TIME OUT," yells the referee as twenty-one players untangle themselves from a seething, struggling mass of humanity. The twenty-second man lies flat on the ground, to all outward appearances dead, while one of his team-mates tries to loosen his head guard and apply first aid. By this time the doctor is on the field. He takes one look at the player and returns to the side line, where he says to the head coach, "He is all right." The player meanwhile is still flat on his back, apparently just as dead as ever. You can hear the people in the stands saying, "He looks badly hurt. I wonder who will take his place?" The whistle blows. The man is on his feet and ready to resume play. What has happened? How did the doctor know that the man could play? It was all over in two minutes.

Again the game is stopped by the whistle. This time our doctor is asking permission of the referee to go on the field. Having obtained it he goes directly to one man. To the spectators nothing is wrong with this player yet he is coming off the field with the doctor - not, however, without visible protests. A substitute takes his place and the game goes on.

Later in the game a player is knocked down by the interference. He gets up limping, tries to walk, and after a few seconds manages to hobble around, although plainly showing that he is suffering great physical pain. This time the doctor gets up from his seat, watches the man intently for a moment and then returns to his place. The game is resumed and our supposedly injured man shows no effects from his recent injury. Again what has happened? The man had apparently been badly hurt yet his actions now show that the doctor was right. How did he know that the man was not seriously injured? He surely gave more outward signs than did the other player who was removed from the game for no apparent cause.

These are but three typical examples of happenings during a football game, which every spectator notices but in the majority of cases forgets. What has happened in each of these cases?

In the first one the man flat on his back made his own diagnosis. "Just my wind, Doc." To make sure that it was not a blow on the head resulting in slight concussion, a few simple questions such as, "What is the score" and "What period is it?" usually suffice to give an accurate account of the man's mental condition. It has been observed many times that the man who can tell what his injury is, and does so, is usually not the man who causes the doctor needless worry on the field. It is the player who insists that he is all right and refuses to admit that anything has happened to him that makes the doctor's work difficult. In the case at hand previous experience has taught that if a player's wind is knocked out the injury is temporarily very uncomfortable but is not permanently disabling. A few minutes' rest is all that is necessary to effect a complete cure.

In the second case where the man was removed by the doctor for no apparent cause), if you had been watching the man as closely as had the doctor you would have noticed that twice he had lined up in the wrong position and each time had to be straightened out by one of his team-mates. He was confused when the signals were given, and did not carry out his assignments during the play. When the doctor asked him the day of the week, the score, etc., he did not know, but insisted he was all right. He had received a blow on the head. He had what is called, for the lack of a better term, a slight brain concussion. From the time he was removed from the game until he was in bed in the college infirmary he was never left alone. The following morning he answered all questions clearly but remembered only going to the field to play. He did not remember the game at all, and he did not know how he got to the infirmary. There was a blank of several hours. As time passed the forgotten hours were accqunted for except for a few minutes following his actual injury in the game. This period will always be a blank, but no permanent injury will result.

The third man with the limp had received a blow on his shin which although very painful for the time being is not lasting. That the man was able to resume play a few minutes after the injury was proof that nothing really serious had happened.

The work of medical advisor to a football team consists of first, the actual care of the players during a game and the subsequent treatment of their injuries, and second, the supervision of their training.

Throughout the game the doctor watches eleven individual men. He sees very little of the game itself. He must watch twenty-two legs and twenty-two arms and know at a glance whether a limp that suddenly develops is serious or not. On the field he has but two minutes to make his diagnosis. In this short time he must decide if this man can perform his duties efficiently. If allowed to continue to play will he injure himself still more? In answering these questions the doctor must always keep in mind, that he is responsible to the player's family and to the college. On no account can he allow a man to play after being hurt if doing so will cause a more serious injury. He is responsible to the coaches for the efficiency of the team, as one man physically incapacitated may lose the game on the next play, because he cannot fulfil his assignment.

Barring the inevitable accident which is omnipresent on the football field, the two chief causes of serious injuries are first, improper protection from lack of padding, and second, allowing men to continue play after they are physically exhausted. With reference to the player's uniform, twelve years ago a majority of the players wore no headguard and the amount of padding they used was left to their own discretion. In contrast, at Harvard, no player since 1907 has been allowed to scrimmage or play in a game without a properly fitted headguard. Furthermore, the same rule has been applied to the pads which protect certain vital muscles and joints. The doctor personally supervises the fitting and use of this "armor."

Experience has also shown that when players are exhausted they become prone to injuries because they no longer have full control of their muscles. Therefore, during all practices and games the doctor carefully watches the condition of each player, and should be the sole judge as to how long he should continue to play. In this respect, throughout eleven years of Varsity coaching, the author never once thwarted the doctor's judgment.

After every practice and game the doctor sees every man who has taken part. He notes in writing all injuries, however slight, prescribes treatment, and orders the injured men to report for further examination before the next practice. Each day he sees the men who have been hurt the day before. If they are fit to resume practice their names are taken off the "Injured List"; if not, they are given the necessary treatment and the progress of recovery of the given injury is recorded.

The second part of the football doctor's work, the supervision of training, begins when the college closes in June. At this time a printed list of instructions is sent to each prospective football player. The sum and substance of this pamphlet is, do not go into such training during the summer as to return to college down to weight. It is better to return overweight. Exercises or games that tend to increase speed and develop accuracy of the eye are best, such as tennis, squash racquets, handball, etc. Swimming is an excellent all-around exercise, but gymnasium work is not well suited for the football player as it tends to make a man muscle-bound.

Many players erroneously think that they should report for football in September "trained fine," and therefore spend the preceding summer months doing some form of hard physical labor so that when the season opens they are "down to weight." Quite often this method ends disastrously. The player goes "stale" and becomes useless to himself and to the team. Here is an example. John Smith, after the spring training season, followed the advice of some friends and went to work on a farm to get into good shape for football. He reported for practice thirty pounds under weight. He was nervous arid restless. His appetite was poor, and he was not sleeping well. He was not allowed to play football. He was told to rest, to get at least ten hours' sleep a night, eat three meals a day and exercise in moderation. In three weeks he gained eighteen pounds. At the end of another month he had gained twenty pounds more and admitted that he never had felt better. Here was an athlete who had over-trained - or gone stale. This may sound like an extreme case but you may rest assured that every year some boy turns up who has been as badly misguided as John Smith.

The football season proper starts two to three weeks before the first game. This period of time is required to bring the men into condition to do the physical work necessary during a contest.

When the players report for practice in September every man is given a careful and complete physical examination, and is required to report any bone or joint injury that he may have received in the previous four months. After practice begins all players are instructed to report every injury, no matter how trivial, to the doctor in charge. They are not to assume that a scratch or a bump is nothing and "will be all right tomorrow." It is not the player's province to decide whether he is physically fit. The doctor is the Supreme Court on this subject; and all concerned, coaches as well as players, must abide by his decision.

Thus a man reports a slight sprain or bruise. His name goes on the "Injured List" and stays there until the doctor thinks he is physically fit to resume practice. That no mistake may be made in this matter a copy of the "Injured List" is sent at the beginning of each practice to the head coach, who can then tell at a glance which players are not available.

The early days of practice are taken up largely with conditioning exercises which limber up the muscles and accustom them to the more strenuous work that is to come. After a short time the soreness and stiffness disappear and the men find that their "wind" is improving. However, at this stage they are still far from ready for the rough and tumble of the game. Even one bad fall now would cause unnecessary bruises and very sore muscles. Later on, after the players have had a few scrimmages, a severe bump or fall will produce scarcely any effect. Accordingly, then, conditioning of the men may be defined as so exercising the whole body, muscles, lungs, etc., that they will perform their respective functions under stress without fatigue; and so toughening the body to blows and falls that they do not produce sore and tender bruises that may last for days. Thus the early season work starts easily and gradually becomes more and more strenuous until at the end of five or six weeks a player should be in nearly perfect condition.

It is difficult to define the word "training" accurately, for it includes not only actually learning the plays and their execution, but also developing the physical stamina necessary to carry them out in competition. To bring about these two ends requires time, patience, and great care of the human machine. After the first week or ten days the squad goes into strict training.