July 10, 2013

Questions From Users of the Manual

Filed under: frequently asked questions,references — amastyleinsider @ 11:11 am
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Q: Section 3.12.5 describes how to cite books with editors and translators but there is no example showing how to cite a book with both an editor and an editor in chief. Should only the editor in chief be cited if one is given for a book?

A: No, I would not exclude other editors’ names if an editor in chief is given. You could extrapolate from the example in section 3.12.5 that shows how to cite an editor and a consulting editor. In that example, repeated below, just replace “consulting ed” by “ed in chief.”

Klaassen CD. Principles of toxicology and treatment of poisoning. In: Hardman JG, Limbird LE, eds. Gilman AG, consulting ed. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill Book Co; 2001:67-80.

Q: When you cite an online reference that will require a password to access the reference, should you include in the reference citation some indication that access is restricted?

A: We wrestled with this question when preparing the current edition and decided against it because different users would have different access rights.

Q: When citing the same work 2 or more times in a manuscript, do you continue to use the same superscript reference number, or do you use a different superscript reference number and relist the work multiple times in the reference list?

A: It is our style to give a reference one number and to refer to it by that number every time it’s cited. This policy is not stated specifically in the manual and perhaps in the next edition it should be. In the current edition, page 44 discusses the situation in which an author might want to cite different (and specific) page numbers from the same reference. The style used is based on the assumption that a reference number “sticks” throughout a manuscript.

Q: Your manual (pp 22 and 183 in print) advises that clinical trials should be registered and that the URL of the registry and the identifying number should be published as a part of the manuscript. Is this still true if the clinical trial has been terminated?

A: Yes, the identifier should be given even if the clinical trial has been terminated. Anyone who chooses to go to the URL provided will be able to read about the trial and will also see there that it has been terminated.—Cheryl Iverson, MA

June 19, 2013

Ex Libris: Grammar Girl’s 101 Troublesome Words You’ll Master in No Time

Filed under: ex libris — amastyleinsider @ 2:12 pm
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Of all the books in Grammar Girl’s 101 words series, 101 Troublesome Words You’ll Master in No Time is probably the most useful for editors. This books lists 101 words that, as author Mignon Fogarty puts it, “are only sort of wrong.” These words are particularly challenging for editors. Do we bow to convention and allow established usage to reign or do we forge new ground (as editors often do) by insisting on up-to-date usage? With this book, Grammar Girl guides the way.

Each entry in 101 Troublesome Words You’ll Master in No Time begins with a response to the question, “What’s the trouble?” In her response, Fogarty points out why the designated word is troublesome. For example, in the entry on healthy, she writes, “Some people insist that carrots aren’t healthy; they’re healthful because only healthful can mean ‘conducive to health.’” After outlining the trouble, Fogarty details the history of the problem. For healthy, she writes, “Healthy has long been used to describe things that improve your constitution. Healthful gained ground against healthy starting in the late 1880s, but healthy fought back and now, although healthful isn’t wrong, healthy is the dominant Standard English word we use when describing fruits, vegetables, exercise, and other things we hope will make us live longer.” Finally, Fogarty answers the question all editors ask themselves, “What should you do?” In the case of “healthy,” she states, “Ignore anyone who says you have to use healthful instead of healthy (unless you’re trying to feign an ‘old-timey’ air).” Fogarty concludes each entry with 1 to 2 quotations from pop culture sources (as she does throughout the 101 words series).

There are numerous entries in 101 Troublesome Words You’ll Master in No Time that are applicable to the medical editor and that support (and occasionally refute) information found in the AMA Manual of Style. The following is a table of terms commonly found in medical editing and an explanation of how the AMA and Grammar Girl handle each term.

Term AMA Grammar Girl
African American “For terms such as white, black, and African American, manuscripts editors should follow author usage. … In the United States, the term African American may be preferred to black (not, however, that this term should be allowed only for US citizens of African descent).” “For Americans of African descent, use African American or black. If the person you are describing is from another country, use another appropriate term, such as Caribbean American.”
Aggravate “When an existing condition is made worse, more serious, or more severe, it is aggravated (also, exacerbated), not irritated.” “In formal situations or if you’re feeling especially sticklerish, avoid using aggravate to mean ‘irritate.’”
Billion “The word million signifies the quantity 106, while billion signifies the quantity 109. Although billion has traditionally signified 1012 (1 million million) in Britain, many British medical journals now use billion to indicate the quantity 109. A number may be expressed in million rather than billion if the latter term could create ambiguity. In that case, the decimal should be moved 3 places to the right. Trillion should be used to denote the quantity 1012.” “Today you can safely use billion to mean 1,000,000,000.” When you are reading old or translated documents, however, be aware of their country of origin and remember that the meaning of billion could be 1,000,000,000,000.”
Data “…retain the use of the plural verb with data in all situations.” “In general writing, if information won’t work because you’re using data as a mass noun to mean ‘information collected in a scientific way,’ data can be singular; however, in scientific writing, always treat data as plural.”
Gender Sex is defined as the classification of living things as male or female according to their reproductive organs and functions assigned by chromosomal complement. Gender refers to a person’s self-representation as man or woman or how that person is responded to be social institutions on the basis of the person’s gender presentation.” “Gender is a social construct, so when you ask someone’s gender, you’re asking whether a person wants to be perceived as what society calls males or society calls female. … If your readers are likely to be extremely squeamish about sex, it’s OK to use gender as a replacement for sex, but if not, try to keep the distinction between the two words.”
Media “In the sense of laboratory culture or contrast media, medium should be used for the singular and media for the plural.” “When media is used as a collective noun, it’s fine to use a singular verb.”
Over Time: Over may mean either more than or during (for a period of). In cases in which ambiguity might arise, over should be avoided and more than used. … Age: When referring to age groups, over and under should be replaced by the more precise older than and younger than. “Unless you work for a publication that follows AP style, freely use over to mean more than if it works better in your sentence.”
Percent “The term percent derives from the Latin per centum, meaning by the hundred, or in, to, or for every hundred. The term percent and the symbol % should be used with specific numbers. Percentage is a more general term for any number or amount that can be stated as a percent. Percentile is defined as the value on a scale of 100 that indicates the percentage of the distribution that is equal to or below it.” “When you are writing about increases or decreases in measurements that are themselves percents, it’s often important to be painfully clear whether you changes are percent changes or percentage point changes.  For example, if 6 percent of students attended swim meets last year, and 8 percent of students attended swim meets this year, that’s a 33 percent increase in attendance, but an increase of only 2 percentage points.”
Preventive “As adjectives, preventive and its derivative preventative are equal in meaning. JAMA and the Archives Journals prefer preventive. “You may certainly choose to use the sleeker preventive, but don’t chide people who prefer the longer form.”
Since Since should be avoided when it could be construed to mean ‘from the time of’ or ‘from the time that.’” “Don’t be afraid to use since as a synonym for because. Just be sure you aren’t creating ambiguous sentences.”
Unique “An adjective denoting an absolute or extreme state or quality does not logically admit of quantification or comparison. Thus, we do not, or should not, say deadest, more perfect, or somewhat unique. It is generally acceptable, however, to modify adjectives of this kind with adverbs such as almost, apparently, fortunately, nearly, probably, and regrettably. … [Unique] should not be used with a comparative (more, less), superlative (most, least), or quantifying (quite, slightly, very) modifier.” Unique is an absolute term, but it’s common to hear people modify it, saying such things a very unique. Grammarians call adjectives such as unique, dead, and impossible ‘ungradable.’ It means they can’t be more of what they already are. … Unique means ‘one of a kind’ or ‘having no equal,’ and things can’t become more unique. … Gradable terms can be modified down, however. For example, almost unique is fine. … Reserve unique for things that are truly one of a kind.”
Utilize Use is almost always preferable to utilize, which has the specific meaning ‘to find a profitable or practical use for,’ suggesting the discovery of a new use for something. However, even where this meaning is intended, use would be acceptable.” “Often, you can replace utilize with use and your sentence will mean the same thing and sound less stuffy. Utilize does have its uses, though. It conveys more of a sense of using something specifically for a purpose or for profit than use does. … Don’t use utilize just because it sounds like a fancy word. When in doubt, choose use. On the other hand, don’t be afraid to use utilize when you’re confident that it’s the right word.”

The above table is meant as a guide for the editor. As always, usage depends on whom you’re writing for and what you’re writing. However, before editors can make decisions on usage, they need to know the options and the reasoning behind them. Both the AMA Manual of Style and Grammar Girl’s 101 Troublesome Words You’ll Master in No Time provide useful guidance on how to handle some of the trickier terms encountered while editing.—Laura King, MA, ELS

June 4, 2013

Questions From Users of the Manual

Filed under: punctuation — amastyleinsider @ 1:31 pm
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Q: I can’t find anywhere in the AMA Manual of Style guidance on having back-to-back sets of parentheses in running text. Here is an example:

 The mean duration of surgery for the computerized-navigation group was 52.6 minutes longer than that of the control group, resulting in a statistically significant difference (P < .05) (Table 1).

I would prefer to see something like this:

The mean duration of surgery for the computerized-navigation group was 52.6 minutes longer than that of the control group, resulting in a statistically significant difference (P < .05; Table 1).

But does the manual have a preference?

A: Short answer: The style manual does not include anything about a pref on use of back-to-back parens, so this is something to think about including in the Punctuation chapter for the 11th edition. (Also, as you’ll see from the few examples below, because we don’t have a policy on this, it has not been handled consistently in our publications.)

Longer answer: Although our first response to your specific example was that we liked the avoidance of back-to-back parens and would favor (as you do) the inclusion of both items in a single set of parens, or would find either version OK, on further thought we decided that this answer was too easy and that often both sets of parens should be retained. Reasons: (1) Although in the example provided it makes sense to combine and use the semicolon, in more complicated sentences it might not be the best choice. (2) Table and Figure citations might be easier to find if not combined with other info.

Below are a few examples from The JAMA Network Journals that might illustrate where combining the information in parens might not be as desirable as keeping the parenthetical items separate.

A significantly higher incidence of SSHL was noted in the HIV group compared with the control group, with an incidence rate ratio (IRR) of 2.17 (95% CI, 1.07-4.40), particularly for the male participants, who had an IRR of 2.23 (1.06-4.69) (Table 2).

Here, keeping the table citation separate makes it clear that the table citation relates to BOTH values given in the sentence, not just the second one. Note that in our journals the first citation of a table or figure is set in different type (here, heavy boldface) to make it stand out.

In this example, where info was combined, it would probably have been better to also have kept the table citation separate as it applied to both bits of info in the sentence:

Mean mandible defect lengths were similar for patients undergoing FFF and LSBF reconstruction (7.8 and 7.7 cm, respectively); STFFs were used to reconstruct significantly shorter defects (mean, 6.0 cm, P<.001, Table 1).

And in this example, which does not include a table or figure citation, similar logic would also probably have made retention of back-to-back parens a better choice since the hazard ratio and P value apply to both, not just the second “n”:

Significantly more patients (n=174) withdrew from the placebo group compared with the chelation group (n=115; hazard ratio, 0.66; P=.001).

Splitting or lumping parentheses should depend more on content than strictly on style.—Cheryl Iverson, MA

May 20, 2013

Quiz Bowl: Editorial Processing and Assessment

Filed under: editing process — amastyleinsider @ 11:22 am
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So, what happens to my manuscript once it has been submitted for publication? Who reads it? Who decides its fate? If it is accepted, what happens next? Help!

Many authors are perplexed by the editorial processing and assessment stages of the publication process. Sometimes it seems as if manuscripts are submitted for publication only to disappear into a sinkhole of unpublished data. Never fear, diligent authors. This month’s AMA Manual of Style quiz covers the procedures involved in editorial assessment and processing.

Here’s an example to test your knowledge of this often puzzling process.

Who on the editorial team makes decisions regarding rejection, revision, and acceptance of manuscripts?


peer reviewer

both the editor and peer reviewer

So, what do you think? (Use your mouse to highlight the text box.)


That one wasn’t too hard. The editor is the head honcho after all, although input from the peer reviewers is invaluable.

If you’re interested in learning more about how manuscripts are processed and assessed, check out this month’s quiz at—Laura King, MA, ELS

May 8, 2013

Significant and Significance

Filed under: usage — amastyleinsider @ 11:38 am
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If there is any doubt about whether significant/significance refers to statistical significance, clinical significance, or simply something “important” or “noteworthy,” choose another word or include a modifier that removes any ambiguity for the reader.

The AMA Manual of Style (§20.9, Glossary of Statistical Terms, pp 893-894 in print) includes definitions for statistical significance (the testing of the null hypothesis of no difference between groups; a significant result rejects the null hypothesis) and clinical significance (involves a judgment as to whether the risk factor or intervention studied would affect a patient’s outcome enough to make a difference for the patient; may be used interchangeably with clinical importance). Significant and significance also are used in more general contexts to describe worthiness or importance.

Often the context in which the word appears will make the meaning clear:

▪ Statistical Significance:

• Exposure to the health care system was a significant protective factor for exclusive throat carriage of Staphylococcus aureus (odds ratio, 0.67; P = .001).

• Most associations remained statistically significant at the adjusted significance level (P < .125).

▪ Clinical Significance:

• Low creatinine values in patients with connective tissue diseases were found to be clinically significant.

• The combination of erythromycin and carbamazepine represents a clinically significant drug interaction and should be avoided when possible.

▪ Worthy/Important:

• His appointment as chair of the department was a significant victory for those who appreciated his skill in teaching.

• A journal’s 100th anniversary is significant and should be celebrated.

Sometimes, however, the context does not clarify the meaning and ambiguity results.

▪ The one truly significant adverse effect that has caused carbon dioxide resurfacing to lose favor is hypopigmentation, which can be unpredictable and resistant to treatment.

To avoid the possibility of ambiguity, some have recommended confining the word to only one of its meanings. However, why cheat a word of one of its legitimate meanings when there are ways to retain its richness and yet not confuse the reader?—Cheryl Iverson, MA

April 23, 2013

Questions From Users of the Manual

Filed under: frequently asked questions — amastyleinsider @ 2:18 pm
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Q: Would you hyphenate “white coat hypertension”?

A: We would follow the latest edition of Webster’s New Collegiate Dictionary. The 11th edition recommends inclusion of a hyphen: white-coat hypertension.

Q: If 2 footnote symbols appear next to each other in a table, should any punctuation be introduced between them?

A: Yes. As with the policy for citation of a reference citation and a footnote symbol side by side (see page 95 in the print), add a comma. So, you might have superscript a,b; or superscript a,c-e.

Q: I would like to know how to cite your 10th edition in the style recommended by the 10th edition.

A: Glad to oblige:

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.

Q: Section 3.10 advises beginning the subtitle of a journal article cited in a reference list with a lowercase letter. Is this true even if the title ends with a question mark?

A: Yes. Here is an example, edited to style:

Mayer AP, Files JA, Ko MG, Blair JE. Do socialized gender differences have a role in mentoring? academic advancement of women in medicine. Mayo Clin Proc. 2008;83(2):204-207.

The same policy would apply if the title were to end with an exclamation point, although those are rare in scholarly article titles!—Cheryl Iverson, MA

April 8, 2013

Option, Alternative, Alternate

Filed under: usage — amastyleinsider @ 12:47 pm

Alternate means “one after the other,” whereas alternative means “one instead of the other”1—and option and alternative are essentially the same thing. Easy peasy, no?

Well, no. At least not quite.

Although few writers would incorrectly use alternative in place of alternate in the sense of “one after the other,” there are subtle differences between these words—and between option and alternative, as well—when they are used in other senses. The potential for confusion is readily apparent when one considers, for example, that option has been defined as “something that may be chosen”2(p871); alternative as “one of two or more things, courses, or propositions to be chosen”2(p37); and alternate as “one that substitutes for or alternates with another”.2(p37) And that’s considering only the use of these words as nouns. As an adjective, alternative has been defined as “offering or expressing a choice” and alternate as “constituting an alternative.”2(p37)

So—is there a way through this thicket?

Option and choice are usually considered interchangeable, but an alternative is an option or choice that stands “instead of the other.”1 Thus, a person faced with numerous options (choices) will always have one more option than alternatives.3 (Some authorities have proposed that alternative should be used only when no more than 2 choices are available. However, few writers observe this distinction.3,4) For example, a diner presented with a dessert menu that lists 4 desserts will—assuming a 1-dessert limit—have 4 options (ie, choices) but only 3 alternatives. Furthermore, it is usually assumed that one of the options will be the original or preferred one, to which the others are alternatives. For example, on that dessert menu, the red velvet cake, tiramisu, and crème brûlée might be alternatives to that triple fudge ganache lava brownie that one has been ogling, in the event that the server comes back with the sad news that the brownie has apparently been everyone else’s first choice as well.

But things get a bit fuzzy when it comes to the choice between alternative and alternate. As suggested above, these words have acquired meanings that are quite close. When a distinction is made, it would seem to hinge on whether a degree of compulsion is in play, with alternative preferred when such compulsion is not present. For example, a person selected to serve as an alternate juror has little choice in the matter; similarly, whereas a person planning a trip might well map out several alternative routes, the same person faced with an unexpected road closure is forced to take an alternate route.5 And, although option and choice can be used interchangeably, alternative has a bit more nuance than choice, suggesting “adequacy for some purpose.”4 Alternative also can suggest a “compulsion to choose”4—although in this case the compulsion is to choose between alternatives (eg, “The alternatives are liberty and death,”4) rather than, as is the case with alternate, a compulsion or duty to serve in place of another (eg, alternate juror, alternate batter).

In practice, although some authorities still advocate maintaining the traditional distinctions between alternative and alternate, actual usage is changing rapidly, and alternative is now often used when a noun is called for and alternate when an adjective is called for.6 However, a big nota bene for medical writers: alternative is used as an adjective in medical contexts when referring to nonallopathic medicine, treatments, or therapies, such as acupuncture, homeopathy, etc. So, the adjective alternate is certainly preferred when referring, for example, to different allopathic treatment choices available to a patient (eg, “the consulting physician recommended surgery but also proposed 3 alternate approaches”).

The bottom line:

● Looking for a word that indicates “one after the other”?1 Use alternate (eg, “Alternate smiles and frowns, both insincere.”7)

● An alternative is by definition an alternative to something else—usually a preferred choice or original plan of action—so one will always have 1 more option than alternatives.

● Although some authorities still maintain the traditional distinctions between alternative and alternate, usage is changing rapidly, and alternative is now often used when a noun is called for and alternate when an adjective is called for—but in medical contexts, the adjective alternative is often used in reference to nonallopathic medicine, treatments, or therapies.—Phil Sefton, ELS

1. Alternate/Alternative. In: O’Conner PT. Woe Is I: The Grammarphobe’s Guide to Better English in Plain English. 3rd ed. New York, NY: Riverhead Books; 2009:88.

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

3. Fogarty M. Quick and Dirty Tips: “Alternate” Versus “Alternative.” Grammar Girl website. Accessed January 16, 2013.

4. Alternate; alternative. In: Garner BA. The Oxford Dictionary of American Usage and Style. New York, NY: Oxford University Press; 2000:18.

5. Alternate vs. alternative. Grammarist website. Accessed March 27, 2013.

6. Alternate, alternative. English Forums website. Accessed January 16, 2013.

7. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:41.

March 27, 2013

Questions From Users of the Manual

Filed under: frequently asked questions — amastyleinsider @ 2:50 pm
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Q: I have sometimes seen myalgia written in its plural form, myalgias. I would no sooner write myalgias than I would write bone losses.  What is your opinion on this?

A: I took a look at both Webster’s 11th and Dorland’s, our principal dictionaries, and both of them define myalgia as “pain in a muscle or muscles.” I think that this is indication that the singular covers both one and many. So, in short, I am in agreement with your reasoning and would use the singular. I also consulted the author of our Correct and Preferred Usage chapter, and she agrees–she feels the plural form is more “jargon-y.”

Q: In the sentence below, would you change frequently occurring to common?

Constipation is a frequently occurring symptom that can result from dehydration, use of certain medications, prolonged bed rest, lack of physical activity, or mechanical changes resulting from cancer or anticancer therapies.

A:  My instinct is that these 2 are not identical. The notion of “frequently occurring” could apply to frequency in a single individual, I think, whereas “common” signifies that it is something that may be experienced by many people (without any regard to its frequency). Roxanne Young, the author of our Correct and Preferred Usage chapter, concurs. You did not say why you were thinking of making the change, but the opinion from The JAMA Network Journals is that we would retain the distinction, however subtle, between frequently occurring and common.

Q: The author instructions in a journal to which I am about to submit a paper refers to the “standard abbreviations within the AMA 10th edition (see pages 502-525).” I notice that a small number of these abbreviations are followed by an asterisk, indicating that they do not require expansion at first mention. Are these the only “standard abbreviations” to which the guidelines might refer? Does the AMA Manual of Style contain other lists that include such “asterisked” items?

A:  The list on pages 502-525 (in section 14.11 for those who use the online manual and don’t find page numbers helpful), does indeed contain a few items that have an asterisk to indicate that they do not need to be expanded at first mention. [NOTE:  As of July 27, 2011, an asterisk was also added after CI (confidence interval). See this in the online Updates.] The page numbers 502 through 525 also include the list in 14.12 , Units of Measure. There are many other little lists of abbreviations throughout the manual, but these lists, in the Abbreviations chapter, are the ones most likely to be intended by the instructions for authors you cite.—Cheryl Iverson, MA

March 12, 2013

Quiz Bowl: Author-Editor Relationship

Filed under: editing process,quizzes — amastyleinsider @ 3:06 pm
Tags: , ,

There have been some famous, even notorious, author-editor relationships: Charles Dickens and Edward Bulwer-Lytton, Ted Hughes and Sylvia Plath, Raymond Carver and Gordon Lish. This month’s quiz takes us on a tour of some of these fruitful and fractious relationships as a means of exploring effective ways for editors to handle issues with authors. The following is an example from this month’s quiz.

Vladimir Nabokov, author of Lolita, notoriously and wittily disdained editors. In a 1967 interview in The Paris Review, he said, “By ‘editor’ I suppose you mean proofreader. Among these I have known limpid creatures of limitless tact and tenderness who would discuss with me a semicolon as if it were a point of honor—which, indeed, a point of art often is. But I have also come across a few pompous avuncular brutes who would attempt to “make suggestions” which I countered with a thunderous ‘stet!’”1

What is the best way for editors to communicate with authors who balk at the suggestions made to improve the manuscript?

a. E-mail the author to tell him/her that all the edits are based on the AMA Manual of Style and therefore not subject to change.

b. Telephone the author to discuss the edits, iterating the rationale and providing resource support for the changes.

c. Do not respond to the author.

d. Eliminate all the edits and publish the paper as the author originally submitted it.

What would you do? Here’s our advice (use your mouse to highlight the text box):

Telephone the author to discuss the edits, iterating the rationale and providing resource support for the changes.

Usually, an author’s insistence to overrule all editorial changes is a knee-jerk reaction to extensive editing. Most authors are aware of the editing process, although some need to be guided gently through it. Communicating with the author and explaining the reason for the changes (as well as providing resource support when necessary) can often defuse a volatile situation.—Laura King, MA, ELS


  1. Gold H, interviewer. Vladimir Nabokov, The Art of Fiction No. 40. The Paris Review. Accessed February 8, 2013.

February 19, 2013


Filed under: Uncategorized,usage — amastyleinsider @ 2:35 pm

“Recognizing that the genetic contribution to health disparities is likely to be relatively limited is not the only reason to question the wisdom of promoting genetic research under the aegis of health disparities.”1

“In several examples published under the aegis of the [Agency for Healthcare Research and Quality], the benefit side rests on the data from randomized controlled trials….”2

“[T]his definition and associated regulations have become de facto rules for US academic and other research institutions and are applied to any work done by their employees or under their aegis regardless of the source of funding.”3

While somewhat infrequently encountered in medical writing, aegis is occasionally used in content related to health policy, institutional oversight, or the conduct of research. It also is occasionally used to refer to a journal’s vouching for the validity of data or other findings published in its pages; when such validity is called into question, a journal may issue a full retraction or simply “withdraw aegis,” ie, issue a statement to the effect that the journal is no longer responsible for the data.4

In its original sense, aegis (Greek aigis [goatskin]) referred to the shield or protective cloak worn by Zeus or Athena in the myths of ancient Greece.5 In the centuries since, the word has by association come to be used idiomatically to indicate defense (“Feeling is the aegis of enthusiasts and fools.”6) or guidance or influence (“They made their valuable individual contributions, but under the Ellington aegis they found themselves constantly enriched musically.”6). Similarly, the word is perhaps most often used in the construction “under the aegis of” to express patronage or sponsorship (“under the aegis of the museum”) and, especially, protection (“a child whose welfare is now under the aegis of the courts”).5

All of which is perfectly comforting. However, the classical roots of the word are far less benign. Whereas aegis-like shields appear in Egyptian, Nubian, and Norse mythology and art,7,8 the most elaborate account of the origins and attributes of the aegis comes, as suggested above, from the narratives of ancient Greek mythology and literature, in which it is consistently depicted as an object possessing fearsome supernatural power.

In one such narrative, the goat deity Amaltheia suckles the infant Zeus, who then—in the curiously detached manner so frequently encountered in mythological accounts—breaks off her horns and flays her hide. From one of her horns Zeus fashions the cornucopia, or horn of plenty; from her hide, he fashions the shield or cloak that would come to be called the aegis, which he then wears, on the counsel of an oracle, into battle against the marauding Titans.9 However, in the hands of Zeus, king of the gods, the aegis is more than a protective device; when in his wrath he shakes the aegis from his perch atop Mount Olympus, thunder crashes, bolts of lightning slash the sky, and fierce storms devastate the land.10 Moreover, in the Iliad, Homer describes the device as the “tempestuous terrible aegis, shaggy [and] conspicuous… given to Zeus to the terror of mortals.”11

But the aegis is associated with deities other than Zeus. In the Iliad, for example, Zeus lends the aegis to Apollo, who wields it to push his enemies back to their ships12; in other accounts, Zeus lends the aegis to his daughter, Athena, goddess of war,12 or presents it to Athena after his conquest of the Titans.9 In the most colorful account, Zeus swallows his wife, Metis, whole—after which Athena is born from Zeus’ head, emerging fully formed and bearing the aegis and other weapons of war.13 Regardless of how Athena comes to possess the aegis, however, in her hands it becomes more formidable still. For example, in the Iliad Homer reverently describes the aegis as no mere goatskin but rather as “ageless and immortal,” worn by “bright-eyed Athene” and adorned with tassels of the purest gold12; moreover, elsewhere in the Iliad he describes the aegis as a dramatic golden cloak fashioned by Hephaistos, god of fire and metalwork,14 to resemble a scaly skin like that of a snake, linked and fringed with writhing serpents, and bearing in its center the severed head of the Gorgon Medusa, eyes rolling and scalp also bristling with serpents.11

Charming as this may be, given the provenance of the word and the fell associations that come with it, how did aegis, apart from its military associations, come to be used to express defense or protection? Perhaps more puzzling, how did it come to be used to express benevolent guidance, influence, or patronage? A possible clue is that whereas early accounts often depict Athena as cultivated, civilized, urbane, and wise, the economy of ancient Greece was bolstered by military pursuits, and in short order Athena came to be depicted as the goddess of war—although, importantly, her military might was tempered by the cultivation and divine wisdom earlier attributed to her.15 Thus, Athena is sometimes viewed as having 2 sides. The first is characterized as wrathful, tempestuous, and destructive; however, the other is characterized as divinely beneficent and endowed with the inclination and ability to grant the gifts of aid, wisdom, and protection to favored mortals.16 The power of both sides is wielded through the supernatural power of the aegis—hence Homer’s description of the device in the Iliad and its depiction in visual art as inky black or brilliant gold.11,12,16

Interestingly, however, while Athena extends divine beneficence and protection—backed by the wrathfulness also attributed to her—she does not authorize those mortals fortunate enough to come under her favor to act on her behalf. Thus, whereas in current usage aegis is correctly used to express defense, protection, guidance, influence, patronage, or sponsorship, its use to indicate “under the jurisdiction of” is considered incorrect.17Phil Sefton, ELS

1. Sankar P, Cho MK, Condit CM, et al. Genetic research and health disparities. JAMA. 2004;291(24):2985-2989.

2. Vandenbroucke JP, Psaty BM. Benefits and risks of drug treatments: how to combine the best evidence on benefits with the best data about adverse effects. JAMA. 2008;300(2):2417-2419.

3. 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; 2007:157.

4. Hammerschmidt DE, Franklin M. The limits and power of peer review. Minn Med. June 2006. Accessed February 13, 2013.

5. Aegis. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:19.

6. Aegis. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:22.

7. Aegis: in Egyptian and Nubian mythology. Museum of Learning Web site. Accessed February 15, 2011. 8. Aegis: in Norse mythology. Museum of Learning Web site. Accessed February 15, 2011.

9. Amaltheia. Theoi Project Web site. Accessed February 13, 2013.

10. Zeus. Theoi Project website. Accessed February 13, 2013.

11. Hephaistos Works 2. Theoi Greek Mythology Web site. Accessed February 13, 2013.

12. Teleporter: aegis mound. Entropia Planets Web site. Accessed February 13, 2013.

13. Athena. Theoi Project Web site. Accessed February 13, 2013.

14. Hephaistos. Theoi Project Web site. Accessed February 13, 2013.

15. Athena. Encyclopedia Britannica Online. Accessed February 13, 2013.

16. Deacy S, Villing A. What was the colour of Athena’s aegis? J Hellenic Stud. 2009;129:111-129. Accessed February 13, 2013.

17. Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:29.

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