SECT. XXXI.—ON THE UVA.
The uvula being, as it were, the quill or plectrum of the organ of speech is often the seat of defluxion from the head, and becoming preternaturally enlarged, of a lengthened form and slender shape, it is called columella; but when thick below and round it is named uva, from its resemblance to a grape, as the other is so called from its resemblance to a column. If, therefore, it cannot be made to yield to general treatment,—I mean evacuations by bleeding and purging,—nor to topical, such as astringents, repellents, and discutients,—we must proceed to the operation, lest, by its constant irritation, it bring on coughs, sleeplessness, and even suffocation. Such, therefore, as are contracted, round, not of a lengthened shape, bloody, or somewhat black, we must decline operating upon; but those that are slender, long, small at the extremity, loose, not very bloody, but whitish, we must operate upon; for the inflammation of them soon subsides. We must only take away as much of the uva as exceeded its natural size; for the complete extirpation of it proves greatly injurious to the parts about the chest, and occasions the loss of voice. Wherefore, having placed the patient on a seat in the rays of the sun, and directed him to gape wide, we seize with the forceps adapted for this purpose, or a common tenaculum, upon the redundant part and drag it downward, and cut it out with the instrument called staphylotomus, or the scalpel used in the operation for the suture of the upper eyelid. After the operation the same things are to be done as are recommended for angiology. But since often, from the timidity of the patient, or the fear of the hemorrhage, or the success attending the treatment by medicines, he declines the operation by instruments, we may rather consume it by means of a caustic medicine. Wherefore, taking the caustic used for burning the eyelids, or some such, we are to fill with it the hollows of the instrument called staphylocaustos, and directing the patient to gape wide, and getting the tongue pressed down with a tongue spatula, we open the instrument sufficiently and grasp with it as much of the uva as we cut off in the other operation. The medicine must neither be of too liquid a consistence, lest it run down from the uva improperly, and burn the adjoining parts (and, therefore, we direct the patient not to swallow during the whole operation of burning), nor very hard, that it may soon act upon the uva. And if from one application the extremity of the uva become black, this will be sufficient, but if not we must use it again. During the whole time of its action the patient must sit with his head bent forwards, in order that the saliva which is melted down with the portions of the medicine may flow from the mouth. The part becomes dead in one hour, and falls off about the third or fourth day. After the burning, having wrapped the index-finger round with soft wool or tow, we wipe the parts about the uvula, or direct the patient to gargle with water. But after this operation, and also that on the tonsils, soothing fomentations from the oil of camomile are to be applied around the neck, and in like manner we may use gargles and liniments.
Commentary. It appears from the Hippocratic treatises that excision of the uvula was sometimes performed in early times. (Prognost. de Morbis, ii; De affect.)
Celsus recommends us not to meddle with the operation when the uvula is red and enlarged, for fear of hemorrhage; but when it is slender, sharp, and white, or when it is pale and thick below, but slender above, it may be extirpated without danger. For this purpose he merely directs us to seize upon it with a forceps and cut it out. (vii, 12.)
Galen describes fully the operation by medicines, but says nothing of excision. (De Med. sec. loc. vi.) Aëtius describes the operation in nearly the same terms as our author. He directs us to grasp the enlarged uvula with a forceps and cut it off, using afterwards some astringent gargle. (viii, 44.) Oribasius briefly mentions the operation, which he directs to be performed with extreme circumspection. (Med. Collect. xxiv, 10.)
Albucasis describes the operation similarly to the Greeks. He directs the operator to get the patient’s tongue pressed down by an assistant; when the operator is to seize upon the uvula and cut off as much as is proper of it. He gives a drawing of an instrument for the operation with caustic medicines. (Chirurg. ii, 37.)
Avicenna’s description is to the same effect, but not so circumstantial. (iii, 9, 15.) Mesue directs us to perform the operation with a heated scalpel of gold. (De Ægr. Gutturis, 3.)
Rhases states that when the uvula is enlarged, but is not red, the operation may be performed without danger. He mentions that some preferred the actual or potential cautery, but that he preferred excision. He describes, but not distinctly, an instrument for applying the caustic medicines. He states that loss of the entire uvula impairs the voice and exposes the lungs to danger from cold. (Contin. vii; and Divis. i, 49.)