[5] The BMJ's first editors were P. Hennis Green, lecturer on the diseases of children at the Hunterian School of Medicine, who also was its founder, and Robert Streeten of Worcester, a member of the Provincial Medical and Surgical Association council.

[citation needed] The first issue of the Provincial Medical and Surgical Journal (PMSJ) was 16 pages long and contained three simple woodcut illustrations.

The longest items were the editors' introductory editorial and a report of the Provincial Medical and Surgical Association's Eastern Branch.

Other pages included a condensed version of Henry Warburton's medical reform bill, book reviews, clinical papers, and case notes.

In their main article, Green and Streeten noted that they had "received as many advertisements (in proportion to the quantity of letter press) for our first number, as the most popular Medical Journal [The Lancet], after seventeen years of existence.

"[5] In their introductory editorial and later statements, Green and Streeten defined "the main objects of promotion of which the Provincial Medical and Surgical Journal is established".

Green and Streeten also expressed an interest in promoting public well-being, as well as maintaining 'medical practitioners, as a class in that rank of society which, by their intellectual acquirements, by their general moral character, and by the importance of the duties entrusted to them, they are justly entitled to hold'.

[17] Manuscripts chosen for peer review are then reviewed by external experts, who comment on the importance of the work and its suitability for publication, before the final decision on a manuscript is made by the editorial ("hanging") committee, so called because of its similarity to committees that decide which works of art should be hung in an exhibition.

[21] The BMJ publishes most e-letters to the journal on its website under the heading Rapid Responses,[22] organized as a fully moderated Internet forum.

The journal has long criticized the misuse of impact factors to award grants and in the recruitment of researchers by academic institutions.

Original research articles continue to be available free, but from January 2006 all other "added value" contents, including clinical reviews and editorials, require a subscription.

The BMJ allows complete free access for visitors from economically disadvantaged countries as part of the HINARI initiative.