The first protective headgear for football players appeared in the 1890s. Annapolis midshipman Joseph M. Reeves, who would go on to become the father of the aircraft carrier, is credited as the first player to wear one because he was told he risked death or “instant insanity” if he took another blow to the head while playing football. There were others who tinkered with similar designs, however, most notably Dr. James Naismith, the inventor of basketball. He had suffered the disfigurement of “cauliflowered ear” from rough football play and designed his invention to prevent ripped ears, not concussions. This seems to have been the most common reason why players began wearing “harnesses” during the last decade of the 19th Century. 

True “helmets” appeared on the football field in May of 1915. Covering the entire skull and both ears in padded soft leather, sporting a rugged chinstrap for the first time, these flat-topped models offered a little bit of suspension between shell and skull, a small measure of protection from the debilitating impacts of the game. Just two seasons later, Red Grange played for the University of Illinois in a teardrop-shaped, padded leather helmet with a chinstrap and ear flaps. Designed by his coach, Bob Zuppke, it would be the standard headgear for all football players until the 1940s, and remains an iconic symbol of the era in American football. 

Which is not to say the transition was total. Football helmets were not mandatory for play at any level in 1915; they were not required at all levels until the Second World War. Even though most players wore them, a few eschewed helmets as unmanly, or too hot, or an interference in their ability to see and hear. 

Some of these same grumbles could be heard in France as every army designed a steel helmet and began issuing them to troops during 1915. Von Schlieffen’s foresight that “every means of modern science” would be brought to bear had been accurate, for the battles of innovation were immediate, and the high rate of fatal head wounds demanded an answer. 

In May — the very same month that those first chinstrapped, fully-enclosed leather football helmets appeared on the practice field — the French Army started distributing a new steel helmet shaped like the one contemporary Parisian firefighters wore. Named for Louis Auguste Adrian, the quartermaster general who had begun to issue steel skullcaps in December of 1914, it was made of low-carbon steel, and fairly effective against shrapnel, though not so much against bullets. 

The Invention Department at the British War Office did not like the Adrian. Wartime logistical challenges were straining the limits of British industrial capacity as it was, while the stapling, soldering, and riveting process of the French helmet’s manufacture was deemed too complex for a nation that was already struggling with a diminished wartime labor force. Martin Boswell, the Imperial War Museum’s curator of uniforms, personal equipment, and flags, has counted “more than 70 complex operations” to make just one Adrian. For example, a single worker had to use 50 different tools to make the decorative badge, which features a flaming grenade and the letters RF (for République Française.) It is a typical example of the contemporary French obsession with perfected craftsmanship, even at the expense of practicality, that had workers precision tooling the individual recuperator mechanism of every 75 millimeter artillery gun with jeweler’s loupes. In the eyes of the War Office, it was simply too complicated, too fancy, and too French. 

The War Office wanted a distinctive helmet — a thing that looked British, and that was easier to make, so the war government solicited ideas. Appropriately enough, this process settled on a design submitted by an American. John Leopold Brodie, an employee at the Army and Navy Store in London, proposed to stamp out helmets in a much simpler process. He offered to demonstrate the stopping power of his design by wearing a sample while a War Office representative fired a .45 caliber pistol at it, and legend says that they did conduct a proving experiment on Brodie himself using a steel bar. The first 4,400 “Type A Brodie” helmets arrived on the Western Front in September of 1915 for experimental use in the Battle of Loos. It won the approval of troops who wore it under fire, and their suggestions were incorporated into the Type B model, which was made from manganese steel that was just as thick as the Adrian, but twice as strong. A better lining and stronger chinstrap lugs were added. By April of 1916, every British soldier serving in the front lines wore a Brodie Type B helmet.

Of course, the Imperial German Army went to war wearing helmets. Shorn of its metal decorations, the iconic pickelhaube (literally “spiked helmet”) could have been the most advanced headgear on the American gridiron, though it was more than 70 years old. Made of hard, boiled leather, it was unable to cope with the wounds of 1915. It could not stop bullets and did not protect a man’s brain from overhead shrapnel bursts. Even rock fragments blown into the air by high explosive shells had enough force to injure or kill a soldier wearing a pickelhaube. 

During September, the same month in which Britain tested their Brodie helmet design at Loos, two professors at the Technical Institute of Hanover designed an all-steel helmet to replace the pickelhaube. Dr. Friedrich Schwerd, a military physician, and Dr. August Bier, a physicist, produced their first prototypes for field testing by the elite stormtroopers of the 1st Assault Battalion in December. Impressed, Field Marshall Erich von Falkenhayn ordered the new Stahlhelm (“steel helmet”) issued to all troops in the field. The first 30,000 of them arrived at the Verdun front in January of 1916, just in time for Falkenhayn’s stormtroopers to put them on and open his epic campaign to “bleed France white.” By 1917, millions of Stahlhelms had been distributed throughout the Imperial German Army; that same year, they began to appear on the heads of the Kaiser’s Austro-Hungarian and Bulgarian allies; by the end of the war, Germany was sharing its supply of helmets with their Ottoman ally, too. 

As one would expect, none of these helmet designs was born perfect. All of them were improved over the course of the conflict. Designed at first to protect against overhead shrapnel bursts, they quickly produced demands for improved webbing to cushion the skull against bullet impacts. Like the very first football “head harness” makers, Schwerd and Bier had also neglected to add a chinstrap, requiring a new model to be issued in 1918. A “cavalry” version was issued with modified flanges to aid in hearing. Yet all three of these designs lasted into the Second World War with relatively minor modifications, underlining how effective they were at the task for which they had been invented. 

Their effects on battlefield medicine were immediate — and perverse. Field hospitals filled up with survivors whose head injuries would have killed them if not for their helmets. Doctors were now treating more head and brain trauma than ever before, while the number of cases of “shell shock” rose dramatically. For while these new steel helmets were very good at stopping small, high velocity objects from penetrating the brain, they offered no protection from blast pressure waves — the signature form of injury on the Western Front, where the use of shrapnel shells was already declining in 1915 as each side deployed more and bigger high explosive munitions to dig the enemy out of his trenches. 

A similar tragedy was forming under the new football helmets. Because fewer young men were dying immediately on the field, or succumbing quickly to head injuries sustained in play, the long-term damage of concussions and cumulative trauma went unremarked. Tackle drills continued to emphasize hard impact instead of “wrapping up” an opponent. Players still launched themselves against one another from low stances. When young men complained of dizziness, coaches still urged them to “play hurt.”

Writing in 1912, Pop Warner claimed that “I have never seen an accident to the head which was serious, but I have many times seen cases when hard bumps on the head so dazed the players receiving them that they lost their memory for a time and had to be taken out of the game” — a description of concussion injury that would definitely be described as “serious” today, and that would likely keep a player off the field for weeks. 

Warner’s attitude was still general to the coaching profession when Patrick, our high school quarterback, suffered his concussion: You gotta play hurt son, there’s a war on Friday. 

However, a century of military medicine and sports medicine has finally begun to grapple with the full reality of traumatic brain injury. Once again, these revolutions in understanding have happened at the same time, in parallel, even hand-in-hand.

During America’s wars in Iraq and Afghanistan, the mode of delivery has been improvised roadside munitions rather than massed artillery fire, but the physics of high explosive blast are still the same as they were on the Western Front. What had changed by 2007 was the medical capacity to detect blast injuries. Military doctors soon realized that an epidemic of brain trauma was unfolding. In another perverse turn, medics determined that the new armored vehicles meant to protect soldiers actually multiplied the effects of a blast by concentrating the shock wave inside the hull. To make matters worse, the soldiers’ helmets often focused the blast energy within the helmet rather than blocking it — a phenomenon called “underwash.”

This was not a result of poor helmet design, but the priorities behind their engineering. The Pentagon had developed headgear made of Kevlar during the 1980s, testing many different models before determining that the German Stahlhelm shape was the best at stopping bullets while allowing the wearer to hear commands. These helmets were not padded on the inside, however, but suspended from an internal webbing similar to the old Brodie helmets. This was for ventilation, as the first Kevlar helmets weighed seven sweltering pounds. Responding to the IED threat, military procurement systems moved quickly to distribute hundreds of thousands of new, lighter helmets equipped with padding to reduce shock. This required a delicate balancing act of materials engineering: if the pads are too stiff, they will transmit more of the blast energy to the skull; made too soft, the padding will not stop the helmet from striking the skull, thus transmitting the impact of bullets and shrapnel. There is no easy fix: a design that reduces blast injury will be less effective against bullets, and vice-versa. 

Nor had football helmet technology languished since Bob Zuppke introduced his “ZH” style helmet in 1917. Over the decades that followed, outer shells were hardened, leather was eventually replaced with hard plastic, padding was thickened, face masks were added, and air bladders were built inside the plastic shell to absorb impact. Yet a 2012 study found that many of the most modern designs were no better at protecting players from TBIs than Zuppke’s leather helmet, and some were actually worse. 

It was an alarming result that added to a roiling new controversy. In 2005 and 2006, a pathologist named Dr. Bennett Omalu had published papers describing CTE in the brain of Mike Webster, an NFL star who died in 2002 presenting severe mental health symptoms, and another Pittsburg Steelers great named Terry Long, who passed away in 2005. Neither man was old, but they had both endured thousands upon thousands of hard collisions while playing in the “trenches,” and indeed linemen have emerged as the principal victims of the disease. The National Football League responded by demanding that the journal Neuroscience retract Omalu’s work. Only in 2009 did the league finally acknowledge that CTE was a real problem and begin taking remedial steps. 

As on the battlefield, this has created a new dilemma for the gridiron. Rules now prohibit players from “targeting” each other with their helmets, or hitting other players’ helmets. New NFL rules have eliminated dangerous blocks, expanded the category of “protected” players, and tried to deter running backs from leading with their head. Yet there are still concussions on the field, and so far, no technological or tactical solution has eliminated accidents, so players remain at high risk of TBI as well as CTE. 

Nor are these changes necessarily popular, as players are being penalized for the devastating hits that audiences love most. Donald Trump spoke for this point of view when he complained that players get penalized for tackling opponents “too hard.” 

They had that last week. I watched for a couple minutes. Two guys, just really beautiful tackle. Boom, 15 yards! The referee gets on television, his wife is sitting at home, she’s just so proud of him. They’re ruining the game! They’re ruining the game. They want to hit! They want to hit! It’s hurting the game. 

Of course, there were Roman citizens howling in anger when the coliseum stopped hosting bloody gladiator matches, too, but we need not look so far back in time for a point of comparison. In 1905, many football fans were outraged that anyone would change the rules to deter the most violent collisions. Writing for Deadspin.com in 2014, Aaron Gordon pointed out that wider use of “head harnesses” was just one way the game struggled to change: 

In the short term, none of these measures made football safer. As [executive director of the Professional Football Researchers Association] Ken Crippen told me, “It just increased the number of punts and field goals.” The true accomplishment was a matter of public relations: The new rules silenced the universities threatening to cancel their football programs and the public outcry resulting from these threats. “They at least got the public off the backs of the football programs,” Crippen said. “They said, ‘Hey, at least we’re trying something.’” 

Naturally, once CTE and concussion became hot topics in the first decade of the 21st Century, the football helmets themselves quickly came under scrutiny. As The New York Times revealed in 2010, no football helmet had ever been tested against a concussion-prevention standard at any level of the game. Instead, all helmets had primarily been designed to prevent skull fracture and brain hemorrhage according to a standard set in 1973. “More than 100,000 children are wearing helmets too old to provide adequate protection — and perhaps half a million more are wearing potentially unsafe helmets that require critical examination,” Alan Schwarz reported. 

The engineering response was swift. In 2014, subsequent testing of new helmets specifically designed to answer the problem found that some could reduce the risk of concussion by half. However, the most advanced new helmet on the market cost $950 — far more than most families could afford, and certainly more than most high schools. While the market has improved as more companies scale up production, the solution to the engineering problem has become a financial problem for communities that play the game.

Furthermore, human nature collides with physics once again. For while no helmet can prevent all concussions, a player will naturally tend to expose the best-protected parts of themselves to the most danger. It is simple human nature. Pop Warner observed in 1912 that some players actually wore a head harness because “they claim [it] gives them more confidence” on the field, encouraging harder hits and riskier play. This phenomenon is known as “risk compensation” or “risk homeostasis,” and addressing it leads to counter-intuitive innovations. For example, college teams have begun to experiment with helmetless tackling drills to condition players against leading with their heads. As the NFL mandates more padding, a new amateur form of the game ditches all the helmets and pads in the name of increased safety. Known as the American 7s Football League, or A7FL, this full-contact version of the sport purports to reduce injury rates through safer tackling techniques. 

It remains to be seen whether these responses will have the intended effects. Nevertheless, something is clearly happening, as it must happen. Sued by the family of a man who suffered CTE from childhood and committed suicide at the age of 25, the youth football league named for Pop Warner settled for an undisclosed sum in 2016. In August 2017, two more families sued Pop Warner for allegedly mishandling head injuries related to CTE. This process will doubtless force some kind of change. If the cost of youth football becomes prohibitive, then younger children may simply have to be restricted to flag football, with tackling and pads and helmets prohibited until age 12 or 14 or even older. Insurance giant AIG decided to stop issuing policies to cover NFL head injuries during 2016, calling the very existence of the game into question. 

Or perhaps not. Maybe the American game of industrial war is so vital a cultural institution, so necessary to the self-image of a nation where the values of work and military virtue are held so dear, that it will continue destroying young brains into the foreseeable future, sustained by popular demand. 

Similarly, more than 350,000 United States service men and women have been diagnosed with traumatic brain injury since 2002, and they tend to be young. Their care will require at least $2 billion a year for the rest of their lives, according to the Pentagon. It is likely that many more injuries have gone unreported because PTSD and depression remain so stigmatized in military culture. How many of these unknown sufferers will end up filling hospital beds and prisons, written off as wards of the state? Only time will tell, and only if we want to know. 

There is a bit of good news on this front. Until recently, CTE could only be diagnosed through microscopic examination of brain tissue after death. Neurologists have now learned to use positron emission tomography (PET) scanning technology to detect the condition in the living, allowing for the development of better treatments and prevention. 

No simple technological or medical fix exists, however. Every time the load on a soldier’s neck is increased to protect the brain — for example, by issuing helmet-mounted blast sensors as the Army did in 2009 — it adds to other forms of injury. 

“I have more than 200 hours of flying with [night vision goggles] that’s weighed 2 pounds,” Sgt. James, an attack helicopter pilot, explains. That, “plus the 4 pound aviation helmet, plus the 24 oz counterweight and the Apache monocle,” along with the constant jarring vibrations of his machine, have added up to a compressed cervical disk and never-ending pain. “I’m 36 years old and beat up by the Army,” Sgt. James says, but he is also too close to retirement to leave service. Assigned to test experimental equipment in the field, he does not look forward to the new Integrated Head Protection System (IHPS). Futuristic in appearance, it offers great protection against bullets, but weighs eight miserable pounds. By comparison, the Stahlhelm weighed about two and a half pounds.

Next: the final post in this series.