England's injury problems continue to mount after the loss of Tom Youngs for the entire autumn was compounded by growing concerns over the long-term health of Geoff Parling.
Youngs is the third Leicester forward to have been ruled out of the QBE Series, having undergone shoulder surgery on Monday to repair damage to his AC joint sustained in the weekend's 45-0 defeat at Bath.
More troubling, however, are the concussion problems that have placed a question mark over Parling's ongoing availability.
Parling has been concussed on several occasions and the head trauma sustained at the Recreation Ground on Saturday was the second incident of its kind in three games.
London director of rugby Richard Cockerill admits Parling faces an uncertain future.
"We're waiting for advice from the specialist, but he won't be fit for London Irish on Saturday and he may need some down-time for obvious reasons," Cockerill said.
"It's a concern for his health. Playing is secondary."
When questioned if there were doubts over his playing career, Cockerill said: "I don't know the answer to that.
"You would like to think that with the right rest and expertise, he will be fine, but I don't know.
"He's doing the usual cog-sport protocols and everything else they do.
"When you're not symptomatic again you can go back to doing exercise and there's a gradual progression back into full training.
"We will take some advice on that from people who know what they're talking about."
The gloomy injury bulletin from Welford Road was more definitive about Youngs, the Lions hooker who missed the summer tour to New Zealand after his wife Tiffany became seriously ill.
The 27-year-old faces three months out and joins fellow England forwards Ed Slater and Dan Cole in a packed Leicester treatment room that now contains over 20 players.
Centre Manu Tuilagi is among the wounded but it is hoped he will recover from a groin problem early next month.
"Tom carried the ball, Dave Attwood fell on him and there was separation of the joint. I can't control that," Cockerill said.
"The collarbone pings. If it pops out, it's rest. If it's unstable, they wire it and it heals over time.
"It's disappointing because Tom is a world class player and it gives us great impact off the bench with him and Leo Ghiraldini in the squad.
"It's not ideal when we already have three front-rowers missing."
Bath's Rob Webber capitalised on Youngs' absence in New Zealand and will be competing with Dylan Hartley for the hooking duties against the All Blacks, South Africa, Samoa and Australia in November.
Northampton trio Tom Wood, Courtney Lawes and Stephen Myler have respective back, shoulder and calf problems, although none of the injuries are thought to be serious.
Saracens prop Mako Vunipola will sit out the autumn following knee surgery.