PAPERS OX MEDICINE AND PUBLIC HEALTH 337 



teeth are used — the p, b, w, f, etc., are impossible to a 

 person with a defective palate. This is true because, in 

 the enunciation of these sounds, the palate is necessary 

 to confine the breath to the oral channel and to prevent 

 it from passing- up through the nasal chambers. 



"It will be borne in mind that the consonant sounds 

 are made by impeding the moving column of breath at 

 certain points above the larynx. The points at which 

 the impediment takes place have been called the stop 

 positions. These have been divided into the anterior, 

 the middle and the posterior stop positions. ; * For 

 all these sounds requiring an impediment in the outgoing 

 column of breath, whichever stop position may be used, 

 it is necessary to have a freely movable and normal pal- 

 ate. 



"The soft palate has a wide range of movement. Its 

 function in vocalization is to assist in controlling the 

 action of the vocal cords and regulating the size and 

 shape of certain important resonance chambers, and its 

 function in articulation is to shut off the nasal from the 

 oral cavity during the emission of the explosive and 

 fricative sounds, and to form contacts with the tongue 

 in the formation of the so-called posterior linguo-palatal 

 sounds." Again he says: "Not only are the tongue 

 contacts important, but in the production of many of the 

 consonants there is a damming up, so to speak, of the 

 breath in the mouth and a slight explosive effort as the 

 sound is emitted. When this takes place in the normal 

 mouth, the velum rises and shuts off completely the oral 

 from the nasal cavities, and this is one of the things 

 which the velum of a cleft palate cannot do and which 

 it must be made to do before we can get the best results 

 from the standpoint of speech. The velum of a cleft 

 palate, therefore, must be united in such a manner that 

 it will be as large and as loose as possible with its muscles 

 in their normal positions and relations, and then the 

 patient should be given such exercises as will have a 

 tendency to develop in these muscles their normal 

 physiological functions." 



A thorough understanding, not only of the importance 

 of speech, but of its mechanism is most essential to sue- 



