212

EXPLANATION OF THE "YANKEE TWANG."

perfection of human speech that the nasal passage for the outflow of sound should at certain times be completely shut off, and all the sound directed through the mouth. If in such cases there be any escape of sound behind the curtain of the palate, the purity of speech is destroyed. The soft palate, in conjunction with the muscular wall of the upper pharynx, must be under active control to produce this result. If the palate be deformed, or either it or the pharyngeal walls paralyzed or inactive, we shall find a change in the tone of the voice, and more or less indistinctness of utterance, depending upon the extent of the deformity or inactivity. The proverbial nasal twang of the "Yankee" is entirely owing to an inaction of these two organs. There is in those cases an escape of sound into the nasal cavity which is altered by the resonance of that cavity, and which should have been shut off. In passing, we may say that this is not owing in any sense to a deformity of those organs in the "Yankee," but rather to a lazy habit of speech imitated necessarily by the children whose ultimatum is to copy their elders, and thus the habit becomes confirmed as the normal condition of the speech of a whole community. But the function of the velum palati in articulate speech is not confined to the interruption of the nasal passage; in the formation of certain sounds it must be depressed and held in firm contact with the dorsum of the tongue, and the sound directed and prolonged through the nasal passages. All this involves a palatal organ of flexibility, mobility, and extent.

The reason why staphyloraphy is so generally a failure, even where it is a surgical success, is because the newly formed septum is rigid, tense, and deficient in length; in the large majority of cases it can not by any possibility be brought into firm contact with the pharyngeal wall, and imperfect speech will necessarily and always follow this defect. To the credit of surgery be it said that it has done probably all it can under the circumstances, and the only surgical hope of the future seems to lie in the direction of making the opera

MECHANISM MORE RELIABLE THAN SURGERY.

213

tion at a very early period of life, with the expectation that, as the organs develop in tissue, function, and activity, the defect will be overcome.

As surgery fails, mechanism comes to the rescue. Where Nature is deficient, she is supplemented by art, and an organ whose function was destroyed by accident, disease, or want of development, can have that function restored by properly adapted mechanism. The restoration of speech to a person who has once possessed that faculty and lost it through a destruction of the palate, is comparatively easy; but to confer the faculty of perfect speech with an artificial organ, upon one who has been afflicted from birth with the absence of the natural organ, and has grown to maturity without the ability of distinct utterance, is a much more difficult problem. In acquired lesions even crude appliances, made without much skill or accuracy, are often very beneficial; while in congenital cases the full resources of science and the nicest adaptations of art are needed to accomplish the desired result.

The partial destruction of any organ of speech may occur after the acquirement of speech, and nature makes an extraordinary effort to overcome the difficulty by a new use and activity of other organs which in a measure supply the deficiency. Thus, the total loss of speech would follow the destruction of the hard palate, but an instant restoration would result upon the introduction of an obturator. But in a congenital case the faculty of perfect speech must be acquired by practice even after the introduction of the most skillfully constructed and scientific appliance. In a description of the treatment of these cases the two classes and the different conditions above referred to must be kept distinctly in the reader's mind.

All apparatus adapted to the roof of the mouth, whether forward or back, to the hard palate or soft palate, may properly be designated as artificial palates; but as such instruments may be divided into two distinct classes, operated upon different principles, and applied in the main to entirely dif

214

DEFINITION OF OBTURATOR.

ferent cases without the possibility of interchange of principle, I therefore denominate the one an obturator, and the other an artificial velum. An obturator, according to this distinction, is a stopper, plug, or cover, hard, non-elastic, and stationary, fitted to an opening with a well-defined border or outline, and shutting off the passage. Such instruments are of nearly universal application to perforations of the hard or soft palate resulting from accident or disease, but they are rarely applicable to a congenital fissure of the velum. An artificial velum is not a stationary stopper, but an elastic,. movable valve, under the control of the surrounding and adjacent muscles, closing or opening the passages at will, and is applicable especially to congenital fissures, occasionally where the soft palate has been destroyed, but never to perforations of either the hard or soft palate.

CHAPTER IX.

HISTORY OF OBTURATORS.

THE term obturator is taken from the Latin obturare, signifying to stop up; and history shows obturators to have been among the earliest applications of mechanism to the mouth. The first recorded definite suggestion of a piece of mechanism to act as a palatine obturator is that of Alexander Petronius, who preceded the celebrated Ambroise Paré by a few years. He says: "If the decayed bone of the palate falls of itself, or if we extract it, the pronunciation is altered so much so that the patient can scarcely be heard. But it is possible, in certain circumstances, to repair this loss; for example, when there is only a hole in the palate, we can stop it up with cotton, with wax, with a gold plate, or in any other way that the genius of the artist suggests, having care to give to these instruments the same concave form as the palatine vault."

The first definite description of an obturator was by Ambroise Paré, whose first work was published in 1541; and although Guillemeau, writing fifty years later, says that obturators were applied by the Greek physicians, it is quite likely it was more a matter of inference by him than an authentic record of a fact. That the principle of an obturator was known to the ancient physicians, and that such a principle would be easily and naturally conceived by a person suffering from a perforation of the palate, is more than probable; and therefore it is likely that relief was obtained by the very simple means within the reach of every one, such

216

AMBROISE PARÉ'S OBTURATORS (1541).

as a piece of sponge or wad of lint thrust into the perforation, or a piece of thin leather, or any membranous substance which could serve the purpose temporarily of a stopper or covering. But the first recorded attempts at making a permanent obturator by mechanism are those of Paré before mentioned. Paré's description is as follows: "Many times it happeneth that a portion or part of the bone of the palate being broken with the shot of a gun, or corroded by the virulency of the Lues Venerea, falls away, which makes the patients to whom this happeneth that they cannot pronounce their words distinctly, but obscurely and snuffling; therefore I have thought it a thing worthy the labour to show how it may be helped by art. It must be done by filling the cavity of the palate with a plate of silver or

FIG. 183.

gold a little bigger than the cavity itself. But it must be as big as a French crown, and made like unto a dish in figure; and on the upper side, which shall be towards the brain, a little sponge must be fastened, which, when it is moistened with the moisture distilling from the brain, will become more swollen and puffed up, so that it will fill the concavity of the palate, that the artificial palate cannot fall down, but stand fast and firm, as if it stood of itself." (See Fig. 133.) "This is the true figure of those instruments whose certain use I have seen not by once or twice, but by manifold trials, in the battles fought beyond the Alps."

Paré gives also another form of obturator, as shown in Fig. 134, which resembles very much the cuff-button of the modern toilet. The larger button or disk being adapted to