Murphy Boxing Books · 13 October 2026

There is a particular kind of courage that boxing celebrates: the fighter who gets off the canvas, survives a punishing round and somehow finds the strength to continue. Those moments become folklore. But the years after the final bell rarely make the highlight reels. For some fighters, the greatest challenge may come long after their last contest.

The warning that came in 1928

On 13 October 1928, pathologist Harrison Stanford Martland published “Punch Drunk” in the Journal of the American Medical Association. His subject was not an obscure new illness discovered in a laboratory. It was a pattern boxing people had already noticed: some fighters, particularly those who had absorbed years of punishment, developed difficulties with movement, speech and thinking. The language used around them was often dismissive. Martland treated the problem as worthy of medical investigation. His account drew on reports of 23 fighters, five personally examined. He also drew attention to sparring partners — men whose exposure could be considerable even without a celebrated professional record.

A name for the damage

The term dementia pugilistica, associated with J. A. Millspaugh’s 1937 writing, became a way of describing neurological decline linked to a boxing career. The name belongs to the history of medicine, but it can mislead if used too loosely today. Not every boxer develops dementia. Not every former boxer with memory problems has a boxing-related disease. And the experiences of those who do become ill are not all the same. The important question is not whether boxing inevitably damages every participant. It is whether repeated head impacts create risks that the sport has a responsibility to understand and reduce.

What the brains revealed

In 1973, J. A. N. Corsellis and colleagues published The Aftermath of Boxing, examining the brains and histories of 15 retired boxers. The work helped move discussion beyond the observations made during life towards physical changes in brain tissue. But a small, selected group of cases could not establish how common such changes were among boxers generally. Subsequent examination of historical specimens using newer diagnostic methods has also shown that the older category did not correspond neatly to one modern pathological diagnosis. Medical history is not a straight line from one label to another.

Dementia pugilistica and CTE are not interchangeable

Chronic traumatic encephalopathy, or CTE, is a neuropathological diagnosis defined by characteristic changes involving abnormal tau protein in particular locations in the brain. At present it can be confirmed only by examining brain tissue after death. That is different from diagnosing dementia, movement disorders, depression or cognitive impairment in a living former fighter. Researchers have developed proposed criteria for traumatic encephalopathy syndrome to study possible clinical presentations, but those criteria are not a definitive living-person test for CTE. Memory loss, changes in mood and difficulty with movement can have many causes. An ex-boxer experiencing such symptoms deserves a proper clinical assessment, not an armchair diagnosis.

What the evidence does — and does not — show

Research links exposure to repetitive head impacts with neurological concerns, and some studies of former boxers have found elevated dementia rates compared with other populations. Such studies require careful interpretation: an association in a studied population is not a prediction for an individual fighter, and differences in study design, career exposure and other health factors matter. Studies of donated brains face another problem: the families who donate may be more likely to have witnessed troubling symptoms. That makes the material invaluable for studying pathology, but unsuitable for calculating the prevalence of CTE across all boxers. Newer research, including findings publicised by the US National Institutes of Health in 2026, has strengthened the link between severe CTE pathology and dementia in studied brain-donation samples. It does not establish a universal threshold of punches beyond which dementia becomes inevitable.

The punishment we do not record

A boxer’s record lists bouts, wins, losses and stoppages. It cannot tell us how many hard rounds were completed behind closed gym doors. Two fighters with similar professional records may have endured very different head-impact exposure. Martland’s concern about sparring partners remains especially striking. The boxer paid to prepare a champion may absorb years of punishment without the recognition or resources that come with a title. We should be wary of romanticising gym wars as proof of character. Technical sparring and carefully managed preparation are not the same as repeated, unnecessary punishment.

Has boxing become safer?

There have been meaningful changes: world-title fights generally last 12 rather than 15 rounds; medical screening, ringside supervision and suspension procedures are established in many jurisdictions. The British Boxing Board of Control publishes medical requirements, including brain imaging for licence holders. Yet a normal scan cannot rule out microscopic CTE pathology, and shorter contests alone cannot establish how much long-term dementia risk has fallen. The Association of Ringside Physicians has argued for careful concussion management and has emphasised that winners can suffer concussions too. The result on the judges’ cards is not a neurological assessment. Nor does a suspension protect a boxer who continues heavy sparring while recovering.

The fighter after the applause

The medical vocabulary is necessary: cognition, movement, pathology, degeneration. But the consequences of serious illness are lived in homes rather than journals. They may involve lost independence, changes to relationships and growing responsibilities for family members. Boxing may have given someone identity, discipline, friendships and purpose. Losing those things in retirement can be difficult even without illness. We owe former fighters the courtesy of refusing to turn their difficulties into spectacle. Slurred speech in an interview or an unsteady public appearance is not sufficient evidence to diagnose CTE in a named champion.

When courage is no longer enough

Boxing asks its participants to manage fear, pain and pressure. It is right to admire that discipline. But the same culture can make it difficult for fighters to admit to confusion, headaches or other symptoms. A boxer determined to continue is not necessarily in the best position to judge whether continuing is safe. That is why the judgement of referees, doctors, corners and governing bodies matters. Stopping a fight need not diminish the person fighting it. Sometimes it is the most important act of protection available.

What does the sport owe its former fighters?

If boxing benefits from the willingness of athletes to accept physical risk, its responsibilities should not necessarily end when the licence expires. Better education about cumulative impacts, more consistent management of sparring, access to neurological assessment and stronger long-term support are all legitimate questions. They are not simple to implement in a sport divided among promoters, commissions, governing bodies and individual gyms. Yet fragmentation is not an argument for ignoring the issue. There are devoted trainers, conscientious officials and careful doctors throughout boxing. Their work deserves recognition — and support from systems capable of learning as the evidence changes.

The lasting count

It is possible to love boxing without denying its dangers. It is possible to admire a fighter’s courage while wishing a contest had ended sooner. And it is possible to acknowledge scientific uncertainty without treating that uncertainty as reassurance. Martland’s warning appeared nearly a century ago. Medicine has travelled a considerable distance since, but there are still questions it cannot answer for every individual. We remember the punches fighters landed, the titles they won and the nights they gave us. Perhaps we should spend more time thinking about the years that followed. The final bell ends the fight. It does not always end the consequences.

Sources and further reading

These references underpin the historical and scientific discussion. This article is an editorial overview, not individual medical advice.

Murphy Boxing Books — Boxing History, Judged by the Evidence.

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