[Reprinted from The Medical News, July 23, 1892.] 
VOMITING INDUCED BY AN ELONGATED 
UVULA; OPERATION; RELIEF. 
By EDWARD F. PARKER, M.D., 
DEMONSTRATOR OF ANATOMY, MEDICAL COLLEGE OF SOUTH CAROLINA, 
CHARLESTON, S. C. 
Vomiting, as a symptom of some disturbance of the 
digestive canal, is so commonly associated with disease 
or functional derangement of the stomach and intestines, 
that we are likely to overlook the fact that the upper part 
of the alimentary tract is sometimes responsible for the 
difficulty. A common division of the causes of vomit- 
ing is into local, central, and reflex. In the pharynx 
and surrounding parts, from their exposed position and 
anatomic relations, we frequently find the origin and 
explanation of this last class. 
Quite recently a case presented itself exemplifying 
this fact, and while impressing upon me the old medical 
axiom that to treat disease successfully we must find its 
cause and remove it, at the same time it illustrated the 
truth that seemingly grave conditions may arise from 
trifling causes, which if not discovered and removed, 
render all treatment useless and ineffectual. 
The pharynx and adjacent parts can always be easily 
and quickly examined, and such examination should be 
made, so that we may consider or eliminate them as 
factors in all disturbances that may possibly originate 
there. In justification of these remarks the following 
case is interesting and instructive. 
During the month of March, 1892, F. G., twenty-one 
years old, consulted me for nausea and persistent 2 
vomiting. His face wore an anxious expression, though 
he was apparently in good health. The nausea had 
been annoying him for some time, but the vomiting had 
only commenced two weeks before. He was scarcely 
able to retain anything on his stomach. His health 
had previously been excellent. Medication had failed 
to give him any relief. I Was struck by the man's face. 
A month or so previously, in examining the throat of 
a patient, I found an elongated uvula. I advised an 
operation and appointed an hour for the next day. The 
patient was alarmed at the idea of any cutting, and did 
not return. Now, though this patient did not complain of 
any symptoms referable to his throat, I thought I recog- 
nized in him my former renegade. This identity, how- 
ever, he denied ; but curiously enough, on examining the 
throat, an extremely long uvula was found, resting on 
the base of the tongue and exciting retching with every 
attempt to swallow. The uvula was unusually elongated 
and tapering in shape, though not equal in length to one 
described by Morell Mackenzie, that was so long that it 
was inhaled into the larynx and produced symptoms of 
suffocation. 
Under cocaine anesthesia a piece more than an inch 
in length was removed, and the next morning the patient 
returned relieved. 
The terms excision and amputation as applied to this 
operation seem to me to be inappropriate and mislead- 
ing, as they imply removal of the organ z'« toto, while 
uvulatome and uvulotomy accurately express the instru- 
ment and the operation. 
Elongation of the uvula, though more frequently the 
result of a chronic inflammatory condition of the 
pharynx and naso-pharynx, which by causing constant 
hawking and coughing leads to lengthening of the 
organ and relaxation of the soft palate, may also be 
congenital. 
In the majority of cases our attention is called to the 3 
throat by a tickling, irritating sensation, as if a foreign 
body was present; nausea and vomiting are not so com- 
mon as symptoms of this condition. 
The patient was a good singer and his voice was 
materially improved by the operation. 
It is in the light of a practical lesson, rather than as 
an unusual or curious incident, that I think this case 
worthy of report, in that it teaches the necessity of mak- 
ing a thorough examination in every case that comes 
for treatment, and warns against any routine in pre- 
scribing drugs for symptoms that may owe their origin 
to many different causes. 
jo Hasell Street.