is is due to one of several causes: either to a reflex condition from
the stomach, due to over-eating or over-indulgence of some other equally
deleterious sort, or to inactivity of the bowels, or to suppressed
perspiration, or to improper or undue use of the vocal organs.

Again, let us glance for a moment at what a good many people deem a
superfluous appendage, the uvula. A patient comes into my office with a
badly swollen uvula. The upper tones of the voice are gone. He has no
complicating quinsy, and in that case I can say without hesitation that
he has outrageously misused his voice. I ask him where he was the
previous afternoon, and find he was jubilantly "rooting" for the New
York Giants in an exciting baseball contest. Now, it in nowise lessens
the force of my illustration that this patient was not a singer and did
not acquire, if you please, his swollen uvula in orthodox fashion. It is
only a short time ago that a man came to me with a pronounced case of
oedematous uvula, or swollen soft palate. He announced to me that he
was no longer a tenor singer, although he had sung tenor for three
years; that lately he had been persuaded that his voice was baritone;
and, indeed, he had been singing, up to the time of coming to me, a
baritone part in opera. It was this which brought him under my hand
as a patient. He had changed his teacher, who had insisted that he was
a tenor, within two months, and since that time had been under the
instruction of the master who had declared that he was a baritone. I had
known him for some time, and the only perceptible change to me in the
voice was a decided tendency to cover and sombre the upper tones. Upon
examination, the only thing abnormal was the condition of the soft
palate and the surrounding tissue extending down both pharyngeal
pillars. The soft palate was swollen to nearly three times its original
size and hung down upon the tongue. The symptoms he complained of were
inability to sing above F, and all high tones were husky. The production
of the upper tones was accompanied with considerable pain. An emollient
gargle was given and, soon after, astringent applications; but in vain.
It was necessary three weeks afterward to amputate the uvula. Within
three weeks more the operation was demonstrated a success in that the
upper tones were fully restored; but I leave the question with the
teachers whether this operation would have been necessary had not this
young tenor been drawn a