Reviewer: Vincent J. Cirillo, Ph.D.        July 17, 2021

 Mr. Dixon has written a very important book, one that should be required reading for  sanctioning and governing bodies, judges and referees, ringside physicians, promoters, trainers, managers, and prizefighters themselves – in short, anyone connected with the sport of boxing. Members of Congress would also benefit, since they failed to support Sen. John McCain’s 2002 efforts to create a Federal Boxing Commission with a national database (medical records, brain scans, MRIs, etc.) to protect the health and safety of boxers. At present, state boxing commissions present a cacophony of standards and regulations. Perhaps it is time for Washington legislators to reconsider federal oversight of the sport. What better primer than Damage?

Long before medical science saw the light, fight fans, sports writers and others in the boxing community recognized that professional fighters who had taken too many head punches exhibited slurred speech, shuffling gait, hand tremors, memory loss, mood swings and, finally, physical helplessness. In his landmark 1928 article, the chief medical examiner of Essex County, New Jersey, Harrison S. Martland, coined the term “Punch Drunk” to describe the mental and physical sequelae of brain trauma in boxers.¹ Martland believed that stumblebums and journeymen were at greatest risk of becoming punch-drunk. Actually, the reverse is true. History has shown that the sport’s greatest fighters proved the most susceptible to brain damage: Sugar Ray Robinson, Joe Louis, Muhammad Ali, Willie Pep, Emile Giffith, Wilfred Benitez, Ezzard Charles, Matthew Saad Muhammed, Jerry Quarry – the list goes painfully on and on. “Ali, ‘The Louisville Lip,’ was all but muted. . . . The Ali shuffle simply became a shuffle” [p. 73].

Sports writer Ralph Wiley said of Sugar Ray Robinson, “[T]his was the greatest fist fighter that ever lived, so if this is what happened to him, this is what happens to them all” [p. 32]. On 29 October 1995, journalist Steve Wilstein published an article on 50-year-old Jerry Quarry in the Los Angeles Times that remains the most heartbreaking portrait of a punch drunk fighter I have ever encountered. “Once one of the most popular fighters in the country, a top heavyweight contender in the 1960s and ‘70s, he needs help shaving, showering, putting on his shoes and socks. Soon, probably, diapers. His older brother James cuts meat into little pieces for him so he won’t choke, has to coax him to eat anything except the Apple Cinnamon Cheerios he loves in the morning. Jerry smiles like a kid. Shuffles like an old man. Slow, slurred speech. Random thoughts snagged on branches in a dying brain. Time blurred. Memories twisted. Voices no one else hears.” [p. 79; Dixon errs in attributing this quote to Pete Hamill in Esquire.]

In 1937, J. A. Millspaugh recommended renaming the syndrome “dementia pugilistica,” since “punch drunk” had such a derogatory connotation. Currently, the syndrome is termed “chronic traumatic encephalopathy” or CTE. CTE is incurable and confirmed only at autopsy, when the tau protein can be identified microscopically. CTE, often simulating dementia, Alzheimer’s disease, Parkinsonism or ALS, has been in the news the past few years, because of the large number of NFL football players whose brains have been examined postmortem and verified to have suffered neuropathology as a result of repetitive concussions.

Neurologist Charles Bernick heads the Professional Fighters Brain Health Study in Las Vegas, Nevada, which monitors the long-term effects of concussive head trauma in living boxers and mixed martial arts fighters. To date, more than 800 subjects have been enrolled in the study which began in 2011. What has all of this research accomplished so far? Nothing. Unless the sport polices itself as a result of the newly acquired knowledge, today’s boxers will be no healthier than their counterparts of yesteryear when the final bell tolls. Boxing must confront its own worst problem. Boxing is the only sport that rewards someone for giving an opponent a brain concussion. “Boxing is American football head injuries on steroids” [p. 170].

Several proposals have been made over the years to make the sport safer for its participants: increase glove size, reduce the number of rounds in a contest, shorten the duration of rounds, require headgear, reduce the number of seconds to recover from a knockdown, mandate longer layoffs after being knocked out, and employ ER doctors or neurologists as ringside physicians. Sadly, all have fallen on deaf ears.

Unlike physics and chemistry, biology has no laws. There are always exceptions to the rule. So too with boxing injuries. Some of the ring’s most famous warriors appeared unscathed: iron-chinned Carmen Basilio (died age 85); Jake LaMotta,”The Raging Bull” (died age 95); Chuck Wepner, “The Bayonne Bleeder” (alive age 82); and Earnie Shavers, “The Black Destroyer” (alive age 76) -- all of whom engaged in numerous ring wars. Archie Moore had 220 fights and was still sharp as a tack when he died at age 81. Why? This mystery, when finally solved, may provide additional insights into ways to prevent concussive head trauma in full-contact combat sports.

Despite its importance, Damage has certain inexcusable flaws, which will limit the book’s use by serious researchers of the subject: no source notes, no bibliography and no index. Readers will find the absence of an index particularly frustrating when searching for specifics on their favorite pugilists.

   1.     Harrison S. Martland (1928). “Punch Drunk.” J. Amer. Med. Assoc., 91: 1103-1107.