1 {scene: Dr Ginny Smith is driving the Joneses somewhere through Italy}
1 Minnesota Jones: It wasn't easy going, excavating Troy. The dry soil turned to dust as we dug, almost choking us.
2 Minnesota Jones: Schliemann himself suffered most. Each time he dug he went through this exaggerated coughing routine to clear his throat.
3 Minnesota Jones: We called it the "Heinrich Manoeuvre".

Sadly for period accuracy, the Heimlich manoeuvre was first described in 1974, and there's no way the Joneses in the 1930s could even know that this is a pun*.

In 2006 the Red Cross adopted the more descriptive name of abdominal thrusts to replace the more colourful Heimlich manoeuvre, named after Doctor Henry Heimlich.

* Hey, this is better than those stupid movies that are blatantly anachronistic, but blithely ignore it.

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2016-09-12 Rerun commentary: I've experienced people doing that "Heinrich Manoeuvre" in classical concerts.

I wonder if it's just a numbers thing - that if you gather 2000 people in one place for an hour or two that it's virtually a certainty that some of them will have a loud coughing fit. Or if there's something special about being in a group of 2000 people who expect you to be quiet that actually triggers coughing.

I bet someone's done a Ph.D. on this topic. (Or if not, they really should.)

[a quick search later]: Bingo. Maybe not a Ph.D., but certainly a study. Andreas Wagener, "Why Do People (Not) Cough in Concerts? The Economics of Concert Etiquette", Association for Cultural Economics International, 2012.

Wagener finds that people in classical music concerts cough approximately twice as much as people generally, and that the distribution in both space and time is highly non-random:

Substantial evidence suggests, however, that coughing in concerts is excessive and non-random. First, the prevalence of coughing in concerts is significantly higher than elsewhere: an average concertgoer coughs around 0.025 times per minute (Schulz 2005; Loudon 1967) – which (under the assumption of a Poisson process) would imply 36 coughs on average per person and day, far more than double the normal cough rate. Sneezes, hiccups, and yawns are in general about as common as coughs (Simonyan et al. 2007). Unlike coughs, however, they are involuntary as they cannot be willfully produced with their complete pattern. Yet, one rarely hears hiccups or sneezes during music performances.

Second, if coughing were purely accidental, it should occur evenly distributed over the concert – which is not the case: the volume of coughing increases with the complexity and unfamiliarity of the music performed; slow movements and quiet passages are more frequently counterpointed with coughs than fast and extroverted ones; and atonal, complex pieces from the 20th century are underscored by heavier concert noises than the more harmonious and familiar pleasantries from earlier times.

That's interesting. However, he goes on to conclude that concertgoers do it deliberately as an intentional breach of concert etiquette, with surmised motives including:

1. Pure expression: "Coughing might be purely expressive: an intentional action without the aim at changing the outside world. [...] In concerts, the utility gains from coughing may [arise] purely from the opportunity to make a statement (independent of its content)."
2. Participation: "Before 1800, cheers but also disapproving comments might break out during performances at any time; rock fans offer running commentary; jazz fans applaud after solos. Even with strict behavioral constraints, music’s emotional qualities would probably never stop audiences from harboring feelings, forming opinions and showing physical reactions. Given that it may always be viewed as a physical reflex, coughing is one of few acceptable ways of active participation within strict concert etiquette. It permits to make oneself heard in the anonymous crowd of concertgoers, to test unwritten boundaries of courtesy, to comment on the performance or to simply document one’s presence."
3. Commentary: "Concertgoers who expect to find pleasant melodies, steady beats, technically perfect performances or enjoyable entertainment may easily be disappointed. Deprived by concert customs of the possibility to explicitly show disapprobation with the music or to abandon the performance, coughing may be an effective comment if musicians play poorly or perform music the listeners do not like."
4. "Tax avoidance": "Concert attendance with a strict etiquette is not pure fun: physical rigidity on narrow and hard concert chairs, speechless attendance and suppression of many vital functions, restraint on emotional expressions and social communication are quite taxing. As with fiscal taxes, people try to avoid such impositions – by substituting taxed activities by untaxed or lesser taxed ones. Compared to other illicit ways of expression (shouting, walking away, clapping, shuffling etc.), coughing is less heavily penalized since it may always be attributed to health conditions for which the cougher cannot be held responsible."
5. Information: "A cough message that conveys that something with the music might be objectionable might be valuable for others in the audience, particularly for those who are unable to assess the quality of the music or its performance by themselves. Ample empirical evidence suggests that aesthetic responses to music are indeed heavily influenced by the immediate environment. In particular, conformity in music reception comes in two distinct forms: compliance and prestige (North and Hargreaves 2008). Compliance arises from people seeking to belong to, and conform to particular social groups that share common values, beliefs, or habits; holding the same music preference is one possibility to express group membership. Prestige – or, maybe better, “informational influence” -- is the desire to make correct judgments about the music (North and Hargreaves 2008). It is especially important when only little is known about the quality of the music or its performance. Individual members of the audience then try to acquire information and to update their own assessment from the judgments of others."
6. Response: "The view that coughs generate positive information externalities opens a new perspective on the herding phenomenon of concert coughing: learning from the cough that others in the audience find something objectionable reassures every single listener of his critical stance and encourages him to cough too. Pennebaker (1980)’s experiments confirm this informational mimetism: people are more likely to cough if they hear others cough, and the closer a person is seated to a cougher the greater the likelihood that she will also cough. Banerjee (1992) argues that audiences obtain information from observing others and are therefore inclined to imitate those with presumably superior knowledge."

Hmmm. I'm no expert in this field, but it seems to me that Wagener has jumped the gun on his conclusions here. He seems to be assuming that the empirical observations that classical concert coughing is more frequent than general coughing and non-randomly distributed to be evidence that it is in some way deliberate. Then he runs with this and starts framing theories about why people would deliberately cough during a concert, based on economic utility and social expression arguments.

I think he's missing a step here. I'd first want to establish that it isn't some aspect of the classical concert environment that actually causes increased coughing in a subconsciously uncontrollable way. For instance, I can imagine that some people are susceptible to the perceived pressure of having to sit silently for a couple of hours, resulting in a sort of adverse reflex reaction which actually makes them more prone to coughing than normal. The old thing that the more careful you have to be, the more likely you are to make some clumsy blunder - because of the unusual psychological pressure.

Anyway, food for thought next time you're attending a classical concert and someone coughs annoyingly.