yet a reasonable amount of precaution will minimize the
chances of attack. Singing in a room where there is smoking is a
prolific source of node formation. Breathing dust-laden air, continued
effort to carry on conversation on the cars or amid street noises, are
fruitful causes of vocal disorder.

The mucous membrane of the vocal cords obeys natural laws in
restoration. A node may disappear in three days, if not teased with
effort. More often, however, it requires from seven to ten days for it
to disappear without treatment. If the singer foolishly persists in
using the voice, the node will extend into the cord tissues, and result
in a most unfortunate condition. The cord loses its elasticity. It
refuses to respond. It will neither act nor will it consent to be acted
upon. It is in a state of collapse, and the voice for singing purposes
has gone, never to return.

Let me illustrate what rest will do for a node. A singer came to me with
a node of three months' standing, on the left cord. She had been singing
with her teacher in the regular course of her lessons at an unfortunate
time, when, too, she was vocally weak. In singing up the scale, and
at the C (as nearly as she could remember), she became hoarse, and, as
she described it to me, "the voice had a hole in it." Throughout the
remainder of the lesson, unless she exercised great care, she would
always break at the point named. Her nose seemed stuffy, and she
compared her nose and throat to a cornet lined with velvet. After the
break, and for the remainder of the lesson, her voice was husky. Her
teacher advised her to seek expert advice. Previously, the voice had
been clear, though she was a novice in singing. After remaining away
from her lessons for two weeks or more and finding that recovery was not
rapid, she came to me. The node could be plainly seen on the left cord.
Before examining her, I tried the voice with the E scale, wrote down
the diagnosis and handed it to her to read. My written conclusions were
verified with the laryngeal mirror. I found no trouble except with the
left vocal cord, the node being in the anterior middle third. On the
summit of the node the mucous membrane appeared very red, budded, and
almost warty. I cocainized the cord, and immediately applied pure alum
in solution to the node itself, but to no purpose. This treatment was
continued for two weeks, without any perceptible change for the better.
Then I ordered the patient to remain qu