{"id":33698,"date":"2015-03-20T18:03:47","date_gmt":"2015-03-20T17:03:47","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=33698"},"modified":"2015-04-17T15:18:21","modified_gmt":"2015-04-17T14:18:21","slug":"jeffrey-aronson-when-i-use-a-word-rough-breathing","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/03\/20\/jeffrey-aronson-when-i-use-a-word-rough-breathing\/","title":{"rendered":"Jeffrey Aronson: When I use a word . . . Rough breathing"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft  wp-image-32935\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson-223x300.jpg\" alt=\"jeffrey_aronson\" width=\"155\" height=\"209\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson-223x300.jpg 223w, https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg 446w\" sizes=\"auto, (max-width: 155px) 100vw, 155px\" \/><\/a>Exploring the English phonemes, I have reached the unvoiced labiodental fricative <em>f<\/em>. When consonantal shift changes <em>p<\/em>, <a href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/03\/06\/jeffrey-aronson-when-i-use-a-word-pah-disgusting\">the unvoiced bilabial plosive<\/a>, into <em>f<\/em>, a breath becomes a sneeze, even though it is the <em>p<\/em> that is plosive.<\/p>\n<p>Let\u2019s start with orthopnoea, the symptom of breathlessness\u2014or worsening breathlessness\u2014on lying flat. But \u201corthopnoea\u201d does not mean breathlessness on lying down. It means breathing [more easily] on sitting up. And the opposite, breathlessness on sitting up, can also occur\u2014as a case history demonstrates.<!--more--><\/p>\n<p>A <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17599218\">patient with peripheral edema and lung crackles on auscultation<\/a>, who appeared to have cardiac failure, not only had no orthopnea, but felt more breathless sitting up; a CT scan showed interstitial pneumonitis, which was attributed to amiodarone.<\/p>\n<p>The Indo-European root ERDH meant to grow properly. The Greek derivative \u1f40\u03c1\u03b8\u1f79\u03c2 (orthos) meant straight, upright, or vertical. [The little comma over the first letter was called a smooth breathing, inserted over an initial vowel to indicate the absence of aspiration; a reversed comma was a rough breathing, indicating aspiration\u2014Latin asper = rough.] So orthopaedics is to do with making children grow properly, orthodontics with making the teeth grow straight, and orthoptics with correcting faulty vision (literal rather than metaphorical\u2014someone ought to invent political orthoptics). Orthoepy is proper pronunciation, orthography proper spelling. Orthopnoea is breathing [more easily] while upright.<\/p>\n<p>A feeling of breathlessness, or worsening breathlessness, on sitting up (i.e. the opposite of orthopnoea) <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10385164\">was first described in a patient with<\/a> a post-traumatic intrathoracic arteriovenous shunt who had a threefold increase in ventilation and reduced arterial oxygen saturation when upright. What should we call that? Well, if orthopnoea means breathing [more easily] upright, what we need is a word that means breathing [more easily] supine. The Greek word for supine was \u1f55\u03c0\u03c4\u03b9\u03bf\u03c2 (huptios; note the rough breathing), suggesting \u201chyptiopnoea.\u201d However, when they described the symptom in a patient with severe obstructive emphysema, <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/5355439\">Altman &amp; Robin invented<\/a> \u201cplatypnoea,\u201d admittedly more euphonious, using the Greek word for flat, \u03c0\u03bb\u1fb0\u03c4\u1f7b\u03c2 (platus).<\/p>\n<p>Confusingly, platypnoea is accompanied by orthodeoxia, hypoxia on sitting upright\u2014a term that <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1256486\">Robin and his colleagues<\/a> introduced in 1976 when they described two patients with right to left vascular shunting in the lung bases associated with chronic liver disease and one with multiple congenital pulmonary arteriovenous fistulae. Since then, there has been a steady increase in the number of reports (figure).<\/p>\n<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/03\/aronson_march_201.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft  wp-image-33717\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/03\/aronson_march_201-300x174.png\" alt=\"aronson_march_20\" width=\"400\" height=\"232\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/03\/aronson_march_201-300x174.png 300w, https:\/\/blogs.bmj.com\/bmj\/files\/2015\/03\/aronson_march_201.png 749w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p><em>Papers published since 1975 retrieved from Pubmed by searching for \u201cplatypnea OR orthodeoxia\u201d (total 329 papers). Click graph to enlarge.<br \/>\n<\/em><\/p>\n<p>&nbsp;<\/p>\n<p>Now what about the \u2013pnoea in orthopnoea and platypnoea? The Indo-European root PLEU meant to flow, giving pleura and pleurisy\u2014and, by metathesis, pulmonary. PNEU was the nasalised form, giving the Greek words \u03c0\u03bd\u03b5\u1fe6\u03bc\u03b1 (p\u1ffdneuma), breeze, breath, spirit, and divine inspiration, and \u03c0\u03bd\u03bf\u1f75 or \u03c0\u03bd\u03bf\u03b9\u1f71 (p\u1ffdno\u0113 or p\u1ffdnoia) breeze or breath. Consonantal shift in PLEU from <em>p<\/em> to <em>f<\/em> gave flow, fly, flitter\u00a0and flutter, float, flotilla, flotsam, fledgling, and fletcher, a man who makes arrows. And the same shift in PNEU gave fneeze. Now that\u2019s not a misprint. Words for sneeze in various old languages all began with fn, like fniezen in old Dutch and fn\u00fdsa in Old Norse. The initial fricative was then dropped, giving modern Dutch niezen, German niesen, Danish and Norwegian nyse, and Swedish nysa. But in English neeze, by association with <a href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/03\/13\/jeffrey-aronson-when-i-use-a-word-pecksniffery\">sniffing and snorting<\/a>,\u00a0became sneeze, although for a while both were in use.<\/p>\n<p>French, on the other hand, has \u00e9ternuer, Italian starnuto, and Greek \u03c6\u03c4\u03ac\u03c1\u03bd\u03b9\u03c3\u03bc\u03b1, which come from a different root, STER, giving us sternutation, the technical term.<\/p>\n<p>A modern relic of fneezing remains: fnarr, fnarr, imitating suppressed snorting laughter, with sexual innuendo. \u201cKnow what I mean? . . . Nudge nudge. Snap snap. Grin grin. Wink wink. Say no more.\u201d Accompanied, perhaps, by a different kind of rough breathing.<\/p>\n<p><em><strong>Jeffrey Aronson<\/strong> is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford&#8217;s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n<p>Competing interests:\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Exploring the English phonemes, I have reached the unvoiced labiodental fricative f. When consonantal shift changes p, the unvoiced bilabial plosive, into f, a breath becomes a sneeze, even though [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/03\/20\/jeffrey-aronson-when-i-use-a-word-rough-breathing\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5762],"tags":[],"class_list":["post-33698","post","type-post","status-publish","format-standard","hentry","category-jeff-aronsons-words"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Jeffrey Aronson: When I use a word . . . 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