Boxing

Paul Ingle (left) during Saturday's fight

The catastrophic brain injury suffered by boxer Paul Ingle has placed his life in the balance.

Injury to the delicate tissue of the brain has caused a large blood clot to form, putting pressure on the brain surface.

Although surgeons acted promptly to operate and remove the clot, it will be days before neurologists know whether he will survive, and how much permanent damage has been done.

At the moment his brain has swollen inside his skull, and he has been drugged to keep him unconscious - being semi-conscious or even awake at this time would not help his recovery, and place him at risk of further damage.

What are the dangers?

Many doctors see boxing as an unacceptably dangerous sport - the British Medical Association (BMA) would certainly like to see it banned.

But medical advisers to the sport's controlling bodies say that with the proper precautions, it need not pose too high a risk.

While boxing accounts for fewer deaths than many other sports, the BMA says this is insignificant compared to the effects of brain damage that may go unrecorded in many boxers.

Cuts and bruises are the most common boxing injuries, and many boxers leave the ring needing stitches to the face and dental work.

Body blows can lead to broken ribs and internal bleeding.

But, as boxing involves powerful people hitting each other repeatedly, often around the head, there are other risks - most serious of all being permanent severe brain damage.

While other injuries repair relatively easily, brain tissue, once damaged, remains damaged.

The symptoms of such brain damage - commonly known as being "punch drunk" - include slurred speech, slow reactions and even occasional blackouts.

Many people assume that the predicament of the world's most famous fighter, Muhammad Ali, was brought about by his numerous "wars" in the ring.

But he is suffering from Parkinson's Disease and there is only circumstantial evidence to suggest it was brought on by his boxing career.

Brain damage occurs in one of two ways:

• Catastrophically, meaning it follows an injury sustained in a single bout. This was the case in the Watson bout, when a blood vessel in the skull burst and a clot put pressure on the brain tissue
• Gradually, meaning the brain damage builds up as a result of repeated blows to the head

The BMA, which represents 84% of the UK's doctors, opposes boxing primarily because of the threat to the brain and eyes.

Dr Bill O'Neill, the BMA's spokesman on boxing, said less serious external injuries could illustrate the impact of unseen damage within the skull.

"Imagine the boxer's nose and the repeated fractures of the nose and transpose that to what's going on inside the brain.

"The boxer can recover from the broken nose - he can breathe again. But at the end of the day he's got a very scarred and misshapen nose.

"Now picture that going on inside the brain."

What treatment is available to boxers?

Doctors who support boxing say there are no serious risks if proper medical care is available at the ring.

Michael Watson's High Court claim centred on whether better treatment early on would have prevented the serious damage he sustained.

Certainly ringside medical care has improved since then and Dr O'Neill said: "It would be fair to say it's becoming more like a casualty department at the ring."

He pointed to the fight involving Spencer Oliver, who suffered life-threatening injuries in the ring in 1998 - four years after Watson's last bout.

Oliver received full emergency care from the moment he left the ring, and he has made a full recovery. He has now become a trainer and boxing pundit.

In 1995 the British Board of Boxing Control introduced a raft of measures to improve safety.

One was the introduction of annual MRI brain scans for boxers, and the minimum length of time between fights for boxers who suffered a knockout was extended from 28 to 45 days.

However, the BMA's concern remains with head injuries.

"If they were to ban punches above the shoulder, we would have to reconsider our policy," Dr O'Neill said.

For the moment it continues to lobby for a total ban on boxing for men or women.

Why are boxing injuries different to those in other sports?

The key difference for the BMA is the intention to inflict hurt.

Dr O'Neill said: "In boxing you aim to punch your opponent's head. If you do that in football, you get sent off."

Professor Hugh Bayne, from Sunderland University, has examined the case law surrounding boxing and suggested a way to get the sport as good as banned.

He wrote in the British Medical Journal that doctors could make boxing illegal in the UK simply by withdrawing their support and refusing to attend bouts.

He pointed out medical cover is a legal requirement at all boxing promotions and, given the dangers associated with the sport, asked if the profession should withdraw its co-operation.