The Lost Chords

The toastmaster began the evening with a typical toastmaster's gag: "Before I cut my throat . . ." Not one of the 200 special guests interrupted him with a laugh. Not one of them could. Actor William Gargan was playing toastmaster in Memphis for the International Association of Laryngectomees--people who have lost their larynges to cancer. Their laughter was muted to a barely audible chuckle.

Toastmaster Gargan was particularly sensitive to their plight. His own voice had been his livelihood in a career devoted to the stage, movies and TV. Then, while touring with the road company of The Best Man two years ago, playing the role of an ex-President who dies of cancer, Gargan himself began to complain of a continually sore throat. Doctors discovered he had cancer of the larynx. His voice box was removed, and what was left of his windpipe now ends at a collar-button-level hole in his neck. When he left the hospital, he was speechless. But last week, like the others at the Memphis dinner, Gargan was talking once more--using esophageal speech.

Swallowing Air. In natural speech, air from the lungs is exhaled through the windpipe (trachea), past the "vocal cords" (membranes of the larynx). If these membranes are tensed and vibrated, a tone is produced. That tone and its timbre are modified by the tongue, teeth and lips to make the different sounds of speech. In the laryngectomee, the exhaled air escapes through the hole in his neck (tracheostomy) where his Adam's apple used to be. But air can also be swallowed through the gullet (esophagus) and burped back again. And the swallowing muscles at the top of the gullet can be made to vibrate. As a result they give a lower tone. In the 1930's, a few laryngectomees discovered that they could produce speech of a sort by swallowing air and controlling their burps. Temple University's Dr. Nathaniel Martin Levin, now practicing in Miami, systematized the method (TIME, Dec. 4, 1939), and many improvements have been made since.

Since cancer of the larynx is curable with early diagnosis and modern surgery in 60% of cases, and 2,000 patients are operated on every year, the number of U.S. laryngectomees is growing fast--so fast, in fact, that the American Cancer Society, which sponsors the I.A.L., has trouble finding enough therapists to train the recovered patients, who like to call themselves "The Lost Chords." The danger is that they will become just that, and permanently, if they are allowed to wallow in their early discouragement.

The best teachers are laryngectomees themselves, especially those who were voice-conscious before they had cancer. And among the many at Memphis, the teacher with the best record was a slight, bright-eyed grandmother of nine from Newton, Mass., Mary Doehler, 71, widow of a chain-store executive, had been an aspiring soprano in her youth and had taught children with speech problems.

When cancer cost her her own vocal cords in 1944, Mrs. Doehler not only taught herself esophageal speech but set about perfecting methods of teaching others. She has written a standard handbook on the technique (it has just been translated into Japanese), and has taught no fewer than 1,300 laryngectomees herself, mostly at Massachusetts Eye and Ear Infirmary.

But No Saxophone. Mrs. Doehler makes each patient practice swallowing air as many as 500 times before she asks him to make a sound. After that it is a four-step process to the first single syllable: open the mouth to let air in; close the mouth; swallow the air; and, finally, open the mouth and say "Bah!" Some determined patients progress from "Bah!" to full and clearly understandable sentences in two or three weeks. Others take many months. "The time varies," says Mary Doehler, "not only with the individual's determination but also with his family. If the family does not encourage him to speak loudly and distinctly, but lets him whisper or communicate in some other way, he may never learn."

Many a laryngectomee begins esophageal speech with cuss words, which have the advantage of being monosyllabic and explosive. Says Mrs. Doehler: "I often tell a man to say 'Damn!' It helps him to relax." One way or another, Mrs. Doehler and her dedicated colleagues have taught esophageal speech to about half of the estimated 20,000 U.S. laryngectomees.

In emergencies, they need special techniques for artificial respiration--as was demonstrated at Memphis by a volunteer who wore a plastic bag over his head, and snugged tight around his neck, for half an hour. But they can eat and drink normally and do practically everything that they could do before the operation--except swim, since they cannot close that hole in the neck. One other exception, notes Manhattan's Speech Therapist John McClear wistfully, is that they cannot play a wind instrument. McClear used to play the saxophone.

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