Jeffrey Aronson: When I use a word . . . Phlegmatic

jeffrey_aronsonThe second of Galen’s four fluid humours of the body, φλέγμα, was associated, when in supposed excess, with a phlegmatic temperament, “not easily excited to feeling or action; stolidly calm, self-possessed, imperturbable; sluggish, apathetic, lacking enthusiasm” (OED).

Although this sounds dull, the ultimate origin of the word is the IndoEuropean root BHEL, associated with verbs meaning to shine, flash, or burn, and adjectivally describing bright colours, such as shining white. Of its many ramifications, I have chosen a few examples.

Deities in various mythologies had names related to Bel or Baal, often associated with light. Belili, for example, was a Sumerian moon goddess and Baal Shamain was a Babylonian god of the sky, sometimes identified with the sun. Beltane was an ancient Celtic Mayday festival, named after Bel, celebrating the Spring equinox, when day and night are of equal length. The Canaanites identified their goddess Baalath with Venus, the evening star. Baalath or Belet was also regarded as a fertility goddess by the Sumerians, and her consort Baal was a Semitic fertility god. Later, Baal came to mean Lord; Beelzebub, בעל זבוב in Hebrew, is literally Lord of the Flies.

BHEL in Greek became PHAL, giving ϕαλᾱρίς, a coot, from its bald white head. Phalaropes are birds with white patches often around the eyes or on the neck. In Russian белый (belyĭ) means white. The beluga is a greyish white sturgeon, Acipenser huso, found in the Caspian and Black Seas and famous as a source of caviar; it is also the name of a white whale of the dolphin family, Delphinapterus leucas (Greek λευκός  = white). In French blanc means white, and to blank [out], blanch, blench, and bleach all mean to turn or become white.

Other colours that come from BHEL are blonde, blue, and, by consonantal shift, the Latin flavus, yellow, giving us flavines, yellow acridine derivatives used as antiseptics, such as acriflavine, and flavones or flavonoids, plant pigments. Some flavonoids have been suggested to be associated with a risk of breast cancer. Others reportedly inhibit growth and induce apoptosis in human breast adenocarcinoma cells in vitro and cause tumour regression in mice. This highlights the fallacy, beloved of those who peddle useless therapies, of lumping together large numbers of compounds under a single heading and claiming benefits for the whole group.

Natural polyphenols, for example, which have been claimed to have antidiabetic effects, to be useful in hypertension and ischaemic heart disease, and to protect against paracetamol hepatotoxicity, form a group of hundreds of diverse substances, including flavonoids, found widespread in plants, insects, crustaceans, and other animals. They can’t all have the same beneficial effects. Some are important, however: flavin mononucleotide and flavin adenine dinucleotide are cofactors in cellular oxidation–reduction reactions.

Shift from l to r, both liquid alveolar consonants, turns BHEL into BHER, giving us bright and burnish, brunet and brown, like a bear. Berries are bright and Anglo-Saxon Berts are all bright (famous) in different ways: Albert (adal = noble), Gilbert (gisil = pledge), Herbert (heri = army), Humbert (hun = warrior), Philbert (fila = much), and Robert (hrod = fame).

Phlegm comes from the Greek words ϕλέγειν to burn and ϕλέγμα inflammation. Phlegethon was a mythological river of fire, one of five rivers in Hades. Phlox is a flame coloured plant. Phlogiston was a hypothetical substance supposed to exist in all combustible bodies, released during combustion; Joseph Priestley called oxygen dephlogisticated air.

The Summoner, from the Ellesmere manuscript of The Canterbury Tales (early 15th century)

In humoral theory an excess of phlegm (not the same as what we nowadays call phlegm) was caused by excess heat and was associated with cold diseases. A phlegmon was an inflammatory mass or localised area of inflammation, such as cellulitis. Apophlegmatisms were medicines taken to remove phlegm. Saucefleme was a disease associated with facial swelling, supposed to be due to salt humours (Latin salsus = salt). Chaucer’s Summoner (picture) “hadde a fyr reed Cherubynnes face ffor sawcefleem he was with eyen narwe.” Carbuncles in Neville Coghill’s translation. Not something to be phlegmatic about.


Jeffrey Aronson is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford’s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.

Competing interests: None declared.