Whatever Happened to Style?

When this journal appeared on the scientific journal stage 70 years ago in 1953, it was called Thoraxchirurgie and published in German. As cardiac surgery had not really been “invented” yet, this was an appropriate title, in the subtitle proudly proclaiming that it was to cover “clinical and operative surgery, pathological physiology, experimental pathology of the organs of the chest, and for anaesthesiology.” We shall better not discuss the last-mentioned subject any further, but concentrate on the surgical ones. Out of 58 articles published in issue 1, seven had a cardiac subject. Let us have a closer look at how they were written.

Four articles had a single author, one had two authors, one had three authors, and one had four authors. There is no apparent structure and compared with today's “original articles”; they are lengthy and overly comprehensive, clear desk-rejects for the modern Editor. Or are they? What they also have in common is a very readable, fluent style of writing. Style, of course, will always be a matter of debate and subjective preferences. This was immortalized in the episode The Builders from Fawlty Towers. Basil Fawlty is wearing a somewhat daring jacket for a weekend trip, with his wife Sybil enquiring “And you're going to wear that jacket, are you?” and him replying “You wouldn't understand, dear. It's called ‘style.’” There you are.

In his brilliant overview “Narrowing of trachea and oesophagus by congenital malformations of the mediastinal vessels and their treatment,”[1] Krauss describes the separation of a vascular ring as follows (translations my own): “There existed no strand as a leftover of the left aortic arch. However, one found an approximately 2 ½ mm wide strand between the aortic diverticulum and the pulmonary artery, relating to the obliterated ductus Botalli, entwined by the recurrent nerve shortly behind its origin from the aortic diverticulum. The ductus Botalli, which stood under considerable tension, was divided between two silk ligatures. After transection, its stumps jumped apart by 2 ½ cm. Thus, the vascular ring, which had been completed on the left by the ductus Botalli, was disrupted [alt.: blown apart], enabling the evasion of trachea and oesophagus.”[a] Anyone who has ever performed such an operation will envisage this immediate effect so vividly described here. You can almost hear the ligament snap.

So whatever happened to the lucid style of writing exemplified here? With the continuously growing number of manuscripts published in print and the associated costs, the IMRAD structure (Introduction, Methods, Results, And Discussion) became more and more popular with editors who were faced with a limited number of pages that could be printed in an issue. A rigid corset aggravated by strict word limits became a welcome tool to relegate overenthusiastic authors. During the 1950s, where our featured article comes from, only approximately 10% of articles published in four leading medical journals followed suit. By the 1980s, IMRAD had become the accepted norm.[2] This certainly made life easier for editors and peer reviewers. The readers, too, found better orientation, knowing instantly where to look for what—certainly an improvement in ever-busier times and the increasing flood of published articles.

What was mainly lost was Style—the individual expression of an author in words, which ideally would make the person discernible. I remember my correspondence with Tom Ferguson, then the Editor of The Annals of Thoracic Surgery, in 1998 because I wanted to include two absolutely nonscientific citations as an introduction to a manuscript.[3] Finally, I was allowed to do it, but I learned a lot about text restrictions and why they exist from an editor's point of view.

Writing a scientific article today is a bit like trying to compress Thomas Mann ramifications into a Hemingway short story. The graphic description of how it feels to receive a thoracic drain in The Magic Mountain would probably have to come down to something like: “In it went. Terrible pain.” Great word count, sparse empathy. The literal sympathy or compassion (i.e., “suffering with” the patient) is definitely better represented inside the Sanatorium Berghof.

Publication History

Article published online:
09 October 2023

• References

• 1 Krauss H. Einengung von Trachea und Oesophagus durch kongenitale Missbildung der Mediastinalgefässe und ihre Behandlung. Thoraxchirurgie 1953; 1 (01) 25-33
• 2 Sollaci LB, Pereira MG. The introduction, methods, results, and discussion (IMRAD) structure: a fifty-year survey. J Med Libr Assoc 2004; 92 (03) 364-367
• 3 Heinemann MK, Brassel F, Herzog T, Dresler C, Becker H, Borst HG. The role of spinal angiography in operations on the thoracic aorta: myth or reality?. Ann Thorac Surg 1998; 65 (02) 346-351