NHS is not (yet) in crisis, but what about school rugby?

I am writing as a rapid response to your Editor’s choice on school rugby in this week's BMJ, with which I fully agree. I have some experience of the problem having followed my son’s career as a school rugby player (Haberdashers Aske School) and at the same time playing for Saracens RFU Club until the age of 17 in 1998. I was terrified that he could get injured that every time he was playing I was there.

At the time Rugby Football Union was an amateur sport, they did not pay doctors: when they learnt that I was a Consultant at the Hammersmith they recruited me for the first adult team as well. It was 1992. My son begged me to accept the invitation to be a doctor for the first team, because he would come freely to watch the matches.

In fact I was in charge of Haberdashers teams when my son was playing, of the whole youth section at Saracens when they were training or playing at home, and often of the first team when they were playing at home.

My experience was in keeping with your Editorial: school rugby is most dangerous, and people in charge usually do not want to agree that this is the case. The teams very often do not have the means to deal with the injuries, I often had to find some ad hoc way of temporarily immobilizing a broken limb. On a Sunday morning in 1995 a hooker broke his neck, and we had no collar to immobilize the neck. The London Hospital sent an helicopter, with a man filming the case because they were producing a new TV programme “The Blues and Twos”: the boy was operated and was saved from any major inability, but when the film was shown they would not even say that the boy had a serious neck injury. A senior broadcaster's son was in the same team, and I got him to write to the producer of that programme: they answered him that they were producing an interesting programme, not a documentary! They had no obligation to tell the truth. When we played the same team again 5 months later the family came to the match to thank me: the boy had a large neck scar, and he told me he was going to be a rugby referee.

I got the youth section of Saracens to have better facilities for dealing with injuries, but I had some difficulty in convincing Haberdashers to do likewise. I cannot make the list of the type of injuries I had to deal with: dislocated joints, fractures, epileptic fits, etc. On another match while a boy had an epileptic fit, our coach forbade me to enter the pitch.

For a long time I wondered why there was such a mass group denial that it was a dangerous sport. I propose to you some possible suggestions. During the boys matches, the most frequent spectators were the boys mothers, whether the fathers were more often at the bar drinking beer, but following the matches with the tail of their eyes. I was often surrounded by the mothers on the touch-line, for the specific reason that they wanted prompt treatment in case their children got hurt. And mostly they did.

I came to the conclusion that because Rugby is the closest to be a War Game, women understand that it is dangerous and do what is possible to get treatment for their children, like befriending the Club Doctor. Men instead think that they and their children are never going to be affected by the injuries of the war. That is why soldiers are mostly male and not female.

One of the Saracens’ father told me in a friendly way that he understood I was trying to prevent the boys hurting each other: but I was wrong to do so, because hey enjoyed doing it. My answer that it would be nice to know how likely they were to get injured was tolerated, but not accepted.

This is something that happened a long time ago. It is upsetting to notice that in the past twenty years not much has changed in knowing more about the prevalence of injuries in school rugby, improving their prevention and possible treatment.

With best wishes

Dr Mario Impallomeni, MD, FRCP
Honorary Physician Saracens RFU Club 1992-2004