It is a pleasure to reflect on my term as editor of Stroke. There were many accomplishments that led to an increased understanding of stroke and its management during that period, and many changes in the journal itself.
Perhaps the most conspicuous change in Stroke occurred in 1988, when the journal moved from bimonthly to monthly publication. By 1989 there was a 50% increase, from 1987, in studies published in Stroke. This figure suggests that not only was there an increasing amount of research published, but that its quality did not appear to have been diluted. Further, it is likely that the overall time to publication of stroke-related research was substantially shortened by monthly publication. It must be noted that these changes could not have been accomplished without a cadre of diligent reviewers and the devotion and hard work of Nancy Lynch Clark, who served as managing editor throughout my tenure. It is they who made the journal larger, with no loss of scientific integrity.
Stroke grew in other ways as well. The subject index and glossary of terms were standardized, using MeSH headings, and an in-house abstracts editor. This was the first and only time that the abstracts editor was not a physician. Submission rates also grew every year until 1990, including a 17% increase in 1989. However, there was a 9% decrease in 1990, probably because 2 new stroke journals, including the European stroke journal, were initiated during that year.
Concerning the evolution of the study of stroke over the last 30 years, it seems difficult to fit the progress of research into number of years of work by a given Stroke editor. Advances were more continuous than discrete. However, one significant watershed in my years of service is that the anticoagulation wars seemed to have ended. Treatment of completed stroke finally joined up as a full partner to studies of mechanisms and models of stroke, its epidemiology, its prevention, and its increasingly more accurate description as a result of the developing sophistication of techniques such as CT, MRI, SPECT, PET, and TCD.
Treatment studies in Stroke during my editing years included investigations of hemodilution, thrombolytic therapy, and a number of pharmacological interventions. Much of this literature was controversial and sparked a disproportionate number of editorial comments. Nevertheless, it seems to me that therapeutic nihilism concerning treatment for stroke began to wane during this time. The result has been the emergence of a very different picture of how to influence the outcome of stroke.
I had originally intended to cite studies published under my editorship that I considered to be seminal. Looking over just the titles and abstracts of these 900 or so articles has been a humbling experience, and I find myself unwilling to single out just a few of them. As all of us know, science proceeds most commonly by small steps, and it often takes a longer retrospectoscope than one represented by a single decade to recognize the truly significant advances. Thus, I prefer to beg the question.
My tenure as editor of Stroke ended as the 1990s ushered in The Decade of the Brain. An appropriate conclusion for this reminiscence is to quote from the editorial on that topic, written by Murray Goldstein, DO, MPH,1 which appeared in the March 1990 issue of Stroke.
Advances made over the last 10 years in the field of stroke research are especially promising and provide new avenues of hope for those at risk for and disabled by this major health problem. In particular, advances in understanding the mechanisms of stroke and its treatment (biochemistry, molecular biology, and pathophysiology) hold promise for changing many of the current ideas and approaches to this problem. Epidemiologic studies that can identify the weight of risk factors, research approaches that could limit the amount of brain damage suffered at the time of a stroke, controlled clinical trials of new medical and surgical therapies, and measures to evaluate and improve rehabilitation after stroke are all areas in which advances are being made and in which even more information is essential. So much has been accomplished, yet we are on the threshold of so much more. There is a new excitement in stroke research—new technology, new findings, renewed promise of stroke prevention, intervention at the time of stroke to limit destruction, new clinical therapies, and hope that new approaches to restoration of function after stroke will improve the long-term outlook for patients. With adequate attention by the scientific community and with funding support, all these things are possible.
This excitement and promise extend into this new millennium. To have served as editor of Stroke, particularly at the advent of such great change, has been one of the most satisfying achievements of my career. I take great pleasure in my memories of my editorship. ⇓