Even when I became a neurosurgeon it was some time before I accepted that the aim of boxing is to inflict brain damage. My father had been an enthusiastic amateur boxer and former army champion and his passion for the ‘big fight’ rubbed off on me. The moment in the 1964 World Heavyweight Championship when Mohammed Ali floored Sonny Liston is as clear to me now as any presidential assassination.

I became as keen as my father on the nuances of the game: crosses, ‘switch-hitting’, the southpaw stance – on the subject of boxing at least I could not be accused of that ‘holier than thou’ attitude we doctors supposedly take on other health matters.

I always knew that the goal of any boxer was to knock out his opponent. For some reason it didn’t occur to me until quite recently what this means – that victory is determined by the amount of brain damage inflicted on the opponent. Blunt trauma to the brain whether it comes from a gloved fist or a motor vehicle causes acceleration of the brain within the skull.

This acceleration is either linear or rotational, causing so called ‘shearing stresses’ to the long tract fibres in the brain. If you should be in any doubt as to the force with which a punch can be delivered, consider the findings of a British research project conducted in 1985. In this study, Frank Bruno was asked to punch an instrumented target suspended from the ceiling as a ‘ballistic pendulum’. His blows attained a velocity on impact of 8.9 metres/second and when combined with peak force on impact represented a blow to the human head of up to 0.63 tons.

It is often argued that a boxer often wins on points rather than a knockout, but points are awarded by ringside judges on one overriding criterion: the likelihood of a knockout. So, when the boxer is aiming his punches ‘head is always best’. The immediate devastating consequences of massive brain injury are well known: death occuring at or shortly after a bout has been widely reported in the public media. What is perhaps less well known is that brain damage occurs in most boxers – it is just a question of degree.

Post mortem studies show that as many as 80 percent of men who have regularly boxed, whether in professional or amateur capacity, have tell tale signs of brain damage. In the living boxer, advances in MRI scanning seem to support this finding.

Although the effects of brain damage will not obvious in most young boxers, there is evidence that intellectual deterioration is detectable in surprisingly large numbers if looked for with neurospychological tests.

Dementia occuring long after retirement from boxing is so well recognised that it has been given its own rather quaint name – dementia pugilistica. It is a ‘fibrillary tangle’ disease that differs in no material waay from Alzheimer’s Disease. Studies have shown that the severity of the condition correlates with the length of a boxer’s career and his total number of bouts. It has also been shown to be more common in the less agile ‘slugging’ style of fighters who tend to take more head punches.

I had a patient myself, not a Marciano or a Tyson, just an ordinary father of three and ex-builder who had done the amateur circuits. He used to shuffle into my clinic with Parkinson’s Disease (that other well known sequel of boxing), his expression and speech betraying the mind of a five year old.

The American Medical Association took a foemal position to ban boxing in 1990, prompting a fierce debate in the popular media.

In reaction to a largely negative press the boxing authorities have taken steps to make the sport more acceptable. Brain scan are now the norm before and after bouts, and referees are expected to intervene if a fighter seems to be taking too much pumishment. But is this enough? There is considerable doubt whether CT or MRI is of any value in predicting brain damage.

Other recommendations that would vastly improve the lot of boxers have gone largely unheeded, especially in the amateur circuits. These include mandatory medical and boxing history records, compulsory head-gear, avoidance of blows to the head and improved boxing ring floors. In a sport so profitable for its promoters, should there not be a national board to oversee standards?

At all major bouts in Ireland and the UK, I trust there will be an experienced doctor in attendance who knows how to resuscitate a severe head injury. But will there have been prior contact with the regional neurosurgical service to ensure streamlining of a critically ill boxer, possibly in need of immediated surgery. If safeguards have not been in place for such high profile bouts as Eubank v. Collins I dread to think what happens at amateur contests around the country.

As far as I know there was only one casualty of my father’s boxing. He liked to shadow box around the house, head bobbing and ducking as he jabbed and hooked at imaginary opponents. On one occasion while shadow boxing my mother he miscalculated an upper cut that was supposed to stop just short of her chin. It connected, and sent her flying over the sofa. She recovered quickly and we all enjoyed the grovelling apologies. I now realise she was not the only lucky one.