Brain Injury in American Football: 130 Years of Knowledge and Denial
1900-1916: Concussion Crisis Strikes Beloved Sport
Part Two in A Series
by Matt Chaney
(Draft passage for pending post at ChaneysBlog.com)
1900-1904: Doctors, Football Officials Clash Over Brain Injuries
By turn of the 20th century, brain concussion was elemental of news events, including for criminal assaults and accidents in mines and factories. Waves of TBI cases resulted from transportation mishaps involving horses, buggies, railroads, and the new motorcars.
Motorcyclists and aviators donned leather football helmets for protection while polo players wore cork headgear covered in cloth, like Dr. Livingstone in the jungle, hoping to soften their head-first falls from horseback.
Newspapers covered sport concussion in the early 1900s as regularly as todays electronic media, especially among athletes in horseracing, baseball, boxing and football. Death in sport garnered biggest headlines, like yet today, but concussed athletes in recovery were also newsworthy.
During football season daily sporting pages were dotted with TBI incidents, describing injury condition of players in varying terms such as dazed, confused, knocked senseless, knocked out, and concussed.
The concept of brain concussion had been traveling through common and medical knowledge for centuries, science historian Emily A. Harrison, PhD, wrote for American Journal of Public Health in 2014, continuing:
As early as the mid-16th century it had been defined as a blow resulting in escape of blood from ruptured tissue. By the early 19th century it was described as an external violence that caused derangement of the brain.
Medical knowledge of TBI advanced after the Civil War, driven by casualty cases of railroad accidents. In reviewing the historical literature, Harrison noted:
[T]rain collisions, frequent in the late 19th century, had generated a large study population for observing long-term effects of concussions of the brain and spine. Physicians said that the new frequency for which they were observing concussions made the long-term behavioral consequences clinically visiblein children and adults.
The field collisions of American footballsport that expanded through society coincident with rail transportationproduced numerous brain casualties as well. But the problem was regarded differently in football than by conventional medicine.
In fact, publicized disagreement over TBI in football pitted medicine against the sport, or conventional doctors versus college coaches, other officials, and injured players themselves.
Sticking points included questions of TBI yet unanswered by verifiable research, particularly the time required for healthy recovery.
No certainty was known, although case studies of train-wreck victims were producing clinical data. Conservative medicine followed the Hippocratic ethic of Do no harm, exercising caution for cerebral disturbance of impact or shock, primarily a prescription of rest for days, weeks, even months.
Dr. W.H. Earles, in a 1903 review for Journal of the American Medical Association [JAMA],wrote:
Clinical reports of competent observers, coupled with everyday experiences, have clearly demonstrated that blows or falls on the head may cause serious trouble, both present and prospective, without producing fracture to the skull wall.
Every case of recent head injury, however trivial it may appear, should, we believe, be treated with the greatest consideration, lest damage to hidden and important structures escape our attention, thus leaving a foundation for future trouble which too often is irreparable.
Turn-of-century medicine increasingly endorsed rest, careful recovery for brain-injury victims of all types. Doctors advised many concussed football players to sit out remainders of seasons, and some were told to quit entirely.
Contrarily, football personnel favored quick return for the brain-injured athlete, if side-lining him at all, and preferably under the authority of coaches and in-house technicians. Football trainers and hireling doctors were branching into what would become known as sports medicine, applying concepts beyond standard practice, and they assumed control in many casualty situations.
Like during and after the 1901 intercollegiate championship game between Harvard and Yale, before a record crowd of 37,000 at Cambridge, Mass. Each team, an affluent gridiron power with staff of trainers and doctors, saw a key player sustain brain injury in the contest.
Harvard captain Dave Campbell, an All-American end, became so groggy he did not see, recounted The Washington Times, but he did not leave the game.
Yale star John De Saulles was knocked unconscious while launching a flying tackle in goal-line defense. De Saulles experienced seizures on the sideline then revived briefly in a locker room, where reportedly a doctor gave him an opiate and said that it was best for the boy to sleep it off.
Following Harvards victory Saturday afternoon, doctors in Boston diagnosed De Saulles with a slight attack of cerebral concussion and admitted him to Massachusetts General Hospital. On Sunday morning, the Yale football association sent for De Saulles, intending to take him home with the team, but hospital officials refused to release the patient.
Doctors said De Saulles was resting comfortably and would recover within the week, improving as rapidly as could be expected. But by Monday night De Saulles was back at Yale in Connecticut, where a headline from campus proclaimed the YALE HERO was Out of Danger:
New Haven, Conn., Nov. 25.(Special)Johnny De Saulles, Yales quarterback, returned to his college home in the cloister tonight with his roommate, Arthur Barnwell, the Yale [baseball] center fielder, who took him from the Massachusetts General Hospital today and brought him here.
The non-bylined report quoted Yale football officials, but no doctor, in announcing De Saulles had recovered from brain trauma sustained in a body shot on the field:
De Saulles is still weak, but danger of permanent injury from cerebral concussion is over. Trainer Murphy says that it was a solar plexus blow received when De Saulles tackled Marshall [of Harvard] which threw him into convulsions on the side lines after the game. Head Coach Stillman shares that opinion. De Saulles has been ordered to keep quiet for a few days.
Walter Camp was not quoted directly, the Yale coaching director, football powerbroker and rules leader who presumably presided over the matter of De Saulles. Instead the writer noted Camp felt exhausted by the strain of the last few weeks and would depart on vacation.
Cultural worry of an emasculated youth population, ill-prepared to fight wars, was a related dynamic. Hysteric notions of manhood were popularized, along with symbols of ruggedness like Teddy Roosevelt and football. The macho-acting, tough-talking T.R. worshipped the gridiron, extolling it in news quotes and speeches. Roosevelt pushed his sons into the blood sport, despite the fact he never played as a student at Harvard.
Manly mindset often prevailed in cases of football injury, particularly TBI, the invisible wound. Players were guilty of ignoring symptoms, although many of the injured could not help themselves in the acute or immediate phase.
During a college game in the Midwest, 1904, a frighteningly concussed player resisted anyones assistance on the field, and eventually got his wish to manage himself, even if delirious. Illinois Wesleyan end Robert Ramage absorbed a blow rendering him dazed, observed The Decatur Daily Review:
He was wholly out of his head at the field, and it took three men to hold him and to keep him from running back into the game. J.W. Race offered his carriage, and in it Ramage was taken to the hospital.
At the hotel Dr. E.J. Brown attended to the injured man. [The MD] said that is was plain there had been concussion of the brain that had caused the dazed condition, but that as far as he was able to see there was no fracture of the skull, nor any cut on the scalp. There was a bad bruise on the leg.
Dr. Brown ordered the man to go to bed, and to stay at the hotel until the early morning train, instead of going home with the team at 6:15 [in the evening].
At about 6 oclock [Ramage] presented himself at the hotel office and announced he was going to the station and home with the boys. No objection was made, and he went. He was rather weak, but was able to get to the depot, where he joined the team and was taken home.
Two days later, the newspaper pronounced Ramage recovered without citing a medical source.
In the same week, Delaware, conflicting viewpoints surrounded the game injury of Vernon Gill, football captain for Maryland Agriculture College. Doctors at a Wilmington hospital said Gill suffered a concussion, but the senior administrator of his college disagreed. The Washington Times reported:
It was learned today from Major Sylvester, president of the M.A.C., that the injured player is not suffering from concussion of the brain, and is in no serious danger. He was badly shaken up, but is expected back with the rest of his teammates in a few days.
The stance of neural specialists clashed with the college presidents view of brain injury, which they regarded as serious for any symptoms. Undoubtedly, TBI in acute phase could alter the senses, mental state, personality and behavior.
Brain-injured football players could struggle with schoolwork, such Yale end William J. MacMahon, who was advised by his personal physician to quit the sport and leave law studies for the semester in October of 1904. Yale coaches called the injury report a rumor and denied knowledge, but MacMahon did not return to football. [Later, both MacMahon and John De Saulles made national headlines as former Yale stars in stormy marriages and crime. De Saulles was shot dead by his ex-wife in 1917, amid acrimony over child custody and adultery. MacMahon was indicted for attempting to murder his second wife in 1928, for beating her into critical condition with a flashlight during a car trip, returning from the Yale-Harvard game; the charge was dropped.]
Doctors knew concussion could spur violence in acute phase, at least, and football was blamed in part for a players suicide, according to this national report:
Janesville, Wis., Oct. 9Leon Ayers, one of the brightest and most popular students in high school, committed suicide at his room in the Y.M.C.A. building last night with chloroform. It is thought that he was mentally unbalanced, the result of a fall from scaffolding last summer and subsequent injuries in a football game a week ago.
The Ayers case was included among football deaths for 1901, for its medical testimony, in the list compiled by news men.
Many specialists believed TBI could become lasting or permanent damage, and concern for re-injury after a diagnosed concussionlater known as second-impact syndromeinspired their side-lining of football players around turn of the century.
Princeton tackle Albert T. Baker had to leave the team in 1903 because of severe trauma. His hometown newspaper in Pennsylvania reported:
Baker was kicked on the head and was in the hospital with concussion of the brain for several weeks. Surgeons examined the wound and decided that it would be dangerous to allow him to play again this season, as a kick or blow on the same spot of the first injury would probably result fatally. Since that time he has not been allowed to play and has been coaching the Freshmen eleven of the school. The coaches speak favorably of Bakers chances for next year and say he would have made the team this year but for his unfortunate injury.
Casualties of TBI were often committed to mental wards, such as this schoolboy football player in 1903:
Columbus, Ohio, Nov. 16Earl Neff, aged 16, was brought to the state hospital for the insane here Saturday from Kingston, Ohio. He is incurably crazed from injuries received in a game of football. He sustained concussion of the brain. He has a mania for studying electricity, in which subject he was interested before the accident.
JAMA editors likened football risks to warfare, such as brain injuries resulting in insanity. Their journal editorial declared: To be a cripple or lunatic for life is paying high for athletic emulation.
A former Purdue player injured in a wreck of the team train sued the railroad over permanent injuries, including brain damage that impaired his eyesight, hearing, memory, and reasoning while paralyzing him on the ride side. The judge awarded him $10,000 compensation.
And a young man died years after a brain injury in football. A report stated:
Chicago, Oct. 11 Max Henry Fleischer is dead as a result of an injury received in a football game six years ago.
Until two months ago Fleischer did not know of [his condition], but as soon as his father learned of it he had an examination made which showed that the young mans skull was depressed. The skull was trepanned [surgically opened], revealing a diseased condition of the brain.
During the last six years Fleischer had suffered from severe headaches. Several times he was found unconscious.
When the accident occurred Fleischer was 15 years old and was anxious to get a place on the regular football team at school. He was kicked on the head and picked up in a dazed condition, but he exacted a promise from his playmates not to talk of the accident for fear his mother would not allow him to play anymore.
While medical science lacked a smoking gun to prove permanent cerebral damage of football collisions, circumstantial evidence abounded.
Harvard president Charles Eliot, famed enemy of football, endorsed medical opinion for the game as a health menace. In February 1905, Eliot wrote that many serious injuries occur which are apparently recovered from in good measure, but which are likely to prove a handicap to the victim in later life.
Sprains, concussions of the brain and injuries to bones are apt to leave behind them permanent weaknesses, Eliot added, which in later life become troublesome.
1905: The First Concussion Crisis for American Football