usage

Questions From Users of the Manual

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Q:    When a bulleted list is introduced by a brief comment, eg, “The principal signs and symptoms of rheumatoid arthritis are as follows,” and all of the items in the bulleted list are from the same source, does a citation need to be placed at the end of each bulleted item or is it sufficient to place the citation at the end of the brief introductory comment?

A:    We would recommend placing the citation within the text that introduces the bulleted list if all the items in the list came from the same source.  If the items came from multiple sources, then placing the appropriate citation at the end of each item would be necessary.

Q:    In this example, would you hyphenate “well child”?

  • He was taken for a well-child [or well child] checkup.

A:    Yes, we would hyphenate in this case.

Q:    The Manual says nothing about how to treat reference citations in the abstract.  Should such citations simply be deleted from the abstract and from the reference list or should complete bibliographic details about the reference be inserted in the abstract parenthetically?

A:    You are quite right that the Manual does not mention how to treat references in the abstract as we never include reference citations (either as superscript numbers or within parentheses in the text) in the abstract (see 2.3, fourth bullet, re not citing references in an abstract).  If an author has included references in an abstract, it doesn’t seem advisable to delete the references altogether.  Discuss with the author trying to include the references early on in the manuscript itself.  It seems unlikely that an author would consider a reference important enough to include in the abstract and then not cite it in the text.

Q:   I don’t see anything in the Manual about how to style “e-mail,” ie, with or without a hyphen.  Help, please.

A:   Although the Manual doesn’t specifically address this point, it does include guidance on capping (see 10.7) and, in that section, it’s clear that the Manual recommends a hyphen in “e-mail.”  If you use the Manual online, for questions like this the “quick search” box is invaluable.  Just type the term you are looking for into the search box and the results should guide you.  If you had begun with “email,” you would have gotten no results, which would—I hope—have tipped you off to try “e-mail,” which produces 3 pages of results.—Cheryl Iverson, MA

Discomfit, Discomfort, Disconcert

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These words are commonly confused, perhaps because they begin with the same four letters and sound similar to boot. Moreover, they now have similar meanings thematically related to the original meaning of discomfit. How necessary is it to distinguish between them?

Discomfit was first on the scene (early 1200s1) and originally was used in the sense of “to defeat in battle.”2 The related form discomfiture, meaning “complete disconcertment or putting to confusion”1—a sense clearly related thematically to the original sense—appeared little more than a century later.

Discomfort also appeared slightly later (late 1300s1) and originally was used in the sense of “Undoing or a loss of courage; discouragement, disheartening.” In a related vein, discomfort also was used at roughly the same time to indicate “Absence or deprivation of comfort or gladness, desolation, distress, grief, sorrow, annoyance.”1 Both of these uses are now largely obsolete, although the word is still often used in a somewhat weaker sense to indicate one’s feeling mildly uncomfortable, either physically or emotionally.1,2

Disconcert was the late bloomer, not bandied about until the late 1600s,1 when it was used in the sense of “To throw into confusion, disarrange, derange, spoil, frustrate”1—again, a meaning clearly thematically linked to defeat in battle. The word is still often used, albeit in a weaker sense, ie, “to disturb the composure of.”2

The upshot? Purists will advocate maintaining the distinction between discomfit and discomfort, using the former only in its original sense of indicating defeat in battle.3 However, as is so often the case, usage is becoming more permissive, and while purists certainly will cringe at the thought, the interchangeable use of these words is gaining increased acceptance. Nevertheless, a few distinctions are worth preserving:

● Discomfit, while occasionally still used in the sense of “to frustrate or thwart,” is currently most often used to indicate mental, rather than physical, states, specifically in the sense of one’s being perplexed or embarrassed—ie, disconcerted. However, its use as either a verb or an adjective now seems stilted or pretentious. For example, Edmund Crispin’s “Widger was not wholly without Schadenfreude at seeing his informative colleague discomfited for once”4 conjures images of Niles and Frasier Crane slouching about in Harris Tweed, sipping sherry and exchanging witty asides. Most speakers will use disconcerted or, finding even disconcerted a tad too uppity, will simply use embarrassed.

● Discomfort is most often used to indicate one’s feeling physically or emotionally uncomfortable, resulting either from the efforts of others or from personal excess: “The excitement produced by the cigar is followed by a feeling of discomfort.”1

● Disconcert, indicating perplexity or disturbed composure, is still occasionally used as a verb but currently is used much more frequently as an adjective, eg, “I find all this very disconcerting.”—Phil Sefton, ELS

1. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:443.

2. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:356.

3. The pedant: comfit and cloy. The Times Web site. http://women.timesonline.co.uk/tol/life_and_style/women/the_way_we_live/article6953527.ece. December 12, 2009. Accessed May 12, 2011.

4. Discomfit. Answers.com Web site. http://www.answers.com/topic/discomfit. Accessed May 12, 2011.

Quiz Bowl: Units of Measure

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Welcome, participants, to the AMA Manual of Style Quiz Bowl. Every month at http://www.amamanualofstyle.com/, we offer subscribers a quiz on different aspects of the manual that help participants master AMA style and improve their editing skills. Previous quizzes have covered topics as varied as correct and preferred usage, genetics, tables, figures, and ethics, as well as numerous other subjects. In this blog, we will offer a sample question from each month’s quiz to whet your appetite. This month’s quiz is on Units of Measure: Format, Style, and Punctuation. So, here goes.

Edit the following sentence based on your understanding of section 18.3 of the AMA Manual of Style.

A total of 50 mg of etanercept were administered subcutaneously twice weekly for 12 weeks.

Well, how did you do? Did you identify the problem? Here’s the answer (use your mouse to highlight the text box):

A total of 50 mg of etanercept was administered subcutaneously twice weekly for 12 weeks.

Units of measure are treated as collective singular (not plural) nouns and require a singular verb (§18.3.3, Subject-Verb Agreement, p 791 in print).

So, did you enjoy this tidbit? If you are not sated, subscribe to the AMA Manual of Style online and take the full quiz.—Laura King, MA, ELS

Are You Nauseous or Nauseated?

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Writers and editors rushing to meet deadlines know the feeling. The effects of stress, a few too many cups of coffee, and perhaps a candy bar or bag of chips in place of a meal can conspire to make the most steely-nerved wordsmith feel a tad nauseated. Or is it nauseous? And what of that stress, that coffee, that ill-chosen meal replacement—are its effects nauseating or nauseous?

Grammarians with more prescriptive leanings (ie, those concerned with language as it “should” be used, which presumably would include most writers and editors) would say that a person feels nauseated and that which has made him or her feel that way is nauseous. Those with more descriptive leanings (those concerned with language as it is actually used, which includes professional linguists as well as armchair observers of language) are eager to point out that while nauseated is still more often used to mean feeling the effects of nausea, the use of nauseous in that subjective sense is rapidly gaining acceptance. Similarly, while nauseous is still more often used to mean causing nausea, the use of nauseating in that causative sense will soon be more prevalent, if it is not already. Debates on the merits of prescriptive vs descriptive use of these terms can be quite heated, and current dictionaries and usage guides often attempt to walk a line between the two camps—which, considering the potential for rancor, is probably not a bad idea, particularly taking into account the ever-evolving nature of language as well as the history of these terms.

So first, a little history. Despite the pronouncements of some prescriptive grammarians promoting the idea that nauseous, when used to mean “feeling the effects of nausea,” is yet another example of a weed newly sprung up in the garden of educated usage, it appears that the term was used in that sense as early as 1604. What is more, it was likely not used to mean “causing nausea” until 1612 or later. At some point, the rule was set forth dictating that nauseous should be used to indicate causing nausea and nauseated to indicate the subjective feeling of nausea—a rule that for the most part held sway until the mid-20th century, when nauseous once again began to be used by persons describing how they feel.

Nauseous, then, when used to describe the feeling of nausea, is something of a grammatical atavism, a throwback to an earlier usage that seems to have fallen into disfavor in the intervening centuries. The term has regained its original meaning in a few generations, a resurrection only accelerated by today’s fast-paced media mix. For example, when comedian Mike Myers’ Saturday Night Live character, Linda Richman, claimed that something “makes me nauseous” (always pronounced as two syllables, with the slightest of pauses when pronouncing the first: “naaw′ shus”), the use of the term in that sense gathered steam in short order, gaining an ever-widening circulation as viewers of the program used it in conversation and e-mails; it likely now lives a healthy and happy life in the various social networking media. Other related terms from the 17th century—nauseation, nauseative, nauseity, nausity—are now obsolete or used very rarely, but for now nauseous as used to describe the subjective state of nausea seems here to stay.

So how does all of this pan out for the person seeking guidance on the use of nauseous, nauseated, and nauseating? As is often the case, an answer—very seldom is there such a thing as the answer—lies in the ever-shifting borders between the spoken and the written word. Whereas the use of nauseous in the subjective sense when speaking now seems a given, nauseated is still holding its own in text. Conversely, the use of nauseous to indicate the cause of nausea is rapidly falling into disuse in spoken conversation (and when it is used, it is sometimes confused with noxious), whereas it maintains only a rapidly diminishing tenuous lead over nauseating in text.

Accordingly, JAMA and the Archives Journals very seldom use nauseous in the causative sense and not at all in the subjective sense (unless part of quoted material); nauseating is used for the former and nauseated for the latter, at least until the dust has settled on another generation or two of language evolution. In the meantime, writers and editors rushing to meet deadlines are encouraged to take steps to eliminate or reduce stress, consume coffee in moderation, and make prudent dietary choices if skipping meals. — Phil Sefton, ELS

Aggravate, Irritate

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Students are commonly taught that these words should be distinguished from one another, with aggravate used to mean “to make worse, more serious, or more severe”1(p24) and irritate to mean “to provoke impatience, anger, or displeasure in.”1(p663) However, aggravate has been used to mean irritate since at least 1611 (in a dictionary, no less: Randle Cotrave’s A Dictionairie of the French and English Tongues)2 and moreover has been used in that sense by such writers as Cheever, Cowper, Dickens, Melville, and Styron.3

Despite that sterling track record, by 1870 the use of aggravate to mean irritate had for some reason begun to provoke finger-wagging,1(p24) and currently such use is more acceptable in conversation and casual writing. (Perfectly understandable, really: who has time to stop and ponder which is correct, when one’s meaning seems clear enough using either word?) On the other hand, more formal writing—perhaps because the reader has the benefit of neither nonverbal cues nor personal acquaintance with the writer—often calls for more precision, and published writing commonly preserves the distinction between these words.1(p24) Hence, many guides to written English continue to maintain that aggravate should never be used to mean irritate; for example, regarding such usage, Bernstein pointedly maintains that “neither the commonness nor the long history of misuse makes it any better than inept.”4

However, even writers who freely use aggravate in place of irritate do so only when describing a mental state—specifically, when someone or something is getting on one’s last nerve. Descriptions of physical states are another matter: while aggravate was used at least as early as the 1800s to indicate physical irritation (“With stinging wood smoke aggravating the eyes”),2 precision mandates that that the distinction between the words be preserved in such contexts. For example, a patient with conjunctivitis does not have an “aggravation of the conjunctiva”; irritation, or a reaction to a stimulus, is the finding here, although the patient might be advised that environmental irritants such as smoke can further aggravate the irritation already present (see §11.1, Current and Preferred Usage of Common Words and Phrases, in the AMA Manual of Style, pp 381-405 in print).

The bottom line:

●Describing a physical finding or state? In casual as well as formal contexts, current usage calls for irritate, with aggravate used only to describe the worsening of the irritation.

●Describing the effects of irksome behavior or circumstances? The use of aggravate to mean irritate is usually acceptable in casual communications and is rapidly gaining acceptance in more formal contexts as well, but persons writing for publication might be wise to use aggravate only to refer to a worsening of one’s irritation. On this point, Bernstein again: “[t]hose who say they are aggravated are, most likely, the same persons who say that in the hospital they were diagnosed.”4—Phil Sefton, ELS

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

2. Aggravate. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:28.

3. Aggravate. Merriam-Webster’s Dictionary of English Usage. Springfield, MA: Merriam-Webster Inc; 1994:49.

4. Aggravate. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:30.

Questions From Users of the Manual

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Q:  Do you recommend end point or endpoint?  I have folks dying on their grammatical swords over this and thought you might have an opinion.

A:  We follow Dorland’s and use end point.  Replying quickly so as little blood as possible is shed.

Q:  I failed to find guidance in the Manual on correct use of the apostrophe with plural compound nouns, eg, the possessive of mothers-in-law.  What would you advise?

A:  You are quite right that we don’t include any examples that address this specifically and it would be helpful to do so.  (A thought for the next edition—or an annotation for section 8.7.3 if you are an online subscriber.)  I would recommend mothers-in-law’s, as in mothers-in-law’s first meeting.  The Chicago Manual of Style also recommends this (section 7.23):  my sons-in-law’s addresses.

Q:  Where is the style going on the treatment of Web site?  We use Web site but are seeing it more and more frequently as website, or web site, or Website.

A:  JAMA and the Archives Journals are still sticking with Web site, but the new edition of the Chicago Manual of Style is recommending website.  So, it appears that things are, indeed, shifting but we have not shifted yet!

Q:  We’re having a debate about the order of footnotes in a table.  Are they ordered left to right, top to bottom?  Or are they ordered by where they fall in terms of the table components (eg, title, column heading, row heading, field) and then left to right, top to bottom?

A:  There’s a great example in the Manual on on page 93 (Table 10).  In that table, which has a raft of footnotes, you’ll see that the order is basically from top to bottom and, within that, from left to right…as we expect readers would move through a table as they were reading it.  That said, there is nothing sacred about this and a publication could certainly establish a different policy (eg, with the table body, priority could be given to footnotes attached to table stubs, so that if you had footnotes a and b in stubs high up in the table and then footnotes c, d, and e in rows below this but NOT in the table stubs, and then footnote f in a later stub, you might decide to make the stub footnotes a through c [renaming f to c] and then the footnotes within the body of the table d through f. )—Cheryl Iverson, MA

A Healthy Discussion

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You’d think a nutritionist would know the correct usage of healthy vs healthful. Not so. At a recent nutrition educational meeting at the AMA, the nutritionist used the words interchangeably: healthful eating or healthy behavior. That’s a head-scratcher for me. I was hoping for clarification after a stinging rebuke—(I have been accused of being dramatic)—when my editing of healthy behavior to healthful behavior in a commentary had been reversed.

Shaken, I turned to the dictionary to confirm my position and found, as I thought, that healthful promotes health and healthy represents the state of good health. Yet, my editor’s complaint was that healthful seemed unnecessary. My attempts at persuasion fell short, so I had hoped the nutritionist’s discussion would help me gain my equilibrium.

Realizing her discussion placed her in my boat, I decided to see what the authorities who address it had to say.

Fowler’s Modern English Usage1 notes that the distaste for the use of healthful is particular to the United States, a “problem that hardly arises in Britain.” Comparing 3 dictionaries for non-English speakers, Editor R. W. Burchfield observes that one calls its use “old fashioned or literary”; a second, “formal.” The third omits it.

Webster’s Dictionary of English Usage2 says the confusion has existed since the 16th century and claims that the distinction between the terms was created as recently as 1881 by Alfred Ayers. Webster’s concludes that those who “observe the distinction between healthful and healthy … are absolutely correct, and in the minority.” Those who “ignore the distinction … are absolutely correct, and in the majority.”

The Chicago Manual3 hedges by making the distinction between the 2 words, but admits “But gradually healthy is taking over.”

As usual, it doesn’t really matter. But what should one do when making it an adverb? Healthfully or healthily? Hmmm.—Beverly Stewart, MSJ

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

2. Webster’s Dictionary of English Usage. Springfield, MA: Merriam-Webster Inc.

3. The Chicago Manual of Style. 16th ed. Chicago, IL: University of Chicago Press; 2010.