UNITED STATES DISTRICT COURT DISTRICT of MINNESOTA in Re
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CASE 0:14-md-02551-SRN-JSM Document 644 Filed 12/08/16 Page 1 of 293 UNITED STATES DISTRICT COURT DISTRICT OF MINNESOTA In re NATIONAL HOCKEY LEAGUE ) MDL No. 14-2551 (SRN/JSM) PLAYERS‘ CONCUSSION INJURY ) LITIGATION ) DECLARATION OF STEPHEN T. ) CASPER, PH.D ) This Document Relates To: ) ) ALL ACTIONS. ) ) CASE 0:14-md-02551-SRN-JSM Document 644 Filed 12/08/16 Page 2 of 293 TABLE OF CONTENTS Page I. QUALIFICATIONS ................................................................................................. 1 II. SCOPE OF OPINIONS ............................................................................................ 3 III. SUMMARY OF OPINIONS .................................................................................... 3 A. Concussions in the Historical Record ........................................................... 3 B. Concussions in Sports ................................................................................... 4 C. Controversies Over the Danger and Management of Concussion Injuries ........................................................................................................... 5 IV. METHODOLOGY ................................................................................................... 6 A. Historical Methods ........................................................................................ 6 B. Potential sources of bias ................................................................................ 7 C. Libraries and archives ................................................................................... 7 D. Timespan ....................................................................................................... 7 E. General historical method ............................................................................. 8 F. Generating keywords and subject-classifications ......................................... 9 G. Selection of journals .................................................................................... 14 H. Selection of other published primary sources ............................................. 17 I. Selection of social and cultural sources ...................................................... 17 J. Selection of secondary literature ................................................................. 18 K. Exclusions ................................................................................................... 18 L. Organization of the Declaration .................................................................. 19 V. ANALYSIS OF THE HISTORICAL RECORD ................................................... 20 A. Introduction ................................................................................................. 20 B. Professional Hockey is an Industry in which Head Injuries are a Common Occupational Hazard ................................................................... 29 i CASE 0:14-md-02551-SRN-JSM Document 644 Filed 12/08/16 Page 3 of 293 C. Core Concepts Gleaned From the Historical Record .................................. 41 1. The Stable Evolution of the Concussion Definition ........................ 41 2. Sports Concussions are Brain Concussions ..................................... 49 3. History of Nomenclature for Long-Term Consequences of Concussive and Closed Head Injuries .............................................. 65 D. Overview of the History of Concussive Head Blows and their Sequelae ....................................................................................................... 69 E. A Series of ―Firsts‖ Develop the Medical Community‘s Understanding of Concussion ..................................................................... 78 1. First Attempt to Systematically Organize the Nomenclature for the Long-Term Consequences of Concussion and Closed Head Injuries .................................................................................... 82 2. First clinical review of the scope of existing medical knowledge about concussion of the brain ........................................ 84 3. First Discussions of Surgical Interventions in Head Injury to Reduce or Resolve Persistent Sequelae ............................................ 86 4. First Reports on Laboratory Studies Providing Animal Models of Brain Concussion ............................................................ 89 5. First Analysis of the Causes of Insanity in an Asylum .................... 90 6. First Follow-Up Study of the Long-Term Outcome of Patients with Trauma to the Head .................................................................. 91 7. The First Retrospective Study of Psychiatric Symptoms Following Head Injury ..................................................................... 94 8. The First Study Comparing Different Groups of Head Injury Patients Using Cross-Disciplinary Methods .................................... 95 9. First Controlled Treatment Study Analyzing the Outcomes of Cerebral Concussion after Different Hospital Procedures ............... 96 10. First Prospective Cohort Neuropsychological Study of Concussion in a Sport ....................................................................... 97 F. Scientific and Clinical Research Providing Evidence and Explanation for the Effects of Concussion and Brain Injury .................... 103 ii CASE 0:14-md-02551-SRN-JSM Document 644 Filed 12/08/16 Page 4 of 293 G. Chronology of Significant Pathophysiological Investigations into Concussion and Closed Minor Head Injuries and their Effects upon the Brain .................................................................................................... 105 H. Head Injury Risk in Amateur and Professional Contact Sports ................ 114 1. Early Medical Voices Expressing Concern about the Risks of Contact Sports ................................................................................ 115 2. Landmark Studies of the 1920s and 1930s Demonstrating Degenerative Brain Pathology in Sports Players ........................... 117 3. Contact Sports and the Emergence of Sports Medicine, 1940 to 1990 ............................................................................................ 126 4. Medical Guidelines for the Management of Concussion in Sports, 1970s to 1990s ................................................................... 136 VI. CONCLUSION .................................................................................................... 143 iii CASE 0:14-md-02551-SRN-JSM Document 644 Filed 12/08/16 Page 5 of 293 I. QUALIFICATIONS 1. My name is Dr. Stephen T. Casper. I am a tenured Associate Professor of History in Clarkson University‘s Department of Humanities and Social Sciences. By training, I am an expert in the history of modern medicine and science. 2. I hold a Bachelors of Science degree in neuroscience and biochemistry from the University of Minnesota, where I also briefly worked in the Department of Neurology as a Junior Scientist in an Alzheimer‘s Research Laboratory before beginning my doctoral training in the history of medicine and science. 3. I earned my PhD from University College London in 2006. I was awarded a fellowship covering tuition, travel, books, and living expenses for the entirety of my doctoral training, which came from an award jointly funded by the Wellcome Centre for the History of Medicine and the Association of British Neurologists. I have also held, respectively, visiting scholar and fellowship positions in the University of Cambridge‘s Department of History and Philosophy of Science, and at the Rockefeller Archive Center in Sleepy Hollow, NY. 4. My expertise is the history of neurology, physiology, neuroscience, and psychiatry. I am also regarded as an authority on the specialization of medicine in history and the historiography of ‗the patient‘ in medicine. 5. I have written and published a scholarly monograph focused on the history of British neurology entitled The Neurologists: A History of a Medical Speciality in Modern Britain, c.1789-2000. I also co-edited with L. Stephen Jacyna the book, The Neurological Patient in History. I have a second edited volume forthcoming with the University of Rochester Press titled The History of the Mind and Brain Sciences: Technique, Technology, and Therapy. I have published peer-reviewed articles, essays, and book reviews in premier history of medicine and history of science journals, including Bulletin of the History of Medicine, Medical History, Isis, and Science in Context. I have also published in scientific and clinical journals, including Science, Brain: A Journal of Neurology, and the British Medical Journal. 1 CASE 0:14-md-02551-SRN-JSM Document 644 Filed 12/08/16 Page 6 of 293 6. My published scholarship has been recognized with numerous invited speaking opportunities at prestigious academic institutions, including Columbia University, New York University, Princeton University, and the Max Planck Institute for the History of Science. I have also presented my research at prestigious national and international academic conferences focused on the history of science, medicine, and neuroscience. My scholarship in the history of neurology has also been recognized by invitations to speak to neurologists and psychiatrists: I have, for instance, given Neurology Grand Rounds at Columbia University and The Ohio State University. I have been an invited lecturer to the Association of British Neurologists and the XII World Congress of Neurology. 7. My service record in the history of medicine is extensive. I am