When I Use an Evidence Based Word . . .

4. From phonemes to roots

Jeff Aronson, Honorary Consultant Physician and Clinical Pharmacologist

Jeff Aronson, Honorary Consultant Physician and Clinical Pharmacologist

If words can be traced back to roots, as I discussed in Part 3, so roots can be traced back to phonemes.

We cannot know what the first spoken word was, but we can be pretty sure that the first uttered sound (Greek φώνημα) was a phoneme, a unit of sound that cannot be analysed into smaller units. English has 44 of them: 24 consonantal sounds, 12 pure vowels (7 short, 5 long), and 8 diphthongs  The 12 pure English vowel sounds are shown in the picture below, representing the oral cavity as a trapezium, and showing the shapes of the mouth and lips (left and bottom) and the part of the tongue (top) that are involved when the phonemes are produced.










Phonemes and graphemes

First, let’s define some important terms. “Phoneme” is defined in the Oxford English Dictionary as “A unit of sound in a language that cannot be analysed into smaller linear units and that can distinguish one word from another.” “Grapheme” is defined as “The class of letters and other visual symbols that represent a phoneme or cluster of phonemes” and “in a given writing system of a given language, a feature of written expression that cannot be analysed into smaller meaningful units”. The dictionary gives an excellent example: the phoneme /f/ is represented by the grapheme <f>, which stands for any one of a range of so-called allographs, i.e. grapheme variants—f and F, ff and Ff, ph and Ph, as in femur and Fanconi, paraffinoma and Ffoulkes, phenobarbital and Phenergan—each of  which has the sound that is represented by the phoneme /f/. Add to those the allograph gh—which sometimes, but not always (that’s for another time), is pronounced /f/—and you have the complete set.

Say “aaaaaaah”

Let’s start with the phoneme /a/. Open your mouth and glottis. Now phonate. The sound will be a vowel. And if you’ve opened wide it will be ‘aaaaaaah’.

The sound ‘aah’ can express various emotions, including:

‘Ah’ can also be a conversational filler, like er or um, an interjection meaning ‘yes’, and a verb meaning to say ‘ah’.

But nowhere in standard dictionaries is ‘say “aah”’ defined as a medical instruction to phonate with the back of the tongue in its lowest position, preferably with a falsetto pitch.

A colleague, composing an exam paper, wanted to describe a patient with a hoarse voice, whose palate moved upwards to the right when he phonated. How, he asked me, should he spell the sound? Now there’s no standard way to spell utterances of this sort that are not proper words. I recommended ‘aaah’, but could have suggested ‘a’, ‘ah’, ‘aah’, and ‘aagh’ or even ‘aargh’.

In 14 textbooks on clinical examination that I have consulted, the instruction to ask the patient to say ‘ah’ appears in the section on examining the ninth cranial nerve. In eight of them the spelling is ‘ah’, in four ‘ahh’ or ‘ahhh’, and in two ‘aah’. Three of the instances of ‘ahh’ were in American texts. In two cases (one ‘ah’ and one ‘ahh’) the authors added an unnecessary exclamation mark.

I prefer ‘aah’ or ‘aaah’, because the sound that the patient is asked to make is prolonged and is the vowel sound a (technically the maximally low and back rounded vowel sound), not the aspirate h (technically a voiceless glottal fricative). It could even be ‘aaaah’, as used in the English translation of the title of a Dutch paper, ‘Zeg ‘ns Aaaa’, which was not about the Dutch TV medical sitcom ‘Zeg ‘ns Aaa’. See the difference?

Counter-examples, such as ahhh and ah-h-h-h-h, are generally American.

Other ‘aah’s include Aah III, a haemorrhagic toxin from the venom of a snake Agkistrodon acutus, Aah VI an N-glycosylated anti-insect toxin that has been isolated from the venom of the Androctonus australis hector scorpion, and the AAH genes, which code for amino acid hydroxylases or autotransporter-adhesin-heptosyltransferase, not to mention AAH (asymmetrical apical hypertrophy [of the heart] or atypical adenomatous hyperplasia [of the prostate or lung]). Then (and I can stop this any time I like) there’s Ah (the SI unit of charge, an ampere-hour), AH (anno Hegirae, in the year of the Hegira), and ‘Say Aah’ the hiphop hit by Trey Songz.

Ahem, I’d better stop there.

A shorter version of this blog was previously published at http://blogs.bmj.com/bmj/2015/02/13/when-i-use-a-word-say-aaaaaaah


Jeffrey Aronson

About Jeffrey Aronson

Honorary Consultant Physician & Clinical Pharmacologist

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