THE FUNCTIONS OF THE UVULA. 29 



1 have observed that a patient, who has just undergone an oj)eration for 

 excision of an elongated and hypertrophied uvula, raay talk immediately 

 in an ordinary tone with greater ease than before the operation, but, just as 

 soon as he utters words with more than the usual force of voice, such, for 

 instance, as he would require to address a person across the street, some of 

 the efforts will remind him of the excised uvula, and though not causing as 

 much pain as the knife did, will cause so much that he will be compelled to 

 cut his sentence short of its intended length. The reason of this effect on 

 the uvula appears to me to be this : the heavy uvula had given so much 

 support to the soft palate that, although it had been acting as an impedi- 

 ment to all kinds of sounds, the velum required very little of its own pres- 

 sure on the base of the tongue (Fig. 6) to prevent it from being thrown into 

 motion by the air from the larynx, but when the superabundant portion of 

 the uvula was removed, the velum required greater pressure upon the base of 

 the tongue to prevent these vibrations, and this pressure was the occasion of 

 the pain. Of course the loss of the whole of the uvula does not interfere 

 with the formation of the two semi-lunar-shaped openings by the free border 

 of the velum and the dorsum of the tongue (Fig. 6), by which the voice is 

 allowed to escape from the mouth, and thus provide for perfect vocalization ; 

 it takes away & part only of the support from the soft palate. Even if there 

 be no stump left by the excision, the tongue will learn to overcome the de- 

 fect by the increased elevation of its dorsum, which may be made more 

 convex than was required to form the two semi-lunar openings when 

 the whole of the uvula was present, and in this way allow both a greater 

 pressure and more of the central portion of the velum to rest on the tongue. 

 But if the soft palate suffer so much of a loss of substance in its central 

 portion', that its concavity is equal to the convexity of the dorsum of the 

 tongue, thereby preventing the formation of the semi-lunar-shaped open- 

 ings, and neutralizing all support, there will be some sounds, such as pass 

 mostly through the pharyngo-nasal cavity and a little through the mouth, 

 given imperfectly in spite of all efforts to overcome it, because the proper 

 tone requires that the velum should be raised to allow a part ot the sound 

 to pass to the mouth, and this act of elevation exposes it to the force of the 

 air from the larynx, which force is the cause of the imperfection of the 

 sounds, by causing the unsupported edge to vibrate. Again, if the loss in 

 the centre of the velum be greater than can be closed by the greatest con- 

 vexity of the dorsum of the tongue, the disability will be equal to that 

 caused by a perforation of the soft palate, and in addition, there will be a 

 tremulousness to many semi-nasal tones, on loud speaking, as addressing an 

 individual at a distance. That the intermittent tone is occasioned by the 

 vibrations of the central portion of the velum, is evidenced by the pain in 

 this part after lengthy speaking in a loud voice. This pain was experienced 

 by two patients while under my care, whose soft palates were notched to 

 this extent by ulceration. 



In answer to the second question: — ^" How to account for the improve- 

 ment of the voice after the removal of the uvula?" — I would ask, if it is 



