beginner. The novice should always select a
the outstretched tongue by means of a napkin in one hand, take up the
non-sensitive or non-irritable throat. Some throats are so
mouth mirror gently with the thumb and first finger of the remaining hand
hardened that they can withstand any amount of manipula-
in exactly the same manner as an ordinary writing pen-handle. Now warm
tion without producing a spasm of the parts; while, on the
its reflecting surface by holding it for an instant over the jet of flame, and
contrary, some throats are so irritable that an expert ex-
then carry it back to the soft palate, gently pressing this portion of the
plorer can obtain a view only after a most persistent and
mouth upwards and backwards with the metal back of the mirror. The
prolonged course of observation. If the beginner should
mirror is warmed to prevent the air from condensing on its surface, which
endeavor to see the larynx of one of these latter individuals,
would form a thick coating on the glass, and thus obscure the vision. During
not only would he utterly fail, but he would no doubt
the journey of the mirror through the mouth, the greatest amount of care
greatly over-estimate the difficulties of laryngeal examina-
should be exercised that none of the tissues of this cavity be touched by the
tion.
instrument, as this might produce a spasm of the parts, which would destroy
the chances of seeing the larynx. When the small mouth mirror of the
There are three main steps in the exploration of the
laryngoscope arrives at the palate, it should be posed so that its reflecting
throat during life, each of which I shall describe individ-
surface shall look downwards and slightly forward, this position being the
ually. These are:
Fig 3.—The Mouth
most favorable one to obtain a complete view of the desired parts. When
Mirror.
1. The arrangement of the head mirror.
the latter instrument is thus located, it will be necessary for the person
2. The adjustment of the illuminator.
under examination to utter some sound in order to open the throat sufficiently
3. The introduction of the mouth mirror.
to see the several organs comprising the larynx. The sound that will gener-
THE ARRANGEMENT OF THE HEAD MIRROR.
ally produce this result is ah, uttered in the ordinary tone of voice. If the
As previously stated, the head mirror is fastened to the brow by means parts are not sufficiently displayed, instruct the person under observa