Traumatic encephalopathy (' punch drunk ') of professional pugilists

Abstract

Three cases of chronic disease of the nervous system, affecting professional pugilists, have been described. In the first, the maximal functional disability appeared immediately after a fight, improved somewhat during the next few weeks, but thereafter remained at a standstill. In the second case the progressively crippling syndrome appeared insidiously during the last few fights of the patient's career. His difficulties had progressed up to the time of his examination four years later, but apparently had not become worse, and were, if anything, improved in the subsequent six years. The third patient also gave evidence of the insidious development of an affliction of the central nervous system appearing five years before he ceased to fight and progressing up to the time of his leaving the ring. However, after the patient's fighting career was over his condition remained stationary or perhaps improved slightly. The clinical picture in each case was very complex and it differed in the one case from the others. The only agreement, however, was in the suggestion of diffuse or scattered lesions of the brain affecting different systems at one and the same time. It is assumed that these patients' difficulties resulted from repeated injuries to the brain received during their pugilistic careers. If probabilities are to be discussed, the first patient was without reasonable doubt injured during his last fight and his subsequent difficulties resulted from it. In the case of the third patient, his difficulties appeared during his fighting career but stopped progressing as soon as he left the ring. The probability here, that his disease was connected with his occupation, is good. The case of the second patient must remain in doubt, for there was not the clear-cut association between his occupation and his disability. Since postmortem study is lacking, the exact pathological mechanism of these cases is to date unknown. The fortuitous occurrence of epidemic encephalitis or syphilis of the nervous system during the pugilist's career cannot be excluded as a cause of the difficulty. However, the frequency of occurrence of conditions of this kind as reported by others among people who followed the profession of pugilism makes it seem very likely that their profession led to their ultimate disablement. It is to be hoped that in the future more statistical data, backed up by pathological studies, may put these conclusions on a firm basis.