Penetrating intraoral trauma may occur in adults as well as children
Authors: S S Rayatt, P Hamlyn, P Magennis
Journal: BMJ (1997)

Gulf war illness Why it took so long to decide to investigateEditor-As it is now six years since the Gulf war, it is reasonable to ask why the problem of Gulf war syndrome has not been resolved. 1 As surgeon general in 1991-4 I want to comment on the unravelling timetable during these six years.At no time have we denied that Gulf veterans have been ill-indeed, whenever possible we have actively recommended their appropriate medical management.Secondly, despite press reports, we have always kept an open mind on the presence of a specific Gulf war syndrome.The Gulf conflict in 1990-1 itself was short, casualties mercifully few, and the sickness rates unremarkable; likewise, when troops returned to the UK the daily sickness rate did not increase.Also at that stage little evidence existed of psychiatric illness or post-traumatic stress syndrome.Some 18 to 24 months later, however, we became aware of a campaign by lawyers to recognise a specific Gulf illness.Up to 200 people were on their books, but despite widespread appeals for them to come forward, including two television appeals, only 15 approached the armed forces medical services.Not surprisingly, among these 15 no pattern of illness emerged.They were all managed appropriately.As we were keen to solve the problem, in October 1993 we appointed a single consultant physician, Group Captain Coker, to see all such patients.At first only a trickle of patients came forward-even by June 1994 (three and half years later) he had seen only 30 patients.Over the next two years, however, these numbers increased so that by January 1997, 1100 had been registered, 920 had been seen and fully investigated, and results had been completed and analysed in 519.A preliminary paper in the summer of 1996 concluded: "From our small database it would not appear that there is a unique cluster of symptoms which would suggest a new pattern of illness in veterans." 2 There was, however, a higher than normal incidence of psychiatric and stress related illness.A large battery of tests was uniformly performed on all the patients, with further investigations as necessary.Now it has been agreed that full epidemiological studies are to be undertaken into the incidence of ill health among UK Gulf war veterans and into their reproductive health.In answering the criticism that these expensive studies should have been instigated earlier, I have tried to show how difficult it has been to decide exactly when this decision could have been made.Early on there were very few patients and no evidence of a syndrome.At all stages we have liaised with our counterparts in the United States.They embarked a little earlier on similar studies as they had similar results to their investigations but dealt with greater numbers.An important reason for writing this letter is because our armed forces may well be placed in similar alien environments in future and we owe it to them to provide the best medical support, which of course includes planned protective and scientifically justified measures against likely threats to their health.