The current number of the Boston Medical and Surgical Journal contains a paper on "The Physical Aspect of American Football" written by Dr. Edward H. Nichols '86 and Dr. Homer B. Smith '00, the two surgeons who had charge of the Harvard football squad this fall. That article is here reprinted, by courtesy of the Harvard Bulletin, except for a certain portion which is a technical description of the injuries received in the game and the methods and appliances used in treating them; and a list of injuries received while playing football prior to 1905, and a list of injuries received during 1905.
The report is presented, first, in order to show the number, character and severity of the injuries which were received, while playing football, by the members of the football squad of one university. The first table of figures includes all injuries received by the players previous to this season, while playing football either at school or at college; the second table includes all injuries received this year. Second, to illustrate general methods which were found to be useful in the treatment of acute traumatisms common among football players; and, finally, to present certain special methods of treatment of special injuries.
The report is based upon (1) the written statements of the players themselves regarding the injuries they had received while playing football previous to this year. Every man was required, on joining the squad, to make out a card for a card catalogue, on which he stated the number and character of his previous injuries. (2) Clinical records which were kept by the writers of the cases which came under their observation and treatment. These records were kept only in cases of injuries of great or moderate severity, practically all of which were sufficient to keep men out of the play for a greater or less length of time. No clinical record was kept, however, of the infinity of minor injuries which constantly came under observation, such as abrasions, scratches, minor contusions. (3) The answers received to a circular letter which was sent, after the close of the season, to every one who had been at any time a member of the squad. This circular letter asked the number and character of previous injuries, the length of time they were kept out of the play by those injuries and the length of time they were kept away from college duties, and whether recovery from those injuries was now complete. Similar questions also were asked in regard to injuries received during the season of 1905. A hundred and fifty such circular letters were sent out and answers were received from one hundred and ten men.
Besides the members of the university squad, players from the freshmen and class squads also were treated, but no clinical record was kept of those cases, nor are they included in the statistics presented in this paper, although a considerable number of serious injuries was treated among members of those squads.
There were 150 men altogether in the football squad, of whom 50, at least, played but a very short time, varying from a few days to a week or two. Of the remaining 100, only 70 can be said to represent the real playing strength of the football squad. This fact makes the proportion of injuries received this year almost double as great as would appear at first sight.
It has been claimed that the number of injuries received this year was unusually great and more numerous than in any preceding season. In the absence of any available records of other seasons, this point cannot be determined accurately, but in our opinion it is probable that this season is not markedly worse than preceding ones. We are confirmed in this opinion by interviews with other men who previously have had medical charge of the football squad. One or the other of us was constantly present at the field, from half past three or earlier until dark. The men were very carefully observed and many injuries were recognized which would have escaped less close observation. In comparing the figures in this paper with those of other institutions where no constant surgical attendance is maintained, the numbers may appear relatively large because, in the absence of such observation, many injuries would escape notice.
The players of the university squad were required by the head coach to report every injury no matter how trivial it seemed to them, to the surgeon in charge. In expectation of numerous minor injuries and with a knowledge of the occurrence, in some previous years, of occasional epidemics of minor infections, special precautions were taken regarding asepsis this year. In the first place, an efficient sterilizing outfit was installed. A sufficient supply of clean towels was provided in order to prevent the possibility of transmission of skin infections, and pains were taken to see that the underclothing of the players was changed frequently. As a result of these precautions there was no case of an infected wound during the season nor did any case of skin infection occur. This result, we believe, has not been paralleled in former years.
Believing that a first-class man slightly injured was inferior to a second-rate man in first-class physical condition, great pains were exercised to prevent injured men from returning to the play too soon. This apparently excessive caution of the surgeons met in some cases with bitter opposition from the players. In fact, one man, at least, stated that if it were not for the presence of a surgeon, he would be playing. The wisdom of caution, however, was shown by the fact that in but two cases were men allowed to play so soon as to have an immediate recurrence of their previous disability. On the other hand, it must be stated that the position of the surgeon is rather a trying one. Football players are quite unlike ordinary private patients. Their disregard for pain is marked and their great desire is to be sufficiently recovered from injury to be able to play, and in spite of what was considered by the players to be excessive caution, a certain number of
"chances" were taken. For instance, a patient, under ordinary circumstances, with a dislocated semilunar cartilage, would be perfectly contented to lead a more or less quiet life for a considerable length of time. The football player, however, as soon as the acute symptoms have disappeared, is quite unwilling to be prevented from playing. In no case was any sedative drug used in order to deaden the pain of an injury so as to allow a player to take part in a game before recovery was complete.
The injuries were received in various ways: some in open play, some in the mechanical drill of "tackling the dummy," but a very great proportion occurred in the "bunch" or "pile" which forms after a player running the ball is tackled. The surgeons very quickly got in the way of watching every pile with great interest and apprehension. The exact proportion between the injuries received in the open and in the pile, however, is not controlled by accurate figures. The number of injuries received in the games and in practice were proportionately about the same.
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Here follow a list of injuries received while playing football prior to 1905, and a list of injuries during 1905. Prior to 1905 there were 216 injuries; during the past year, there were 145.
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(1) Judging from our own experience, a very considerable number of the so-called bruised shoulders must have been partial dislocations of the outer end of the collar bone.
(2) Judging from this year's experience and from conversations with the players, we believe that the figures under concussion is much too small.