(<SXA Archives of

t/ Emergency MedicineEDITORA. D. Redmond

ASSISTANT EDITORM. Prescott

EDITORIAL ASSISTANTR. L. Gibb

EDITORIAL A. D. Redmond, North Staffordshire Trauma Centre, Princes Road,BOARD Hartshill, Stoke-on-Trent ST4 7GJ, U.K.

V. Dallos, Whipps Cross Hospital, Whipps Cross Road, Leytenstone,London Eli, U.K.K. Little, The Royal Infirmary, Lauriston Place, Edinburgh EH3 9YW,U.K.M. A. Mason, Medway Hospital, Windmill Road, Gillingham, Kent ME75NY, U.K.D. J. Williams, St Thomas's Hospital, Lambeth Palace Road, London SE17EH, U.K.D. W. Yates, Hope Hospital, Eccles Old Road, Salford M6 8HD, U.K.

BAEMREPRESEN-

TATIVES

INTER-NATIONALADVISORY

BOARD

N. G. Kirby, President, Guy's Hospital, St Thomas Street, London SEl9RT, U.K.G. G. Bodiwala, Treasurer, Leicester Royal Infirmary, Infirmary Square,Leicester LE1 5WW, U.K.C. J. Cutting, Chairman, Publications Committee, Taunton and SomersetHospital, Musgrove Park Branch, Taunton, Somerset TAl 3HQ, U.K.

R. J. Goris, The Netherlands; T. Hamilton, Australia; P. Huguenard,France; R. N. Illingworth, U.K.; I. McA. Ledingham, U.A.E.; R. A. Little,U.K.; K. I. Maull, U.S.A.; C. v. d. Merwe, South Africa; C. E. Robertson,U.K.; B. M. T. Rowat, Canada; H. B. Stoner, U.K.

Archives of Emergency Medicine provides aforum for the publication, disseminationand discussion of original clinical and scien-tific research on all aspects of the subject.Particular emphasis is placed on the acutephase of surgical, medical, paediatric, obste-tric and psychiatric emergencies, especiallyin relation to the diagnosis and managementof the acutely ill. It is intended that resuci-tation be a major component of the scientificcontent. The Journal, which has been adop-ted by the British Association for Accidentand Emergency Medicine and the Emer-gency Medicine Research Society, publishesboth original papers and review articles.Case reports or preliminary communicationswill be accepted if sufficiently noteworthy orinteresting.

Subscription information. Archives ofEmergency Medicine is published quarterly(one volume per annum) and the subscrip-tion prices for 1993 are £112.50 (Europe),£124.00 (rest of world) and $219.00 (U.S.A.and Canada), in all cases post free.

Orders for current subscriptions and backissues should be sent to Blackwell ScientificPublications Ltd. Journal SubscriptionsDepartment, Marston Book Services, PO Box87, Oxford OX2 ODT, U.K. all other businesscorrespondence, including orders for off-prints and advertising space, should beaddressed to Blackwell Scientific Publica-tions Ltd, Osney Mead, Oxford OX2 OEL(Telephone [0865] 240201; Telex 83355 Med-bok G; Fax [0865] 721205). The Journal isdispatched within Europe by surface mail, toother continents by various forms of airspeeded delivery: to the U.S.* by air freightfor forwarding by second-class post, to Indiaby air freight for guaranteed local delivery,and to all other countries by AcceleratedSurface Post.

*Post Master, send address changes toArchives of Emergency Medicine c/o MercuryAirfreight International Ltd, 2323 EFRandolph Avenue, Avenel NJ07001 (USMailing Agent) Second Class postage paid atRahway NJ.

This journal is printed on acid free paper.

Archives ofEmergencyMedicine

Edited by A. D. REDMOND

Volume 10

1993

BLACKWELL SCIENTIFIC PUBLICATIONS

Oxford London Edinburgh Boston Melbourne Paris

Berlin Vienna

© 1993 Blackwell Scientific Publications Ltd.Authorization to photocopy items for internal or personal use, or the internal or personal use of specificclients is granted by Blackwell Scientific Publications Ltd for libraries and other users registered with theCopyright Clearance Centre (CCC) Transactional Reporting Service, provided that the base fee of $10.00per copy is paid directly to CCC, 27 Congress Street, Salem,MA 01970, USA. This consent does not extent toother kinds of copying, such as copying for general distribution for advertising or promotional purposes,for creating new collective works or for resale. Special requests should be addressed to the Editor.0264-4924/93 $10.00.

Published by Blackwell Scientific Publications LtdOsney Mead, Oxford OX2 OEL, England25 John Street, London WC1N 2ES, England23 Ainslie Place, Edinburgh EH3 6AJ, Scotland238 Main Street, Cambridge MA 02142, USA54 University Street, Carlton, Victoria 305, AustraliaDusseldorfer Strasse 38, D-10707 Berlin, GermanyRue de Lille, 75006 Paris, FranceFeldgasse 13, A-1238 Vienna, Austria

ISSN 0264-4924

Typeset in Hong Kong bySetrite Typsetters LtdPrinted in Great Britain byBell & Bain Ltd, Glasgow

Archives of Emergency Medicine, 1993 10, 63-71

JOURNAL SCAN 22

Acta Psycliiatrica Scandiinavica

O'Donnell I. &Farmer R. D. R.

Magne-Ingvar U.eLt al.

Suicidal acts on metro systems: an international perspective

The social network of people who attempt suicide

1992: 86, 60-63

1992: 86, 153-158

Anmbutlance

The use of buccal GTN by paramedics

Anmerican Joturnal of Psychiiatry

Perry S. et al.

Swinson R. P. et al.

Predictors of posttraumatic stress disorder after burn

Brief treatment of emergency room patients with panic attacks

1992: 149, 931-935

1992: 149,944-946

Amiiericanl Journal of Suirgery

Treatment of compound fractures'Review article with 111 references'

1992: 161, 693-701

An1nals of the Royal College of Sturgeovns of Englantd

Porter J. M.

Allen D. R. et al.

McGee T. R. et al.

Brearley S. et al.

Nayeem N. et al.

Cugoni H. L. &Whitworth I.

Marston R. A.

A prospective audit of regional anaesthesia for hand surgery 1992: 74, 89-94

Intra-arterial thrombolysis should be the initial treatment of the acutely ischaemiclower limb 1992: 74, 106-111

Should we palpate foot pulses? 1992: 74, 166-168

Peripheral pulse palpation: an unreliable sign 1992: 74, 169-171

Care of road traffic accident victims in a district general hospital 1992: 74, 212-217

Injuries related to wind speed 1992: 74, 294-296

Alcohol-related hand injuries: an unnecessary social and economic cost1992: 74, 312-313

63

Belshaw G. &Reece A.

1992: 7, 11

Seligson D. &Henry S. L.

64 Journal Scan

Huneidi A. H. S. &Afshar F.

Botha A. J. et al.

Delayed intracerebral haematomas in moderate to severe head injuries in youngadults 1992: 74, 345-350

The Royal London Hospital Helicopter Emergency Medical Service: First phase1990 1992: 74, 130-134

(College and Faculty Bulletin)

Annals of Sturgery

Fabian T. C. et al. Factors affecting morbidity following hepatic trauma 1991: 213, 540-547

Archives of Diseases of Childhood

Intravenous volume replacement-which fluid and why? 1992: 67, 649-653

Brain Injury

Bishara S. N. et al. Post-traumatic amnesia and GCS related to outcome in survivors in a consecutiveseries of patients with severe closed-head injury 1992: 6, 373-380

British Jouirnal of Anaesthesia

Fatal tracheal compression after haemorrhage into the axilla'Cause of bleeding was # neck of humerus'

1992: 69, 322-324

British Jouirnal of Clinical Practice

Sen B. & Maitra A.

Wilson P. B.

Benboe S. J. &Barrett J. A.

Ernst E.

Owen T. D.

Ponray P. &Pepper J.

Lim A. et al.

An audit of trauma deaths in Newcastle'Importance of vital signs and R-RTS values emphasized'

A survey of head injuries in a DGH'A useful study'

Doctors knowledge of socio-legal aspects of patients care'Doctors fared badly'

Conservative therapy for tennis elbow'A good review of a common condition'

Humeral fractures in 'arm wrestlers''Sports injury of a special kind'

Aortic dissection'Twice as common as ruptured aortic aneurysm'

1992: 46, 13-15

1992: 46, 16-18

1992: 46, 28-29

1992: 46, 55-57

1992: 46, 98-99

1992: 46, 127-131

Perforation of an abdominal viscus associated with a pneumothorax1992: 46, 141-142

Apparent elevation of serum CK-MB not due to AMI 1992: 46, 149-150

British Jouirnal of Hospital Medicine

Korgaonkar G. &Tribe D.

Doctors, confidentiality and the law

Huskisson L.

Cook L. B. &Varley S.

Dickey W.

1992: 48, 124-126

Cugnoni H. et al.

Frerk C.

Downes E.

McRorie E. R.

A&E consultants must remain on the the shop floor

Management of patients with airway obstruction

Consultants need to refresh resuscitation skills

Obtaining venous access in a fitting patient

Journal Scan 65

1992: 48, 273

1992: 48, 273

1992: 48, 339

1992: 48, 433

British Jotirnal of Intenisive Care

Beaulieu P. F. M. &Vilain L. B.

The emergency medical assistance service in France'A comparison with the UK - not favourable'

1992: 2, 260-267

British Joturnal of Nuirsing

Minitracheostomy: the benefits for patient care 1992: 1, 492-495

Drtugs

Pedersen A. et al. The place of intracardiac injections in the treatment of cardiac arrest1991: 42, 915-918

Enmergency Medicine

MEDLINE Updates 17 - September 1992Available from: Medical Information Service

British Library Document Supply Centre Boston SpaWetherbyWest YorkshireLS 23 7 BQ

£25 per year in Europe. Also available as Database Files for IBM compatiblecomputers with hard disc, £75 per year

Healthi Builletin

Usal H. &Beattie T. F.

An audit of hand injuries in a paediatric accident & emergency department1992 July, 285-287

Hospital and Conirnuniity Psychiatry

McDuff D. R. &Johnson J. L.

Hierholzer R. et al.

Labbate A. &Snow M. P.

Classification and characteristics of army stress casualties during OperationDesert Storm 1992: 43, 812-815

Clinical presentation ofPTSD in World War II combat veterans 1992:43,816-819

PTSD symptoms among soldiers exposed to combat in the Persian Gulf1992: 43, 831-832

Health Trends

Miller E. et al. Quality assurance in Guy's Hospital Accident and Emergency Department1992: 24, 38-40

Nelson S.

66 Jouirnal Scan

Hospital Update

Jacyna M. R. et atl.

Bloor R. N.

Whewell P.

de Lacey et al.

O'Dwyer F. et atl.

Chiu K. et tl.

Ross S. et tl.

Aldhoheyan A.

et al.

Murphy J. &Moore F.

Moulton C. &Yates D.

Lovell N.

Mody I. B. &Maurice E.

Smith R. et al.

Demetriades D.et al.

Taams M. et al.

Daly K. &Thomas P.

Kiwerski J.

Fosse E. &Husum H.

Cutting P. &Agha R.

Burgess P. &Fulton R.

Bodenham A. et al.

Ghurye M. et al.

How does medical audit differ from research? Is a computer necessary1992: 18, 592-596

Social drinker? Detecting and assessing alcohol problems 1992: 18, 607-611

Psychological stresses of being a doctor 1992: 18, 569-570

Setting up hospital audit one model 1992: 18, 670-676

uijlirtyDo elderly patients following trauma require hospital admission? 1992: 23, 295

A prospective study on hip fractures in patients with previous cerebro-vascularaccidents 1992: 23, 297

Clinical predictors of unstable cervical spine injury in multiply injured patients1992: 23, 317

Traumatic interpericardial diaphragmatic hernia 1992: 23, 331

Escalator injuries 1992: 23, 336

Barrow trauma in a washing machine 1992: 23, 339

Under-reporting of trauma from lorry drivers? 1992: 23, 343

Fracture of the occipital condyle: a case review of the world literature 1992: 23, 350

Fracture of the odontoid in a toddler 1992: 23, 352

Role of prophylactic antibiotics in open and basilar fractures of the skull: arandomised study 1992: 23, 377

Post-traumatic abdominal mucormycosis 1992: 23, 90

Trauma deaths in the South West Thames Region 1992: 23, 393

Injuries to spinal cord in elderly patients 1992: 23, 397

Surgery in Afghanistan: a light model for field surgery during war 1992: 23, 401

Surgery in a Palestinian refugee camp 1992: 23, 405

Gallbladder and extra-hepatic biliary duct injury following abdominal trauma1992: 23, 413

Permanent tetraplegia in an infant following improper use of a car seat belt1992: 23, 420

Acute upper airway obstruction due to a ruptured vertebral artery caused byminor cervical trauma 1992: 23, 424

Lewis K. E. &Woodside R. E.

Behrens et al.

Failinger &McGavity

Labelle et al.

Ashcroft et al.

Gebuhr et al.

Bell & Coleridge

Reiser

Guttman &Hamilton

Wright et al.

Schutte P.

Editorial

Journal Scan 67

Jourinal of Advaniced Ntursiuig

Patient satisfaction with care in the emergency department 1992: 17, 959-964

joutrinal of Bonie ai(d loinit Suirgery

Prevalence of seropositivity for HIV in patients with severe trauma1992: 74A, 641-646

Unstable fractures of the pelvic ring 1992: 74A, 781-791'Comprehensive review'

Lack of scientific evidence for the treatment of lateral epicondylitis of theelbow 1992: 74B, 646-652

Measurement of blood flow in tibial fracture patients using positron emissiontomography 1992: 74B, 673-678

Isolated ulnar shaft fractures 1992: 74B, 757-760'Isolated fractures of the distal two thirds do better in functional bracing'

Journal of Emiiergenicy MedicineX

A comparison of diagnostic peritoneal lavage and computed tomography (CTscan) in evaluation of the haemodynamically stable patient with blunt abdominaltrauma 1992: 10, 275-281

The use of cough CPR in patients with acute myocardial infacrction1992: 10, 291-295

Objectives to direct the training of emergency medicine off-service rotations1992: 10, 357-367

Fast track in the emergency department: a one-year experience with nursepractitioners 1992: 10, 367-373

Jolrnal of the Medical Defenice UniionI

Medical confidentiality and crime 1992: 8, 68

Jotrnal of Medical Ethics

Resuscitation policies -action required 1992: 18, 115-116

Dawson C. et l.

Shanker N. S. &Goriny C. C.

Shanker N. S. &Crawford A. D.

Joutrinal of th7e Royal College of Stirgeonis of Edinibuirghi

Use of calcium alginate to pack abscess cavities 1992: 37, 177-179

Mallet finger: long-term review of 100 cases 1992: 37, 196-198

Comminuted Colles' fractures: a prospective trial of management1992: 37, 199-202

68 Journal Scan

Haddock G. &Pollock A. J.

James M. R. &Hill J.

Paediatric trauma: Northern Iraq - the Kurdish refugee crisis 1992: 37, 221-224

Prevertebral haematoma as an inconsistent sign due to cervical spine fractures1992: 37, 267-269

Joutrinal of the Royal Society of Medicinie

Goodwin A. P. L.

Shutte P.

Cox R. A. F.

O'Flaherty D. &Adams A. P.

King M. B. et al.

Wong P. S. &Pugsley W. B.

Forrest F. C. et al.

Cardiopulmonary resuscitation revisited

Assisting the police with their enquiries

Lightning and electrical injury

Endotracheal intubation skills of medical students

1992: 85, 452-453

1992: 85, 510

1992: 85, 591-592

1992: 85, 603-604

Emotional distress in doctors: sources, effects and help sought 1992: 85, 605-608

Partial cardiopulmonary bypass for the treatment of profound accidental hy-pothermic circulatory collapse 1992: 85, 640

Cardiac injury and electrocution 1992: 85, 642-643

Jotrnal of Tratunia

Kane et al.

Davis et al.

Hems & Simpson

Durham et al.

Lorenz et atl.

Garnavos

Henry J. A. et at.

Brahams D.

Impact of the Los Angeles County Trauma System on the survival of seriouslyinjured patients 1992: 32, 576-583'No statistically significant improvement in survival overall following the openingof trauma centres'

An analysis of errors causing morbidity and mortality in a trauma system: aguide for quality improvement 1992: 32, 660-666'There was a 4% error rate. 53% of these errors were during resuscitation'

Prevention of hand injuries in cycle accidents 1992: 32, 683-685'One fifth of injuries are to the hand. Proper cycling gloves are recommended toprevent injuries'

Emergency center thoracotomy: Impact of prehospital resuscitation1992: 32, 775-779

'No blunt trauma survivors. Prehospital ET tube improved survival'

Emergency Thoracotomy: Survival correlates with physiologic status1992: 32, 780-788

'Concludes that thoracotomy is contraindicated when cardiac arrest is notwitnessed and in most blunt trauma'

Technical note: Modifications and improvements of the Milch technique forthe reduction of anterior dislocation of the shoulder without premedication'94.5% success rate with no anaesthesia' 1992: 32, 801-803

Lancet

Toxicity and deaths from 3,4-methylenedioxymethamphetamine ("ecstasy")1922: 340, 384-387

Call of enquiry into ambulance directive 1992: 340, 421

Livesey J. R. et al.

Tenenbein M. &Adamson I. Y. R.

Editorial

Southall D. P. &Samuels M.

Morley C. eLt al.

Rees M. R. et al.

White C. deB et al.

Editorial

McCrirrick A. &Kestin I.

McCombe A. et al.

Waldron H. A.et al.

Inhalation injury with a new infant safety device in a child

Desferrioxamine and pulmonary injury

CRP, AIDS, and public panic

Inappropriate sensor application in pulse oximetry

Journal Scan 69

1992: 340, 424

1992: 340, 428

1992: 340, 456-457

1992, 340, 481-482

Diagnosis of recurrent suffocation in children 1992: 340, 481

Cardiac resuscitation with percutaneous cardiopulmonary support1992: 340, 513-521

'Early intervention' in psychiatric emergencies 1992: 340, 555

Needlesticks: preaching to the converted? 1992: 340, 640-642

Haemodynamic effects of tracheal compared with intravenous adrenaline'Some re-thinking' 1992: 340, 868-870

Motorcyclists and wind noise 1992: 340, 911

Needlestick injuries 1992: 340, 975

Medici,ie, Scince anld the Law(

Havard J.

Teff H.

Patel F.

Rouse D. A. &Fysh R.

'No fault' compensation for medical accidents

The Hillsborough football disaster and claims for nervous shock

Lethal cardiac tamponade

Body packing presenting as sudden collapse

1992: 32, 187-188

1992:32,251-254

1992: 32, 257-260

1992: 32, 270-271

N'W Eniglanid Joutrznal Medicine

Kulig K.

Doberling B. N.et al.

Editorial

Ward D. R.

Initial management of ingestions of toxic substances - Review article1992: 326, 1677-1681

Comparative efficacy of alternative handwashing agents 1992: 327, 88-93

Handwashing and nosocomial infections

Pharmaceutical promotions - a free lunch

1992: 327, 120-122

1992: 327, 351-353

Neutrology Neutrosuirgery anid Psychiatry

Young W.

Hankey G. J. et al.

Medical treatment of acute spinal cord injury 1992: 55, 635-639

TIA: when patients are at high (and low) risk of serious vascular events1992: 55, 640-652

Postgradutate Medical Joutrinal

The evaluation of dizzyness in elderly patients 1992: 68, 558-561Ahmed N. eXt al.

70 Journal Scan

King D. et al.

Evans R. C. &Evans R. J.

Kafetz K. &Luder R.

Jahangiri M. et al.

The law and medical fitness to drive: a study of doctors knowledge1992: 68, 624-628

'Highlights medical ignorance!'

Accident and Emergency Medicine I 1992: 68, 714-734'Excellent review - only 299 references!'

Safe use of streptokinase in myocardial infarction in patients aged 75 andover 1992: 68, 746-751'Safe to use in the elderly, though long delay before initiated'

Naproxen associated vasculitis 1992: 68, 766-7

Stlrgery

Karanjia et al.

Leofler

Bruce & Borz

Fluid and electrolytes in surgery 1992: 10, 6

HIV and emergency surgery 1992: 10, 8

Intussusception in childhood 1992: 10, 9'Presentation is very varied and a high index of suspicion is needed'

Sitrgeriy Gywnaecology Obstetrics

Durham R. M. et al. Penetrating injuries of the stomach 1991: 172, 298-302

Suigical Itif'ction)

Harper N. J. N. Severity of illness scoring systems in the ICU

Tliorax

Donnelly S. C. &Haslett C.

Graham A. N. J.et al.

Barnes

Bowler S. D. et al.

Morell et al.

Barritt P. W.

Lheureux P. et al.

Cellular mechanisms of acute lung injury

Randomised clinical trial of chest drainage systems

1992: 47, 260-263

1992: 47, 461 -462

Effects of corticosteroids in acute severe asthma 1992: 47, 582-583

Corticosteroids in acute severe asthma 1992: 47, 584-587

Controlled trial of iv corticosteroids in severe acute asthma 1992: 47, 588-591

General Practitioners and acute asthma 1992: 47, 669-670

Acute and long-term respiratory damage following inhalation of ammonia1992: 47, 755-756

TRRL (Tranisport and Road Researcli Laboratoriy Reports)

LF2054 Compulsory wearing of seat belts by rear seat passengers in cars 19911992 February

1992: 4, 77

Journal Scan 71

Chest

Green et gil.

Robin & McCauley

Ziment

McGwier et al.

Pulmonary embolism in younger adults 1992: 101, 1507-1511'Normal physical examination and lack of hypoxaemia more common. Alsosurvival rate higher in treated cases compared with older patients'

Sudden cardiac death in bronchial asthma and inhaled beta-adrenergic agonists1992: 101, 1699-1702

Infrequent cardiac deaths in bronchial asthma 1992: 101, 1703-1705'Two review articles discussing the increasing mortality of asthma'

AMI associated with iv injection of Pentazocine and Tripelennamine'A case report of a drug abuser' 1992: 101, 1730-1732

Journal of Puiblic Healthi Medicinie

The measurement of patient satisfaction'A topic of interest that can be difficult to evaluate'

1992: 14, 236-249Carr-Hill R. A.

Archives of Emergency Medicine, 1993, 10, 72

NOTICE

The next meeting of the Injury Research Group will take place on 5 April 1993 at KabiPharmacia, Milton Keynes, U.K.

In the morning there will be free communications and in the afternoon asymposium on 'Growth hormone, insulin-like growth factors and their relevance totrauma'.

For further details please contact: Dr R.N. Barton, Injury Research Group, NorthWestern Injury Research Centre, Stopford Building, Oxford Road, Manchester M138PT. Tel: 061 275 5188; Fax: 061 275 5190.

Editorial correspondence should be directed tothe Editor, A. D. Redmond, North StaffordshireTrauma Centre, Princes Road, Hartshill, Stoke-on-Trent, ST4 7GJ, U.K.

Manuscripts should be sent to the Editor ofArchives of Emergency Medicine, Dr A. D.Redmond. Contributors must send three com-plete copies of the text, tables and figures andretain one copy as the Editor does not acceptresponsibility for damage or loss of paperssubmitted. Manuscripts must be typewrittenon one side of the paper only, with widemargins, be double-spaced and bear the title ofthe paper and name and address of theauthor(s), together with the name of the hospi-tal, laboratory or institution where the work hasbeen carried out. The name and full postaladdress of the author to whom readers shouldaddress correspondence and offprint requestsshould be given on the first page; this willappear as a footnote in the Journal and thepublishers will send the proofs to this authorand address unless contrary instructions arewritten on the manuscript. An informativesummary of not more than 200 words must beincluded, and should appear at the beginning ofthe paper, immediately after the title. TheEditorial Board reserves the right to makeliterary changes. Papers should normally bedivided into summary, introduction, methods(and/or materials), results, discussion, acknow-ledgements and references. SI units should beused throughout. The relative importance ofheadings must be clearly indicated. The maincategories of heading are capitals, side bold andside italics. If necessary, small capitals may beused for subsidiary main headings. Papers areaccepted on the understanding that they havenot been and will not be published elsewhereand on acceptance they become copyright of theJournal. The printing of a letter to the Editor isconsidered a full publication and the aboverules apply.

Illustrations should be referred to in the text ase.g., Fig. 2, Figs 2, 4-7, using Arabic numbers.Each figure should bear a reference numbercorresponding to the number in the text, andshould be marked on the back with the name(s)of the author(s) and the title of the paper. Wherethere is doubt as to the orientation of anillustration the top should be marked with anarrow. Photographs and photomicrographsshould be unmounted and glossy prints andshould not be retouched. Colour illustrations

are not acceptable. Diagrams should be onseparate sheets; they should be drawn withblack ink on white paper and should be at leasttwice the size of the final reproduction. Linesshould be of sufficient thickness to stand reduc-tion. Each illustration should be accompaniedby a legend clearly describing it; these legendsshould be grouped on a separate sheet of paper.

Tables should be as few as possible and includeonly essential data; they should be typewrittenon separate sheets and given in Romannumerals. A list of illustrations and tablesshould accompany the manuscript.

References The number of references should berestricted as much as possible. Journal titlesshould appear in full. References to booksshould include the editor(s), publisher andplace of publication. In the text referencesshould follow the Harvard style: Smith & Jones(1991) and Jones et al. (1991) if there are morethan two authors. Check carefully that thereferences in the text and in the reference listagree. Where several references appeartogether in the text they should be listed inchronological order. If several papers by thesame author from the same year are cited, a, b, c,etc. should be put after the year of publication.References should be listed, double-spaced atthe end of the paper in alphabetical order of(first) authors as illustrated:Anderson E., Folklow B., Hilton S. M. & SmithM. (1991) A study of assault victims attendingan accident and emergency department.Archives of Emergency Medicine 8, 1-10.Davidson F. & Carter S. (1991) Fractures inchildren. In: A. Smith (Ed) Paediatric Emer-gencies, pp. 26-9. Blackwell Scientific Publica-tions, Oxford.

Proofs will be submitted to the author respon-sible for proof-correction (see under Manu-scripts) and should be returned within threedays. Major alterations to the text cannot beaccepted.

Offprints Twenty-five offprints of each paperare supplied free, but additional copies may bepurchased if ordered on the printed card whichwill be sent to the author with the proof.

Extraction services. The Journal is covered byIndex Medicus, MEDLINE and Current ContentsClinical Practice.

Copyright and photocopying (©) 1993 Blackwell Scientific Publications Ltd. Authorization tophotocopy for internal or personal use or the internal or personal use of specific clients is granted byBlackwell Scientific Publications Ltd for libraries and other users registered with the CopyrightClearance Center (CCC) Transactional Reporting Service, provided that the base fee of $10.00 percopy is paid directly to the CCC, 27 Congress Street, Salem, MA 01970, U.S.A. This consent does notextend to other kinds of copying, such as copying for general distribution for advertising orpromotional purposes, for creating new collective works or for resale. Special requests should beaddressed to the Editor. 02644924/93 $10.00