The consensus of American medical opinion in the late '50s, at the time of The Lancet editorial, could be summed up in the words of Dr. Ira McCown, medical director of the New York Athletic Commission, who wrote in a research paper in 1959 that the notion of punch-drunk was a "medical cliché with which to label any boxer whose performance and behavior in or out of the ring is unsatisfactory or abnormal."
A series of conspicuous fight deaths in the early '60s brought renewed medical attention to boxing. In the spring of 1960 Charlie Mohr, a middleweight from the University of Wisconsin, died of a hematoma he suffered while defending his NCAA championship in Madison, Wis. Mohr was wearing headgear. An overhand right to his padded left temple literally propelled his brain against the other side of his skull, where the fatal damage occurred. His death led to the banning of boxing as an intercollegiate sport, but the controversy over the circumstances continues. The editor of Ring magazine claimed earlier this year that Mohr had gone into the ring with an aneurysm, a cerebral blood vessel waiting to burst. But this charge is hotly disputed by the neurosurgeon who operated on Mohr, and he was the only man to examine Mohr's brain.
In 1962 the professional boxing world was shocked by the death of Benny (Kid) Paret in a welterweight title bout with Emile Griffith. Paret had been knocked out twice in the previous year—demonstrating, in the view of some observers, a serious inability to defend himself. That wasn't a big consideration; Paret was known for being able to absorb punishment. Significantly, he had taken a pre-fight EEG and had been found normal.
Davey Moore, a former flyweight champ, was killed in a Los Angeles bout in 1963. Moore, too, had taken and passed an EEG, but he apparently lied to the California authorities about other health problems. It was clear that the medical supervision of boxing was superficial and, thanks to disparate standards among state commissions, gravely inconsistent. Some boxers were fighting in different states under different names; commissions had little knowledge of medical histories. But the very lack of data and the paucity of long-term research dissuaded most doctors from pressing for reform. Boxing, after all, was a popular and powerful industry.
A 1962 JAMA report asked for upgraded safety standards and more thorough medical exams in boxing. It also called for experimentation with "less padding in the gloves so that the threat of damage to the hands will inhibit the power of blows." At the time, eight-ounce gloves were in general use, as they are today. Compared with the six-ounce gloves used early in this century, they reduced hand injuries and facial cuts, but they allowed boxers to punch each other harder in the head.
Meanwhile, in Britain, research on the punch-drunk syndrome continued. A book-length study completed by Dr. A.H. Roberts in 1969 established the condition as a statistical reality. Roberts examined 224 men randomly selected from among 16,781 who had registered as pro fighters. All were retired. Seventeen percent had hard evidence of brain damage, in the form of drooling, slurring, unsteady gait and/or memory loss. An unspecified number of others showed "disturbed neurological function." Roberts' statistics also indicated that the longer a boxer's career had been, the more likely he was to have conspicuous punch-drunk symptoms.
In the same year a psychiatrist named John Johnson reported on the psychological problems of former fighters in the British Journal of Psychiatry. Johnson found that 16 of the 17 subjects he examined were suffering from one or more of the following clinical conditions: chronic amnesia, morbid jealousy, undue rage reactions or outright psychosis. Using air encephalography, a technique that produces an X ray after air is injected into the brain, Johnson also found a pattern of cerebral atrophy in 10 of the 17. It had long been known that brain tissue doesn't regenerate, that damaged brain cells are lost forever. More than half the men in the sample, in other words, were missing brain tissue. Johnson was interested in the charge that punch-drunk fighters had drinking problems. Alcoholism, like senility, can cause loss of brain cells and evoke psychological disturbances similar to the ones he studied, but Johnson maintained that the patterns of damage in his air encephalograms of boxers were never seen in alcoholics.
In 1973 came the most important study to date, when the brains of punch-drunk fighters were examined in physical detail. Dr. J.A.N. Corsellis, a neuropathologist, and his colleagues in England performed autopsies on the brains of 15 former fighters who had died of natural causes. Friends and family members had provided accounts of the boxers' conditions in later life, from which Corsellis had determined that they had been punch-drunk. The autopsies revealed a striking pattern of cerebral atrophy in 14 of the 15. Though the researchers said that medical controls in boxing had probably improved since their fighters were active, they warned: "...there is still the danger that, at an unpredictable moment and for an unknown reason, one or more blows will leave their mark. The destruction of cerebral tissue will have then begun and although this will usually be slight enough in the early stage to be undetectable, it may build up, if the boxing continues, until it becomes clinically evident. At this point, however, it could already be too late...."
The abnormalities and atrophy Corsellis found were located deep in the middle of the brain, around the septum pellucidum (illustrations, pages 62-63), and also in the cerebellum, the outer section close to the back of the head. The cerebellar structures regulate muscular coordination and balance. A person with damage here may slur his speech or may appear to stagger—"walk on his heels," in ring parlance. The deep midline regions help regulate short-term memory. Forgetfulness may occur if a person has lost tissue here. The conspicuous hallmarks of this damage are abnormally enlarged ventricles, the ventricles being the brain vessels filled with spinal fluid. They expand to fill the space left by the tissue atrophying around them. A more critical finding is a cavum septum pellucidum—literally, a cave in the septum. The jarring from cumulative punches may eventually cause the septum to pull apart, leaving a tunnel-like hole two to eight millimeters wide between the ventricles.
In the 1970s came the introduction of the tool that has revolutionized the medical literature on boxing. This is the CAT scan (computerized axial tomography), a highly advanced form of X ray. With it, abnormalities in the brain can now be observed as they develop and before they result in symptoms. Within the past year three independent studies utilizing CAT scans have come to similar conclusions about chronic brain impairment among boxers.