It was with great interest that I read Baker & Williams’ persuasive account outlining the correct use of the term ‘fasciculation’.¹ The plural ‘fasciculations’, they argue, has erroneously slipped into the medical vernacular since Denny-Brown and Pennybacker coined the singular term in 1938.² Fasciculation, they emphasise, represents a ‘state of being’ and therefore is a binary entity; fasciculation is either present or it is not. On reading this fascinating etymological tour, I felt compelled to present a counter-argument. I propose that the oft-used plural form represents much more than mere solecism.

There are alternative ‘…-ation’ words where the plural form is not only acceptable, but indeed preferred. Take ‘congratulations’ as an everyday example. In medicine, there is the widely accepted use of ‘palpitations’, as acknowledged by its definition in the Oxford English Dictionary: Throbbing, quivering, or contraction of a part of the body; spec. perceptibly fast, strong, or irregular beating of the heart; an instance of this (frequently in plural).

Jeff Aronson examined this precise issue, highlighting the distinction between count (or unit) nouns and non-count (or mass) nouns.³ A count noun can be preceded by the indefinite article (‘a’/‘an’) and can take singular and plural forms (eg, a muscle, some muscles), whereas a non-count noun is restricted to the singular form (eg, sugar, evidence). There are even examples of words where the meaning changes depending on its categorisation (eg, ‘a glass/two glasses’ as a count noun, but ‘some glass’ as a non-count noun).

This is not simply of semantic importance. If one restricts fasciculation to its singular form, one is at risk of stifling scientific enquiry. The utility of qualitative judgments, such as ‘sparse fasciculation’ or ‘florid fasciculation’, is limited. Quantification is a prerequisite for accurate measurement, and it is through measurement that we learn about the world around us.

For some non-count words, quantification is facilitated by the accompaniment of a suitable count noun, such ‘grain(s) of sugar’ or ‘piece(s) of evidence’. In a similar fashion, the term ‘fasciculation potential(s)’ has arisen to aid electromyographic quantification. But this term would be an inaccurate descriptor for ultrasound or MRI. Maybe ‘fasciculation twitch(es)’ or ‘fasciculation event(s)’ would suffice, but this approach is an unwieldy one. If, instead, we accept that fasciculation can coexist as both a non-count noun (like the first description by Denny-Brown and Pennybacker) and a modernised count noun, the predicament is resolved.

In so doing, we could begin to embrace such contentious phrases as: Fasciculation consists of numerous fasciculations.

With this renewed approach, I suggest that both purists and pragmatists can stand side by side, happy in the knowledge that both are right (and equally wrong) at the same time.