Nouns - Grammar

AMA Manual of Style - Stacy L. Christiansen, Cheryl Iverson 2020


A clear understanding of grammar is basic to good writing. Many excellent grammar books provide a detailed discussion of specific principles (see 23.3, Resources, General Style and Usage). In this section, the focus is on how to avoid common grammatical and writing errors. The content of this chapter is organized from the smallest parts of speech (eg, nouns and pronouns) to larger structures (eg, sentences and paragraphs).

7.1 Nouns.

Nouns (words that name a person, place, thing, or idea) may serve as subjects or objects. Nouns are classified as common, proper, or collective.

Common nouns name something generic and are lowercased unless they appear at the beginning of a sentence or in a title.







Physicians and hospitals should work within the parameters of the plan.

Editors decide what to publish based on a variety of factors relevant to that journal.

Title: Addressing Physician Burnout: The Way Forward

Proper nouns name something specific and are always capitalized (see 10.3, Proper Nouns).


North America

Declaration of Helsinki


Collective nouns name something abstract, something uncountable, or individuals treated as a group. Collective nouns are usually common nouns (see 7.5.5, Collective Nouns).





The society has released new guidelines that detail the diagnosis and treatment of cardiomyopathy. (But: The Society of Critical Care Medicine published new sepsis guidelines this year.)

7.1.1 Nouns as Modifiers.

Although nouns can be used as modifiers, overuse of noun modifiers can lead to a lack of clarity. Purists may demand stricter rules on usage, but, as with the use of nouns as verbs (see 11.4, Back-formations), the process of linguistic change is inevitable, and grammatical rigor must be tempered by judgment and common sense.



depression episode

depressive episode, episode of depression

elderly over-the-counter drug users

elderly patients using over-the-counter drugs

In The Careful Writer, Bernstein1 advises the use of no more than 2 polysyllabic noun modifiers per noun for the sake of clarity. However, long noun strings are sometimes difficult to avoid in scientific writing. If several of the attributive nouns are read as a unit, the use of more than 2 may not compromise clarity. Thus, noun strings may be more acceptable, for the sake of brevity, if the terms have been previously defined without noun strings. Some acceptable examples appear below.

community hospital program

sudden infant death syndrome

risk factor surveillance system

nicotine replacement therapy

baseline CD4 cell counts

placebo pain medication

health care workers

autism spectrum disorder

proficiency testing program

HIV vaccine trial

clinical research organization

blood glucose concentration

tumor necrosis factor

physician claims database

community outreach groups

acute respiratory distress syndrome

If there is a possibility of ambiguity, hyphens may be added for clarity (eg, large-vessel dissection) (see, Hyphen, Temporary Compounds).

An appositive is a noun or noun phrase that describes another noun or noun phrase.2

Jonas Salk, developer of the first successful inactivated polio vaccine, was born in New York.

Ipilimumab, a cytotoxic T-lymphocyte—associated antigen inhibitor, has been approved for the treatment of advanced melanoma.

Appositives are often set off by commas because they are considered nonrestrictive (ie, not essential to the meaning of the sentence). Sometimes, however, an appositive is restrictive and not flanked by commas (see 8.2.1, Comma).

Christiaan Barnard, a South African heart surgeon, performed the first human-to-human heart transplant.

South African heart surgeon Christiaan Barnard performed the first human-to-human heart transplant.

7.1.2 Modifying Gerunds.

When a noun or pronoun precedes a gerund (a verb form ending in -ing that is used as a noun), the noun or pronoun is possessive (see 8.7, Apostrophe).

The toxicity of the drug was not a factor in the patient’s dying so suddenly.

The award recognized the researcher’s planning as well as her performance.

Present participles (used adjectivally) should not be confused with gerunds. In the sentence below, the objective case (them) is correct.

I watched them gathering in the auditorium.

If the possessive their were used instead of the objective them, the emphasis would be on the action (gathering).

I supervised their gathering of the samples.

7.1.3 Subject-Complement Agreement.

Subjects and complements should agree in number.

The boy can tie his own shoes.

We asked trial participants to return their pill dispensers.

However, when the complement is shared by all constituents of the plural subject, that noun remains singular.

The authors were asked to revise their paper.

Most of the patients in the trial were asked to track their blood pressure.