Peripatetic
editorial notes
Writing
well
Ceylon
Medical Journal, 2000; 45:
49-51
To
write for doctors about the art of writing might appear presumptuous or be
thought foolhardy. Don't the diplomas and degrees we have got by dint of bard
work confer on us the ability to teach, examine and write well, in addition to
the ability to doctor well? Perhaps they do. One thing is certain. Neither
superb schoolteachers nor excellent writers claim to be able, for example, to
perform any surgical operations or manage patients in intensive care units.
Anyone who writes about how to write well runs the risk of having his or her
writing examined critically and minutely. But writing about the art of writing
seems no more risky than making a speech about the art of lecturing. Some risks
have to be taken. It might be least hazardous to start with punctuation.
Stops
Periods,
question marks and exclamation points are the end of sentence punctuation marks.
Their use is usually straight-forward. The exercise of commas, semicolons,
colons and dashes generates more contention. They are sops used within a
sentence to signal "a break or pause in thought, to set off material or to
introduce a new but connected thought"(1). Commas are the weakest of the
three are the and colons the most forceful.
Stops have a 'grammatical' duty as well as a 'rhetorical' one. The former has to
do with construction of a sentence eg.
1 The rash which had been present for a week, disappeared quickly after
prednisolone
therapy.
2 I am compelled, however reluctantly, to impose this punishment.
The
'rhetorical' duty is to introduce shades of meaning, as illustrated by the
following pairs of sentences.
3 He was apparently willing to support you.
4 He was, apparently, willing to support you.
5 I went to Manel's house and I found him there.
6 I went to Manel's house, and I found him there.
The fourth sentence above contains a hint of doubt about his bona fides
lacking in the previous one. The fifth is
a bland statement, whereas the sixth conveys a small element of surprise.
Two other general observations on the use of stops are worth remembering. Taste
and common sense are more important than any rules; you put in your stops to
help your readers to understand you, not to please grammarians. And you should
write in such a way that they will understand you with a minimum of help of that
sort" (2). "It is a sound principle that as few stops should be used
as will do the work. Everyone should make up his mind not to depend on his
stops" (3).
Comma
The
contemporary fashion is to use few commas, but fashions vary from time to time;
and good writers of a given period may disagree among themselves about
tradition. One authority asserts: There are definite rules for using
commas" (1). Another boldly declares: "The use of commas cannot be
learned by rule" (2). It would be obviously futile here to take sides. The
writer is safe who follows current convention and uses commas only when a pause
or break is required to avert ambiguity, confusion or untidiness in diction.
As with most other matters pertaining to style, right and wrong use of commas is
best illustrated by examples.
(a) Commas are appropriate
for enclosing parenthetical words, phrases or other expressions that interrupt
the flow of a sentence eg. after all, on the other hand, of course, therefore,
moreover, however etc
7
The real problem. of course, is to obtain uncontaminated specimens of urine.
8 The wisest
thing to do, unless the biopsy report is conclusive, is to withhold fluorouracil
therapy.
9 However, radioiodine uptake by the
gland did not support a diagnosis of Graves' disease.
10 The battered-child syndrome, the clinical signs of which are often hard to
detect, is an important consideration in this case.
(b)
Use a comma before a conjunction (eg and, but, or, for, so, yet) introducing an
independent clause.
11 The fever settled, but the ESR remained very high.
12 Cheek the blood glucose level if you are in doubt, for hypoglycaemia
is a great deceiver If both clauses are short, a comma may be omitted.
13 This test is reliable but very
expensive.
14 I have Bright's disease and he has mine. [S J Perelman, quoted in
reference(1)].
15 Nero fiddled while Rome burnt.
(c) In a series of three or more items or terms with a single conjunction, use a
comma after each, excepting the penultimate one. This comma is often called the
'serial' comma.
16 The hospital has specialists in surgery, medicine, paediatrics and
anaesthesiology.
17 We catheterised the patient under anaesthesia, irrigated his bladder and
started him on intravenous gentamicin.
With the serial comma, accepted practice varies. Some authorities
favour a comma between the penultimate item (or term) and the conjunction
(sentences 18 and 19). But a writer must be consistent about the use of the
serial comma. Do not use both conventions in a single article. Journals prefer
one or the other, but they have to be consistent, too.
18 The patient's blood was
examined for urea, electrolyte, and glucose content.
19 Chest physiotherapy, broad-spectrum
antibiotics, and maintaining fluid balance are critically important In such
cases.
However,
a comma is unnecessary if there are only two modifiers (sentence 20), or in a
series of three or more modifiers, if they are seen as one term or entry
(sentences 2land 22).
20 The appropnate test would be a
randomised double-blind clinical trial.
21
We studied only Sri Lankan gaeriatric haemodialysis
22 These patients had progressive
chronic renal failure.
More about the comma in the next issue of the CMJ.
References
1. Iverson C. American
Medical Association manual of style. 9th
ed. Baltimore: Williams and Wilkins; 1998.
2. Gowers E. The complete plain
words. (Revised by Greenbaum
S and Whicut J) Penguin Books; 1986.
3. Fowler
H W. Modern English usage.2nd
ed. Oxford: Oxford
University Press (revised by Gowers E); 1998.
Colvin
Goonaratna,
Joint
editor, CMJ