These are guesses based on clinical observation. In fact, too many of the assumptions about concussions in football are based on observation instead of hard data. Take this question: Do concussions have a cumulative effect?
The answers: "Definitely" (Kelly), "Possibly" (Maroon) and "I know of no football player who has had residual neurological impairment from repeated insults to the head" (Joe Torg, the Eagles' team doctor). Torg says that boxing's punch-drunk syndrome doesn't apply to football, because rarely is a football player knocked unconscious.
Still, even one of Toon's neurons screams that concussions do add up. Toon was the Jets' emergency quarterback early in his career, taking snaps on Saturday in case disaster struck on Sunday. He knew the entire offense. Later, after numerous concussions. Toon would break from the huddle, split to his position and sometimes have trouble remembering his own assignment.
"You can see on the tapes the difference in force of the blows [that caused my concussions]," says Toon. "Each new concussion came from less of a blow, and recovery time increased. The last one, against Denver [Nov. 8, 1992], was hardly direct contact." After that concussion, Toon retreated to a dark room for six weeks, turned into a recluse and even contemplated suicide. He never played again.
Toon knew he was a different man from the one who had joined the NFL and immediately invited comparisons with Jerry Rice, but he had no way of measuring exactly how different. Only one NFL team, the Steelers, even attempts such a measure. In 1991 Pittsburgh instituted preseason neuropsychological tests. The tests establish individual baselines, measuring just how mentally aware each player is before a concussion. That gives the Steelers a basis for comparison after a concussion.
After the studies were instituted, former Steeler coach Chuck Noll "would be asking when a player would be fit after a concussion," Maroon says. "Instead of saying, 'Well, it's my feeling he isn't ready,' I had something tangible to show him."
Following his last concussion, Hoge went to Pittsburgh, where as a Steeler in 1993 he had taken a baseline test. Maroon reexamined and retested him. "His scores were significantly lower than at the start of 1993," Maroon says. "I told him. 'Look, Merril, here's where you were. Here's where you are.' " Hoge retired three days later.
To continue playing football would have left Hoge, who was suffering from postconcussion syndrome, at risk for something far more dangerous. There are fewer than 10 documented cases in sports of second-impact syndrome (SIS), a catastrophic brain swelling caused by a blow to an athlete who already shows postconcussion symptoms, and the odds against SIS are lottery long. That, however, doesn't console Lawrence and Irene Guitterez of Monte Vista, Colo. "He just thought it was something trivial," Irene says of her son, Adrian, who was a running back on the Monte Vista High team three years ago. "He had a headache and was sore, but it seemed like cold symptoms. He wasn't one to complain. He wouldn't say anything to anybody. He wanted to play in the Alamosa game."
He did play. At halftime Guitterez, who had suffered a concussion in a game two weeks before and had not yet shaken the symptoms, begged teammates not to tell the coaches how woozy he felt. When he was tackled early in the third quarter, he got up disoriented and then collapsed. Five days later he died.
When SIS is mentioned to Aikman, he is silent for 10 seconds. "We're all at risk," he says finally. "There are guys playing—and I might be one, for all I know—who have played with concussions without even knowing it. But because of the nature of the game, everyone is at risk."