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A history of the The Bone & Joint Journal, with Frank Horan

The story of how The British Editorial Society of Bone & Joint Surgery (BESBJS), and its flagship The Bone & Joint Journal came to be, is an interesting tale which begins at the birth of orthopaedic surgery as a specialty in its own right, and ends as the field stands today; a cooperative and global network of orthopaedists. In this illuminating article, the late great Frank Horan, formerly Editor of The Journal of Bone & Joint Surgery British Volume tells the society’s full history.

The American Orthopedic Association

The earliest journals devoted to orthopedic surgery were principally from Germany, with the Zeitschrift fur Orthopadie being perhaps the best known. Publication in English did not start prior to the formation of the American Orthopedic Association.

This organisation had its first meeting in June 1887, held in the house of Dr Schafer, a prominent New York orthopaedic surgeon. It was decided then that a regular meeting would be held. The reason for the formation of the association was that there were an increasing number of surgeons in the United States practicing orthopaedics, virtually solely (although there were also many general surgeons still performing our specialty). It was felt that there was a need for people to join together. In particular, Dr Schafer mentioned the need to have a closer liaison with orthopaedic surgeons in Europe. The next meeting was a year later; at this time Dr Schafer again emphasised the need for such an association, not only to bring together American orthopaedic surgeons, but also to secure a better recognition in Europe for American orthopaedic surgery.

After the second meeting, it was decided to publish transactions. These were simply records of the meetings which had been held and did not contain any other original material. The American association began to thrive, and in 1903, they felt that it was reasonable to change the title of their publication to the American Journal of Orthopedic Surgery. This was necessary because they had decided that they would encourage submissions from people who did not necessarily attend their meetings. They continued to be a successful entity and matters proceeded smoothly until the Great War.

The Great War

The interesting thing about this particular ghastly exercise was that the American forces came into the combat in Europe in about 1917. Prominent American orthopaedic surgeons had realised that this was going to be the case, and Joel Goldthwait, an orthopedic surgeon in Boston, gathered together a number of orthopedic surgeons who would be prepared to come to Europe to help treat their expeditionary force. Meanwhile, Robert Jones, doyen of British orthopaedics had been charged with organising the care of the wounded from the First World War and by the middle of 1916 to 1917, he had established a string of hospitals around the United Kingdom solely treating wounded soldiers from the Western front. The principal centre in London was at Hammersmith Hospital, and when the Americans came over, most of their surgeons were housed there. Robert Osgood, another orthopaedic surgeon from Boston was a leading member of this group and found himself as the principal assistant to Robert Jones in the organisation of affairs.

Plainly the meetings of this large group of American surgeons provoked considerable interest among them all, and Osgood suggested to Robert Jones the formation of the British Orthopedic Association. It may be wondered why we were so late in this country in having such an organisation; there had been earlier attempts at a British orthopaedic society meeting

as early as 1894, with meetings held either in London, Bath, Birmingham or Liverpool. The principle aim of these was to try and steer away fracture care from general surgeons. However, the society only lasted for four years. There were several reasons for this; firstly, people did not particularly like travelling the distances involved, and secondly, British medicine was at that time dominated by surgeons and teaching hospitals in central London. The relationships between the various parties were not always smooth. This society did publish transactions, which was just records of the meetings, circulated to members, but it never achieved any particular status. British surgeons were producing clinical papers and observations at this time, but the papers were sent either to the journal of the Royal Society of Medicine (where an orthopaedic section was founded in 1919), The British Journal of Surgery or in The Journal of Obstetrics and Gynecology. Towards the end of the Great War, the question of the foundation of the British Orthopaedic Association arose again and a preliminary meeting was held in the Café Royal in November 1917. There were 18 prominent orthopaedic surgeons present.

The British Orthopaedic Association

It was decided to form a society, and the first meeting was held in February 1918, chaired by Walter Bristow. Now the question of a journal arose; where could they publish papers if they produced them? As a result of Osgood's influence, it was decided that the American journal would also become the official volume of the British Orthopaedic Association.

As a result, the journal changed its title and in 1919 became the Journal of Orthopaedic Surgery looking after the two associations. This continued as a title until 1922, when, because of the increasing influence and scope of orthopaedic surgery, the title was changed to the Journal of Bone and Joint Surgery. The editor then was Elliott Bracket (based in Boston, USA), a potent force in the spread and success of the journal. Matters continued reasonably well.

From the British point of view, we had a member of the editorial board of the American journal, but because of the difficulties in travel (it was necessary to spend virtually a week in a boat to get to North America) the two outfits never met, and all arrangements were done by correspondence. There was a British editorial committee, but tensions began to arise because of the paucity of the papers from the UK as well as the fact that the American editor had final choice. This resulted in rumblings of discontent from those in the UK who did not have their papers accepted when they wished. With the formation of the American Academy in the early 1930s, the journal also became the official publication of that organisation. Such affairs continued until the Second World War.

The British volume

In 1938 in England, TP McMurray, a prominent orthopaedic surgeon from Liverpool, felt that the British should have an independent journal and expressed this at meetings of the council of the British Orthopaedic Association. In 1943, the role of British editorial secretary was discussed again. It was felt that we in the UK did not have sufficient access to publications and, therefore, in 1944 a subcommittee of the association was established to consider the situation. It is noted in the minutes of the association in August 1946 that “we favoured the establishment of a British journal”. It must also be remembered that because of the Second World War, orthopaedic surgeons from the Commonwealth and the United States were working in Great Britain again and the wish to have a separate method of publication was also clearly expressed by Commonwealth colleagues. The association gave Sir Reginald Watson-Jones the task of implementing progress.

At this time, the Americans were somewhat concerned at the new venture. They recognised the need for a journal organised from London and looking particularly to people from the Commonwealth, but on the other hand, they did not wish to lose the links which had been built up over the years. At this time, William Rogers was the American editor and the president of the American Orthopedic Association was RA Harris, a Canadian from Toronto. They were anxious to maintain the link and came across in May 1947 to meet the Brits, and in particular Sir Reginald Watson-Jones. At this meeting, it was decided that the British should publish a journal retaining the old title of the Journal of Bone and Joint Surgery but be considered as the British volume. The first meeting of the editorial board of the British volume was held on 25 July 1947.

Royal approval

The chairman of the new journal was Professor Harry Platt, later Sir Harry, and the editor Sir Reginald Watson-Jones. Watson-Jones was a key figure in British orthopaedics, a man of great drive and personality. He produced a classic book on the management of fractures written in the early part of the war which became a worldwide ‘bible’, being the first major textbook on fractures published in English.

One of the problems in establishing a journal at this time was the lack of paper, which was still rationed post-war. Sir Reginald had very wide connections though, and he approached the late Harold Wilson, who was then President to the Board of Trade and eventually became Prime Minister; paper for the journal’s publication was allowed! Sir Reginald was also the orthopaedic surgeon to the Royal Family, and when the first volume was produced, he sent a copy to the King. We have in the archives, a letter from Sir Alan Sells who was the principal secretary to the King, congratulating us on the production of the journal and wishing its success. The journal flourished from its early days on the British side, and although the British Orthopaedic Association was prepared to pick up any financial deficit, this was never necessary.

The masthead of the journal for both the British and American volumes contained details of the two editorial boards, the secretaries, and those who were assisting in the production of the journal. Because of the relative financial success and the realisation that the journal should not be looked upon as an arm of the British Orthopaedic Association, a fresh society was formed in 1953, the British Editorial Society of Bone and Joint Surgery. This organisation exists still in pretty much the form in which it was devised. It is entirely separate from any other connection, financially independent and has no reliance on the British Orthopaedic Association. The latter have a place on the council of management by invitation and the president attends our meetings.

The virtue of the editorial society has meant that the journal can remain entirely independent, both financially and with regards to its educational content. The society achieved charitable status, which has been a considerable help in its financial success. However, it must be remembered that the basis of this status lies in, and I quote, “the advancement of education and diffusion of knowledge in orthopaedic and allied surgery”. This means that whilst the journal is our principle means of fulfilling this mission, we would be free to run courses, provide scholarships and similar activities. This is partly done by offering funding to the ABC travelling fellowships from Britain to the United States.

A new home and a new name

Initially the journal was housed in the Royal College of Surgeons, but relationships were not entirely sound because of the high rate of the rent, which the college felt was appropriate, and so the organisation was moved to the rooms of Sir Reginald Watson-Jones in Great Portland Street. He had three floors of a building there; a basement, ground floor and first floor, and the journal was placed in the basement. Initially we produced four volumes per year. If you care to look at them now, you will see that there were principally accounts of case studies, case reports and similar. These were generally speaking written by eminent orthopaedic surgeons of the day. The journal was reasonably successful and increased in size. By 1981, there were five British and five American volumes, and by 1990, 12 American and six British.

When John Goodfellow was editor, it became clear to him that our publication of abstracts of papers, read at meetings, simply took up too much space and he, therefore, initiated the supplement Orthopaedic Proceedings. This still exists and indeed is immensely popular. When I was editor, I thought perhaps it was an unnecessary expense, but when I made inquiries as to whether people found it useful and appropriate, I was told very clearly that it was to continue. Currently we have the abstracts of almost 50 national and international societies. People find them very useful, particularly when undergoing research activities. Now, apart from publishing the supplement and the main journal, when the European Federation of Orthopaedics and Trauma came into being, they decided to publish European instructional course lectures.

The first meeting of this association, which was in Paris, was dealt with by Massel, a French publication company, but the standard of the translations and editing was not felt to be adequate. Therefore, the journal was asked to take the matter on. It became clear that with the increasing amount of basic scientific research undertaken in orthopaedic surgery, a journal was required, which would deal with this aspect of our work. In the United States it was the Journal of Orthopedic Research, but people in Europe felt that they had difficulties getting published in this journal. We were, therefore, approached by the European Orthopaedic Research Society (EORS) to ascertain whether we could help them in funding a journal of their own. The practicalities were that a separate publication would not have been financially possible but we decided that we would, in association with EORS, open a separate research section within our journal. Neil Rushton became the editor and it was extremely successful.

Overall, the size of the journal gradually increased. By 1990, the American volumes had reached 12 issues per year, and the British came up from six to eight in 1999. By 2005 this was one per month, namely 12 per year, coming out more or less at the same time as the American volume. The reason for this was partly the great increase in papers that we have been offered, and secondly, because of the ease of marketing and organisation running a monthly volume.

Following lengthy discussions with our American colleagues in 2012, they expressed the wish to end the joint association. The British volume continued but from January 2013 has been named The Bone & Joint Journal. It follows the objectives defined in the original charter and maintains its position as a ‘World Journal’, publishing material of the highest intellectual and editorial standards from all sources.

The future

So, how is the journal produced? Well, we have an editorial board. There are 35 members at the current time with representatives from Canada, South Africa, New Zealand, Australia, Europe, EFORT and EORS. The members from the Commonwealth come once a year, but otherwise we meet five times each year in our headquarters at 22 Buckingham Street, just off the Strand in Central London. What is the object of these meetings? The way that papers are dealt with is by sending them out to two reviewers initially, and if agreement is reached, the paper will probably then be published. If they disagree, they are sent out to further reviewers, and if we cannot get a clear view of people's opinion of the paper, they will then be discussed at the editorial board when the full membership is present. Usually out of a rather heated discussion, a proper consensus is achieved, and the editor will go ahead and publish the paper.

The object of the journal is to educate orthopaedic surgeons. It's our sole reason for existence and we take pride in trying to produce papers of the highest standard which are written and edited in a way which will be understandable to all our readers. It must be remembered that over half of our readers do not speak English as their first language. We continue to manage well and I think that the journal will go ahead for many years. We have a well-developed website, which increases in complexity and content every year, but the paper journal fulfils a different need and we hope it remains, as it were, a good read.

You can listen to the podcast version of this interview here.