The first was published in February 1982, in the British Journal of Neurology, Neurosurgery and Psychiatry. In this study Casson and other specialists performed detailed neurological examinations, EEGs and CAT scans on nine professional boxers in New York shortly after they'd been knocked out in a bout and on a 10th boxer who had been stopped on a TKO. The 10 boxers, who came from all weight divisions, were from 20 to 31 years old. CAT scans showed that five of the boxers had cerebral atrophy. "We were surprised by [these] findings [in] active boxers," Casson and colleagues reported. Three fighters who had become champions all showed signs of brain damage. A fourth boxer, who was top-ranked, had a normal scan, but he was the only boxer in the series with an organic mental syndrome—memory loss and confusion. Further analysis revealed that the number of bouts was probably of critical importance. Of the five fighters with 20 or more fights, four had cerebral atrophy; of the five fighters with fewer than 12 fights, only one did. The CAT scan of one fighter, whom Casson characterized as a "slugger," showed a cavum septum pellucidum, and he'd had more fights than any of the others. "Since none of the boxers had been knocked out more than two times in their careers," the researchers concluded, "a cumulative effect of multiple subconcussive head blows is the most likely culprit."
Last November in The Lancet, Dr. M. Kaste and a team of physicians at the University of Helsinki reported on 14 boxers (six professionals and eight amateurs) who had been Finnish, Scandinavian or European champions. Using EEGs and CAT scans, the physicians found brain injury in four of six professionals and in four of eight amateurs.
Finally, in the controversial JAMA issue of last January, Dr. Ronald J. Ross, a Cleveland radiologist, and colleagues published a paper that agreed with the key finding of Casson and Kaste: the more bouts, the worse the CAT scan. Their study involved 40 boxers, only two of them still active. Thirty-eight had CAT scans, and 24 had a complete neurological examination. "The number of bouts fought was significantly related to the presence or absence of ventricular enlargement," wrote the researchers. Moreover, "Patients with abnormal findings on CAT examination did have more frequent neurological symptoms and abnormal neurological findings."
In the same issue with the Ross study was a report by a scientific council formed by the AMA to summarize what was known about brain injuries and deaths in boxing. (Although the report cited the literature on chronic injuries, the council was formed primarily as a reaction to Classen's death. Classen, a middleweight, had been knocked out twice in the eight months before his fatal fight, proving that little had changed in the medical regulation of boxing since Paret's death 17 years before. Kim's death occurred as the council was completing its work.) The council did not recommend a ban on boxing, although two passionate editorials in the front of the journal did so. Instead the council called for a national registry of boxers' records and medical histories, more training for ring personnel and standardized safety regulations among state and local commissions. Responding to the JAMA initiative, Congress has once more held hearings and proposed legislation to create a federal boxing commission.
Casson, meanwhile, says that he has now seen examples of cavum septum pellucidum on the CAT scans of eight pro boxers. It's disquieting that five of the eight are former world champions and two others were top-ranked. Champion fighters stay on their feet in the ring; they can take a punch. The question is, how much will they have to pay for that durability later in life?
Ali has a cavum septum pellucidum, SPORTS ILLUSTRATED has learned. The abnormality shows up clearly on his CAT scan, along with other indicators of damage or atrophy, such as an enlarged third ventricle. The scan was performed at New York University Medical Center in July 1981, five months before Alt's final fight, with Trevor Berbick. In the radiologist's written report, these two findings are noted, but the conclusion is that the scan is "negative," meaning normal. It's a question of interpretation. In reviewing CAT scans of the general population, neuroradiologists occasionally see a cavum or a widened third ventricle. This atrophy is more often characteristic of older people. But most neuroradiologists aren't familiar with the scans of boxers. They don't know that the atrophy like that found on Ali's scan shows up in 50% of boxers with more than 20 bouts—a percentage far higher than in the general population, and that, by other criteria, these same boxers often show evidence of brain impairment. The cavum abnormality is found four times as frequently in boxers as in non-boxers.
As far back as 1976, Dr. Ferdie Pacheco, a general practitioner who has known Ali since 1962, warned him that he should retire from the ring to avoid brain and kidney damage. In 1977, Pacheco quit working Ali's corner. "If you spent 20 years in boxing and an equal amount of time in medicine, you could see brain injury coming up," Pacheco says. "He took some mammoth beatings. There were the fights with Frazier, Foreman and Norton, to say nothing of all the sparring with Larry Holmes and Michael Dokes. Holmes and Dokes were not ordinary sparring partners. They're now heavyweight champions of the world. A moron could add up the picture of impending brain damage, and I urged him to quit because I didn't think it would be wonderful to have the most joyful, talented guy in the world stumbling around and mumbling to himself. But he was the one who wanted to stay on stage. The only role he knew was being champion. I'd just as soon have been wrong."
At the time of his first warnings, Pacheco was unheeded—understandably, perhaps, because he had no data, no hard proof. But in April of 1980, after Ali announced that he was returning to the ring after a 10-month "retirement" to fight Holmes, his father, Cassius Clay Sr., publicly expressed concern. "I thought he wasn't walking good," he said. "I thought maybe his hip was bothering him. I wasn't sure of his speech, either, but the way I look at it, that boy has been fighting since he was 12 years old. A man can only stand so many licks to the head."
Ali went to the Mayo Clinic in July of that year for a series of tests. The Mayo report, attesting that he was normal, reassured Nevada authorities that he was fit to fight Holmes in October. But after his poor showing—Holmes was awarded a TKO when Ali didn't come out for the Nth round—Ali consulted Dr. Dennis Cope, a specialist in endocrinology at the UCLA Medical Center. Ali revealed that he'd been taking excessive amounts of medication for a thyroid condition while training for the Holmes bout. One of the drug's effects had been to help Ali lose weight, but it also left him drained for the fight. However, Cope's report released in December 1981 declared Ali's thyroid gland normal. Cope also wrote that a neurological examination, which included an EEG and a CAT scan, had found no abnormalities except for a partial or complete loss of smell. The report stated, "The patient tended to talk softly and to almost mumble his speech at times; but when he was questioned about this, he was able to speak appropriately without any evidence of a speech disorder. He was evaluated by a neurosurgeon and neurologist who felt that his speech pattern was not pathologic." The report concluded, "The patient's health status is excellent and there is no evidence from a health standpoint that he should be limited whatsoever in his activities."
Two weeks later Ali visited England. Interviewed on BBC radio, he slurred his speech, and when he recited a poem on how he would beat Holmes in a rematch, listeners found most of it incomprehensible. The BBC canceled the broadcast of a taped interview for another program because Ali's speech was too slurred to be understood. A BBC spokesman said, "It was very sad that so much of what history's most celebrated fighter said was unintelligible." When a London reporter asked him if he could possibly be punch-drunk, Ali replied, "I have heard about people being punch-drunk, but I do not feel drunk." He added, "When you get as great as me, people always look for some type of downfall."