The hypothesis by Tompkins and colleagues that the internationalization of general surgical journals has occurred is proven, but they fail to provide convincing arguments for why this has occurred and why the trend has been greater with the British Journal of Surgery (BJS) than the other publications.
The loss of the British Empire may have benefited the BJS, which like Britain has had to look increasingly to Europe and beyond and not just to the English-speaking world. This may explain the greater reduction, proportionally, in national articles in the United Kingdom compared with the United States. The increase in European publications reflects a policy change by the BJS to encourage greater cooperation with European surgical societies, providing a wider readership for their members. Thus, during a 30-year period between 1969 and 1999, the number of United Kingdom–based national publications in the BJS decreased from 82% to 47%, whereas the number of European articles increased from 2% to 28% during the same period. There was no discernible trend in publications from the rest of the world. The US journals seem to have attracted a greater contribution from Asia than from Europe.