Abstract
After World War II, organized tackle football programs for boys younger than high school age grew enormously in popularity in the United States, prompting concerns from pediatricians and educators about the sport's physical and emotional health effects. At the same time, sports medicine was emerging as a sub-specialty. Examining how American sports medicine doctors and football coaches established their professional authority on youth football safety in the 1950s and 1960s reveals how their justifications for this collision sport were connected to broader cultural trends. Doctors and coaches, who were virtually all men, emphasized their firsthand knowledge of an all-male sport that was widely promoted as a means of teaching boys to become men. They insisted that proper supervision and equipment were sufficient to protect young athletes. Their arguments for youth football's benefits were based on the belief that men best knew how to impart desired values such as loyalty, patriotism and discipline to boys. In framing football's health risks as manageable with adult supervision, coaches and sports medicine doctors played a crucial role in promoting the vision of American manhood associated with tackle football.
“Whenever young men gather regularly on green Autumn fields, or Winter ice, or polished floors to dispute the physical possession and position of various leather and rubber objects according to certain rules, sooner or later somebody is going to get hurt.”
–Thomas B. Quigley, Harvard Medical School, 19591
In 1959, Carl Willgoose, a professor of health and physical education, was alarmed by a trend of increasingly young football teams. Boys were no longer waiting until high school to don pads and helmets. Writing for the Journal of School Health, Willgoose noted that in Nassau County, New York, a single village football league would attract hundreds of boys to a call for players. “There is a pee wee division for 10 year olds, a junior varsity division for 11 year olds, and a midget division for 12 year olds… . Football for younger boys may already be here to stay.”2 “Pee Wee” football was becoming a big business, and raised a different set of health and safety questions than other popular organized youth sports, such as Little League baseball.
Willgoose was uncertain whether football was a “medically sound” option for children. He was concerned about physical injuries as well as emotional health. Small boys were playing “under the kind of pressure conditions which involve newspaper displays, athletic editorials, large adult crowds in attendance, and a game tension comparable to high school or college athletics.” Willgoose concluded with a call for research to examine whether the health benefits of highly competitive contact sports for young children outweighed the risks.3
Indeed, the growing number of boys playing football before high school in private leagues was of increasing public and medical concern. “He is somewhere between 8 and 14, and he wants to play football. In fact, he is playing football. Is it good for him?” asked the Chicago Daily Tribune in 1955.4 Parents looking for an answer to this question solicited medical advice, and also sought guidance from educators, football coaches, and sports administrators.
In the 1950s and 1960s, football expanded remarkably, overtaking baseball in many ways as America’s national pastime.5 Television helped transform football into the most viewed professional sport in the United States, while leagues for elementary and middle-school-aged boys took off. Adults supervising the youth game needed to address its risks and defend its benefits for children. Examining how doctors and football coaches established their professional authority on youth football reveals how their justifications for this collision sport were connected to broader cultural trends. The framing of football’s risks was influenced by a variety of beliefs about the moral value of youth sports, and expertise on the subject was gendered. Doctors and coaches, who were virtually all men, emphasized their firsthand knowledge of an all-male sport that was widely promoted as a means of teaching boys to become men.
Furthermore, there was significant overlap between these groups of adult male authorities: many doctors who conducted research into football injuries were also involved in supervising the sport as coaches, team physicians, or parents. The tension between promoting football and studying its risks influenced how many doctors and coaches conceived of the dangers, and constrained the solutions they proposed.
The question of how medical and educational professionals framed the risks of youth football sits at the intersection of multiple literatures, including histories of public health risk, youth sport, medical professionalization, and gender. Historians have found that the 1950s and 1960s were a key era for both the rise of organized youth sports and the increasing professionalization of sports medicine and allied sciences in the United States, yet the close connections between these two developments have remained relatively understudied.6 In consolidating their professional authority on sports safety, sports medicine doctors and coaches argued for expanding their own involvement in overseeing boys’ sports. Furthermore, while American historians have examined the history of public health risks associated with numerous leisure activities and products, from cigarettes to children’s toys, few have examined public health risks in youth sports.7 Youth sports have been largely framed as health promoting activities constituting part of children’s physical education, rather than treated as potential sources of harm.8
Cold War beliefs about gender and family roles have been analyzed in a range of contexts, such as domestic life, women in the labor force, and in community organizations.9 Martha Verbrugge’s history of women’s physical education provides important insights into how 1950s attitudes toward gender intersected with beliefs about physical activity.10 The increasing popularity of competitive youth sports for boys during this period offers another rich field for study of gender history. In particular, youth football represented an arena where women could be largely excluded, and where men were charged with overseeing young boys’ development. Beliefs about men’s supervisory role, in turn, shaped youth football safety as a medical issue in an era when childhood play was increasingly supervised by adults.11
Counting Injuries
Since the emergence of tackle football, doctors had commented on the sport’s health effects, often emphasizing the particular vulnerability of youth. For example, a 1907 editorial in the Journal of the American Medical Association (JAMA) highlighted that out of the 14 football players killed that fall, none was over 20 years in age. The editorial concluded that there was no need to hesitate “in deciding that football is no game for boys to play.”12
Through the early decades of the twentieth century, several doctors published reports in leading American medical journals on football injuries. Physicians most likely to observe football injuries included orthopedists, surgeons, pediatricians, and school physicians. Doctors affiliated with schools that had football teams tended to serve predominantly white, wealthy communities. Colleges were most likely to have a school or team physician to look after their athletes; some elite prep schools did as well. But public secondary schools often lacked medical staff able to treat and document injuries. Consequently, youth football injuries were probably greatly underreported. Published injury counts generally did not include injuries sustained by high school players at less affluent schools. Nonetheless, these counts represent important early efforts at documenting football injuries as a medical concern.
For example, in the 1930s Thomas N. Horan served as a resident physician at Cranbrook School. At this private boys’ preparatory school in Bloomfield Hills, Michigan, 80 percent of the students played football. In 1934, Horan reported on the number and types of injuries he had seen among Cranbrook students in the previous four football seasons (1930-1933). He observed the most commonly injured regions of the body (fingers, hands, ankles, muscles, knees) and offered recommendations such as warm-up exercises before games and the use of protective padding and Ace bandages.13
At Phillips Academy, an elite preparatory school in Andover, Massachusetts, school physician James Roswell Gallagher also reported on athletic injuries. Based on data from 1940 to 1947, Gallagher found that varsity football had the highest incidence of major injuries per player, followed by junior varsity football. Combined, these two levels of football averaged more than twenty times as many major injuries per player as did soccer or lacrosse. Knee and head injuries in football were of particular concern. To prevent knee injuries, Gallagher suggested calisthenics, taping, and the exclusion of players whose “state of development and linear build” made them vulnerable. Head injuries, on the other hand, were more difficult to control. “The best in helmets and the proper fitting of helmets is the least, and perhaps the most, that can be done,” acknowledged Gallagher.14
In this article, Gallagher insisted that he was not concerned with the “relative merits” of the particular sports he studied, but with documenting the types of injuries one might expect.15 In fact, however, he had previously expressed concern about school football. By the 1930s, the rapid expansion of high school sports had resulted in intense debates over the nature of interscholastic competitions. As Heather Munro Prescott observes in her history of adolescent medicine, Gallagher felt the physical education department at Phillips Academy was more preoccupied with creating a winning football team than fostering physical fitness among all its students. In the early 1940s, he took control of the physical education department and redesigned the program to provide each student with an individualized exercise regimen. The particular needs Gallagher observed among his teenaged patients, from athletic injuries to mental health concerns, eventually led him to become a central figure in the development of adolescent medicine.16
At the college level, Augustus Thorndike, Jr., who served as physician to Harvard University’s athletic department beginning in 1926, was one of the most prominent doctors to report his medical findings on the sidelines. His articles and monographs contributed to the development of sports medicine as a subspecialty. In a 1938 New England Journal of Medicine article, Thorndike wrote that he had observed the most serious injuries in informal games or individual recreation, such as skiing, baseball and polo, rather than organized football. Even so, more individuals were participating in sports, such that more injuries were to be expected. Doctors would need to be responsible for preventing recurrent minor injuries.17
In 1940, after Thorndike published another review of common athletic-related injuries, Time Magazine profiled the doctor’s work. While most sports injuries were slight, Thorndike acknowledged that “more accidents occur in football per playing hour than in any other game.” Nonetheless, Time claimed, nobody was more vehement than this eminent physician, himself a former Harvard football player, about the physical benefits of athletics.18 Rather than arguing for limitations on athletic participation, he supported medical supervision to protect athletes.
Thorndike’s perspective was hardly unique. Doctors overseeing youth athletics typically promoted the overall health benefits of organized contact sports. They saw their supervisory role as ensuring that participants could enjoy these benefits. Even those physicians without any athletic team affiliations, and those who were most concerned about the physical risks of football or boxing for young children, hastened to make clear that athletic competition could not and should not be eliminated. “Competition is part of our American way of life,” emphasized a pediatrician in a 1958 JAMA article on youth athletics.19 Cold War fears only amplified support for competitive athletics as a buttress against communism.20
Professional Responsibility and “Natural” Hazards
Beliefs in the value of organized sports were widespread in American society, including among medical professionals. Yet team physicians occupied a particularly ambivalent position, in some ways reminiscent of the dilemma that company doctors faced while studying occupational illnesses. Company doctors’ duty to their employers was in tension with their duty to their patients.21 But unlike company doctors, who were paid to be held accountable to corporate employers, most doctors and coaches serving youth football teams were volunteers. Their potential conflict of interest was not financial, but rather ideological. The team physician’s very role compromised the equipoise that would be needed to assess the real risks of the sport. In other words, doctors serving school teams may have underestimated the risks of youth football because they believed a priori in its value.
In this sense, football coaches were in a similar position to team doctors. Their role inherently involved both promoting football to the public, as well as protecting players’ well- being. Coaches naturally expressed faith in the value of competitive athletics. But amid public concerns over athlete deaths and football’s overall safety, coaches found it essential to demonstrate that they were addressing injuries. Notably, coaches sought to track deaths and severe injuries themselves through the American Football Coaches Association (AFCA).
In December 1921, college football coaches had formed the AFCA in part due to their alarm over the professionalization of the sport. As John Sayle Watterson recounts in his history of college football, coaches expressed moral opposition to students profiting from their football talents. But they also feared the threat that the American Professional Football Association, established in 1920 and renamed the National Football League in 1922, posed to the college game.22 At the association’s 1931 annual meeting, Coach John Heisman told the rules committee in an open discussion that football-related deaths occurred every year, “and what are you going to do about it? You cannot just laugh it off and you cannot just argue it off. That is not the way the public and the press are built.”23 In 1932, AFCA president Mal Stevens explained that in the past year the association had decided to embark on a study of the sport's safety “so that we would be in a position to either answer the criticisms which have been directed at us, be able to refute them, or to acknowledge the criticisms as just and try to improve the game.” While in ensuing years the AFCA would make changes to the particular format of the survey, the organization continued to collect information on football injuries and deaths every year.24
Coaches had to serve as ambassadors for their sport while also overseeing the physical regimens of their players and maintaining the health of their teams. Coaches such as John Heisman, Vince Lombardi, and Pop Warner were celebrities in their own right. A photograph of Mal Stevens signing a football for two girls at New York’s 1939 World's Fair indicates the public profile that many football coaches enjoyed, particularly at the college level (see Figure 1). The multiple roles that coaches occupied were further compounded when they had other careers as athletes, physicians, or both. For example, Mal Stevens, a former football player as well as a coach, would go on to a career in orthopedic surgery treating sports-related injuries.25
Mal Stevens, former AFCA president, signs a football for two girls at New York’s World's Fair in 1939. Manuscripts and Archives Division, The New York Public Library. “Sports - Football - Mal Stevens signing football for two girls,” New York Public Library Digital Collections. Accessed September 6, 2017 at https://digitalcollections.nypl.org/items/5e66b3e8-92fd-d471-e040-e00a180654d7.
Mal Stevens, former AFCA president, signs a football for two girls at New York’s World's Fair in 1939. Manuscripts and Archives Division, The New York Public Library. “Sports - Football - Mal Stevens signing football for two girls,” New York Public Library Digital Collections. Accessed September 6, 2017 at https://digitalcollections.nypl.org/items/5e66b3e8-92fd-d471-e040-e00a180654d7.
At the high school level, the National Federation of State High School Associations (NFHS) oversaw interscholastic sports, including football, in participating member schools across the United States. While the NFHS did not have its own survey of injuries and deaths comparable to the AFCA’s, the organization did periodically share available safety statistics with its membership. For example, at its 1948 annual meeting, the NFHS presented football injury counts from an insurance company study. The company reported these statistics according to several factors, such as player’s position, age, date, and the nature of the competition (game versus practice). But these numbers were useful neither for calculating rates, nor for evaluating whether any of these factors were meaningfully associated with injuries. For example, the highest percentage of injuries occurred among 17-year-olds (see Table 1). However, the high percentage was “due to the fact that a large majority of high school players are of that age.” Without knowing how many athletes of each age had played tackle football in total, and how many of the players out of this sample had been injured, such numbers did not provide a meaningful indication of risk.26
Football Injuries by Age, Security Life and Accident Company28
| Age | Percent of Total Injuries |
|---|---|
| Under 16 | 25.5 |
| 16 years | 28.7 |
| 17 years | 38.5 |
| 18 years | 5.3 |
| 19 years | 1.5 |
| 20 years | 0.5 |
| Total | 100 |
| Age | Percent of Total Injuries |
|---|---|
| Under 16 | 25.5 |
| 16 years | 28.7 |
| 17 years | 38.5 |
| 18 years | 5.3 |
| 19 years | 1.5 |
| 20 years | 0.5 |
| Total | 100 |
Football Injuries by Age, Security Life and Accident Company28
| Age | Percent of Total Injuries |
|---|---|
| Under 16 | 25.5 |
| 16 years | 28.7 |
| 17 years | 38.5 |
| 18 years | 5.3 |
| 19 years | 1.5 |
| 20 years | 0.5 |
| Total | 100 |
| Age | Percent of Total Injuries |
|---|---|
| Under 16 | 25.5 |
| 16 years | 28.7 |
| 17 years | 38.5 |
| 18 years | 5.3 |
| 19 years | 1.5 |
| 20 years | 0.5 |
| Total | 100 |
Moreover, systematic epidemiological analyses to identify risk factors associated with football injuries and deaths remained limited to nonexistent. In fact, the very notion of injury prevention as a field of public health inquiry was new. An injury epidemiologist whose career began in the 1950s recalled that “the literature on epidemiology and injuries before the 1960s was sparse.”27 Studying injuries systematically required a shift from a prevailing view of injuries as random or unpredictable “acts of God” to understanding injuries as predictable and preventable occurrences.
Injury Prevention, Sports Medicine and Pediatricians
In the 1950s and 1960s, researchers increasingly began to attribute injuries to dangerous environments or poorly designed systems, rather than happenstance or the carelessness of individuals. Some historians have analyzed changes in the English language to illustrate this shift. For instance, John C. Burnham has argued that the very term “childproofing,” which emerged in the 1950s, illustrated this new understanding that engineering solutions could effectively protect the safety of children.29 The 1964 publication of Accident Research: Methods and Approaches, a textbook devoted to the epidemiology of injuries, was an important landmark.30 Another key development was increasing attention to preventing automobile-related injuries, highlighted by the 1965 publication of Ralph Nader’s Unsafe at Any Speed.31
Doctors pointed to such efforts in other fields in order to call for similar organized efforts to address injuries among athletes. For example, Augustus Thorndike introduced a 1956 article on sports injuries with a discussion of James P. Mitchell, the U.S. Secretary of Labor. Mitchell had drawn public attention to the importance of preventing occupational injuries and deaths that affected nearly two million workers. Despite continuing “appalling numbers,” the disability rate among American workers had declined from 1943 to 1954, a visible success for industry and insurance companies. Yet in contrast with efforts to enhance worker safety, Thorndike observed “little organized endeavor on the part of coaches, trainers, and others in the field of sport to institute training programs along the same lines.”32 Indeed, sports medicine and related fields were only beginning to grow more specialized. The American College of Sports Medicine was founded in 1954, and not until 1960 did the American Medical Association (AMA) develop a Committee on the Medical Aspects of Sports.33
Meanwhile, changes to football rules and equipment intended to enhance player safety were in some ways heightening risks, notably by increasing the use of the head as a weapon. In 1939, the NCAA football rules committee required college players to wear helmets throughout games.34 Subsequently, plastic helmets and face masks were introduced.35 A 1955 Sports Illustrated article described the new equipment as “an unscientific patchwork of steel-hard fibers and plastic which not only fails to protect the wearer but has converted him into a human battering ram.”36 Sports medicine practitioners would later attribute the mid-century organization of sports medicine associations particularly to growing concerns about football safety.37
The growth of sports medicine required its practitioners to confront the competing nature of their obligations. In 1975, for example, several sports medicine experts participated in a roundtable discussion of the legal, ethical, and moral questions involved in their field. As one panelist, a general surgeon and team physician for the Cleveland Cavaliers, observed, the team physician’s first obligation was to the player. Even so, “the physician also has an obligation to the coaches, or in professional teams, the owners, because he must help obtain the maximum function of an athlete.”38 Expressing this perception more colloquially, one reporter would describe team physicians as “a combination of Dr. Spock and Dr. Feelgood.”39
Sports medicine thus seemingly occupied a compromised position as a medical field. Its objectives included not only protecting player health, but also improving sports performance. Nonetheless, the medicalization of sports-related injuries lent greater professional authority to trainers and doctors. For example, a 1965 news story highlighted the increasingly scientific nature of athletic training. Whereas athletic trainers had once primarily dispensed aspirin and rubdowns, marveled a Chicago Tribune sports reporter, they now “bandied about and absorbed technical terms that would send Dr. Ben Casey scurrying for his medical dictionary.”40
Despite this new scientific veneer, large-scale systematic studies of football injuries remained rare. Doctors and coaches had repeatedly called for better data, but medical societies, funding agencies and public health organizations had not developed formal centers or programs that would support systematic research on youth sports injuries. In 1959, George B. Logan, who would later serve as the president of the American Academy of Pediatrics (AAP), noted that “there is remarkably little factual material published on the injury rate among children engaged in various sports.”41 As late as 1964, the author of a JAMA article on high school football injuries observed that “no data have been gathered which demonstrate which parts of the game or equipment are responsible for the injuries.”42 A 1966 report from the AAP found that 65 boys had died directly as a result of participating in high school football from 1960 to 1964, a figure that highlighted the need for research.43
Even without much in-depth data before the mid-1960s, such tabulations of deaths and severe injuries troubled many doctors and educators. Several leading medical and educational organizations had already felt compelled to oppose football for prepubescent children. In 1953, the National Education Association (NEA) hosted a two-day conference in Washington, DC on program planning in games and sports for young children. The 44 delegates in attendance recommended banning football and other contact sports for children aged twelve and younger. George Maksim, representing the AAP, argued that “the risk of permanent bone and joint injuries is just too great.” Pop Warner football’s representative at the conference cast the lone vote against recommending a ban on football and other contact sports.44
Leaders of youth football leagues naturally dissented from banning football, but prominent medical organizations were not persuaded of organized football’s overall benefits for youngsters. In the decade after the NEA conference, many doctors continued to object to football for young children. In 1957, the AAP’s Committee on School Health, which had been founded in 1931, published a policy statement on competitive athletics for children twelve years or younger.45 According to the statement, due to children’s susceptibility to bone and joint injuries, “body-contact sports, particularly tackle football and boxing, are considered to have no place in programs for children of this age.”46 A Time Magazine article quoted several physicians who emphasized that collision sports such as football could not be made appropriate for young children. “Cutting down the field and changing the rules doesn't make football a kid's sport.”47 The November 1960 Bulletin of Westchester County’s Medical Society published an editorial calling for limiting football among pre-adolescent children, stating that “one permanent deformity as a result of such activity is an unwarranted risk.”48
Doctors and educators who believed that any permanent deformity resulting from youth football was unjustified had little data to indicate just how severe or minimal this risk might be. Yet during this period medical concerns about football for growing children focused a great deal of attention on bone and joint injuries. Consequently, in addition to pediatricians, orthopedists were particularly vocal in their opposition to tackle football. Of 403 orthopedists who responded to a 1947 questionnaire on the safety of competitive sports, only 19 indicated that they considered football safe for participation for the junior high school age group. One respondent observed, “I believe it is a tragic situation when any school permits the students to participate in football in the 10th grade or below.”49 Yet 153 respondents considered boxing safe, and 235 approved of touch football.50
Indeed, doctors offered relatively few objections to the physical risks of high school football among older teenagers. The entrenchment of football in high schools likely influenced medical understandings of football’s risks. At mid-twentieth century, it may have been more culturally feasible—or even merely conceivable—for doctors and educators to contest the novel expansion of football to younger ages, rather than challenging the widely accepted place of football in high schools.51
Yet doctors’ and educators’ objections did little to stem the extension of football programs to include younger children. According to Hollis Fait, an instructor in physical education at East Oregon College of Education, “almost without exception the literature which has appeared has been in opposition. Many physical educators and professional groups have gone on record opposing interscholastic competition for pupils below the tenth grade. Yet the practice continues.”52 Strikingly, the recommendations of professional societies such as the AAP against football among elementary and middle school aged children went largely unheeded. That countervailing arguments overshadowed the exceptional degree of cultural authority American physicians had attained at mid-twentieth century underscores the growing social power of competitive youth sports during this period.53
Fathers, Mothers, and “Sissy” Boys
Doctors’ and educators’ objections to football for young boys lacked influence in part due to prevailing cultural anxieties about gender. American style football had emerged in the late nineteenth century, when movements toward greater social and political freedoms for women were raising concerns about the feminization of American culture.54 The Cold War amplified longstanding fears about proper gender and family roles, as well as popular connections between football and the military. These forces made football a particularly attractive way to promote patriotism, discipline and fitness among American boys.55
The view that boys needed to be “toughened up” and experience a certain amount of risk was promulgated at the highest levels, notably in presidential fitness programs motivated in part by reports finding that American schoolchildren fared poorly on a measure of muscular fitness as compared to European children.56 As one columnist observed in 1955, boys anxious to convince their skeptical mothers to allow them to play football would likely “make full persuasive use of the fact that the President [Eisenhower] has come out strongly in favor of more competitive sports among youth.”57 Football and other contact sports offered the opportunity for physical contact in a modern world where gadgetry made life “too easy” for growing boys. Both Eisenhower and his vice president, Richard Nixon, were former college football players themselves and extolled the sport’s virtues. “I believe that competitive body contact sports are good for America’s young men,” Nixon told the AFCA at a 1958 luncheon.58
Such comments were also part of a wider discourse about overprotective mothers that was influenced in particular by American author Philip Wylie. A novelist who first achieved fame with works of science fiction, Wylie subsequently turned his pen to non-fiction.59 Wylie’s best-selling 1942 book Generation of Vipers popularized the term “momism,” defined as “excessive attachment to, or domination by, the mother.”60 Doctors, commentators and scientists referenced this notion in the popular press, warning of the dangers of domineering mothers stifling their children’s growth. As one psychiatrist wrote in the Saturday Evening Post, “One can have little patience with these moms who worry constantly and needlessly about the health of healthy children … . Undue solicitude on mom's part is harmful.”61 Thus, mothers were blamed not only for the illnesses and injuries and their children suffered, but also for being unduly protective. As Steven Mintz and Susan Kellogg observe, “it seems clear that the underlying source of anxiety pervading child-rearing manuals during the postwar era lay in the fact that mothers were raising their children with an exclusivity and in an isolation without parallel in American history.” By preventing children from taking risks, mothers were accused of placing American youth, particularly boys, at risk of becoming unfit. 62
Fathers, on the other hand, were expected to encourage their sons to take risks and have adventures.63 They were typically assigned responsibility for preventing a boy from becoming a “sissy,” which the coordinator of the New York State Health Commission defined as a child “who gets too much satisfaction from what his mother does for him and not enough from what he does for himself.”64 On this view, fathers needed to encourage their children to take risks and limit mothers’ influence if necessary. In fact, the bumps and bruises associated with football were in many ways considered essential to developing boys’ masculinity. “Football is a game designed to make men out of boys. It is healthy for young men to bump heads on Saturday afternoon.”65 In this sense, injuries represented healthy badges of manly honor, whereas reporting an injury widely assumed to be minor was considered a sign of feminine weakness.
Tackle football would protect boys from becoming “sissies” by fostering male supervision and excluding feminine influence. The term sissy was homophobic; football was not just about making boys into men, but making boys into straight men. Indeed, in the 1960s satirist Russell Baker would dub young men uninterested in sports “asportual,” writing that the great majority of such men “live in shame of their peculiar tastes and seek to conceal them by pretending to enjoy sports as much as the normal man.”66 The notion that football would prevent effeminacy in boys drew on longstanding associations between athletic competition and “civilized” forms of aggressive manhood, moral self-improvement, and physical prowess.67
Yet the risks boys took to avoid the stigma of “softness” alarmed some medical practitioners. William Brady, a physician and popular health columnist, warned that the fear of being perceived as a sissy was causing players to obey coaches’ orders to the point of harming their own well-being. He recounted a story of a boy who had sustained a concussion playing football, but did not reveal that he suffered a constant headache for fear that he would be considered weak. His parents only learned of his symptoms when his vision began getting blurry; the boy ultimately had to spend a month in the hospital. Brady concluded that high school boys should not play football.68
The Burden of Proof
Given such dangers, who had the authority to interpret the available medical evidence on the risks and benefits of youth football? Comparing the views of John Reichert, an assistant professor of pediatrics at Northwestern University Medical School, and Creighton Hale, the director of research and vice president of Little League Baseball, Inc., illustrates this contentious issue. In 1958 and 1959, Reichert and Hale each authored lengthy examinations of existing research on competitive athletics for young children. The contrast between their perspectives reveals a contest over which evidence was considered reliable, who had the authority to best interpret the evidence, and where the burden of proof ought to lie in evaluating the benefits and risks. It also indicates a growing divergence between pediatricians and academic physicians on one hand, and sports doctors, researchers and administrators on the other. The increasing professionalization of coaching and sports medicine introduced different professional imperatives and preferred policy actions in assessing the risks and benefits of youth sports.
As an assistant professor of pediatrics, previous chair of the AAP’s Committee on School Health, and member of the city of Chicago’s Board of Education, Reichert had exhibited an extensive interest in school health. In 1958, Reichert wrote a JAMA article assessing debates over competitive athletics for children younger than 13. While acknowledging that the lines were not too clearly drawn, he nonetheless described two distinct groups as standing on each side of the issue. On one side were people who believed that some limitations should be placed on competitive athletics for young children: “In this group are the majority of educators and physicians who have studied the issue.” On the other side stood a group largely composed of “sports promoters, professional athletes, sports fans, and some coaches,” who considered highly organized sports desirable for young children.69 Reichert observed that more research was needed on the long term effects of athletic competition, but in the meantime, “one must doubt the claim that the stress of competition promotes optimum growth and development.”70
In the face of scientific uncertainty, Reichert counseled that the preponderance of medical opinion favored a cautious approach. Much of this uncertainty specifically centered on tackle football. As safer alternatives, Reichert recommended touch or flag football for children. To support this opinion, he cited a personal communication from Eddie Anderson to Fred Hein, both physicians with interests in youth health and fitness. In fact, Anderson was a successful college football coach at the College of the Holy Cross who had also earned a medical degree, and who would later be inducted into the College Football Hall of Fame. These experiences lent him credibility as an authority on both football and health. Anderson had observed that touch football would be a better training program for pre-teenagers than tackle football. Further citing an NFHS handbook, Reichert wrote that “about 60% of all injuries occurring in tackle football occur while tackling or being tackled,” and that a switch to supervised touch or flag football would eliminate these injuries. He concluded that his recommendations were based on “the considered judgment” of most educators and physicians who had studied the problem.71
Not surprisingly, sports organizers disputed such assessments. Creighton Hale, vice president of Little League Baseball, Inc., characterized efforts to discourage competitive athletics for pre-high school age children as a “crusade.” Hale, a prominent youth sports administrator, was also a physiologist with interests in sports safety research. A former athlete himself, Hale had attended the University of Nebraska on a track scholarship. Before joining the Little League organization as its director of research in 1955, Hale had earned a doctorate in physiology. He would design a batting helmet to cover the full head and ears, and would later serve as the president of Little League baseball.72
Hale’s 1959 Journal of Health, Physical Education, and Recreation article observed that medical professionals’ studies had thus far been largely limited to opinion pieces and review articles. Hale criticized how “the armchair philosophers and the encyclopedic researchers, utilizing their intuitive knowledge and the crystal ball,” had transformed competitive athletics for young children into the most controversial topic of the 1950s for the American Association of Health, Physical Education, and Recreation. Though he also noted that more studies were needed, Hale nonetheless contended that the available research was favorable toward the educational value of athletic competition. He wrote that children who participated in competitive sports attained higher social status and prestige, and that they were more likely to exhibit many “desirable personality traits,” such as cooperation, confidence, leadership, sportsmanship, and sociability. While the children who participated in sports such as football and baseball were primarily boys, Hale also cited research indicating that girls with athletic experience showed similar social benefits, such as improved leadership qualities, greater activity in clubs, and improved emotional stability.73
Hale further asserted that “normal” children would not be harmed by strenuous physical activity. To support this claim, Hale largely sidestepped concerns about physical injuries in contact or collision sports. Rather, he sought to refute beliefs that strenuous activity might damage children’s hearts or hinder their growth. Citing several physiological studies on child development of the heart and arteries, Hale claimed that human hearts were protected by “certain safety valves which prevent physiological trauma during and following strenuous activity.” The physiological basis for this assertion is unclear and dubious.74
To defend against claims that interscholastic sports might harm children’s growth, Hale cited several studies comparing the rate of physical growth in youth who participated in athletics with those who did not. The findings of these studies were mixed. Hale acknowledged that differential rates of maturation in children of the same age meant that child athletes needed to be carefully matched against competitors of a similar developmental stage to prevent injury. Nonetheless, for Hale, the existence of studies finding that youth athletes were taller and heavier than their non-athlete counterparts was sufficient to discount concerns about the impact of athletics on growth.75
Both Reichert and Hale, then, acknowledged a lack of research evidence and critiqued debates over competitive youth sports as being based in emotion rather than fact. Yet they reached very different interpretations of the available research. At the outset of his article, Hale suggested that personal experience playing sports and male gender—two factors which were certainly not independent of one another in the 1950s—lent those making claims about sports safety greater authority and credibility. Hale implied that those seeking to place limits upon competitive sports for children were biased against athletics. He cast suspicion on the basis for safety concerns in a gendered fashion: “It has been established that women are less favorable toward athletic competition than men and that people who have not had athletic experience are less favorable toward competition than those having this experience.” Hale’s arguments were further based on the view that the burden of proof lay with doctors and educators to clearly demonstrate detrimental effects of competitive sports. He regarded limited and inconsistent medical evidence on the harmful health effects of youth sports, even sports as seemingly dangerous as boxing, as failing to meet this standard.76
Reichert, on the other hand, elevated the authority of medical and educational professionals to assess sports’ health effects over the views of athletes, coaches or administrators. He recommended that children should participate in safer alternatives in the absence of evidence demonstrating that full body contact sports were not harmful. Perhaps most strikingly, Reichert challenged not only claims in favor of the benefits of competitive athletics, but also beliefs that adults could effectively mitigate the risks of injuries. Arguing that the notion that “injuries can be insignificant with adequate and intelligent adult supervision” contained numerous fallacies, Reichert asserted that children were susceptible to bone and joint injuries, as well as organ damage that might not be immediately evident, but could manifest itself weeks or even years later. Even the most careful adult supervision could not control such risks. Reichert concluded that immature children’s bodies were too vulnerable to safely engage in body contact sports such as football or boxing, and that “the burden of proof rests with those who disagree.”77
A Supervisory Imperative
Among his arguments, Reichert had highlighted and disagreed with a prevailing assumption that adequate adult supervision would reduce injuries. He likely emphasized this point in response to the widespread belief that adult-organized athletics were safer for children than unsupervised sandlot games. This notion underlay much medical and coaching advice, and was often asserted as fact in the medical and education literature without supporting data. For instance, in 1947 an orthopedic surgeon wrote that “sand lot” games were “far more dangerous than supervised school competition where children should be well matched and taught how to defend and protect themselves.”78 On this view, adults protected children by ensuring that only players of a similar age and size competed against each other, and by instructing young athletes in football techniques. Such techniques included, for instance, coaching children in how to fall so that they would not land on their heads or necks, hitting other players with their shoulders instead of their heads, and keeping their necks straight (never bent up or down) as they hit.79
The emphasis on adult supervision was driven in large part by the perspective of those commenting on youth football safety. Personal involvement in football as a parent, coach, team physician, or trainer often motivated physicians to examine the sport’s medical aspects, and shaped their advice. A pre-existing involvement with the sport helped inspire physicians to consider football as an important and worthwhile subject of study. On the other hand, these physicians were unlikely to consider banning or limiting football. They instead generally regarded the sport as beneficial overall, with careful medical management sufficient to mitigate the risks.
Even before competitive youth sports expanded more rapidly after World War II, this perspective is evident. For instance, Joseph H. Burnett worked as a physician at Boston City Hospital and served as the attending physician for schoolboy games at Dorchester, Massachusetts, for many years. Players gave him the nickname “Hot Towels Burnett” for his standard treatment for bumps and bruises.80 His football safety research focused on high school and college players. In a 1940 New England Journal of Medicine article, Burnett compared injuries among Harvard College players versus Boston high school teams. He attributed differences in the percentages of injuries to the former setting having far more supervision than the latter. Unorganized play “is unsafe, produces serious injuries and gives football an unjustified reputation as a dangerous game,” Burnett concluded.81
Burnett therefore advocated for “a campaign of education and helpful advice” to respond to the risks of unregulated play, writing that adult supervision, adequate playing equipment, and removing injured or tired players from the game would help eliminate serious injuries. He extrapolated his findings and recommendations based on older players to younger ones. Burnett praised fathers in Belmont, Massachusetts for organizing their 8- to 14-year old sons into teams and supervising their matches as an ideal strategy for preventing injuries in this age group. He concluded that with such oversight, football was “certainly worth while.” Burnett added that “young America will play football, with or without helpful supervision, so that it is the duty of their elders to help regulate the playing of juveniles.”82
Among the elders regulating the youth game—coaches, parents, trainers, and doctors— doctors unsurprisingly argued that team physicians should be the primary medical supervisors of the sport. Team physicians’ duties included conducting physical exams of players before the season began, as well as observing and treating players as necessary throughout the course of the season. Team physician James Daly argued that physical examinations were especially important in football, because while all boys ought to have the opportunity to participate in athletics, football was especially dangerous. As a result, it would be “a serious mistake to include football for boys without real aptitude.”83 Physicians, then, would need to determine which boys possessed sufficient aptitude to safely participate.
Physicians also argued that they ought to hold the final authority in diagnosing and treating any injuries that might arise, whether minor or severe. “The team physician's prerogatives of early diagnosis and treatment must not be usurped by coach or trainer, lest a minor injury become aggravated by continued play, causing a long period of disability,” explained Thorndike.84 He argued that doctors were essential to early detection of injury, because coaches were necessarily primarily interested “in the technical perfection of team and position play,” and thus could not be expected “to spot a limping or arm-weary player.” Adult supervision of youth football therefore required a clear division of labor, separating medical oversight from coaching responsibilities.85
In a 1957 article, orthopedist Rodney Atsatt described his 25 years of experience serving as football team physician at Santa Barbara High School in California. In addition to reviewing several kinds of specialized first aid involved in addressing football injuries, from treating a charley horse to taping ankles, Atsatt offered broader thoughts on the role a physician should play. While advocating for the authority and independence of a team physician, he also implied that the physician might assist with the team’s success on the field by advising the coach. Atsatt wrote that a football coach ought to have “complete confidence in the doctor’s judgment,” not only in deciding whether it was safe for a boy to continue playing, but also in “matters of psychology.” To address the latter issue, Atsatt described how he would observe the boys’ attitude while taping their knees and ankles prior to games and relay his impressions to the coach. He proudly noted that his resulting observations would influence the coach’s pep talk to the players. Atsatt provided an example of how, after he advised the coach to appeal to his players’ pride after one game’s disheartening first half, the team came back from a 20-0 deficit to win. Atsatt’s oversight of youth football was clearly not limited to providing medical care.86
Atsatt’s account also reveals how physicians functioned to reassure the spectators on the sidelines that potentially frightening injuries were being professionally managed. In his discussion of head and neck trauma during games, Atsatt advised that after a hard blow where a player emerged with “wooziness” but did not lose consciousness, the doctor ought to carefully observe the athlete but need not remove him from play. But if a player were “really out cold” on the field, he ought to always be brought off on a stretcher in case he had sustained a neck injury. Moreover, “it is very bad from the standpoint of the spectators to see a semiconscious boy walked off the field with his head bobbing from side to side, to say nothing of the possibility of further serious damage to the patient.” In this way, a team physician not only worked to protect player health, but also to prevent the unfolding of a disturbing scene following a serious injury.87
The belief that adult supervision not only prevented physical injuries, but also helped influence moral, emotionally healthy boys, shaped medical advice. In a 1956 JAMA guest editorial, Dr. Allan Ryan characterized the AMA as working with educators and coaches to highlight “the character-building advantages of football” while minimizing “the danger of young boys playing too many games in one season.” Ryan portrayed football as a healthy sport for building boys’ bodies and promoting teamwork, but one that could be dangerous, even “a killer and a maimer,” without medical supervision. He advocated for regular physical examinations of players conducted by physicians, properly fitting uniforms, and pre-play warm-ups as effective means to preserve the assumed benefits of the “wholesome and valuable” sport.88
Coaches and league administrators defended and promoted football in very similar terms. For example, Don C. Osgood, president of the East Fullerton Midget Football League, told a Los Angeles Times reporter that football was “becoming a safe, wholesome sport for the grade school youngster” because games were “under the strict supervision and the safeguards imposed by the mothers and fathers themselves and by the Pop Warner Midget Football Association of America.”89 Indeed, promoters of Pop Warner and other youth football leagues made remarkable claims for the safety of the sport. Osgood continued in his remarks, “Unlike sand-lot football in which injuries sometimes mar contests, Pop Warner League is amazingly free of mishaps… . When healthy boys meet in a body-contact sport such as football, there’s not much chance of a serious injury.”90
Not all doctors were convinced by claims that “the sport is as safe for youngsters as for their older brethren.” Citing a study of high school football injuries, Fred Hein wrote that “the younger and greener a youth,” the more likely he was to sustain an injury.91 Still more doctors contended that football experience and skills did not appear to confer any particular protection. A 1962 examination of high school football injuries in California found that “head injuries occurred, for the most part, in players whose ability was considered excellent or good.”92 Others questioned the adequacy of physical examinations, which were often offered in assembly line fashion and focused on more readily apparent orthopedic abnormalities, as a means to identify children who should not play football.93 An attendee at a 1962 conference on head injuries reported seeing 120 boys processed in the space of three hours, and observed that this time was insufficient to thoroughly examine so many participants. Moreover, it was unclear whether physicians had effective methods to identify which children were at greatest risk.94
But with arguments highlighting adult supervision as the key to safety, many parents increasingly insisted on supervision in order to protect their sons. To some parents, only the presence of adults could make football suitable for the smallest boys. As one father told the Chicago Daily Tribune, “You hear a lot about these kids being too young for this game, but with the supervision and rules in Pop Warner football this isn’t true.”95 This desire for supervision to promote safety extended through the high school level. For instance, in 1956, three hundred parents signed a petition presented to the Board of Education in Los Angeles, California, requesting increased coaching staffs for the “safety and welfare” of high school football players.96
A Long Island youth football league kept its own statistics to reassure worried parents. The league collected and shared injury data not only to provide evidence of the sport’s safety, but also to reinforce the importance of supervision provided by organized leagues such as itself. In 1956, the league reported that in the previous year, among 288 players who had participated in a total of 9,706 boy-practice hours and 418 game hours, only eight injuries were reported. Neither the nature of these injuries nor the methods for data collection are described. Yet the New York Times journalist who reported these figures concluded, “It is reasonable to assume that many more injuries would have resulted if the same number of boys had played sandlot football on vacant lots, without proper supervision or equipment.”97
Several historians and philosophers of medicine have discussed the notion of a “technological imperative” prevailing in medicine, particularly in the United States.98 In youth football during this period, there might be said to exist a “supervisory imperative”: a prevailing belief that adult supervision was necessary and sufficient to provide for safety. Such supervision was promoted as a primary approach to address youth football injuries, especially as private leagues for young children proliferated. The investment of coaches and team physicians in football influenced not only their understanding of risks but also the solutions they promoted to address safety concerns. Coaches and doctors recommended the involvement of more coaches and doctors, and the supposed need for supervision in turn justified the existence and expansion of organized youth leagues run by adults.99
Moreover, adults’ management of youth football represented a prism through which larger societal quandaries were being played out, from proper gender roles to racial discrimination. As protests over the Vietnam War and the civils right movement took place in the 1960s, coaches and athletic administrators were often associated with more conservative-leaning politics. As American author James Michener characterized his coach in his 1976 book Sports in America, “Like most coaches, he considered Democrats bad, and labor union people, and troublemakers, and college professors, and radicals, and anyone not wholeheartedly in support of the good society as he experienced it.”100 In the face of unrest and challenges to powerful institutions, coaches and athletic administrators promoted tackle football as a buttress against seemingly unpatriotic and undesirable behavior among youth. They argued that athletic programs in general, and football in particular, could foster in students a sense of loyalty to the United States and to “traditional” American values. In 1967, Art Baker, a football coach at Clemson University, summarized this perspective:
Coach Baker’s interpretation of the moral benefits of sports for American youth was addressed to physicians reading the Journal of the South Carolina Medical Association. An accompanying editorial comment noted that the state medical association was greatly concerned with safety in athletics, and was consequently seeking to promote close relationships between physicians and athletic coaches. As part of this effort, the chairman of the association’s Committee on the Medical Aspects of Sports had submitted Baker’s article for publication.Perhaps never in the history of the United States have we needed to develop loyalty so badly as today. Everywhere we look it seems some group of American youth is demonstrating against something, often nothing worthwhile… . I am firmly convinced that if all American students were a part of a good athletic program we wouldn’t have the draft card burnings, the long-haired beatniks, the burning of our sacred “Old Glory,” or the waving of the enemy’s flag in our streets.101
The ability of sports to foster American pride and loyalty in response to activism in the streets was thus foregrounded by a professional medical association as part of its examination of the medical aspects of athletics. Baker’s article illustrates the close connections between coaches and physicians in framing the risks of youth football. Cultural fears similar to Baker’s persisted among physicians through the 1970s. Writing of the risks and benefits of youth football in 1975, orthopedic surgeon Richard W. Godshall editorialized, “I would certainly rather have one of my children play football than smoke ‘pot’ in some dark room.”102 Notably, Baker’s article also included an extended reflection on the religious, specifically Christian, aspect of coaching, reinforcing the connection between American football, patriotism, and Christianity. The conceptualization of football injuries as a medical issue was thus deeply tied up with ideological, moralistic, religious, and even nationalistic beliefs about the role of youth sports, as well as the country’s direction more broadly.103
Conclusion
By the mid-twentieth century, as organized tackle football expanded to increasingly include children younger than high school age, doctors and coaches asserted their authority on football safety in new and more professionalized ways. The way these men framed their expertise was decidedly gendered. Not only were sports doctors and coaches nearly exclusively men, but particularly in the absence of epidemiological data, their experiential knowledge of sports was valued as a key element of safety expertise. This largely excluded women’s perspectives, especially mothers’ concerns about the sport’s safety for their sons, from being considered authoritative. Indeed, some sports administrators explicitly emphasized the importance of male athletic experience to credibility on matters of football safety. Moreover, male experts’ experiential knowledge of football was associated with “making boys into men.” Their arguments for the benefits of organized youth football were based on the belief that men best knew how to impart desired values such as loyalty, patriotism and discipline to young boys. Male supervision could most effectively transmit the “wholesome” sport’s benefits to boys while minimizing its risks.
As sports medicine developed as a sub-specialty, the attitudes of team physicians toward competitive youth sports increasingly diverged from those of pediatricians and educators. In the 1950s, the American Academy of Pediatrics and the National Education Association issued recommendations against youth football for children under 12. By contrast, team physicians, sports researchers, coaches, and administrators highlighted the moral benefits of organized football and insisted that proper supervision and equipment were sufficient to protect young boys. While doctors and coaches who promoted organized youth football undoubtedly believed in the sport’s character-building qualities, their arguments downplayed and sometimes even masked football’s physical risks. Team physicians and coaches had a stake in the expansion of organized football to young children that pediatricians lacked.
That medical warnings against tackle football went largely unheeded, while arguments in the sport’s favor prevailed, suggests that sports medicine had consolidated increasing professional authority by mid-twentieth century. But it also indicates the cultural meanings attached to organized sports that football coaches and sports doctors successfully tapped. Most Americans viewed youth football as a way to make boys into men with desired cultural traits. In framing the sport’s health risks as manageable with adult supervision, doctors and coaches played a crucial role in promoting the vision of American manhood associated with tackle football.
ACKNOWLEDGMENTS
My profound thanks to the faculty and staff of Columbia University's Center for the History and Ethics of Public Health, the American Academy of Arts & Sciences, and NYU Langone Health's Division of Medical Humanities for their immense help and support throughout previous iterations of this project. I am particularly grateful to Merlin Chowkwanyun, James Colgrove, Masako Hattori, and the anonymous peer reviewers for their comments on earlier drafts of this article.
Footnotes
Thomas B. Quigley, “Harvard Leads Field in Medical Care of Athletes,” Daily Boston Globe; November 15, 1959, A35.
Carl E. Willgoose, “Health Implications of Highly Competitive Sports at the Elementary-Junior High Level,” J. of School Health (1959): 224-227, 225.
Ibid., 225.
Marcia Winn, “Fit the Exercise to the Growing Boy,” Chicago Daily Tribune; October 20, 1955, C1.
Jesse Berrett, Pigskin Nation: How the NFL Remade American Politics (Urbana, IL: University of Illinois Press, 2018).
Neil Carter, “The Rise and Fall of the Magic Sponge: Medicine and the Transformation of the Football Trainer,” Social History of Medicine 23;2 (2009): 261-279; Jack W. Berryman and Roberta J. Park, eds. Sport and Exercise Science: Essays in the History of Sports Medicine (Urbana: University of Illinois Press, 1992); Jack W. Berryman, “From the Cradle to the Playing Field: America’s Emphasis on Highly Organized Competitive Sports for Preadolescent Boys,” Journal of Sport History 2 (1976): 112-131; Michael H. Carriere, “‘A Diamond is a Boy’s Best Friend’: The Rise of Little League Baseball, 1939-1964,” Journal of Sport History 32;3 (2005): 351-378.
See, for example, Allan M. Brandt, The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America (New York: Basic Books, 2007); Barron H. Lerner, One for the Road: Drunk Driving Since 1900 (Baltimore: Johns Hopkins University Press, 2011); David Rosner and Gerald Markowitz, “‘Educate the Individual… to a Sane Appreciation of the Risk’: A History of Industry’s Responsibility to Warn of Job Dangers Before the Occupational Safety and Health Administration,” American Journal of Public Health 106;1 (2016): 28-35; Nancy Tomes, “Merchants of Health: Medicine and Consumer Culture in the United States, 1900-1940,” Journal of American History 88;2 (September 2001): 519-547; Barbara Young Welke, “The Cowboy Suit Tragedy: Spreading Risk, Owning Hazard in the Modern America Consumer Economy,” Journal of American History 101 (2014): 97-121.
Richard A. Swanson and Betty Spears, History of Sport and Physical Education in the United States (Dubuque, Iowa.: WCB Brown & Benchmark, 1978).
Elaine Tyler May, Homeward Bound: American Families in the Cold War Era, 20th anniversary edition (New York: Basic Books, 2008), Joanne Meyerowitz, Not June Cleaver: Women and Gender in Postwar America (Philadelphia: Temple University Press, 1994).
Martha Verbrugge, Active Bodies: A History of Women's Physical Education in Twentieth- Century America (Oxford, UK, University of Oxford Press, 2012).
Howard Chudacoff, Children At Play: An American History (New York: New York University Press, 2007).
“Football Mortality Among Boys,” JAMA 49 (1907): 2088.
Thomas N. Horan, “Analysis of Football Injuries,” JAMA 103;5 (1934): 325-327. On Cranbrook School and Dr. Horan’s role as resident physician, see “Michigan Fosters Cranbrook Plan,” The Michigan Alumnus 38 (1932): 445-446, 450.
Gallagher’s study included approximately 650 boarding students per year, ranging in age from 13 to 18 years old. J. Roswell Gallagher, “Athletic Injuries Among Adolescents: Their Incidence and Type in Various Sports,” Res. Quart. 19;3 (1948): 198-214.
Ibid.
Heather Munro Prescott, A Doctor of Their Own: The History of Adolescent Medicine (Cambridge, Harvard University Press), 1998. See especially Chapter 2, “J. Roswell Gallagher and the Origins of Adolescent Medicine.” For Gallagher’s own perspective, see J. Roswell Gallagher, “The Origins, Developments and Goals of Adolescent Medicine,” J. of Adolesc. Health Care 3 (1982): 57-63. On debates in the late 1920s and early 1930s over interscholastic high school sports, see Robert Pruter, The Rise of American High School Sports and the Search For Control, 1880-193 (Syracuse: Syracuse University Press, 2013).
Augustus Thorndike, Jr., “Trauma Incident to Sports and Recreation,” New England Journal of Medicine 219;13 (1938): 457-465. See also Augustus Thorndike, Jr., Athletic Injuries: Prevention, Diagnosis and Treatment (Philadelphia: Lea & Febiger, 1938). For a brief review of Thorndike’s career and his contribution to the development of sports medicine, see Bertram Zarins, “History of the Massachusetts General Hospital Sports Medicine Service,” Orthopaedic Journal at Harvard Medical School (no date): 108-110. Accessed September 5, 2017 at http://www.orthojournalhms.org/volume9/manuscripts/ms13.pdf. See also his obituary, “Dr. Augustus Thorndike, 89, Sports Medicine Specialist,” New York Times; February 1, 1986.
“Athletes’ Injuries,” Time 36;8; August 19, 1940, p. 48.
George Maksim, “Desirable Athletics for Children,” JAMA 168; 11 (1958): 1431-1433, 1432. Similarly, in 1957 Sports Illustrated quoted Maksim as saying, “Competition is part of the growing child that should be recognized, accepted and directed.” Kenneth Rudeen, “The Verdict,” Sports Illustrated; August 26, 1957. Accessed September 6, 2017 at http://www.si.com/vault/1957/08/26/602895/the-verdict
Jeffrey Montez de Oca, Discipline and Indulgence: College Football, Media, and the American Way of Life During the Cold War (New Brunswick, NJ: Rutgers University Press, 2013).
Diana Chapman Walsh, “Divided Loyalties in Medicine: The Ambivalence of Occupational Medical Practice,” Soc. Sci. & Med. 23;8 (1986): 789-796.
John Sayle Watterson, College Football: History, Spectacle, Controversy (Baltimore: Johns Hopkins University Press, 2000), 155.
“Report of Rules Committee,” Athletic J. 12;7 (1932): 19-24, 20. John Heisman was a renowned football player and coach, for whom the Heisman trophy for most outstanding college football player in the United States would later be named.
American Football Coaches Association, Proceedings of the Twelfth Annual Meeting of the American Football Coaches Association (New York, New York: December 27-28, 1932), 5. The AFCA’s annual survey included figures for football played at the sandlot, club, high school, and college levels. Since 1931, the AFCA has tabulated the numbers of catastrophic football injuries and fatalities. Two doctors compiled these statistics through 2008. Frederick O. Mueller and Robert C. Cantu, Football Fatalities and Catastrophic Injuries, 1931-2008 (Durham, North Carolina: Carolina Academic Press, 2011).
Mal Stevens, former AFCA president, signs a football for two girls at New York’s World's Fair in 1939. Manuscripts and Archives Division, The New York Public Library. “Sports - Football - Mal Stevens signing football for two girls,” New York Public Library Digital Collections. Accessed September 6, 2017 at https://digitalcollections.nypl.org/items/5e66b3e8-92fd-d471-e040-e00a180654d7.
H.V. Porter, “National Federation Annual Meeting,” Scholastic Coach 18;6 (1949): 44-46; 6046.
Jess F. Kraus, “A Journey To and Through Injury Epidemiology,” Injury Epidemiol. 1;3 (2014): 1-3, 1.
Ibid.
John C. Burnham, “Why Did the Infants and Toddlers Die? Shift in Americans’ Ideas of Responsibility for Accidents—From Blaming Mom to Engineering,” J. of Soc. Hist. 29 (1996): 817–838.
William J. Haddon, Jr., Edward A. Suchman, and David Klein, Accident Research: Methods and Approaches (New York, NY: Harper and Row, 1964).
Ralph Nader, Unsafe at Any Speed (New York, NY: Grossman Publishers, 1965). For a discussion of earlier conceptualizations of injuries as acts of God, see Hermann Loimer and Michael Guarnieri, “Accidents and Acts of God: A History of the Terms,” Amer. J. of Public Health 86;1 (1996):101–107. On developments in injury prevention as a field of public health, see Julian A. Waller, “Reflections on a Half Century of Injury Control,” Amer. J. of Public Health 84;4 (1994): 664–70.
Augustus Thorndike, “Prevention of Injury in Athletics,” JAMA 162;12 (1956): 1126-1132, 1126.
On the history of sports medicine including the influence of World War II military research, see Jack W. Berryman, Out of Many, One: A History of the American College of Sports Medicine (Champaign, Ill.: Human Kinetics, 1995) and Douglas W. Jackson, “The History of Sports Medicine, Part 2,” Amer. J. of Sports Med. 12;4 (1984): 255-257. On the 1950 foundation of the National Athletic Trainers’ Association and the development of athletic training education, see Gary D. Delforge and Robert S. Behnke, “The History and Evolution of Athletic Training Education in the United States,” J. of Athletic Training 34;1 (1999): 53-61.
Watterson, College Football.
J. Nadine Gelberg, “The Lethal Weapon: How the Plastic Football Helmet Transformed the Game of Football, 1939-1994,” Bulletin of Science, Technology & Society 15;5-6 (1995): 302-309.
William H. White, “Armor that Does as Much Harm as Good,” Sports Illustrated; October 31, 1955.
Bernard R. Cahill, “American Football and the Evolution of Modern Sports Medicine,” Journal of Orthopaedic Surgery (2003): 107-109.
“Round Table: Legal, Moral, and Ethical Questions in Sports Medicine,” Physician and Sportsmedicine 3 (March 1975): 71-84, 71. A professional athlete participant in this roundtable, Keith Erickson of the Phoenix Suns, expressed the view that many athletes felt that team physicians were only interested in management’s point of view. “If [a player] was hurt, he just had to get back and play as soon as possible.” Similarly, former NFL player and North Dallas Forty author Peter Gent told Newsday in 1982, “when I think of the lies told to me about my health, all the things the doctors did to me to get me ready…they purposefully deceive you about your physical health.” John Jeansonne, “Tackling the NFL’s Cocaine Problem,” Newsday; July 4, 1982, D1.
Neil Amdur, “Once More, Doc, With Feeling,” New York Times; August 22, 1974, 41.
Robert Markus, “Trainer Now Man of Science; Era of Aspirin Bluff Gone,” Chicago Tribune; June 15, 1965, C3. Dr. Ben Casey was the title character of an American TV medical drama which ran from 1961 to 1966. For a history of early athletic training written by an athletic trainer, see Matt J. Webber, Dropping the Bucket and Sponge: A History of Early Athletic Training, 1881-1947 (Prescott, AZ: Athletic Training History Publishing, 2013).
George B. Logan, “Essential Medical Supervision in Athletics for Children,” JAMA (1959) 169;8: 786-788, 787. Logan accepted the presidency of the American Academy of Pediatrics in 1967. See George B. Logan, “Acceptance of the Presidency of the American Academy of Pediatrics,” Pediatr. 40;6 (1967): 1049.
Richard H. Alley, Jr., “Head and Neck Injuries in High School Football,” JAMA 188;5 (1964): 118-122, 118.
American Academy of Pediatrics, Report of the Committee on School Health of the American Academy of Pediatrics (Evanston, IL: American Academy of Pediatrics, 1966): 72.
Jack Walsh, “Football Ban Urged For Youngsters,” The Washington Post; May 27, 1953, 30. The 44 delegates who made the recommendations included representatives from the American Academy of Pediatrics, the National Education Association, American Medical Association, the Pop Warner Foundation (football), Little League Baseball, and other medical, educational and recreational groups. For a summary of the conference, see J. Bertram Kessel, “Planning Games and Sports for Youngsters: Highlights of the National Conference on Program Planning in Games and Sports for Boys and Girls of Elementary School Age,” Journal of the American Association for Health, Physical Education and Recreation 24 (1953): 8-9.
Marshall Pease, American Academy of Pediatrics: June 1930 to June 1951 (Evanston, IL: American Academy of Pediatrics, 1952.)
American Academy of Pediatrics Committee on School Health, “Competitive Athletics: A Statement of Policy: Report of the Committee on School Health, American Academy of Pediatrics,” Pennsylvania Med. J. 60 (5) (1957): 627-9, 629.
“Doctors on Sport,” Time Magazine; December 12, 1960, 74-75.
“Curbs on Football for Smaller Boys Asked by Doctors,” New York Times; November 18, 1960, 33.
CL Lowman, “The Vulnerable Age,” J. of Health and Phys. Educ. 18;9 (1947): 635-636, 693.
Ibid.
Michael Oriard, Reading Football: How the Popular Press Created an American Spectacle (Chapel Hill, NC: University of North Carolina Press, 1993); Gerald R. Gems, For Pride, Profit and Patriarchy: Football and the Incorporation of American Cultural Values (Lanham, MD: Scarecrow Press, 2000).
Hollis Fait, “Needed: A Policy on Junior-High Interschool Athletics,” J. of the Amer. Assoc. for Health, Phys. Educ., and Recreat. 21;8 (October 1950): 20-21, 20.
Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1983).
Gems, For Pride, Profit and Patriarchy.
Ibid. See also de Oca, Discipline and Indulgence.
Rachel Louise Moran, Governing Bodies: American Politics and the Shaping of the Modern Physique (Philadelphia, PA: University of Pennsylvania Press, 2018).
Dorothy Barclay, “Competitive Sports: The Pros and Cons,” New York Times; August 28, 1955, SM48.
“Third-String End Honored Guest at Football Coaches’ Luncheon,” New York Times; January 9, 1958, 46.
David Seed, “The Postwar Jeremiads of Philip Wylie,” Sci. Fiction Stud. 22; 2 (July 1995): 234-251, 236.
Rebecca Jo Plant, Mom: The Transformation of Motherhood in America (Chicago: University of Chicago Press, 2010), 21. See especially chapter 2, “Debunking the All-American Mom: Philip Wylie’s Momism Critique.”
Edward A. Strecker, “What's Wrong With American Mothers?” Saturday Evening Post, October 26, 1946, 88.
Steven Mintz and Susan Kellogg, Domestic Revolutions: A Social History of American Family Life (New York: The Free Press, 1988), 190. Mothers were blamed for being overly emotional and protective, as well as not emotional or loving enough. For instance, during this period autism was attributed to “refrigerator mothers” who were supposedly cold, emotionally distant and insufficiently nurturing. This thesis remained popular until the 1970s. See Jeffrey P. Baker, “Autism in 1959: Joey the Mechanical Boy,” Pediatrics 125 (2010): 1101-1103; Adam Feinstein, A History of Autism: Conversations With the Pioneers (London: Wiley-Blackwell, 2010). See also Sarah S. Richardson et al., “Don’t Blame the Mothers,” Nature 512 (2014): 131- 132.
May, Homeward Bound, 98.
Samuel Middlebrook, “The Importance of Fathers,” Parents Magazine; December 1947, 28, 78. Cited in May, Homeward Bound, 140.
Bob Holbrook, “Friedman Raps Parents: Brandeis Coach Says Football Makes Men Of Boys,” Daily Boston Globe; October 28, 1958.
Russell Baker, “Observer: The Muscular Opiate,” New York Times; October 3, 1967, 46.
See, for example, Gail Bederman, Manliness & Civilization: A Cultural History of Gender and Race in the United States, 1880-1917 (Chicago: University of Chicago, 1995); Anthony Rotundo, American Manhood: Transformations in Masculinity from the Revolution to the Modern Era (New York, NY: Basic Books, 1993); Clifford Putney, Muscular Christianity: Manhood and Sports in Protestant America, 1880-1920 (Cambridge, MA: Harvard University Press, 2001).
William Brady, “Student Badly Hurt Averting ‘Sissy’ Title,” Los Angeles Times; December 11, 1952, B8.
John L. Reichert, “Competitive Athletics for Pre-Teen-Age Children,” JAMA 166;14 (1958): 1701-1707, 1701. Prior to its 1958 publication in JAMA, Reichert read this article before the Section on Pediatrics at the AMA’s 1957 annual meeting. In 1957, he had also published a similar article to the 1958 JAMA piece. See John L. Reichert, “A Pediatrician’s View of Competitive Sports Before The Teens,” Today’s Health 35 (1957): 28-31.
Ibid., 1703.
Ibid., 1706. See also Kevin Carroll, Dr. Eddie Anderson, Hall of Fame Football Coach: A Biography (Jefferson, NC: McFarland & Company, 2007). Anderson also spent several years coaching at the University of Iowa. Fred Hein had served as secretary of the Joint Committee on Health Problems in Education for the National Education Association and the AMA from 1949 to 1957. “Fred V. Hein Receives R. Tait McKenzie Award 1973,” Sch.Health Rev. 4;4 (1973): 22. The source of the claim that 60% of all injuries occurring in tackle football were associated with tackling is unclear.
Lance Van Auken and Robin Van Auken, Play Ball! The Story of Little League Baseball (University Park: Pennsylvania University Press, 2000), 110-111. See also Charles Euchner, Little League, Big Dreams: The Hope, the Hype and the Glory of the Greatest World Series Ever Played (Naperville, IL: Sourcebooks, Inc.: 2006).
Creighton Hale, “What Research Says About Athletics for Pre-High School Age Children,” J. of Health, Phys. Educ., and Recreat. 30;9 (1959): 19-21, 43.
Ibid, 19.
Ibid, 19.
Ibid, 19.
John L. Reichert, “Competitive Athletics for Pre-Teen-Age Children,” 1706.
C.L. Lowman, “The Vulnerable Age,” J. of Health and Phys. Educ. (1947) 18;9:635-636, 635.
Lou Little, “Teach Your Boy to Play it Safe,” Baltimore Sun; September 26, 1954.
Paul Costello, Massachusetts High School Football Association, email to author, June 13, 2015. See also The Gridiron Club of Greater Boston, “Dr. Joseph H. Burnett Award,” Accessed April 26, 2014 at http://gridclubofgreaterboston.com/awards/dr-joseph-h-burnett-award.html
Joseph H. Burnett, “A Review of Injuries in Boston Secondary Schools,” New England Journal of Medicine (1940) 223;13: 486-489, 488. On the expansion of highly organized youth sports, see Jack W. Berryman, “From the Cradle to the Playing Field: America’s Emphasis on Highly Organized Competitive Sports for Preadolescent Boys,” J. of Sport Hist. 2 (1976): 112- 131.
Joseph H. Burnett, “A Review of Injuries in Boston Secondary Schools,” 489.
James J. Daly, “Treatment of Athletes,” California Med. 88;6 (1958): 441-442, 441.
Augustus Thorndike, “Prevention of Injury in Athletics,” JAMA 162;12 (1956): 1126-1132, 1131.
Ibid, 1128.
Rodney Atsatt, “The High School Football Team Physician,” California Med. 87;4 (1957): 263-265, 263.
Ibid, 263.
Allan J. Ryan, “The A.M.A. and Sports Injuries,” JAMA 162;12 (1956): 1160-1161.
Clyde Snyder, “Hard but Safe-Hitting Midget Grid Lines Bring Cheers From Parents,” Los Angeles Times; November 17, 1957, J1, 18, J1.
Ibid, 18.
Fred V. Hein, “Educational Aspects of Athletics for Children,” JAMA 168;11 (1958): 1434- 1438.
Richard H. Alley, Jr, “Analysis of Injuries to Southern California High School Football Players,” in American Medical Association Committee on the Medical Aspects of Sports, Proceedings of the National Conference on Head Protection for Athletes (Chicago, IL: American Medical Association, 1962), 20-24, 21.
John Baumann, “Preseason Football Examinations: An Evaluation,” Journal of the American College Health Association 17;1 (1968): 22-23.
“Third General Session: Reports from Workshop Sessions.” Francis Murphy, MD, presiding, pgs. 59-62. American Medical Association Committee on the Medical Aspects of Sports. Proceedings of the National Conference on Head Protection for Athletes. Chicago, IL: American Medical Association, 1962.
Robert Dickerman, “Colts and Devils Practice Hard and Play Harder,” Chicago Daily Tribune; October 15, 1961, SW1.
“Parents Ask for More School Football Coaches,” Los Angeles Times; October 9, 1956, 9.
Howard M. Tuckner, “Small Fry Football League on Long Island Still Growing; Supervised Program Much Safer Than Sandlot Games,” New York Times; November 18, 1956, 222.
The concept of a technological imperative includes among its several definitions the notion of a strong faith in, focus on, and proliferation of technological approaches to address medical problems. See, for example, Bjørn Hoffmann, “Is There a Technological Imperative in Health Care,” Internat. J. of Technol. Assess. in Health Care 18;3 (2002): 675-689; David J. Rothman, Beginnings Count: The Technological Imperative in American Health Care (New York: Oxford University Press, 1997).
Kathleen E. Bachynski, “Tolerable Risks? Physicians and Youth Tackle Football,” New England Journal of Medicine 374 (2016): 405-407.
James Michener, Sports in America (New York: Random House, 1976), 17. On the NFL and American politics in the 1960s and 1970s, see Berrett, Pigskin Nation.
Art Baker, “A Coach’s Responsibility to His Players,” J. of the South Carolina Med. Assoc. 63 (November 1967): 400-404, 402.
Richard W. Godshall, “Junior League Football: Risks vs. Benefits,” J. of Sports Med. 3;3 (1975): 139-144, 144.
“I believe we should use whatever influence we have on these young lives for the good of His Kingdom.” Baker, “A Coach’s Responsibility to His Players,” 403.
