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'Slug Nutty' Boxers, 'Head Scrambled' Football Players, and the Role of the Neuropathologist in Protecting the Public

Posted Apr 30 2011 7:56am
American boxer John Heenan (1835-1873)
As part of National Lab Week activities, I delivered a presentation yesterday to staff at the College of American Pathologists headquarters in Northfield, IL on the topic of chronic brain injury among football players. Repetitive brain trauma in sport was first recognized among boxers, and thus the early-onset dementia -- and, in some cases, parkinsonian symptoms -- associated with this kind of trauma was named dementia pugilistica. Since the recognition of this phenomenon in other sports, most notably football, the entity has been renamed Chronic Traumatic Encephalopathy (CTE). Among the first papers describing repetitive traumatic brain injury in sport was one authored by neuropathologist Harrison S. Martland, MD , who published his results in the Journal of the American Medical Association in 1928 (Punch Drunk: JAMA 91:15, [1928] p. 1103-1107). Dr. Martland -- who worked in the pathology department of the City Hospital in  Newark, NJ and the office of the Chief Medical Examiner in Essex County, NJ -- wrote that "fighters in whom the early symptoms are well recognized are said by the fans to be 'cuckoo', 'goofy', 'cutting paper dolls', or 'slug nutty'." Dr. Marland concluded his report of 23 cases of dementia pugilistica with a call-to-arms to neurologists and neuropathologists
"The condition condition can no longer be ignored by the medical profession or the public. It is the duty of our profession to establish the existence or non-existence of punch drunk by preparing accurate statistical data as to its incidence, careful neurologic examinations of fighters thought to be punch drunk, and careful histologic examinations of the brains of those who have died with symptoms simulating the parkinsonian syndrome. The late manifestations of punch drunk will be seen chiefly in the neurologic clinics and the asylums, and such material will practically fall to the neuropathologist connected with such institutions."

As was the case 100 years ago with boxing, chronic brain damage in "head scrambled" football players is now being widely acknowledged. It is the obligation of every blue-collar neuropathologist to advance our knowledge of CTE by recognizing it in our autopsy cases and supporting the work of the two white-collar neuropathologists most involved in bringing football-related CTE to public attention: Dr. Ann McKee of Boston Univeristy and Dr. Bennet Omalu of West Virginia University. With more than four million children and young adults playing football in this country, it is our moral obligation as neuropathologists and as citizens to become active participants in the public discussion surrounding this important social and public health issue.
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