Every time a boxer dies there is shock and dismay. Then the inevitable question: "How can this happen?"
The answer is both simple and complex.
"It's contact, and you're always going to have some deaths by injury," said Baltimore's Frank Gilbert, chairman of the South Atlantic branch of the U.S. Amateur Boxing Federation. "But you're also going to have them in football and you'll have them in rugby and you'll have them in other contact sports. It's never gonna stop."
It stopped for Hayes Singletary Jr., who died one week ago today. On Dec. 19, the 19-year-old Potomac High School graduate had stepped from a ring at the Hillcrest Heights Gym after sparring five rounds and collapsed. A doctor at the Washington Hospital Center, where Singletary died of what the medical examiner's report called an acute subdural hematoma, said the injury was caused "by one punch or several punches."
There were reports that Singletary had been suffering headaches for a couple of weeks prior to the sparring bout, although his trainer, Chris Cline, denied knowing about them.
It was the second death in about a year at the gym, which is part of the Hillcrest Heights Boys Club in Prince George's County. Both incidents raise the question of whether the sport of boxing is doing enough to protect the people who compete and whether there is close enough supervision of fighters at all levels.
Elwyn Kemp, 18, another fighter who works out four days a week at Hillcrest Heights, knew Singletary and said his preparation seemed solid.
"He was training all right," Kemp said. "The trainers (all volunteers at Hillcrest Heights) would be the first to know if something's wrong. Sometimes they know before you do."
None of the three trainers who worked with Singletary could be reached and James Merrick, who runs the Hillcrest Heights club, declined to comment.
Kemp called the two deaths at the club in a year "freak accidents."
Regardless of the cause, deaths in the sport have led to a call for its prohibition by, among others, the American Medical Association. The doctors group has said that the sport's "unique objective" of trying to inflict pain on an opponent makes it dangerous and wrong.
"There is overwhelming evidence that cumulative damage from trauma to the head results from 20 or 30 pro bouts," said James Stacey, an AMA spokesman. "The trauma severs capillaries and nerve fibers. The kind of case you're discussing (the death) is rare, but the fact remains that blows result in cumulative damage to the head. If the name of the game is to hit somebody in the head, you're gonna get damage."
Supporters of the sport argue that banning it would make boxing more dangerous by removing the supervision that goes with sanctioning.
"They tried a similar thing with Prohibition," said Chester O'Sullivan, director of the Maryland Athletic Commission. "People just made whiskey in their own bathtub. It'll be the same with boxing. If they eliminate it (make it illegal), they'll just go in barns and club basements. You would have so many more deaths."
But even now regulations vary from state to state and opinions and rules vary on such things as the size of gloves, whether gloves should have thumbs (which many believe contribute to eye injuries) and whether fighters who have suffered certain injuries (such as detached retinas) should be allowed in the ring again. The number of rounds in fights also varies from amateur to professional, from weight class to weight class, and from one professional group to the other.
Opinion varies, too, on how much medical knowledge is necessary at ringside. In Maryland, as in most states, there is no licensing of trainers required and clubs are not required to have medically schooled personnel on hand during sparring.
Dr. Robert Voy is the chief medical officer of the U.S. Olympic Committee and a vocal supporter of the sport. He said there are steps that can be taken to improve the quality of gyms and trainers, but there are limits.
"A trainer is only as good as the information that the athlete gives him. They can get a head injury from a street fight or something else and fail to tell the trainer," Voy said.
"I think that gyms ought to be licensed, and have some life support system and be medically regulated . . . There ought to be a certification process for persons who purport to be responsible for the athletes."
Gilbert manages the gym at the Loch Raven Optimist Club in Baltimore, where 18 fighters work out and he trains part time. He has no medical training but said that at the club, "We constantly ask them, 'How do you feel? Are you okay?' "
Dr. John Stiller of George Washington University Medical Center's department of neurology, who has done research into chronic head injuries of boxers, agreed that licensing would be a good step.
"If you licensed trainers, that might be a help. If you gave them first aid courses and other instruction, so they can tell when somebody's too tired or hurt."
Stiller said organization could also improve the sport.
"If there was a central boxing commission, it would be easier to do studies," Stiller said. "Even without rule changes, a commission that does physical exams and keeps records would at least cut down on cases of people boxing in one state under one name and going to the next state to fight under another."
Former heavyweight champion Floyd Patterson, who from 1977-84 served on the New York Athletic Commission, agreed. "That would be the best thing," he said. "If there was a central commission overseeing all of boxing, there would be one rule and one regulation for all the states."
Patterson, like all the others interviewed, said he knew of no national sanctioning body for fight trainers.
Jim Foxx, president of the USABF, said the sport nevertheless has made many changes suggested in recent years, such as "wearing head gear and better control of personnel." Most trainers are former boxers, who don't necessarily have extensive training in the medical areas of the sport.
"Yes, we do have a lot of former boxers acting as trainers, but we are in the process of developing, with doctors, some medical seminars and certification," Foxx said.
The USOC's Voy would like to see doctors help boxing rather than "doing something stupid like trying to ban the sport."
"That's why we're undertaking a study with Johns Hopkins University," Voy said. "We want to find out what occurs in the cases of chronic head injury. How many bouts is too many? How many blows is too many? When we find out the results we'll change the rules if that's what's needed.
"Football almost got itself banned. Then the AMA and some of its doctors discovered that spearing was dangerous and they have now outlawed it. But you can't outlaw a sport that has as much tradition as boxing. As Ernest Hemingway said, boxing is the epitome of sport. One man against another, with nothing more than their bodies."