Ambiguous, Equivocal

These words often are taken to mean the same thing—which in some contexts they indeed do. When used to refer to test results or experimental findings, for example, both words are properly used to indicate uncertainty, ie, that the findings can be understood in more than one way.

However, a distinction comes to bear when one is referring to statements, either written or oral. Although both words also can properly be used when referring to a statement subject to more than one interpretation, accepted usage holds that ambiguous is the proper choice if the resulting uncertainty seems unintentional1(p39) and that equivocal is the way to go if the uncertainty seems to have been intentionally introduced to confuse or deceive.1(p423) The deceptive intent is key, and it is worth noting that whereas the verb equivocate is an accepted word, ambiguate is not.

Deceptive intent might be inferred from the immediate context of surrounding statements. Often, however, intent is inferred from the larger context, ie, the history of the issue under discussion or the (perceived) character of the person making the statement. Given the latter means of inference, it is not surprising that the use of equivocal to refer to deceptive statements has been accepted since the late 1700s—about the time that the word also came to be commonly used to describe persons believed “[d]oubtful in character or reputation; liable to unfavorable comment or description; questionable; suspicious.”2(p527) Equivocal is still occasionally used when referring to such persons, but current usage, particularly in the social media, tends to favor terms somewhat more colorful.

Equivocal also can imply that a person has used ambiguous language in a qualifying way to avoid personal commitment to the statement made.1(p423) This meaning, however, although a bit more neutral than the meaning already noted, still hints at something less than savory. In short, although using ambiguous and equivocal interchangeably to describe a statement will be correct in some instances, writers tempted to use equivocal in place of ambiguous would do well to remember that the former has additional connotations often freighted with “nasty overtones.”3

Perhaps because clarity and certainty are seldom used for deceptive purposes, matters are less complicated in negative constructions: unambiguous and unequivocal both indicate that a test result or a statement has only one interpretation. However, because equivocal carries negative connotations, unequivocal is often used to emphasize a lack of deceptive intent.

As a side note, another word, unequivocable, has been used interchangeably with unequivocal since the early 1900s.2(p2166) How this monster came to be is a matter of some conjecture, but it likely arose either from innocent confusion over the proper spelling and pronunciation of equivocal or from a desire to use a loftier-sounding word (although it is difficult to imagine an instance in which unequivocal would not be lofty enough). In any case, unequivocable and its variants are often considered nonstandard.1(p1366)

The bottom line:

● Referring to test results or experimental findings having more than one interpretation? Ambiguous and equivocal are both correct, but it is worth noting that the latter can have negative overtones and is perhaps best avoided unless the reporting of results seems intentionally unclear.

● Referring to a statement having more than one interpretation? Remember that all equivocal statements are ambiguous, but not all ambiguous statements are equivocal. If the statement seems intentionally unclear with the goal of distancing or deceiving, use equivocal.

Unambiguous and unequivocal both indicate that something has only one interpretation, although when describing a statement unequivocal is sometimes used to emphasize an absence of deceptive intent.

Unequivocable, while found in some dictionaries, is often considered nonstandard and should probably be avoided.—Phil Sefton, ELS

1. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003.

2. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991.

3. Ambiguous, equivocal. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:38.

A Few Thoughts on Fewer and Less

All of the usual English-language usage books seem so sure that they give little more than a compound sentence to explain that fewer should be used when referencing things that can be counted and less when referencing quantity or things that can be measured.

The AMA Manual of Style1 points out that the 2 words “are not interchangeable.” Then explains the difference by advising readers to “[use] fewer for number (individual persons or things) and less for volume or mass (indicating degree or value).” It offers the following examples: “Fewer interventions may not always mean less care” and “The authors evaluated fewer than 100 studies yet still reported more support for the conventionally prescribed therapy.” The entry is followed by a note that provides 2 more examples including parenthetical explanations:

spent less than $1000 (not: spent fewer than $1000)

reported fewer data (not: reported less data)

The Associated Press Stylebook2 entry says, “In general, use fewer for individual items, less for bulk or quantity” and provides the following examples, or should I say commands:

Wrong: The trend is toward more machines and less people. (People in this sense refers to individuals.)

Wrong: She was fewer than 60 years old. (Years in this sense refers to a period of time, not individual years.)

Right: Fewer than 10 applicants called. (Individuals.)

Right: I had less than $50 in my pocket. (An amount.) but: I had fewer than 50 $1 bills in my pocket. (Individual items.)

The Elements of Style3 elliptically warns, “Less should not be misused for fewer” with the following explanation. “Less refers to quantity, fewer to number. ‘His troubles are less than mine’ means ‘His troubles are not so great as mine.’ ‘His troubles are fewer than mine’ means ‘His troubles are not so numerous as mine.’”

A Writer’s Reference,4 a college handbook, is equally economical: “Fewer refers to items that can be counted; less refers to items that cannot be counted” followed by its example for usage: “Fewer people are living in the city” and “Please put less sugar in my tea.” (I’d rather that you didn’t put any sugar in my tea.)

But if the rule were so easy as these commonly used English-language usage references suggest, why are people confused?

If anything is certain about language, it is that nothing is certain: a truism that often frustrates my composition students, who simply want the answer when no one true answer exists. In the case of fewer and less, Webster’s Dictionary of English Usage5 and Fowler’s Modern English Usage6 support my position by telling an entirely different story about how to use less and fewer, with Webster’s devoting 3 and a third columns to it and Fowler’s devoting about 3 columns over 2 entries.

The former launches the alternate-usage discussion with a metaphoric clearing of its throat to suggest, however, that the general usage rule cited in most English-language reference texts “has only one fault–it is not accurate for all usage” and offers a rule amendment for using less:

less refers to quantity or amount among things that are measured and to number among things that are counted.

In other words, less can be used in both cases. Webster’s punctuates its point by saying the amended rule has actually reflected common usage for say “the past thousand years or so.” The general rule became established and embraced by most language scholars, so Webster’s theorized, from a 1770 comment about less made by Robert Baker in Reflections on the English Language. He wrote:

The word [less] is most commonly used in speaking of a Number; where I should think Fewer would do better. No fewer than a Hundred appears to me not only more elegant than No less than a Hundred, but more strictly proper.

Thus, a modest preference has become, as Webster’s points out, “elevated to an absolute status.” That transformation, the entry laments, may be due to the reluctance of “many pedagogues … to share the often complicated facts about English with their students.” In fact, Webster’s points to the Oxford English Dictionary as showing that “less has been used as countables since the time of King Alfred the Great.”

Although Fowler’s trends toward the generally accepted usage rule, it recognizes that perhaps the “complicated facts about English” should in fact be elucidated. As a means of clarification, it uses parts of speech to explain the usage differences. It says that “few and its comparative adj. fewer are used with countable nouns, i.e. with nouns that have both a singular and a plural form (book/books)…; or with collective nouns (fewer people…)” but, “[l]ess which is a comparative of little, is properly used with uncountable or mass nouns: in other words less refers to quantity and is the opposite of more (less affection, less power, less misery).” Furthermore, Fowler’s acknowledges when less can be used “idiomatically with plural nouns … esp. distances (it is less than seventy miles to London)” and the like.

In its final example in the few entry, Fowler’s notes the “regrettable” trend of “the use of less with an unprotected plural noun.”(That’s an expression that’s new to me.) One of the example sentences of that violation is

There will be less 100% loans about.

Don’t we all know that?—Beverly Stewart, MSJ

1. Iverson C, Christiansen S, Flanagin A, et al. AMA Manual of Style: A Guide for Authors and Editors. 10th ed. New York, NY: Oxford University Press; 2007.

2. Goldstein N, ed. The Associated Press Stylebook and Briefing on Media Law. New York, NY: Basic Books; 2007.

3. Strunk W, White EB. Elements of Style. 4th ed. New York, NY: Longman; 2000.

4. Hacker D. A Writer’s Reference. 6th ed. Boston, MA: Bedford/St Martin’s; 2009.

5. Webster’s Dictionary of English Usage. Springfield, MA: Merriam-Webster Inc; 1989.

6. Burchfield RW. Fowler’s Modern English Usage. 3rd rev ed. New York, NY: Oxford University Press; 2004.

Quiz Bowl: Fill in the Blank

When is a girl really a woman? When is a boy a man? When do children stop being children and become adults? Okay, we are starting to sound like a style manual version of Bob Dylan—but these answers are not blowing in the wind, they are in an AMA Manual of Style quiz on age and sex referents. Below are some simple fill in the blank exercises to guide you when you take this quiz.

Use the following terms to fill in the blanks: woman, man, newborn, adolescent, and infant. (To see the answers, highlight the blank space with your mouse.)

A person from birth to 1 month of age is a(n) newborn.

A female person older than 18 years is a(n) woman.

A male person older than 18 years is a(n) man.

A person aged 1 month to 1 year is a(n) infant.

A person aged 13 through 17 years is a(n) adolescent.

For additional exercises on age and sex referent usage in medical publications, take this month’s quiz at www.amamanualofstyle.com.—Laura King, MA, ELS

Envy, Jealousy

Words that convey similar meanings sometimes come to be used interchangeably. In the case of envy/envious and jealousy/jealous, though, the move seems to have been in one direction only; jealousy is often used in place of envy (“I’m so jealous of your new job”) but not vice-versa (one does not write, for example, “He was poisoned by his envious wife.”). Theodore Bernstein further points out that jealousy is sometimes used, not merely in place of envy, but as a stronger form: “‘There, within a stone’s throw of the sea, he makes his home, and his description of how he does this makes one move from envy to downright jealousy.’”1 A human, and perhaps all-too-familiar, state of affairs—anyone who denies having experienced such a progression of emotion is either hopelessly out of touch with his or her feelings or a liar.

However, although jealous has been used in place of envious since the late 1300s2 and using jealous as a more intense form of envious creates no confusion, it is often held that the words have distinct meanings and that this distinction should be maintained. Even authorities sometimes flounder around a bit when trying to nail the distinction,3 but in general envy is taken to convey a coveting of the wealth, possessions, or success of someone else,4 whereas jealousy is often taken to convey a state of “intolerance of a rival for the possession of a thing which one regards as peculiarly one’s own or for the winning of which one has set one’s heart….”4 Jealousy also can be used in a less grasping sense to indicate the understandable guarding of some possession or attribute, as in “new colonies were jealous of their new independence.”5 Both of the latter meanings highlight that jealousy concerns an attitude toward something that one has or believes one has. In this sense, envious and jealous are not interchangeable—one can jealously guard something, but one cannot enviously guard something.

However, jealous also often carries a frank note of hostility, “a strong implication of distrust, suspicion, enviousness, or sometimes anger.4 This might suggest why the person seeking a word with a bit more heft than envious will sometimes use jealous instead—quite simply, when casting about for a suitably malicious word in the heat of the moment, jealous is low-hanging fruit.

On the other hand, envy is not the innocuous little milquetoast that it at first seems. True, it can be used without malice; one can say, for example, “I don’t envy him his mother in law.” Equally true, it has in the past been used in a noble sense—Aristotle wrote of “good envy,” an admiration that drives one to emulate another3—although that usage has been rare since the 1600s and is now nearly obsolete.6 Certainly, envy carries less emotional charge than jealousy. But to assume that envy is simply a meek cousin of jealousy is to make a mistake.

If jealousy implies strong emotion that often is perhaps all too apparent to everyone involved, envy can imply something more clandestine; as Joseph Epstein puts it, “Malice that cannot speak its name, cold-blooded but secret hostility, impotent desire, hidden rancor, and spite all cluster at the center of envy.”3 Used in this sense, envy suddenly becomes a different animal altogether, and, as Epstein further points out, “The openness changes the nature of the game. Envy is almost never out in the open; it is secretive, plotting, behind the scenes.”3 Perhaps this is another reason that jealousy is often used, albeit subconsciously, in place of envy—after all, envy is one of the Seven Deadly Sins; jealousy is not.

In short, although envy and jealousy have long been used interchangeably and jealousy has come to be frequently used in place of envy, the words do denote different states, and the careful writer should take care to maintain the distinction between them. Both can be used in neutral ways (“She was jealous of her honor”; “I don’t envy him his workload”), but both also can carry weightier meanings; in choosing between them, one might keep in mind that “The real distinction is that one is jealous of what one has, envious of what other people have.”3

The bottom line:

● Looking for a word that expresses the coveting of what someone else has? Use envy.

● Looking for a word that expresses the guarding of what one has or believes one has? Use jealousy.

● Keep in mind that although jealousy is often used as a more intense form of envy, it might be better to use another word or to reword the sentence so as to retain envy.—Phil Sefton, ELS

 

1. Envy, jealousy. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:166-167.

2. Jealous. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:892.

3. Epstein J. The green-eyed monster: envy is nothing to be jealous of. Washington Monthly website. http://www.washingtonmonthly.com/features/2003/0307.epstein.html. July/August 2003. Accessed December 13, 2011.

4. Envious, jealous. Merriam-Webster’s Dictionary of Synonyms. Springfield, MA; Merriam-Webster Inc; 1984:295.

5. Jealous. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:671.

6. Envy. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:523.

Flaunt, Flout, Vaunt

Malapropisms: as users of language, we are all guilty of using them sometimes. In the heat of trying to express ourselves, we use one word in place of another—particularly when those words sound similar—and soon we are flaunting accepted usage. Or would that be flouting accepted usage?

To begin with, flaunt relates to vainglorious or ostentatious display, whereas flout denotes an expression of disdain or contempt, often for something forbidden by rule or custom (one grammar blog neatly sums this up by stating that “you flaunt something you like and flout something you don’t”1). Flaunt is used transitively (“Lamilia stopped off to flaunt her ermine and her jewels”) as well as intransitively (“Lamilia came flaunting by, garnished with the jewels whereof she beguiled him”2(p602)) and also is often used in a quasi-transitive sense2(p602) (eg, the currently common “If you’ve got it, flaunt it”). Similarly, flout may be used transitively (eg, the currently common “flout the law”) or intransitively (“It never came into our thoughts… to flout, in so bold a manner”2(p609)). However, flout is not typically used in the quasi-transitive sense.

So flaunt and flout, while often confused, do have distinct meanings. Prescriptive grammarians will point out that flaunt and flout are thus distinct terms and should not be used interchangeably, whereas grammarians with more descriptive leanings will be less inclined to observe a distinction in meaning, in particular maintaining that flaunt may sometimes be used when prescriptive usage would call for flout. Indeed, some authorities, such as Merriam-Webster’s Collegiate Dictionary, now accept the use of flaunt in place of flout in certain constructions—specifically, when the transitive is required (“meting out punishment to the occasional mavericks who operate rigged games, tolerate rowdyism, or otherwise flaunt the law”3). However, at least in relation to this pair of words, the prescriptivists would seem to hold the upper hand. First, flaunt is acceptable (from a descriptive standpoint) in place of flout only when the transitive is required. Second, flout is rarely used in place of flaunt. Third and most importantly, flaunt and flout are similar only in the way they sound, rather than in their (until recently) accepted meanings.

To further complicate matters, though, flaunt is sometimes—albeit quite rarely—confused with vaunt, which denotes boasting or bragging. Like the former, vaunt may be used transitively (“He vaunts his Conquest, She conceals Her Shame”2(p2217)) or intransitively (“They laud their verses, they boast, they vaunt, they jest”2(p2217)) and as early as the 1600s was used in a quasi-transitive sense (“to vant it or vie in gaming”2(p2217)). However, the confusion between flaunt and vaunt stems not only from their marked similarity in sound but also from their somewhat similar meanings (to display oneself boastfully or ostentatiously, often so as to show off one’s attractiveness or possessions, compared with using language boastfully, often to boast of an accomplishment). Indeed, given the similarities in sound and meaning that exist between these two words, it is perhaps surprising that they are not confused more often. On the whole, however, language users usually seem to recognize the difference between these words, and even descriptive usage does not yet support the use of vaunt in place of flaunt or vice versa.

In short, flaunt, flout, and vaunt are sometimes used as malapropisms for one another, particularly in spoken language. However, these terms have distinct meanings and, despite their similarity in sound as well as the increasing support in some circles for sometimes using flaunt in place of flout, currently it is preferable to maintain the distinctions between these terms and to use them as they have predominantly been used over time. Or, to take some liberties with the quasi-transitive:

If you’ve got it, flaunt it;

If you did it, vaunt it;

If they forbid it, flout it.—Phil Sefton, ELS

1. Motivated Grammar: Flout good taste; flaunt your excesses. http://motivatedgrammar.wordpress.com/2008/02/23/flout-good-taste-flaunt-your-excess/. Accessed November 30, 2011.
2. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991.
3. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA; Merriam-Webster Inc; 2003:477.

Condition, Disease, Disorder

“Disease often fortifies the system against the action of remedies.”

“Disorder often fortifies the system against the action of remedies.”

Which of these sentences is correct? As it happens, the first is an actual quote (H. C. Wood, 1879)1(p445) and so in that sense is the “correct” one. However, the question remains: What are the differences, if any, between disease and disorder? For that matter, where does the often-used condition fit in? While these terms are frequently used interchangeably, differences between them do exist and can assist the person wishing to use them in more specific senses.

Condition is perhaps the least specific, often denoting states of health considered normal or healthy but nevertheless posing implications for the provision of health care (eg, pregnancy). The term might also be used to indicate grades of health (eg, a patient might be described as in stable, serious, or critical condition). While this term is often used in medical discussions to specifically indicate the presence of pathology or illness, Dorland’s Illustrated Medical Dictionary provides no definition of the term used in this sense. Merriam-Webster’s Collegiate Dictionary, however, defines condition as “a usu. defective state of health,”2(p258) and the Oxford English Dictionary similarly opines that it denotes “[a] state of health, esp. one which is poor or abnormal; a malady or sickness.”1(p309) In lay conversation condition is sometimes used euphemistically when a discreet term is desired for reference to a state of health, either well or ill—for example, delicate condition was once commonly used to refer to either pregnancy or alcoholism. Similarly, condition understood specifically to indicate the presence of pathology or illness is sometimes used as a value-neutral term when a stronger term might not be desirable. When such considerations do not come into play, a condition conferring illness can be further classified as a disease or a disorder.

“He was full of such disease. That he may nought the deth escape” (1393).1(p445)

Disease is often used in a general sense when referring to conditions affecting a physical system (eg, cardiovascular disease) or a part of the body (eg, diseases of the foot). The term also may be used in specific senses—for example, a writer might refer in general terms to neurologic disease or in specific terms to Alzheimer disease. But disease is perhaps most often used when referring to a condition that possesses specific characteristics. In this vein, Merriam-Webster’s defines disease as “a condition of the… body or one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms…”2(p358); the Oxford English Dictionary defines the word similarly but particularly stresses structural change as a cause.1(p445) Dorland’s concurs with these sources but makes clear that the impaired functioning associated with the diseased state may constitute “any deviation from or interruption of the normal structure or function…” and further elaborates that “the etiology, pathology, or prognosis may be unclear or unknown.”3(p535)

“A Fever is the first disorder that affects the Blood and Vessels” (1725).1(p449)

Compared with disease, disorder is less restrictive: Merriam-Webster’s defines it simply as “an abnormal physical or mental condition,”2(p360) a definition with which Dorland’s largely concurs.3(p555) The Oxford English Dictionary emphasizes that disorder involves a disturbance of function but again further stresses structural change, this time in negative terms, stating that disorder is “usually a weaker term than DISEASE, and not implying structural change.”1(p449) This emphasis on functional rather than structural change has been in place since at least the late 1800s, when the Lexicon of Medicine and Allied Sciences stated that disorder is “a term frequently used in medicine to imply functional disturbance, in opposition to manifest structural change.”1(p449) Because disorder, like condition, is relatively value-neutral when compared with disease, it is often used in place of the latter term when a less stigmatizing or less alarming term is desirable—eg, a clinician might at first refer to a patient’s disease as a disorder to reduce the patient’s initial anxiety; similarly, the same patient might initially refer to his or her recently diagnosed disease as a disorder in conversations with family and friends.

In short, what distinguishes condition, disease, and disorder from one another would seem to be their relative emphases on functional change, structural change, presence of signs and symptoms, and, perhaps to a lesser extent, the gravity a writer wishes to convey:

Condition simply indicates a state of health, whether well or ill; a condition conferring illness might be further classified as a disease or a disorder—however, condition might be used in place of disease or disorder when a value-neutral term is desired.
Disease denotes a condition characterized by functional impairment, structural change, and the presence of specific signs and symptoms. As an aside, Dorland’s equates the terms illness and sickness with disease; while these are often used to indicate the state or experience of disease, they are also sometimes used as value-neutral alternatives for disease.
Disorder, in contrast, denotes a condition characterized by functional impairment without structural change and, while certain disorders or categories of disorders might be accompanied by specific signs and symptoms, their presence is not required for a condition to be termed a disorder. Like condition, disorder is sometimes used as a value-neutral term in place of disease.—Phil Sefton, ELS

1. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991.
2. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA; Merriam-Webster Inc; 2003.
3. Dorland’s Illustrated Medical Dictionary. 31st ed. Philadelphia, PA: Saunders; 2007.

Cheat Sheet for Abbreviations Style

Abbreviations are a convenience, a time saver, a space saver, and a way of avoiding the possibility of misspelling words. However, a price can be paid for their use. Abbreviations are sometimes not understood. They can be misread, or are interpreted incorrectly. … The person who uses an abbreviation must take responsibility for making sure that it is properly interpreted.—Neil M. Davis1

Abbreviations are used widely in medical articles, and great care should be taken to provide expansions that define these abbreviations. The AMA Manual of Style includes a straightforward rule regarding the use of abbreviations: Define abbreviations at first mention by providing the expanded term first, followed by the abbreviation in parentheses, and the abbreviation is used thereafter.

But for every rule, there are exceptions.

Some Exceptions:

• Avoid creating abbreviations for terms that are easy to spell out and do not take up a lot of space. For example, it is not advisable to abbreviate “catheter ablation” as “CA” or “immune response” as “IR.” Also, avoid using too many abbreviations in any one article.

• If a term is better known as an abbreviation, provide the abbreviation first with the definition following in parentheses. “The TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling) staining assay was carried out using an apoptosis detection kit.”

• It is inelegant to begin sentences with abbreviations, unless the expansion is so unwieldy that using the abbreviation makes sense. The previous example, TUNEL, also works here. Rather than begin a sentence with the cumbersome expansion, it is acceptable to begin the sentence with the abbreviation TUNEL.

• Abbreviations should not be introduced in headings. If an abbreviation is being used for the first time in a heading, expand the abbreviation in the heading; then, at first mention in the running text after the heading, expand the abbreviation again, with the abbreviation following in parentheses. Use the abbreviation thereafter.

• Some very common abbreviations do not require expanding at first mention, such as AIDS, TNM, UV, and CD-ROM. A complete list of these abbreviations is provided in section 14.11, with those that do not require expansion denoted by an asterisk.

• The efficiency of using an abbreviation is lost if the abbreviation is used only one time, so as a rule of thumb, introduce an abbreviation only if it is used at least 2 or 3 times.

Items of Note:

• Tables, figures, and abstracts are treated as separate items from the text, so abbreviated terms must be reexpanded in each of these items.

• Use the appropriate article (a or an) before an abbreviation according to the sound following the article (eg, a UN resolution, an HMO plan).

• Use a lowercase s (and no apostrophe) when making abbreviations plural (eg, NSAIDs).—Lauren B. Fischer

1. Davis NM. MEDical ABBREViations: 28,000 Conveniences at the Expense of Communication and Safety. 13th ed. Warminster, PA: Neil M Davis Associates; 2007:1.

Masterful, Masterly

Writers are often taught that masterful and masterly mean different things and to ensure that they are used correctly. Masterful, so such thinking goes, is taken to mean “suggestive of a domineering nature,” or “inclined and [usually] competent to act as master,”1 whereas masterly is used to denote “having the power and skill of a master.”1

However, the use of masterful to mean “skillful” is now widespread; as Bernstein, clearly a proponent of maintaining the distinction, pithily puts it, “masterly is never misused; masterful often is….”2 Moreover, it seems that the distinction has not always been observed. Whereas masterful has been used in the sense of “domineering” since the 1330s,3 it also was used to mean “skillful” as early as 1613.3 And whereas masterly was used in the sense of “skillful” since the mid 1600s,3 it also was used to mean “domineering” as early as the 1530s,3 although that use has been obsolete since the late 18th century.3

In short, both words have been used to indicate “skillful” since roughly the time of King James I of England. However, the idea that writers should distinguish between them is comparatively new1—and such a late addition of a distinction is the reverse of the more common case, in which a distinction between words ceases to hold sway as the language evolves.

The origin of the distinction? Merriam-Websters posits that it was “excogitated by a 20th century pundit”1—this “pundit” apparently none other than Henry Watson Fowler, editor of The Pocket Oxford Dictionary, coeditor of The Concise Oxford Dictionary and The King’s English, and author of A Dictionary of Modern English Usage.4 In the latter work, Fowler established a distinction between masterful and masterly that was taken up by authorities such as Bernstein2 and that continues to be trumpeted to this day.5 Fowler’s reason for introducing the distinction? Masterly has only 1 sense (at least since its use to mean “domineering” became obsolete), so masterful should be limited to a single sense as well.1

However, some also have argued for the use of masterful in place of masterly in adverbial constructions, pointing out that although masterly is properly used as an adverb as well as an adjective, its use as an adverb seems awkward, even incorrect; eg, “He paints masterly.”2 Moreover, masterly, like many words ending in “y,” is what Bernstein (who nevertheless advocates distinguishing between the words) calls a “reluctant” adverb—ie, a word that resists serving as or being turned into an adverb.6 To make matters worse, masterly takes another adverbial form, the admittedly horrid masterlily.

Where does this leave the conscientious writer? Like Fowler, several modern authorities deem the distinction a valuable one5 and often advocate recasting a sentence to allow a more mellifluous use of a reluctant adverb5,6: hence, the sentence “Its wooden gables… showed how masterly they had been carved of old”3 might be recast as “Its wooden gables… showed the masterly manner in which they had been carved of old,” or similar. “A retreat of this kind,” Bernstein maintains, “is better than clumsy bravado.”6

At least one like-minded authority, however, has conceded that the battle to maintain the distinction—whatever its merits—has likely been lost.5 The prevalence of masterful in everyday usage confirms that opinion, receiving further support from the fact that the words have developed in roughly parallel fashion over time.3 Merriam-Websters concurs, maintaining that masterful used in the sense of “skillful” “has continued in reputable use all along; it cannot rationally be called an error.”1 Moreover, it has been suggested that using masterful in its original sense might even confuse readers now accustomed to the use of masterful to mean “skillful.”7

The bottom line:

● Using masterful in place of masterly to mean “skillful”? You’re in good company, and that usage has a long history. However:

● Set on maintaining a distinction between masterful and masterly? You can’t go wrong there, either. True enough, some readers might be confused by the use of masterful in its original sense—but since when do writers shrink from using words correctly to avoid confusion?—Phil Sefton, ELS

1. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:764.

2. Masterful, masterly. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:269.

3. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:1045.

4. Sheidlower J. Elegant variation and all that. The Atlantic Online Web site. http://www.theatlantic.com/past/docs/issues/96dec/fowler/fowler.htm. December 1996. Accessed September 16, 2011.

5. Masterful, masterly. Good English Rules! Web site. http://www.goodenglishrules.com/masterful_masterly.htm. Accessed September 16, 2011.

6. Adverbs, reluctant. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:27.

7. Masterful vs. masterly. Grammarist Web site. http://www.grammarist.com/usage/masterful-masterly/. Accessed September 16, 2011.

Jarring Jargon

Theodore M. Bernstein, in The Careful Writer: A Modern Guide to English Usage, describes jargon as “meaningless, unintelligible speech,” which is how some people might describe their last conversation with their physician. In science and medicine, many barriers to clear communication exist, with jargon being one of them. In fact, it’s so difficult for physicians and patients to communicate clearly that a federal program has been created to promote simplified health-related language nationwide. The Health Literacy Action Plan is a “national action plan to improve health literacy.” The entire action plan is 73 pages (which is probably their first mistake) and it highlights the fact that we have a problem.

As editors, we know that jargon is to be avoided in medical literature. While jargon may evolve for the most innocuous of reasons, it is a vocabulary specific to a profession that sometimes is esoteric or pretentious and that can be confusing to those not familiar with it (sometimes to those familiar with it as well). “Inside talk” can be just that by design—it keeps outsiders out. Therein lies the source of the negative feelings about jargon.

In addition to being exclusive, some jargon is offensive and unprofessional. Have you ever seen an FLK? Probably. That’d be a funny-looking kid. “We bagged her in the ER” sounds ominous; what it means is that a patient was given ventilatory assistance with a bag-valve-mask prior to intubation in the emergency department. Hopefully the emergency department physician didn’t describe the patient as a GOMER. This means “get out of my emergency room” and could refer to, for instance, an elderly patient who is demented or unconscious and near death and who perhaps should die peacefully rather than occupy emergency department resources. In this example, jargon diminishes the complexity of a situation that should be dealt with in a more thoughtful way. As Bernstein writes, “All the words that describe the kinds of specialized language that fall within this classification [of inside talk] have connotations that range from faintly to strongly disparaging.”

Jargon also sometimes violates rules of grammar, eg, turning nouns into verbs, “The doctor scoped the patient,” or creating back-formations, like “The patient’s extremities were cyanosed,” instead of “The patient’s extremities showed signs of cyanosis.” Jargon can sometimes appear to depersonalize, by defining a person in terms of a disease. A “bypassed patient” may be one who has undergone coronary artery bypass graft surgery rather than one who has been overlooked. Sometimes, patients might be referred to by their organs, such as “the lung in room 502” instead of “the patient in room 502 with lung disease.”

The AMA Manual of Style lists examples of jargon to avoid in section 11.4, Jargon. Some other examples that we’ve collected over the years are listed here:

* Collodion baby is better phrased as collodion baby phenotype or “the infant had a collodion membrane at birth.”

* Surgeons perform operations or surgical procedures, not surgeries.

* Rather than say a patient has a complaint, describe the patient’s primary concern.

* Do not use shorthand (eg, exam for examination, preemie for premature infant, prepped for prepared).

* Euphemisms sometimes are not clear and should be avoided: “The patient died” is preferred to “The patient succumbed or expired”; the same holds true for killed vs sacrificed (in discussion of animal subjects).

* Patients aren’t “put on” medication, they’re treated with medication. Also, patients aren’t “placed on” ventilators, they’re given ventilatory assistance.

Certainly jargon does have its place. It is specialized, and those in the same field can use it to communicate precisely and quickly. However, when it comes to medical and scientific publications, jargon is best avoided. Bernstein ends his entry on “inside talk” with the following: “It must never be forgotten that the function of writing is communication.” Clear enough.—Lauren Fischer

Ventilate or Ventilation

“The patient was ventilated.”

“We decided to ventilate the patient.”

Such statements are commonly overheard in critical care units and other areas when clinicians discuss the care of a patient experiencing insufficient or absent respiration. Both statements use forms of ventilate in ways that—because they appear in this sense in the latest edition of Merriam-Webster’s Collegiate Dictionary—are correct and so may be used in medical journals. However, writers and editors have a valuable opportunity to ensure the continuing precision of the language through careful use of such terms and their variants, referred to as back-formations.

As discussed in the 10th edition of the AMA Manual of Style, “Back-formation is the creation of a new word in the mistaken belief that is was the source of an existing word” (see §11.3, Back-formations, in the AMA Manual of Style, p 407 in print). Back-formations are formed by the removal of a suffix (either a derivational suffix such as -ion or an inflectional suffix such as the plural -s) from a word that actually appeared first, changing its part of speech and forming a new word. Thus, the verb ventilate when used in the clinical sense may well be such a form, as suggested by its appearance in common use slightly later than the appearance of the noun ventilation (early 1900s vs 1890s, respectively).1 Interestingly, however, users of the English language had been busily back-forming for some time before that: ventilate as used in the closely related sense of exposing the blood to air, now obsolete or nearly so apart from its use in the study of physiology, likely also represents a back-formation that appeared some 50 years after ventilation as used in this sense (1660s vs early 1600s, respectively).2

Back-formation plays a valuable role in language evolution, producing neologisms that often subsequently enter common use. However, coining verbs through back-formation can result in medical jargon (see §11.4, Jargon, in the AMA Manual of Style, pp 408-409 in print) that is vague, depersonalizing, and sometimes downright comical in the images it can evoke. Taking the case in point, for example, what does “the patient was ventilated” mean, exactly? Was the patient perforated? Fitted with louvers? Left outdoors?

While it is commonly understood that the use of ventilated in this sense in spoken English denotes the use of a mechanical ventilator or other means of artificial respiratory assistance (eg, use of a bag-valve-mask apparatus), it typically refers to the former. However, in written materials, the use of mechanical ventilation should be explicitly reported when appropriate. In addition, eschewing the use of assistance altogether is perhaps advisable, and certain constructions (eg, “was” or “on” constructions) should be avoided if they lead to ambiguity such as that noted above. For example, “the patient was ventilated” and “the patient was placed on a mechanical ventilator” should be rewritten to read “the patient underwent mechanical ventilation.” In some instances, it might also be helpful to report additional information to clarify whether the intervention was invasive (ie, required endotracheal intubation, nasotracheal intubation, or tracheostomy) or nonvasive (eg, used a mechanical, sealed-mask approach such as BPAP [bilevel positive airway pressure]).

Writers and editors of medical information, then, should be vigilant when using terms coined through back-formation. Such terms should not be used if they do not appear in a current dictionary of reference. Those that do—eg, ventilated—may be used, but writers and editors should take care to ensure that they are not used in ways that are vague, depersonalizing, or unintentionally comical. Ultimately, however, a bit of back-formation is not a bad thing—for example, edit is a back-formation coined from editor.3Phil Sefton, ELS

1. Ventilate. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:2223.
2. Ventilation. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:2223.
3. Back-formation. In: Hoad TF, ed. The Concise Oxford Dictionary of English Etymology. Encyclopedia.com Web site. http://www.encyclopedia.com. Accessed August 5, 2011.