Injury (1987) 18,371-372 Printedin Great Britain 371

Editorial Peter London has retired this year from the Chair- manship of the Editorial Board after 18 years, at a time of intense interest and discussion on ways of providing for the future care of the injured patient in the British Isles. His initiative in 1965 to start a new journal had the prime purpose “to ease the task of those who wished to keep themselves informed about activities in many fields that can contribute to the care of the injured”. This initiative has been a landmark in the development of the surgery of trauma in the United Kingdom. The Birmingham Accident Hospital in the 1940s and 1950s was prominent in the lead to provide care for the injured patient. The Institute of Accident Surgery was set up to encourage the teaching and education of all aspects of the care of the injured patient. Parallel with these developments was the rapid advancement of individual surgical disciplines resulting in highly successful units dealing with cranial, plastic, vascular, thoracic, facie-maxillary and orthopaedic injuries. The last 20 years has seen the interest of surgeons absorbed and narrowed within these disci- plines. In 1969 Injury: The British Journal of Accident Surgery was launched for those interested and involved in the total care of the injured patient. The Journal depended upon the support of those who needed a forum to speak across the board of all disciplines. At that time the Journal did not represent a society of specialists but spoke rather for individual surgeons working often independently. In this venture he was

Bloodshed and its estimation

There may seem to be little point in reminding readers of what happened 30 years ago in a field that has developed enormously since then. The severely injured patient can now be subjected to tests and measure- ments that provide marvellously detailed information about an extensive range of bodily functions. Besides these, the much simpler investigations of Ruscoe Clarke and his colleagues may seem to pale into little more than historical significance. This is by no means true. No part of the world is free from serious injuries and in most of those parts in which there is any prospect of successful treatment of some of the serious injuries there is no access to the elaborate modern methods of diagnosis that guide treatment in centres of excellence.

Ruscoe Clarke and his colleagues confirmed and extended the classic studies of Grant and Reeve and so dispelled much of the dangerous confusion and impre- cision on the subject of ‘shock’. That was in itself a

partnered by Richard Batten as the first Editor of the Journal, a formidable team, combining dedication and enthusiasm. An estimate of the success of their work can be measured by the expansion of the Journal from 4 issues a year in 1969 to the present 6 issues a year and an increase in the papers in each issue from 15 to 25 papers. The size of the Editorial Board has remained unchanged, representing interests of all disciplines, but it is now supported by 26 foreign correspondents whose colleagues contribute some 40 per cent of all papers submitted to the Journal for publication. Many surgeons within the British Isles and abroad owe a great debt to the example and leadership of Mr. London and Mr. Batten in the production of Injury. It is now hoped that their contribution injury with its expressed pur- pose at looking at the whole “plan of the battle” will continue through its contributors to maintain the spirit of enquiry and thought of all those actively interested in all aspects of the injured patient.

Peter London has been an outstanding ambassador for British surgery and a tireless and dedicated surgeon at the Birmingham Accident Hospital. His many resi- dents over the years and his numerous friends through- out the world will wish him well in retirement. The Editorial Board is very grateful to him for his willing- ness to remain on the Editorial Board as an editorial consultant so that the Board will continue to have the benefit of his very wide experience and wisdom.

valuable advance. In addition, they showed that simple clinical observation can provide useful guidance in the management of bleeding following serious injuries of all kinds. The accuracy of these methods leaves much to be desired in comparison with modern methods, but they are available to any clinician who is willing to use his eyes, ears, hands and head and has been shown how to do so.

It is easy to dismiss such views as being out of date and to say that the seriously injured are in obvious and urgent need to intravenous infusion and that the conrol of that can be achieved with remarkable accuracy by the use of modern methods. That cannot be denied but there are three important considerations to be set against a dismissive attitude of this sort.

First, the young and healthy can suffer serious injury without at first showing signs of rapidly increasing hypovolaemia. It is by no means unknown in the bigger

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and better hospitals for a patient with, for example, closed fractures of the tibia and femur to be despatched to the X-ray department on route for manipulation and splintage, perhaps with general anaesthesia, with a confident but misguided statement that he or she is ‘not shocked’. Although the order of loss of blood from such injuries is likely to be from 30-50 per cent of the blood volume this well-established fact is set aside in favour of the mere opinion that the patient is ‘not shocked’. Such an opinion is presumedly based on the belief that ‘shock’ is a state not a train of events that may suddenly develop clinical manifestations and that in the absence of those manifestations there is no need for intravenous infusion.

Second, it is by no means unusual to see pale victims of injury in wards after the period of intensive care is

over but without their pallor exciting comment or pro- voking an enquiry about the haemoglobin. The depar- ture of resuscitative captains and kings does not end the need for looking after the patient in a simpler way.

Third, there is an understandable tendency to favour what is elaborate, precise and expensive over what is simple, effective and cheap. One result is the atrophy of powers of clinical observation. In this field (and others) Dr Topley has reminded us that we should not discard the simple things that will serve both doctors and patients well when there are serious injuries to be dealt with, and particularly when resources are scanty.

P.S. LONDON

Important Announcement 1n@ry is now published by Butterworth Scientific, having previously been published by IOP Publishing under the John Wright Journal imprint. All correspondence for the Journal should now be sent to:

Mary Korndorffer Managing Editor, Medical Journals Butterworth Scientific Ltd Westbury House Bury Street Guildford GU2 5BH Surrey