The Aim is to Maim

When one prizefighter hits another in the head, his objective is to render the opponent temporarily unconscious by a simple concussion, which usually leaves no permanent damage. But a hard blow can also bruise the brain, breaking some of its blood vessels and destroying nerve cells. This kind of damage can kill. The death in Manhattan last week of Benny ("Kid") Paret, 25, after nine days in a coma, from brain injuries suffered in his world championship bout with Emile Griffith, underscored the charge that "in boxing, the aim is to maim."

The medical mechanics of head injuries and knockouts in boxing are complex. A welterweight like Griffith delivers a punch with an average force of 10 foot-pounds of kinetic energy. What this force does to a fighter's head depends not only on how and where the blow strikes but on the position of the struck head and the state of the supporting neck muscles.

Inner Bruises. If a fighter is alert and well coordinated and has his neck muscles taut and his chin tucked in, he can take many full-force punches to the head with relatively little risk of brain injury. Only rarely does an exceptionally powerful blow to the chin break or unhinge the lower jaw and drive bony structures back to damage the lower part of the brain.

If the fighter has his head a bit higher and less securely anchored by his neck muscles, a severe blow to practically any part of the head will make the skull move in the direction of the punch. The jelly-like brain does not accelerate as fast as the rigid skull, so part of the brain is in effect struck by bone. Usually the effect is no worse than that produced when any fleshy part of the body is hit with a hard object: a bruise, from the breaking of minute blood vessels. A long succession of moderate contusions (bruises), which cause slow, leaky hemorrhages, may permanently damage small parts of the brain, causing the "punch-drunk" state in veteran pugilists.

Broken Vessels. The worst injuries in boxing occur when a fighter's neck muscles are relaxed, so his head can bounce like a punching bag on a spring. Such was the case with the groggy Paret on the ropes in the twelfth. With a trip-hammer succession of alternating right uppercuts and left hooks, Griffith slammed Paret's head from side to side. Different parts of Paret's brain were hit by the overlying skull with enough force to break blood vessels between the middle (arachnoid) and outermost (dura mater) layers of the brain's covering (meninges). The resulting accumulations of blood and clots (called hematomas), together with multiple bruises and severe swelling, exerted intolerable pressure on several parts of Paret's brain and cut the elaborate circuitry of the nervous system at a number of points. He would have fallen, which might have saved his life, but

Griffith's punches helped to hold him up. When neurosurgeons got to Paret, they drilled holes in his skull and removed as many hematomas as they could reach, but it was too late. The bruising, for which they could do nothing, and the pressure of the hematomas had crushed too much of the brain's structure and killed too many of its delicate, irreparable nerve cells.

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