What do we mean when we talk about “Concussion”?

By Richard C. Mendel, MD on February 8, 2014
What do we mean when we talk about “Concussion”?
Public pronouncements of decreased incidence of concussions are likely not accurate.

In boxing it is very common to see a fighter retire with some slightly thickened speech and within a few years they’ve progressed to being completely incoherent…

George Foreman once said, “Boxing is the sport to which all other sports aspire.” I am certain that it’s in large part due to the courage inherent to not just great fighters, but probably more importantly, most fighters. Like everything else, the courage can be a double-edged sword with high consequences.

In 1971 Eugene “Cyclone” Hart was the hottest prospect Philadelphia boxing had seen in years. The middleweight residents of just North Philadelphia at that time included “Bad” Bennie Briscoe, Willie “The Worm” Monroe, Bobby “Boogaloo” Watts, Stanley “Kitten” Hayward, and “Cyclone” Hart. Talented Philadelphia amateurs in the years before legalized gambling in Atlantic City turned professional after hundreds of amateur bouts and Hart was no exception. He was still a teenager in May of 1971 when he stopped “Kitten” Hayward in the first round at The Arena in West Philadelphia at 45th & Market Streets. Hart’s record was 21-0 (with 20 knockouts); the only fighter to have gone the distance with him was veteran contender Don Fullmer.

Hart had very spindly legs that were the result of childhood polio, but the upper body of a heavyweight. His most remarkable asset was his left hook. Several years later when heavyweight Roy “Tiger” Williams left Muhammad Ali’s training camp and became one of George Foreman’s sparring partners in Zaire, a reporter asked Roy, “Who is the hardest puncher you have ever faced?” Obviously, a soft question to showcase George’s power, but Roy was very articulate and pensive, so he paused and then said, “Cyclone Hart, a middleweight from Philadelphia. When he hit me in the body his arms were in me up to his elbows.” In a post-fight interview with “Bad” Bennie Briscoe after he and Hart fought to a 10-round draw Briscoe remarked, “That boy’s punches could knock down the walls of Jericho.” Vito Antuofermo added, “He hits so hard that he really shouldn’t be allowed to fight.”

On September 21, 1971 at The Spectrum in South Philadelphia, “Cyclone” Hart was the main event when he faced former light middleweight champion Denny Moyer. Moyer was a rugged fighter who had a record of 80-22-4 including an unsuccessful title shot with Carlos Monzon the year before. The fight was competitive over the first five rounds, but in the sixth round with Hart’s back to the ropes, both he and Moyer fell through the “too loose” ropes several feet onto the judge’s table and then to The Spectrum floor.

Both fighters were injured and the fight was ruled a No Contest. In 1971, neither CT scans or MRI scans were an option. The presumptive diagnosis of “concussion” was rendered. I can’t really judge what impact that injury had on Moyer—he enjoyed a very successful career and retired from boxing in 1975 with a record of 97-38-4. Denny Moyer developed dementia and was living in a nursing home near his home of Portland, Oregon when he died on June 30, 2010 at the age of 70 from dementia pugilistica (or “punch drunk syndrome,”; there are several other terms including chronic traumatic encephalopathy). The grim ending is so common among fighters that it actually loses much impact (the same description could easily be applied to Jimmy Young, Greg Page, Jerry and Mike Quarry, Floyd Patterson, Johnny Tapia, and numerous others). Fighters rarely seem to enjoy a happy ending. The great story of George Foreman reinventing himself and becoming fabulously rich with his great sales skills stands in stark contrast to what is most often recited. Rather the stories of fighters who have fallen on hard times such as Muhammad Ali, Bobby Chacon, Wilfredo Benitez, and Rocky Lockridge are much more frequent.

The scenario of boxers that sustaining punishment over long periods of time and slowly erode is well established. Although it happens less often, there are examples of much more explosive damage occurring in a much shorter time periods despite it not being recognized. “Cyclone” Hart was never the same after the September 21, 1971 fight with Denny Moyer. He fought 18 more times until 1977, but his record was 9-8-1 in that period. In 1977, after losing to Vito Antuofermo he retired for five years, and then lost a single comeback attempt in 1982. Prior to his 22nd fight he had never been knocked out, even as an amateur. After the Moyer fight eight of his nine losses came by knockout (Willie “The Worm” Monroe beat Hart via a 10-round decision). “Cyclone” did have some flashes of his former brilliance in late 1975 when he beat “Sugar” Ray Seales by decision at Boardwalk Hall in Atlantic City and followed it up with a 10-round draw with “Bad” Bennie Briscoe at The Spectrum. When examining his 30 wins only two went the distance (Don Fullmer and Ray Seales).

In the past 20 years scientists have learned more about the brain than was ever known in the rest of recorded history. Concussion comes from Latin and translates as “to shake violently.” With all of the advancements it is almost easier to understand what concussion is not. Concussion is not a loss of consciousness, but a loss of consciousness is often sighted. Concussion at one time referred to what we now refer to as a “closed head injury.” A closed head injury implies trauma that involves only the brain while the leathery covering and skull are not injured.

Concussion has taken on a meaning that suggests it is a “mild” type of traumatic brain injury. In science when something can’t be accurately measured less accurate descriptions are often used until numeric measurements can be applied. By the early 1980s CT scans became widely available, and by the end of the 1980s MRI scans were becoming widely available. Once available, concussion became the term used to describe head injuries in which the CT scan or MRI scan did NOT show blood, bruising, or structural damage of the brain. So “concussion” was used to describe patients that had trauma with symptoms, but CT and MRI scans were “normal.”

Just because an injury isn’t seen on a CT or MRI scan does not mean the injury is “mild or minimal.” Physicians and researchers now understand that the brain cells (neurons) are temporarily poorly functioning with low electrical levels and high levels of glutamate (an important transmitter). While this is not as severe as a bleed or large area of bruising, it is misleading to suggest it is “mild or minimal.” The American Academy of Neurology and many other medical and scientific organizations are trying to better describe concussion and traumatic brain injury, but as far as the average person is concerned it describes some brain malfunction that when sustained repetitively over time has been well characterized in the sport of boxing since at least 1920, when Dr. H.S. Martland, a British neurologist, used the term “dementia pugilistica” to describe what has often been referred to as “punch drunk syndrome” or the current scientific moniker of “chronic traumatic encephalopathy.”

In boxing it is very common to see a fighter retire with some slightly thickened speech and within a few years they’ve progressed to being completely incoherent. Symptoms often do not appear early in a disease, and frequently in neurological diseases many do not appear until the disease is well-advanced. People are often surprised when they are first shown the inside of the skull (sometimes called the cranial vault) because unlike the smooth rounded exterior of the skull the interior has many rough irregular and sharp bony portions that can result in bruising of the brain’s surface.

There has been a significant interest generated in “concussion” and closed head injuries in the last several years. Most of it is in many ways driven by the National Football League, and probably much more forceful is the influence of millions of mothers who have children playing organized football. Research money is allotted much more generously when large organizations such as the NFL, NHL, NCAA, and others get involved and generate interest.

In the mid to late 1970s much of the pioneering basic science studies were conducted by neurosurgeons like Thomas Generalli, MD at the primate head injury laboratory at the University of Pennsylvania. (Public outcries generated by PETA’s raid of the lab made national headlines after the scenes of graphic violence imparted to baboons were uncovered. But the information and technological advances from the last two decades has served to convince researchers just how modest our understanding really was not very long ago.) The research from the primate head injury studies provided tremendous insights that are still being sorted out. The physics of force delivery explained why angular punches (hooks, uppercuts, and overhands) much more frequently resulted in knockouts than punches that resulted in linear acceleration. This pattern was attested to by neurosurgeon Michael J. O’Conner, MD after watching a Ring Magazine film (on VHS tape) that featured famous knockouts, the vast majority of which were the result of hooks, uppercuts, and overhand punches, rather than straight right or left hands.

Trainers, ex-fighters, and many fans understand the common paths leading to brain damage and hard times, but I think there are examples, although less frequent, of fighters who sustain significant damage in much shorter periods of time. “Cyclone” Hart’s experience in 1971 started me thinking about head injuries in different ways. There are numerous fighters who sustained damage that seemed to change them forever. One example is another Philly fighter, Meldrick Taylor who in the fight against Julio Cesar Chavez boxed so beautifully in the first 10 rounds, only to change plans and try to exchange with Chavez. The result was Taylor sustained a blow-out fracture of an orbit (eye socket) and with that he sustained a closed injury that changed the entire rest of his career.

I thought about “Cyclone” when Tommy Hearns came to The Spectrum to fight Alfonso “Fonzi” Hayman in 1979, because Hearns was 17-0 with 17 knockouts and it seemed reminiscent of Hart eight years before in the same venue. Much of the prefight hype centered around whether Hearns would knock out Hayman. Hayman was a cagey veteran fighter with a lot of pride. He made it clear that he had no intention of being stopped in his hometown. Hearns really displayed tremendous talents that night, but Hayman decidedly went the distance. After the fight his forehead was so swollen that he couldn’t place his glasses on his forehead. That fight raised the question of why some fighters receive a debilitating injury, but others like Hayman underwent similar force with little obvious effect. Are the symptoms of concussion a function of where the damage was sustained in the brain, is one person more susceptible to head trauma than others, or does the ability to recover vary as well?

Another tragic consequence of a closed head injury was the 1986 fight in Las Vegas when Tommy Hearns fought for the first time in eleven months after losing to Marvin Hagler. Hearns was to face James “Black Gold” Shuler, a gracious person and a tremendously talented amateur from Philadelphia who was a rising star as a professional with a record of 22-0. Shuler sustained a first round knockout loss to Hearns that night, but seemed to recover well after the fight. After returning to Philadelphia from Las Vegas Shuler purchased a Kawasaki Ninja Cycle, and despite being in a congested intersection in Philadelphia he collided into a tractor-trailer and was pronounced dead at the scene. It seems probable Shuler likely was suffering from what is often referred to as a post-concussion syndrome. It frequently is described as a feeling of being out of sorts, almost as though you feel like your watching yourself on a film. There is frequently diminished fine motor control and processing speed that is transient and may last for up to six or eight weeks after the trauma.

The reality is that as our knowledge gets better we may soon be able to understand what falls into a safe zone and what is no longer safe. Until that time it is counterproductive to use the words “mild” or “minimal” traumatic brain injuries. This is especially true when the patient is an athlete in whom just a slight decrease in function and reaction time can be critical.

There seem to be a few reasonable steps to limit injury. Usually just paying attention to a problem reduces its incidence. Given the repetitive chronic nature of the injuries it is most likely to occur where the fighter spends the most time—in the gym rather than in actual bouts. So more caution and supervision in the gym may be beneficial. Staying in condition helps avoid sloppy training habits such as “boxing your way into shape.” Ed Benzel, MD, the chairman at The Cleveland Clinic Department of Neurosurgery, and several researchers there have done some interesting work testing protective equipment (headgear, football helmets, etc.) to compare different materials for safety and efficacy by attaching devices (accelerometers and receptors) to measure impacts. Just by paying more attention to prevention of injuries is likely to reduce them. In closing, common sense and keeping the importance of avoiding “concussion” is likely to be beneficial in reducing injuries. Until there is a tested and reproducible measurement system that can accurately describe an injury, it is very unlikely that public pronouncements of decreased incidence of concussions are accurate.

Richard Mendel, MD, FACS was an amateur fighter with hundreds of amateur fights with the Philadelphia Roofers Union. He fought professionally in 1983-1984 as a middleweight (undefeated with only a few fights) before attending college and medical school at the University of Pennsylvania. Today he is a neurosurgeon with a great deal of experience with brain and traumatic head injuries. He has treated (at no charge) numerous former and some current fighters with medical care and services since 1989.

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  1. Brandon McMorries 09:56am, 02/12/2014

    Dr. Mendel, thank you so much for responding back to my questions.  it’s apparent that you’re a very classy guy, and I’ll take the liberty of stating that many of us would enjoy having a drink with you while discussing our favorite sport.  I tend to agree with your opinion regarding regular old fist-fights.  But then again, society has been frowning on that for a few decades now.  Still, there are just some people that need a good ass-whippin’ to get their attitude in check lol.  This subject is endlessly fascinating to some of us out here, and your insight and answers are also intriguing.  I’m a bit envious that you were so fortunate to have lived in an area so rich in boxing tradition and action.  Your mention of that particular section of West Philly is quite interesting in itself, and it begs the question of genetics vs environment as I’m sure that most of those fighters deemed it a sense of extreme pride to be so durable.  I could go on and on about this subject, but I’ll spare you.  Just know that down here around Midland, Texas, you have a friend waiting to buy the first round.
    All my best,
    Brandon McMorries
    Tarzan, Texas

  2. richard c mendel 08:48am, 02/12/2014

    Brandon McMorries,
    Thanks for your questions and I’ll try to address them in order.

    1) Thick Skulls-this has been brought up many times and I don’t think this is all that significant for a few reasons: a. I have seen that the thickness of the calvaria (rounded exterior of skull) does seem to vary somewhat, but the mechanism for closed head injuries (which includes concussions) is the brain (which floats in a sac of spinal fluid) is exposed to forces causing it to impact the inside of the skull. The prominences on the inside of the skull are there to accommodate the large, folded brain, and these are often very thin and almost paper-like. b. Although there are variations in thickness I think that it is the base of the brain and skull base that result in injury not the outer cortex as much.

    2. Great question- the ability to take a punch is in a romantic way are thought of as a measure of toughness and willpower (and I suppose in some ways that is probably somewhat true). Any biologic system has tolerances, and put bluntly anyone hit correctly is susceptible. Time eventually beats even the formerly invincible young athlete- and it always seems to come as a surprise. They brain has an incredible number of connections (pathways) between cells, and I’m sure everyone has somewhat different wiring. What is also complex is the sensory system sending signals to the brain.  In a particular section of West Philadelphia (in and around 69th Street and extending into Upper Darby) there were many, many fighters like Rocky Tassone, Richie “The Bandit” Bennett, Mike Picciotti, Steve and Mike Sheeran, Al Fero, Guy Gargan,  Joey Constantino, Leroy Diggs, Marty Capasso, Teddy Mann, etc who seemed to be unstoppable. That area of town was referred to as “The land of the iron-chinned people” and so you had better be in shape to go the distance.

    3. I empathize with those nagging thoughts, and I’m sorry for you. The thing is that we live in a crazy world. Outlawing something doesn’t mean it disappears, and often it limits what outlets or releases a person has. You know I have often heard arguments about making all kinds of things (of course including boxing) illegal. Often what results is something more nefarious and dangerous. The more active or perhaps more-violent kids need a release. It is not as though these particular kids (or people) are debating between joining the church choir versus amateur fighting. Everyone is different and we all make different choices.

    There are many times that I wish in some way plain old fist fights have fallen out of favor. What have they been replaced with…knives and guns? People shot each-other over movie theatre seats. I really prefer individual sports for many younger people as it teaches people how to lose. Winning is easy, but in life you don’t always win. Adrian Broner was so heart broken because he didn’t understand that he was not unbeatable. Look at the graciousness of great champions after losing. Look at what Muhammad Ali said about his March 8, 1971 loss to Joe Frazier.

    I never liked Toughman contests, BUT George Chuvalo was discovered at one. I think that in truth boxing really takes a tremendous commitment and it is not the kind of thing that can be supervised without a good trainer.
    Lastly, you describe that the fighter really didn’t sustain much punishment so one possibility is that the fighter may have had an abnormal blood vessel (aneurysm or AVM) that may have bleed.

    The brain really wasn’t designed for combat, but disagreements are part of life. Learning to work out those disagreements can be troublesome for lots of people (most often disadvantaged people with little other resources) so I think fighters and fight fans need to be their own advocates. The safer boxing can be made while still preserving its spirit is not up to regulatory agencies, but rather us.

  3. Brandon McMorries 03:56pm, 02/11/2014

    Dr. Mendel, thank you so much for this article.  Like you and many of the others that have commented on this subject, I find it fascinating.  And I really appreciate your service to these former and active fighters.  I also appreciate your dedication to the sport, and it’s improvement.  I have a few questions.

    1.)  I’ve heard stories about some boxers having thicker skulls than normal, which is one of the reasons that they were so durable.  Is there anything to this notion? 

    2.)  What, in your opinion, do you think are the reasons why some people can take an enormous punch, while others have the dreaded “glass jaw”?  You mentioned the possibility of the jagged edge boniness of the interior part of our skull as potentially being a factor.  What else do you think contributes to it?

    3.)  Years ago, my boxing club would lease out one of our sparring rings to the Toughman Contest, and we would also serve as Seconds.  There was an incident in College Station, Texas where a 26 year old man suffered a brain injury, went into a coma on-site, and died within the week.  I suffered tremendous guilt over this tragedy for years.  Within months of this incident, those events were outlawed in Texas as a direct result.  Granted, it’s difficult to know all of the pertinent factors pertaining to this incident, but in your opinion, what would have caused a man that had fought one fight on one night (and won), and a portion of a fight the following night (and he was winning) to suffer a brain hemorrhage?  This man was not taking a sustained beating, nor did I notice that he was “hurt” in either fight.

    Thank you again for all that you do.

    Brandon McMorries
    Tarzan, Texas

  4. richard c mendel 06:29pm, 02/10/2014

    Thanks for asking- I fought as an amateur for years, and as a pro only had a total of 4 pro fights-and was 4-0 with 3 KO’s, but thanks to my trainer Steve Traitz and Martin J. Durkin (our team physician) along of course with my Mother -I was steered in the right direction (and perhaps the only time it really mattered) I actually listened.
    There is no doubt in my mind that the discipline I got from training is what allowed me to survive such a long haul of medical school and residency training. I’m also very certain that the Hart vs. Moyer fight is what motivated me to be interested in head trauma.
    I realize that in boxing there really aren’t very many happy outcomes when long careers are concerned, but I feel really fortunate that I learned a lot of lessons that I think of all the time. There are few things that bring me more satisfaction than taking care of fighters, especially the guys I knew who were contenders, and maybe even more importantly the guys that could have been.

  5. Irish Frankie Crawford Beat Saijo aka Gimpel 11:35am, 02/10/2014

    Dr. Richard Mendel-How many amateur bouts did you have? 2 and 0 with 2 KOs as a Pro….then on to being a neurosurgeon….got to be a book in there somewhere. Have you seen the photo online of the baby reaching out of the uterus through an initial two inch incision in the uterus and grasping the surgeon’s finger. It is reported that the surgeon began to weep and had to pause before resuming the caesarian procedure.

  6. richard c mendel 05:37pm, 02/09/2014

    You would be surprised how often heroes and idols are forgotten. My idol as a kid was “Cyclone” Hart, but I was in awe of many fighters including Richie Kates. A few years ago another ex-fighter and I were looking for some seats at one of Joe Hand’s cards in Philly. We chose to sit more towards the back because there were two guys we wanted to say “hello” to that were sitting a couple of seats apart; and I don’t think anybody noticed that they happened to be Richie Kates and Iran Barkley.

  7. richard c mendel 05:25pm, 02/09/2014

    One thing that never ceases to fascinate is how virtuous people often portray themselves to be. There are things we do and things we do not do; those choices are what makes an individual. “Sewers” and dumpsters are not bad places to look since it can be very surprising to see what ends up there.
    A long time ago Frank “The Animal” Fletcher was asked about his unconditional love of fighting and he responded with the following:

          “I hate to admit it, but I only like it better when the pain comes.”

    That quote has been putting a smile on my face for the better part of three decades, and my partners can attest to the fact that it hangs on a wall in my operating room.

  8. Ted 11:18am, 02/09/2014

    Anyone who knows anything about “The Great Light heavyweights” knows about Richie Kates

  9. Ted 11:15am, 02/09/2014

    Erm. Wife beating brutes and sleazy crooks. Ha. Maybe you are onto something there. lol

  10. Robert Ecksel 10:52am, 02/09/2014

    Anything that inspired cultural touchstones like the book “The Harder They Fall” and the film “Raging Bull” is worthy of my love.

  11. Thresher 10:03am, 02/09/2014

    How can you love something that lives in a sewer?

  12. Robert Ecksel 07:38pm, 02/08/2014

    We can love boxing without our love being unconditional. After all, we’re not dogs and boxing isn’t our master. It’s at times like these that I think of a quote by Budd Schulberg (who pretty much exemplified what it means to be at the top of the hit parade): “As much as I love boxing, I hate it. And as much as I hate it, I love it.”

  13. Ted 07:29pm, 02/08/2014

    Clarence George, come on now, bad can be good and dark can be light. My next one coming will really put you in a funk. lol

  14. richard c mendel 07:02pm, 02/08/2014

    That is a good point as well. We tend to think in terms of exceptions to the rule rather than the rule itself. Why would a good trainer send a fighter out for the next round if he understood his fighter was dangerously impaired? My friend for 30+ years, Matthew Saad Muhammad is a perfect example of “the invincibility of the brazen youth.” Matt could come back (and did almost times without number) when nobody else could have. Matt fought local great Richie Kates (from Vineland, New Jersey) in The Spectrum.
    The late Nick Belfiore (Juniper Gym in Philly) dragged Matt back to the corner with the tops of Matt’s shoes and laces dragging on the canvas. Matt somehow knocked out Kates in the next round. That is the exception NOT the rule.
    The fight could have reasonably been stopped earlier and we would been none the wiser. The heroics that I can recall from the 60’s and 70’s inspires me to this day, but the truth is that the human brain isn’t meant to absorb beatings. The exact same scenario played out when Matt stopped the great Marvin “Pops” Johnson in the same ring a short time later while fighting for the NABF title. When a fighter starts to fade, or fall far behind there should be a much lower threshold for stopping a fight.
    The beauty of fighting is present in both amateur and professional fights. Fights are often interesting when the fighters aren’t of the top caliber, but are evenly matched. Paying attention to the skills and the thinking (ring-generalship are often satisfying). As a physician I really appreciate what boxing provided to me. However, remember that youth is wasted on the young, and it isn’t acceptable to allow a young man to subject himself to punishment that he can’t even conceive of when it doesn’t come due until two decades later.
    The stories of “gods and heroes of Greek and Roman mythology are most likely the stories of exceptional people that we more than idolize in our culture presently.”

    P.S. In case you were wondering why you hadn’t heard of Richie Kates it may be because of a talent density in the Philly area in the 1970’s. Richie Kates began as a middleweight and grew into the light heavyweight division. The middleweights in Philly included Bennie Briscoe, Cyclone Hart, Willie “The Worm” Monroe, Bobby “Boogaloo” Watts, and Stanley “Kitten” Hayward. The light heavyweights included Matt Franklin who became Matthew Saad Muhammad, Leon (who of course became a heavyweight) and Michael Spinks (who trained in the 69th Street Gym), a nice young Jewish boy named Mike Rossman (also from Vineland, NJ- who at the ripe age of 21 fought and defeated Victor Galindez). In addition to the locals, Russell Peltz was importing Marvin Hagler, David Love,  Eddie “The Flame” Gregory (later Eddie Mustafa Muhammad) and Alvaro “Yaqui” Lopez to The Arena and The Spectrum to avoid any paucity of competition. Dwight Braxton, Frank “The Animal” Fletcher, Curtis Parker were a few years away.

  15. Irish Frankie Crawford Beat Saijo aka Gimpel 05:57pm, 02/08/2014

    Dr. Richard Mendel-“post concussion syndrome”.....It frequently is described as a feeling of being out of sorts”.The cameraman in the corner was focused on Magomed during the rest period after the first round…. if his behavior doesn’t fit this description I don’t know what does….he was clearly “out of sorts” and not mentally ready for the second round. Moreover, his performance for the remainder of the fight evidenced ” a slight decrease in function and reaction time” which proved to be “critical”.

  16. richard c mendel 05:14pm, 02/08/2014

    Some very good comments:
    a. Mr. Clarence George- you are lucky, when I was young I just always wanted to be a fighter and had few other interests. I am the father of four sons, and tried to steer them to wrestling because I couldn’t stand the idea of seeing them get punched.

    b. Ted -Couldn’t agree more. When I was very young I used to watch Richard Steele (on TV) fighting as a middleweight in Los Angeles. Pretty solid fighter, but tended to run out of gas in later rounds. As a referee I thought he was terrific and sustained undo criticism. Steele was a fighter and he knew what he was doing. Remember that stopping a fight too early is unquestionably preferable to the alternative.

    c. Matt-excellent question- the more complex a species the more nurturing they require. So bigger brained species have offspring born not ready to be independent. Despite wider hips, etc a woman gives birth to an infant that doesn’t have a hard skull, but a soft flexible skull, and the brain is folded to minimize the size of the head to make passage in the birth canal possible.
    Unlike a calf or pony that is standing within hours of birth-the human baby gets carried around for a year or so and during that time the skull is well on its way to fusing together.

  17. Irish Frankie Crawford Beat Saijo aka Gimpel 05:00pm, 02/08/2014

    Clarence George!-I was worried that you might have run off with that comely “Oriental Dancer” in your building.

  18. Robert Ecksel 04:00pm, 02/08/2014

    I defer to my betters whenever possible. There’s nothing more exciting than a well contested boxing match, rare though they are, and Dr. Mendel agrees. But let’s be real. It’s beautiful when a rose blooms in a garbage dump, but just as a rose is a rose is a rose, a garbage dump is a garbage dump is a garbage dump.

  19. Clarence George 02:55pm, 02/08/2014

    Ah, I see that the morbid obsession with corruption, concussion, dementia, and death continues unabated and unsated.  “We’re boxing fans, naughty boys.  Spank spank spank, spank spank spank, spank our booties, spank our booties.”  Well, not mine, thanks all the same.

  20. Ted 01:19pm, 02/08/2014

    And welcome to Boxing.com, Doc.

  21. Ted 12:30pm, 02/08/2014

    For me the single most important thing would be that a referee would be compelled to stop a fight once a fighter falls hopelessly behind in a fight and is showing signs of fatigue. Make that a non-negotiable rule. I am writing about it right now.,

    Do it NOW!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  22. Ted 12:22pm, 02/08/2014

    If I have noticed one thing over the years, it’s that some of the most severe injuries (and fatalities) occur in the late or even last round when fighter fatigue has set in, .

  23. Matt McGrain 11:35am, 02/08/2014

    Absurdly good.  Thanks doc.  From an evolutionary point of view, why are our skulls rougher from the inside?  Just the window of survivability too narrow for it to make any difference who passes on their genes when?

  24. Irish Frankie Crawford Beat Saijo aka Gimpel 11:28am, 02/08/2014

    Dr. Richard Mendel-This article is off the charts informative and educational…...“unlike the smooth rounded exterior of the skull, the interior has many rough, irregular and SHARP bony portions that can result in bruising the brain’s surface”....you think so?...and wouldn’t that answer the question, “is one person more susceptible to head trauma than others?” “The research” showed that “The physics of force delivery explained why angular punches (hooks, uppercuts, and overhand) much more frequently resulted in knockouts than punches that resulted in linear acceleration”....I can attest to this, many years ago I witnessed a jerk being KOd by a slap to the side of his face….and I always thought he was a bitch who went down from just the shock of receiving a hard blow to the face!

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