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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 May 26; 334(7603): 1104.
PMCID: PMC1877929
When I use a word

Words that count

Jeff Aronson, clinical pharmacologist, Oxford

I have previously described the difference between count (or unit) nouns and non-count (or mass) nouns (BMJ 2004;329:30). Briefly, a count noun can be both singular and plural (a filler, my filler, those fillers, many fillers), whereas a non-count noun, which usually takes a singular form (furniture, some furniture, much furniture), is strictly speaking neither singular nor plural. If you can put the indefinite article, “a” or “an,” before a noun—indeed, if it requires some such determiner—it is a count noun. Some nouns can be of both types, with different meanings—two glasses (count noun), some glass (non-count noun). This happens, for example, when a noun can mean both an object (a medication—that is, a medicine) and an act (medication).

Here are some bête noires—plural forms of non-count nouns:

  • Methodologies (use “methods”)
  • Mortalities (use “deaths”)
  • Surgeries (use “operations” when it doesn't mean doctors' places of work)
  • Symptomatologies or symptomologies (use “symptoms”)
  • Toxicities (use “adverse effects” and remember that toxic effects form a subset of all adverse effects; see BMJ 2004;328:1173).

Other erroneous forms that I have spotted include anaphylaxes, bioavailabilities, functionalities, monitorings, safeties, and numerous hypos and hypers (such as hypocalcaemias, hypoglycaemias, hypernatraemias, and hyperkalaemias).

But some nouns that are properly non-count can still have plural forms. This happens if there are different types of the thing. For example, one reads about chemistries (organic, inorganic, etc), comorbidities, musics (classical, heavy metal, ska, etc), pathologies, and technologies, even though these are non-count nouns.

“Palpitations” is an interesting case. Palpitation is a non-count noun, but the plural form has largely taken over in colloquial use. The definition of palpitation that appeared in the second edition of the Oxford English Dictionary (1989) was: “The beating of the heart; esp. a violent and rapid pulsation resulting from exercise, strong emotion, etc; throbbing; spec. such increased activity of the heart arising from disease of the organ itself or other parts of the body.”

However, the definition in the current online version of the OED recognises modern use and helpfully distinguishes the singular and plural forms thus: “Throbbing, quivering, or contraction of a part of the body; spec. perceptibly fast, strong, or irregular beating of the heart; an instance of this (freq. in pl.)”. So, it would make sense to regard palpitation and palpitations as two non-count nouns, with singular and plural forms and related but different meanings (like damage and damages), respectively the violent and rapid beating and the symptoms that you get from it. In this interpretation palpitation causes palpitations, and, conversely, one can have palpitations without palpitation. The misuse of “palpitations” to mean “palpitation” is not new; the earliest example cited in OED is from a 1728 poem called “Spring” by James Thomson (“Her wishing Bosom heaves With Palpitations wild”).

However, bioscience authors have not abandoned “palpitation” altogether: when I searched all fields in PubMed, I found 951 hits for “palpitation” and 2049 for “palpitations”—a large but not overwhelming majority. Even so, there are several examples in which the two forms are used interchangeably, and it is not clear that authors always acknowledge a difference of the type that I have described.

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