Can Football Be Saved From Head Injuries?—A Historical Perspective

KANSAS CITY, MO - NOVEMBER 27: Safety Troy Polamalu #43 of the Pittsburgh Steelers is injured while hitting Steve Maneri #68 of the Kansas City Chiefs during the game on November 27, 2011 at Arrowhead Stadium in Kansas City, Missouri. (Photo by Jamie Squire/Getty Images)

In an attempt to redress the inadequacies of my knowledge of football history, I recently picked up a short book, "The Forward Pass in Football," by Elmer Berry, B.S., M.P.E. Berry wrote it in 1921 and was head coach of the football and baseball teams as well as the Associate Director of the Physical Department, and a professor of Physiology and Physiology of Exercise at the International YMCA College in Springfield, Mass.

Professor Berry began the book by detailing the many changes made in the rules of football between 1906 and 1914. These changes were effected because of how dangerous the game had become. The danger was vividly illustrated by this off-hand remark: "Internal injuries often developed and an unwarranted large number of deaths occurred." Somehow, the word "unwarranted" was more telling than any amount of descriptions of carnage could have been.

As Berry relates, a conference in 1906 attended by representatives of 70 colleges was called for the purpose of abolishing football as an intercollegiate sport. Instead, "men of vision" managed to save the game. These men believed the problem was not with the game of football but with the manner in which it was played. According to Berry "They contended that a new game should and could be produced that would be more open, less dangerous and more interesting than the old game." As a result of their arguments, the National Collegiate Athletic Association was formed and a rules committee appointed to salvage what could be saved of the old rules and replace what couldn't be saved with new rules. These rules "would make it a new game." (Emphasis in original.)

This raises the philosophical question of what the game of football is. As we face a similar crisis, rules are being adjusted to attempt to reduce head injuries, and many people bemoan the alterations to the game as it has been played for the past few decades. At what point do the changes render the game "football" in name only? Will anyone notice in 50 years?

Ivan Cole wrote a thought-provoking article last week about the current crisis [Threat of Concussion Issue Bringing Down the NFL Very Real Possibility.] If I correctly read his argument, he believes concern over the concussion issue is already beginning to marginalize the sport at the youth level, and this will eventually trickle up to the NFL as the pool of players becomes smaller.

Cole also hinted at the possibility (he believes it is already occurring) of a sort of racial and/or economic divide as better-educated and more affluent parents prevent their children from participating in youth football. This raises the specter of the development of an essentially gladiatorial class who sacrifice themselves for the amusement of the rest of us. (They will undoubtedly continue to be handsomely compensated. The question is whether that makes it okay.) Mewelde Moore referred to the players as "modern-day gladiators" when I interviewed him over a year ago. I’m sure he isn’t the only one to feel that way.

Unlike most of the gladiators of old the players choose to do this. It might be fair, though, to ask whether they choose to play football with full knowledge of the possible consequences. And can 21-year-olds be considered to be fully competent to weigh long-term consequences against present benefits? But that’s a slippery slope, I fear. The better question to ask is, can the game as it is currently played be altered to reduce head injuries to an "acceptable" level without radically changing its character?

If football can’t be saved in its current incarnation, is it worth saving? Like those in the early 20th century who bemoaned the loss of the traditional rules and considered the adoption of the forward pass as converting the game into basketball, many now are fearful of the effects, both intended and unintended, of the new rules. And yet, in my opinion, the new rules aren’t going to solve anything, because they don’t go nearly far enough.

I suspect football as it now stands may well be unfixable, because rule tweaks may not be sufficient to reduce the inherent danger of head trauma. Players whose position is not one particularly subject to concussions (linemen, for example) have been found to have significant brain trauma from the thousands of small repeated stresses to which they are exposed. Soccer, which many parents consider the ‘safe’ alternative to American football, is coming under scrutiny because of the evidence of long-term damage from heading drills. If just knocking your head against a soccer ball over and over is unhealthy, how can repeatedly knocking your head against other players be good for you?

Let's return for a moment to what occurred 100 years ago and see whether it has any current application. I believe it does, mainly because the rule changes instituted between about 1906 and 1913 were substantial enough to inspire Professor Berry to declare football a "new game." What were those changes?

They included the change from advancing five yards to advancing ten yards being necessary for a first down, the addition of a fourth down, and the legitimization of the forward pass. The game was opened up a good deal by these changes. The basic game plan had to change, and of necessity became much more about strategy and less about brute force. This had not only the desired effect of reducing the danger to the players but increased the popularity of the sport, since the spectators could actually follow what was going on.

For Berry, the new rules dispersing the players more widely over the field rather than concentrating everyone on the line of scrimmage had an unforeseen additional salubrious affect—it helped to solve the "moral" problem, as he termed it. Here is the moral problem, in his words:

"Everything was hidden in the mass play. Spectators could see little of the real game, nothing of the ‘dirty work.’ Much of it could not be seen even by the officials...Close lines, petty irritations and difficulty of detection tempted many a man to foul play. We would like to think that the cleanness and high standard of sportsmanship of the new game is an indication of rising character and realization of ethical values of sport. Doubtless it is, but at the same time no small part of it is due to the openness of the new game; the fact that not only officials but spectators can see most of what happens."

As we all know, the "rising character and realization of ethical values of sport" have long ago eliminated any sort of hanky panky, and football as we have it today is played by men of unquestioned high character. This is a great relief to me personally, just as it evidently was to Professor Berry. But let us now turn to the question of what we can learn from history.

I suspect the rule tweaks Goodell and company are trying in an attempt to retain the violence but reduce the liability are insufficient. The picture at the head of the article is a case in point. The tackle was perfectly legal, and resulted at least in "concussion-like" symptoms for Steelers SS Troy Polamalu.

If small changes are not sufficient, what's next? Is there a way to once again fundamentally alter the game to decrease the inherent dangers to an acceptable level while retaining public interest in the game? I believe this can be done. I’m not proposing any specific changes to the game, as that is not my current purpose, but some possibilities were put forth in the comments following Ivan’s article. These included changing the equipment in various ways, making the field larger, and phasing in a weight limit for players. Maybe some or all of these would help. Perhaps none of them would.

Is it feasible to remove all danger from the game? Of course not. It isn’t possible to reduce all danger from the act of getting out of bed in the morning, either, although head trauma usually isn’t a side effect. The rule changes in the early 20th century didn’t eliminate risk from the game. It’s somewhat difficult to determine how much difference they made, as statistics on fatalities were not kept after about 1915. But given that deaths directly attributable to football, at least in the short term, are very rare nowadays, and essentially unheard of at the NFL level, it would seem that the evolution of the game in conjunction with the evolution of the equipment has made a substantial difference.

The main lessons I believe we can derive from what happened in the early 1900s are:

1) You can’t do things by halves. The tinkering with the rules the NFL is presently trying is in my opinion a cynical attempt to appear to address a very real concern without actually doing much of substance. To make a real difference in the amount of head trauma sustained by football players is likely to require a major overhaul such as was effected 100 years ago. Attempting to protect a few marquee positions without addressing the issue among the arguably even more vulnerable linemen and backs is not only morally bankrupt but is unlikely to ultimately succeed from a business/liability standpoint.

2) People don’t like change. The outcry at major changes to the game is unlikely to be much worse than the outcry at minor changes. There is going to be an outcry, no matter what.

3) The rule changes in the early 20th century resulted in the game being more elegant in its design and more fun to watch. It’s difficult for us, from our current vantage point, to imagine a new set of rules resulting in a similar improvement to the game, but given sufficient human ingenuity applied to the task, it is definitely a possibility. There is certainly enough money at stake to induce people to work on the problem.

Can scientific advances or improvements in equipment provide answers to the head injury issue without requiring changes in the game? It would be nice to think so. But that may be a pipe dream.

Supposedly there are already helmets that reduce head trauma. If these helmets are proven to make a significant difference, it is astonishing that the NFL doesn't already require their use. But given how concussions occur (as a result of the brain smacking into the inside of the skull) it is difficult to see how a helmet could help much. I would love to be wrong about that.

The therapeutic/medical research side might yield more of promise, but at the moment there isn’t much sign of it doing so. However, the damage caused by repeated brain trauma is similar in many ways to the damage done by Alzheimer's, and therefore discoveries in one line of research could potentially have application for the other.

Perhaps the lesson we can take from history is to not fear the unknown. The game of football survived a major upheaval 100 years ago and actually thrived in the wake of it. I'm hoping history will repeat itself.

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