Sports
Sportsmen

James Nicholas, M.D.: "Nick the Knife" (1970)

A few Sunday afternoons ago, a big New York Jet tackle, Roger Finnie, defending against an end sweep, was clipped to the turf, where national television captured him writhing in agony. After a time-out was called, onto the San Diego field trotted both the Jets trainer and its orthopedic surgeon, James A. Nicholas, M.D. The latter, a balding man wearing glasses and a business suit, observed that Finnie's leg was bent from the knee at an abnormal angle. The doctor quickly diagnosed not only torn ligaments but a dislocated knee cap that accounted for especially excruciating pain. Nicholas first put his own legs underneath Finnie's knee, in order to take weight off the damaged leg, and then put his hand on the kneecap and delicately moved it back into place, reducing the pain resulting from dislocation, somewhat easing the tackle's discomfort.

Two Jets linemen, Winston Hill and John Schmitt, then lifted Finnie up and helped the hobbling player to the sidelines, where he was put on a stretcher. Carried into the locker room, Finnie was disrobed and closely examined. "Within ten minutes," Nicholas told me, "I knew he needed an operation, as did Roger." The Jets' traveling secretary, John Free, telephoned Lenox Hill Hospital in Manhattan to obtain a bed. A temporary splint was put under Finnie's leg. When the Jets flew back to New York that night, arriving well after midnight, he was taken directly to the hospital, where an orthopedic resident checked him in. Nicholas meanwhile went to his home in Westchester for a couple of hours sleep.

Since such ligament injuries should receive immediate attention, the doctor arrived at Lenox Hill early the following morning to open Finnie's damaged knee and repair it with two permanent staples in an hour-long operation. Later that morning the doctor dictated an injury report that was immediately typed with copies going not only to the Jets management but also, as required by league rules, to the commissioner's office. Within a week, Finnie was released from the hospital, hopefully to return to the team next summer. Should the staples bother him, they can be removed at a later date.

The aim of the operation, which is no more than two decades old, is repairing the torn ligaments immediately, not only to restore proper functioning, but also to prevent later disability. Further physical rehabilitation, beginning with exercises, could possibly restore Finnie's leg to its former strength. Prior to this surgical advance, the leg would have been put directly into a cast in which it would have "healed" but remained permanently weak, or perhaps reconstructed in a later operation. This reconstructive procedure was usually less effective than immediate repair, Nicholas judges, not only because the operation was more complicated, involving five separate stages, but also because a reconstructed ligament is never capable for regaining full prior strength.

Finnie's operation was the fifth of its kind during the 1971 season. The earlier beneficiaries were the quarterback Joe Namath, flanker Harvey Nairn, tackle John Elliott, and tight end Wayne Stewart. The last three will probably be out of action for the remainder of the season. "Ligaments, which are the substance binding two bones together at the joint, take about six months to get well," their doctor began to explain. "After an operation they go into a plaster cast for six weeks, and then it takes between three and six months to recover the power, motion, and stability equal to the joint on the other side." Nicholas has so far operated on seventy-six Jet knees in his time. Given his enthusiasm for such treatment, players sometimes call him "Nick the Knife."

Though dwarfed by his sideline companions, some of whom are awesomely huge, Nicholas is just under six feet tall and fairly well-built, as well as clean-shaven, black-haired with grey temples, bespectacled and hazel-eyed, with an easy smile that illuminates his presence, even when announcing medically forbidding news. He has been the Jets' "team physician and orthopedic consultant" since the organization was formed in 1963, when he followed some players from the defunct New York Titans. He has not missed a game since. His job requires him to accompany the Jets to every match, whether home or away, examining them before, watching them during, and checking up on them afterwards. Anyone suffering a malady, or even asking a question, usually get a lengthy, rapidly articulated, somewhat pedantic analysis, as his knowledge of their individual physical conditions is just as encyclopedic. Too spontaneous for calculated deception, Nicholas is a straight-talker, as everything he says, or does, or decides, reflect a self-confidence absolutely necessary for his destiny-making trade.

He also files weekly reports on those who are injured. It is those that are frequently cited, along with his name, on television and in the press. Quotations attributed to him in newspapers generally come not from Dr. Nicholas's office, which does not talk to reporters, but the Jets press department, which releases selected passages from his medical reports. In the event of injuries to players' backs or limbs, he will usually undertake the appropriate orthopedic surgery himself. Other medical problems are either handled by his younger brother, Dr. Calvin Nicholas, a Long Island internist who is the official "team physician and medical consultant," or farmed out to a board of specialists. The Jets also retain a dentist, Dr. Michael Koplik, who, like the Nicholas brothers, takes his black bag to the sidelines of every home game.

Just before the game we attended together, a gut-breaking 14-13 loss to Baltimore, Nicholas saw in his stadium office a Mets baseball payer complaining of a back pain incurred while playing basketball. "What exactly were you doing when it happened?" the doctor asked, as the ballplayer stripped down, demonstrating from memory what he did before he lay across the examination table. With a brusqueness perhaps typical of orthopedists, Nicholas moved the player's legs about, pushing on his knees and then lifting up his bottom, eliminating certain negative possibilities with every move that didn’t prompt pain. "Does that hurt?" he repeatedly asked. "No," the player repeatedly said. "You're not very bad, boy," he smiled. Once the pain's source was discovered, Nicholas prescribed not medicine but several favorite exercises: standing away from a wall and pushing off it while one's heels remain flat on the floor, and "ballet dips" that are done by putting one's leg up on a table and then bending the knee of the other leg.

A bit later, the lead kick returner, Chris Farasopolous, exchanged a few words in Greek while his doctor checked out a plastic pad used to protect a back injury suffered the week before. Winston Hill, a mammoth tackle with a heavily taped leg, complained about pain in his biggest toe and asked for some Novocain. Caressing the joint, Nicholas diagnosed a sprain and refused his request for a shot. "I'm looking for a name this long, Doc," Hill mused, his meaty hands moving apart. "It's not so impressive to have a sprained toe." Later, speaking generally, he told me that he sometimes doubts players who claim a back injury, only to add, “But I can’t do anything about backs.”

While on the sidelines, James Nicholas is the forty-eighth member of a forty-seven man squad. Energetic, enthusiastic, impulsive, loquacious, he continually churns up and down the edge of the field, talking primarily with the injured players who dress in civilian clothes and sit slightly apart from the team. Everyone treats Nicholas politely and deferentially, calling him "Doc," even when he tries, usually in vain, to give coaching advice. As passionately involved as any Jet, he cheers good plays and boos bad ones and even once incurred a fine for invading the referees dressing room after the infamous Oakland-New York-Heidi game of 1968. He attributed that day's unnecessary violence, which caused several injuries, to "inconsistencies in the penalties—the officials lost control." Since one of them had visited his stadium office for an examination of his backache before the game, Nicholas felt entitled to make another "house call" on his recent patient, only to pay this time, rather than get paid. Practical in his office, this doctor can be a crazed fanatic at the game.

For the Baltimore game, he donned a green "Jets" windbreaker, brown corduroy slacks, and a green wool Santa Claus cap with a white tassel. The temperature was fiftyish, and his Jets were a charged-up underdog. Though the good doctor never needed to go onto the field (or write a Monday-morning report), not once did he sit down on the long team bench—his sense (and love) of the theatrical would forbid that, and there was too much else for him to see and do. One concern was the veteran defensive end Gerry Philbin's playing with the Derotational Knee Brace that Nicholas had developed several years before. It had been used successfully by quarterbacks such as Joe Namath, Don Horn of Denver, and Bill Nelsen of the Cleveland Browns, as no knees encased in it had ever been injured. However, never before had an interior lineman worn the steel and rubber contraption during a game. Having suffered some partially torn knee ligaments a few weeks before, Philbin was returning to action sooner than originally expected than would otherwise be possible.

"This is a tense moment for me," Nicholas whispered, as Baltimore came out of its huddle and ran their very first play directly at Philbin, who successfully executed the tackle. "He broke the play. Did you see that?" Nicholas cheered. Every time the defensive end performed brilliantly, as in recovering a fumble or in tacking John Unitas for a long loss, Nicholas felt relief and pride. "He was a key man all day long," he told me later. "That's the difference between playing and not playing. People don't realize how much we've been hurt by having all those guys out." After the game, Philbin told reporters, "The brace held up well and enabled me to take several good shots." He later came by the Doctor's locker-room office and thanked him. "Without it, Doc, I would have been lost."

Nicholas followed the game closely in other ways, constantly surveying such recent Jet injuries as Phil Wise's thumb, John Schmitt's neck, and Earlie Thomas' rib cage, in addition to such older repairs as Emerson Boozer's knee (his most elaborate surgery) and John Dockery's shoulder. He told the Jets coaches about hidden injuries he observed in the Colts' players and discussed with the team's trainer the physical performances of individual Jets, noting whether one was favoring his shoulder and another his leg. When the rookie blocking back Steve Harkey reported blurred vision in one eye, both Nicholas and his brother Calvin checked it out. After Rich Caster dropped a pass into the end zone, suffering catcalls from the fans, it was Nicholas who met him at the sidelines, putting his arm around the wide receiver's waist and walking him back to the bench, repeatedly advising him to ignore the mean crowd. And when Caster later caught a touchdown pass, he too thanked Nicholas for his encouragement.

Back in the dressing room after the game, Nicholas was relieved that no one had been seriously hurt this Sunday, unlike the others, but aggressively furious about the score as yet another misfortune in a disastrous season. "We outplayed them most of the game. We had the ball most of the time. We outran and outpassed them, but lost the breaks and the referees' decisions. If we won this, we could have taken all [!] the others. Instead, we're eliminated from contention. To lose it this way is the hardest thing possible for the team." He personally excused the ambulance driver hired for every game. As we left the depressed dressing room, kids rushed up screaming. "Who are you? Who are you?" "Dr. James Nicholas," he replied, flashing his diamond ring earned as a member of a team victorious in the Super-Bowl; and he gladly signed their programs, just like any other Jet.

Nicholas's job grew on one hand out of increasing public interest in football and, on the other, out of the increasing roughness of the game, as players are both bigger and faster than before. "There were stars twenty years ago who could not play today, or at least not last as long," remembers Dr. Edmond J. McDonnell, orthopedist to the Colts since 1947, "but the biggest difference is that twenty years ago the owner's wife's gynecologist might be taking care of the team." Since approximately eight percent of all professional players undergo surgery each year—two-thirds of them for their knees—the expense of injuries, including salaried time lost through recuperation, runs into millions of dollars.

Injuries have also become more crucially consequential, not only in the careers of individual players, but also in the fortunes of a team—or the misfortunes of the Jets these past two post-Super Bowl seasons. "This is the first time in eleven years our totals have been so high at this point in the season," Nicholas noted after the game. "Other teams in the past have exceeded us—take the Eagles a few years back; but this time we're leading the league, so to speak, with twenty-two serious injuries. That lead, like much else, may change by the end of the year. What has been particularly disastrous, though, has been the quality of personnel injured this year."

Thoughtfully searching for appropriate generalizations, he attributes the Jets' exceptionally high injury rates these past two years not to any ominous tendencies but, simply, misfortune. "Some people blamed our high rate last year on the players' strike, which reduced training, but nothing like that happened this year. The figures fluctuate, I find, but the average stays the same. Though we had nine knee injuries last year, there was only two the year before. The yearly average for the past decade has five knee operations, which is how many I've already done this year."

Pursuing his scientific interest in ratios and comparative statistics, he once deduced that 68 percent of all players during his years at the Titans and then the Jets had, at one time or another, injuries that kept them out of two consecutive games and that, though 42 percent of the team had such serious injuries in 1960, the percentage declined to 39 between 1963 and 1965 and 26 during 1966 and 1968. It climbed to 60 percent in 1970 and, by the end of October 1971, the rate was 46 percent. Failing to rise at all in November, it stood by the end of the year at 48 percent. Another statistical conclusion is an average of "one knee operation per eight men per year in pro football."

Over the years he has also observed that certain positions are more injurious than others—and that certain injuries plague particular positions—but discovered no correlations between injury and, say, race. Older professionals are less likely to suffer serious injuries than players in their first two seasons, since the more dangerous "special teams"(for kick-offs and punts) are staffed largely by younger men, the veterans are more experienced, and those less-fit have already been weeded out.

Sports medicine was a rather late development in Nicholas's own professional career. Born in Portsmouth, Virginia, in 1921, of Greek parents (originally named Karanicholas), he grew up in neighboring Norfolk and came to New York in 1931, when his parents separated. Living on West 180th Street in Washington Heights, he attended George Washington High School, where he played inauspiciously on the football and baseball teams. He then went to New York University downtown in Washington Square, majoring in biology with a minor in philosophy. In addition to compressing four years of college into three, thanks to summer courses, he worked nights as an elevator operator for, as he remembers, "$29.72" every other week and learned to sleep on the job. In the summer times, he and his brother played semi-pro baseball for the New York Independents at "five dollars per game."

In 1942, he entered Long Island Medical College, now called Downstate, again compressing four years of school into three and co-editing his class's yearbook. (Brother Calvin went first to Fordham and then to Cornell, where he was a star pitcher, later following James to Downstate.) Receiving his M.D. in 1945, he was drafted into the army and assigned not to cardiology, as he initially hoped, but to orthopedics, which turned out to be more opportune than he expected. Retiring from Fort Dix with the rank of captain, he began his specialty with a year of residency at Lenox Hill Hospital under Dr. Sidney Gaynor, who was, and still is, physician to the New York Yankees.

He met Greek-born Kiki Chris in 1951 and married her the following year, also deciding then to settle permanently in the New York area. However, soon called back into the Korean War, Nicholas was assigned to Fort Devens in Ayer, Massachusetts, where he was chief orthopedist for nine months. This turned out to be "a great assignment. What it did was polish me off and bring me my second involvement in sports medicine as doctor to all the Fort's teams."

Once back at Lenox Hill, he made a sub-specialty not in sports medicine but metabolic bone disease—or what makes bones soft—which meant that most of his patients were aged, infirm, and female. His related interest in the management of adrenal diseases during operations earned him a place on the medical team that worked on John F. Kennedy's spine in 1954, because it was feared that the Senator, who suffered from Addison's Disease, might thus be vulnerable to further complications during extensive orthopedic surgery. In 1955 Nicholas received Certification from the American Board of Orthopedic Surgery. Three years later he founded the Metabolic Bone Disease Clinic at the Hospital for Special Surgery, which he headed for six years.

In 1960, a patient named Harry Wismer, a sometime sports announcer, asked Nicholas to take care of the New York Titans, which Wismer had then owned. At first Nicholas turned down the job, because his practice was already too busy ("I was a Giants fan, besides"); but when a Titan player died in Texas, Nicholas accepted, quickly developing a loyalty toward "this bunch of rejected players." Investigating his new professional specialty, he found surprisingly little knowledge (and not even a consistent terminology). Most of it came from Dr. Don O'Donoghue, who taught at the University of Oklahoma's medical school and had written a textbook on athletic injuries. Seeking out O'Donoghue, Nicholas took his week-long courses at various conferences of the American Academy of Orthopedic Surgeons. Another pioneer was Dr. George Bennett, who taught the Colts' Dr. McDonnell at John Hopkins. When the Titans became the New York Jets in 1963, the new owners hired Weeb Ewbank, formerly a coach at Baltimore, who in turn solicited McDonnell's advice on a team doctor. He recommended the Titans' Nicholas, who was then selected from several prospects to make the new Jets.

He loves the game "absolutely," to quote his favorite adverb, diligently reading several sports papers and quizzing players, as well as watching the games nationally televised on Monday night. Along the way he made good friends, inviting Jets to his house for family dinner and easily identifying with their socio-economic upward mobility. "Players are more intelligent and more knowledgeable than they used to be," he notes, "and they also lead more complicated lives, especially in New York. One of the great side effects of my job now is keeping in touch with young people who expose you to certain perceptions and problems you'd otherwise miss."

A few seasons back, just before a Kansas City game, the elder Dr. Nicholas severely hurt his own back while catching a football thrown by another overage Jet. Early in his medical-athletic career, he got into a players' brawl in which, lacking a helmet, he was knocked down, his nose bloodied, an eye blackened, and his body helped off the field. (His weak elbow, which he can't quite straighten, comes, however, from a pre-Titan skiing accident.)

It was Joe Namath who made Nicholas more famous, when the quarterback arrived in 1965 with both a headline-making contract and an equally publicized swollen, wobbly right knee injured at Alabama the year before. Not only lessening his performance, this malady made any professional football career precarious. Nicholas attributes Nameth's weakness to sub-optimal athletic medicine, as the quarterback failed to receive the necessary reparative operation immediately after getting hurt (and probably couldn't have gotten such surgery in Alabama anyway). Just after the contract was signed, Nicholas operated on Namath's right knee, tightening the inside ligament, removing both the medial cartilage and an ancient cyst on the back of the joint. A second operation on that knee, performed late in 1966, took out the lateral cartilage and twenty-two bone fragments, as well as rerouting two tendons.

Namath's left knee, previously known as the "good knee," hit the operating table early in 1968, when both a torn tendon and a ligament were repaired and a cartilage removed. Nicholas remembers all those operations as "harrowing experiences because of all the publicity. But the operations all turned out fine. They've already allowed him to play five years of championship professional ball." For the first of these operations, Doctor Nicholas also took the radical step of using in the diagnosis a colored dye that, because it is radio opaque, enables better visualization of a variety of anatomical structures. The resulting publicity helped made the technique originating in Europe, called arthography, more acceptable in America. In more ways than one, therefore, has sports medicine (and the partnership of Namath and Nicholas) contributed to the progress of surgical artistry.

Just before the Baltimore game, Namath too came into Nicholas's locker-room office, sat down on the table, pulled up his outrageously patterned flared cuff, and exposed a wide and long fresh scar surrounded by streams of older ones. Namath had been hit from the side while making a tackle following an interception in an exhibition game at Tampa in August, and he had not played since. As Nicholas tested the left leg in various ways and discovered it was strong, Namath complained of weakness in his big toe and nerve-pains that accompanied certain movements. Nicholas scratched sharp points along Namath's foot to test its sensitivities. Then his sure fingers fondled Namath's knee for the damaged nerve. "It's neuropraxia, Joe, and it will take its own good time to get well," he smiled sympathetically. "When will the discoloration go away, Doc?" his familiar nasal voice asked. "In a few years, Joe." And he lifted the other cuff to reveal older criss-crossing signs of medical handiwork. Once the doctor departed, Namath told me, "After four operations, I have complete confidence in him. If he tells me to play, I play; if he says I should retire, I retire." Namath returned to action two weeks alter, throwing three touchdown passes, nearly overcoming a large San Francisco lead.

By now Nicholas's private practice is typical, alas, of any medical celebrity with several hospital affiliations and more than enough previous patients (and no need for new ones). Even Nicholas's veteran patients are neglected during the football season, as his secretary, Miss Peggy Pappas, suffers no qualms about telling autumn callers, in her staccato Greek-accented voice, "No, Doctor Nicholas can't see you until January [or February"]. Why don't you call Doctor. . . ."

His reputation has brought him athletes of all kinds, ballet dancers, musicians, actors, and even a Hollywood stunt man (who now surreptitiously uses a knee brace), all of whom are treated with an abruptness mediated by a smile. "It's common practice for sports physicians to be approached by those who are already treated well by other doctors. We waste a lot of time that way," he said between puffs on one of his rationed cigars. "The fact that one treats a football team doesn't meant that he's going to be the best doctor for you." Some private patients regard him as unsympathetic, in part because they fail to recognize that his hearing is slightly impaired, but mostly because he seems to enjoy manipulating a patient's body to discover pain and he draws medical conclusions so speedily.

Telephone calls also pour into his office with requests for verbal advice, usually regarding post-operative rehabilitative procedures; and in response to a call from the New York Knickerbockers, the day I was there, he ordered a special exercise machine for Willis Reed. When the physician to a prominent college football team called, Nicholas answered his query and then, even alert of the Jets need for intelligence, asked his own about the professional prospects and physical conditions of the doctor's best players. "There's no snobbery in the guy," notes his sideline companion, the sports artist LeRoy Neiman. "He talks to everybody equally." Under his knife have also passed several hundred high school and college athletes.

Operations are customarily done on weekday mornings, beginning quite early and usually at Lenox Hill. The day we met for lunch, he had already completed three. Patients requiring only diagnosis and advice are seen later in the day at his rather spare nearby office. In the interests of efficiency, he hands out printed sheets prescribing all sorts of rigorous regimen, sometimes adding personal notations with a felt pen colored "Jets green." In a desk drawer are scale models of the various joints, so that both orthopedic points and possible operations can be efficiently illustrated.

Two mornings each week, Nicholas supervises his Lenox Hill residents in their clinical practice with indigent patients (already familiar, it seems, with the hospital's reputation in the field), as both his personal and professional commitments make him especially eager to help any recent graduate from medical school who would like to specialize in sports medicine. For thirteen weeks each year, he teaches two mornings a week at Cornell Medical College's Hospital for Special Surgery. He recently joined Dr. Charles Bucher, chairman of physical education at New York University, in conducting a course on sports medicine to Ph.D. candidates at the School of Education, in addition to giving intensive seminars on the subject at both major medical colleges and conferences of the American Academy of Orthopedic Surgeons. Working several days a week at a variety of tasks, he rarely spends an entire day at his Scarsdale home.

Around five times a month, he estimates, he gives gratis lectures to coaches, trainers, physical-education teachers, and equipment-manufacturers. "We must get this knowledge out to the grade-school-neighborhood levels," he frequently asserts, "and so we must be teaching teachers." To no surprise, he was also the co-founder and first president of the professional Football Physicians Association. Freebees, he estimates, consume thirty per cent of his working hours.

His current orthopedic researches include, first, the development of surgical procedures, especially relating to the correction of knee instability. In addition to publishing results of this research, he regularly makes slides, films, and even cassettes that Lenox Hill distributes to interested colleagues. In the mail recently arrived, for his perusal, visual material reporting a Nicholas-style operation done on the joint of a dog's leg. He has also been doing detailed physiological analyses of both typical athletic movements and their most common malfunctions. For a strictly medical press he is authoring a textbook on the knee.

A third interest is equipment design. In addition to publishing recent research on the actual use of his knee brace, he is collaborating with the Lenox Hill Brace Shop in a light-weight plastic model. Then there are comprehensive statistical studies of athletic injuries, one recent article having the self-evident title of "The Relationship of Football Injuries of Playing Positions: A Statistical Review of Injuries over Nine Years." Into the highly prestigious Journal of the American Medical Association (a.k.a. JAMA), he put an essay on knee-ligament injuries and professional football players, signifying that his kind of sports medicine has become a respectable scholarly subject. His fame makes his position within his profession very delicate. Since doctors are not allowed either to advertise or to publicize themselves, permission to do this profile had to be obtained, at considerably delay and with certain stipulations, from the Medical Society of the County of New York.

The general principles of sports medicine, Nicholas suggests, his hoarse voice revealing a trace of the South, "are alleviating pain, providing support, controlling hemorrhage, and encouraging both immediate healing and maximal functional recovery." His own Jets practice he regards as a "model" for all sports medicine. "You're on the field when an accident happens, so you see it," the inveterate explainer begins, "you're first on the scene, so you watch its evolution; and you know intimately the medical history of the injured. Then you treat it by the best means available, without any regard for expense, and ideally return the injured function to optimal use. This kind of medical care should extend not only to college and school kids but also to other sports and even dancers, though it rarely has so far. I've seen pros who have had bad legs, for instance, since high school. If they had been fixed then, those players would have no problem at the pro level." Because the ideal is the recovery of optimal use, the sports doctor's goals must be much higher than those of standard orthopedic surgery. Fortunately, he can rely on the expectation that the professional athlete will work as hard as possible to regain his strength.

As the athlete's body is a system whose parts must function optimally, so is an athletic team similarly systemic. It is Nicholas's job to see that all parts of that system are medically optimal. To the team's president, Philip H. Iselin, "Jim is the backbone of the operation." His liaison to the team is the trainer, Jeff Snedeker, a slight, quiet, fair-featured man with an M.A. in Athletic training, who has also been with the Jets since 1963. Snedeker too defines his job as "the prevention, the cure, and the rehabilitation of athletic injuries," leaving diagnosis to the doctors. Unlike them, however, the trainer is continually is "in residence" with the team. It is he, rather than the doctor, who supervises the tapings, issues the non-prescription drugs, and oversees the rehabilitative exercises. "'Paramedical' seems to be the current word for this role," Snedeker muses.

Nicholas's pet peeve this year has been unnecessary roughness. As a romantic exponent of clean football, he regards the sin of clipping as supremely contemptible, especially for damaging vulnerable knees. Among other "inexcusably" injury-causing sins he lists "cheap-shots," which means hitting a ball-carrier after he goes down; slugging, especially in the groin; "hammering" with a karate chop; "spearing," which is butting with one's helmet. "The 'cure' here," he judges, "is better discipline within the team," alleviated by better equipment. The helmet, he suggests, could be padded on the outside as well, to lessen its possible usefulness as an attack weapon. He hopes eventually to provide every player with a knee brace, "much as we now give them shoulder guards." Nonetheless, he admits that injuries are inevitable in a game that depends so heavily upon speed, overpowering impact, and surprise, all of which are also universal causes of injury.

Another element in the prevention of athletic injury is an adequate estimate of the individual's body and its relation to the sports he wants to pay. Toward this end Nicholas introduced a crucial distinction between tight-jointedness and loose-jointedness:

The tight-jointed individual usually is susceptible to muscle strains and tears-pulls of various degrees-so that Achilles tendon raptures, thigh and calf muscle injuries, and hamstring pulls are very common in this type of individual. It's rare that he suffers injury to his knee ligaments. Loose-jointed individuals, on the other hand, are more supple and agile. They can touch their palms to the floor without bending their knees or their elbows touch each other, or sit in the lotus position, or turn their feet out 180 degrees the way Charlie Chaplin does. They are generally better athletes, because they can turn more sharply, change direction more quickly, and can, for instance, take a wider swing in golf. Compare George Nock, who's loose, with Emerson Boozer, who must literally spin his body to turn. However, when the hyper-extensible joints of loose people are placed in positions of abnormal stress, particularly in rotation, impingement and tearing occur more frequently. They sprain their joints [whereas muscles are strained, to quote one effort toward consistent terminology]. For them protective taping, if not bracing, can be necessary, in addition to exercises for strengthening such joints by exercise.

The professional longevity of such indestructible players as Don Maynard and Larry Grantham, his remaining fellow ex-Titans both now over thirty, Nicholas attributes to their "stiff joints." Tight people are more likely to have the degree of muscle power necessary in the interior line. "In half backs, the ideal seems to be loose-joined but physically strong enough to control such flexibility, such as Jim Brown."

It follows that just as every athlete should be aware of kinds of injuries to which he is prone so should his efforts at "conditioning" suit his individual needs. "The idea of getting fifty men in unison to bend and touch their toes, and then lie on their backs and spread eagle is absolutely ridiculous," Dr. Nicholas declared over lunch. "One man should be exercising the way a ballet dancer does at the barre to stretch his muscles while another can do push-ups and a third sit-ups. What he does also depends on the sport. For those that embrace violence contact at high speeds require strong thighs, while others don't."

When I asked him to demonstrate the negative effects of my tight joints on my own athleticism, he invited me to simulate a golf stroke. As soon as I put my arms over my right shoulder, he pulled them yet higher until I yelped in pain. "This is how high you could go if your joints were loose," he declared, reminding me of the sadism endemic in orthopedists. Nonetheless, his point made, I've been stretching and stretching ever since.

I also used to believe that an athlete had to gets lots of sleep, avoid smoking and drinking, and the like; but I discovered that this too is a highly individual things. Sure, it's established that cigarettes are a toxic, carcinogenic agent; but a lot of good football players smoke. Cigarettes might be more deleterious to a runner.

More specifically, he judges that football is essentially safe in the Peewee and Pop Warner Leagues; but once boys become twelve or thirteen and their growth speeds up, Doctor Nicholas would advise against the participation of those who are too small, too obese, too slow, too weak, too uncoordinated, and too loose-jointed (as well as those who suffer from physical defects that could only be further aggravated). Even so, on this level of football, injuries are different from those prevalent in the pros, consisting mostly of fractures and knee-cap dislocations. Players susceptible to such injuries rarely survive into the college ranks. "Another factor to consider is the program itself. In high schools where equipment is poor, the fields are bad, the training is poor, and emergency medical facilities are not immediate available, there will surely be a lot of serious injuries."

Though the younger of Nicolas's own two sons plays football as an end and linebacker on a peewee team, the Mamaroneck Lions, which recently won a national championship (with his father supplying some knee braces), his mother confesses her concern with his playing. "Peewee football is a safe sport when you think of all the other things that can happen to kids who play sports," father Nicholas judges. "Let's face it, there are hazards all around us. It also teaches discipline, teamwork, and sacrifice, and these are all positive values." Wherever kids are desperately eager to play a game, he insists, it might be wiser to operate on their orthopedic weaknesses, or let them play anyway, because the opposite choices might cause serious emotional damage and subsequent behavior problems. With sadness does he tell of a black high-school basketball star who suffered kneecap injuries so serious that some orthopedists (along with the boy's mother) forbade his playing. Though Nicholas himself tried to refute them, their decision stood; and the athlete died a short while afterwards of a heroin overdose.

He and his associate Dr. William A. Liebler also serve as doctors to the New York Rangers, Nicholas favoring his commitment to the Jets during the autumn-winter contests. Even though hockey causes more fatalities, he regards it as a far less injurious contact sport. While the Jets were physically devastated this past season, the Rangers in nearly as many official games suffered only one serious injury by mid-November—Pete Stankowski's brain hemorrhage, which Nicholas farmed out to a neurosurgeon. "We have to develop a lighter helmet for hockey—one that also enables them to hear better than the current model. No one wears one now until his head is seriously injured." Dr. Nicholas does not travel with the Rangers, unlike the Jets, as injuries on the road are customarily handled by the host's resident physician. "There are lots of cuts and lacerations in hockey, but fewer serious accidents. Though there is more velocity on skates, the players are smaller, the protective equipment heavier, and the ice has more 'give.' The game actually has fairly low morbidity, or injuries causing time lost from work."

The most controversial topic in sports medicine today is the use of drugs, the key issues being what is and isn't admissible. Such critics of the game as Dave Meggyesy, Bernie Parrish, Chip Oliver, and Jack Scott have charged that trainers carry comprehensive medicine chests, dispensing everything, often without the players' knowledge, from tranquilizers to painkillers, from energizing amphetamines to mysterious anabolic steroids that help put on weight. Former players have filed multi-million dollar lawsuits against their respective teams for the physical damage allegedly caused by such drugs.

Though Nicholas will in principle agree to the modern definition of a person as a body abetted by medicines, his practical advocacies are more limited than such theory suggests. Romantic about the game and even about the rewards due winners, he can be a hard-nosed pragmatist about the helpfulness of medicines. Anabolic steroids, which figure in those lawsuits, he regards as "dangerous except to substitute for missing adrenal glands or sex glands, which is a rare problem in football players." Unlike certain other team physicians, he refuses to give Novocain before or during a game, reasoning that it is "a dangerous desensitizer. It abolishes pain which, we must remember, is a mechanism for protecting the injured part." Never? "Well, I might put it into a severe bruise, because that's not likely to be reinjured. I once put Xylocain into Al Atkinson when he suffered a partial shoulder separation during the first half of the Super Bowl. I reasoned that since he was the only middle linebacker available, his absence from a championship game would have been especially lamentable; and it was clearly the final game of the season." It is also acceptable to shoot a painkiller into an injured player who is probably not going to re-enter the game.

Nicholas is also opposed "absolutely" to athletes in contact sports using systemic modifiers, such as alcohol, tranquilizers, amphetamines, barbiturates, and hard drugs before a game, not only because of their primary effects upon performance but also for a secondary reason he regards as most important. Should an athlete require surgery, the presence of such drugs in his system can severely complicate anesthesia, sometimes causing death. "For the same reason I oppose their use by anyone driving a car," he told me during half time. "I'm not the authority here, but you can check it out with our anesthesiologist at Lenox Hill, who always asks a kid undergoing surgery whether he's taken anything." He paused to sip some soda.

"If any Jets take pep pills, they do it without my knowledge. There was a rash of speeds in 1962-1965, but I never gave them then. In my pre-season talks, I warn the players not to take them." What about non-contact sprinters? "There's no place for amphetamines in sports." He proceed to tell me a terror story about a Jets defensive lineman, unnamed as usual, who took some speeds, he claimed for the first time, before a game in which he suffered a concussion. The player seemed okay at first, but later that evening he was rushed to a hospital with severely increased blood pressure and went into a coma for several hours. "We worried about serious hemorrhage." The player has since gone onto another team. "In athletes, as in society, though, alcohol is more of a problem than drugs."

The team's locker-room medicine cabinet includes aspirin, antiseptic, analgesics, antibiotics, fungicides, vitamins, topical anesthetics, alka-seltzer, and several kinds of resuscitative drugs. Directly underneath it is a printed warning against dispensing drugs that must be individually prescribed. "Before a game," Nicholas added, "we use anti-histamines for hay fever and bad allergies, paregoric for diarrhea, and Maalox for upset stomachs. We use systemic drugs, like vaccines, only for specific infections. That's really my brother's department, but I know what he uses. As for erogenics, or energizers, the best one I know is water."

He also uses cortisone or butazolidine, which reduces pain in the course of shrinking the inflammation of joints; but it takes more than twenty-four hours to act, it is best given after a game, or a few days before one. "It's dangerous," he adds, "but not in the ways I described before." The doctor himself is fairly abstemious, scarcely drinking, smoking only cigars, and often skipping an entire meal. Into a pocket diary he diligently notes how many calories he ate, cigars he smokes, and miles he ran that day. "If I don't put it in writing, I can't do it. That's my key to self-discipline."

Chuck Hughes' heart attack, the game's most recent fatality, Nicholas attributes to fate and the athlete's personal condition. "His chest pains had already been diagnosed, and it was reported that an autopsy discovered he had an old man's heart, though this couldn't be known in advance. Any tense situation off the field might have killed him. Since it was the first heart attack in professional football in as long as I can remember, no generalizations can be made. I worry more about heart attacks in spectators, which I've seen—once at the Rangers last year. A football coach died on the sidelines in Miami last year. During the Clay-Frazier fight last year, there were two heart attacks, including someone I know. It's for the spectators, not the players, that we need these new sideline resuscitators."

Though characterizing himself as "once a very liberal young man," Nicholas now defends the current un-liberal Greek government, which decorated him with honors, as "superior, with qualifications, to the anarchy Greece would otherwise have." He's too much of a sports romantic to accept the recent 'radical" criticisms of professional athletics. David Meggyesy's Out of Their League (1970), probably the most popular critique, he finds more specific than general. "He says his arm was almost amputated after an injury. Well, that must be baloney. Not in twenty years have I heard of an arm amputation in sports. Also, what Meggyesy is talking about is Syracuse [University] and St. Louis [Cardinals]. It's important to recognize that teams are different—coaches and personnel are different. You can see that some teams are big and others small. The Jets have a lot of Texans, because our former chief scout had good connections there. Some coaches favor loose-jointed players without realizing it, and others tight. And teams are different in collective personality too. The Jets don't have the kind of problems Meggyesy exposes." (A prematurely retired Jet, George Sauer, though a general critic of the professional game, recently concurred that the Jets "are very different from the way Dave describes the Cardinals.") Though Nicholas keeps in touch with the other teams' doctors, not only through his new professional associations, but often dining with them before their mutual games, he refuses for professional reasons to comment on their individual current competences and principles.

On the new issue of the artificial turf, criticized most prominently by Dr. James Garrick, whom Nicholas usually respects, he has contrary expectations. "The players I know don't much like it, mostly because it causes burns of the skin, as well as more sprains of the toe and arch—the problems of ballet dancers and basketball players. Since players wear softer shoes on the hard turf, it can produce a hot foot. On the other hand, cleats are a prime cause of knee injuries on a dry grass field. The hardness of the new surface probably produces more fractures around the upper extremities, but so do natural turfs in sub-freezing temperatures, as in Green Bay and Minnesota. Comparative evaluations must therefore also consider great differences in climatic conditions. Though artificial turf is usually more advantageous in the rain, it was in the New England game this last year, played in a sea of water, that the Jets suffered their first serious injuries on the new turf. In other words, there are many variables to consider, and we don't have enough evidence."

When I quoted the publicized statistic of the Houston Oilers' eleven knee injuries during its first year of artificial turf in its stadium, Nicholas promptly responded. "Yes, but the University of Houston, which uses the same field, had absolutely none that year. Our own experience on the Jets finds the artificial turf safer, but that isn't enough of a sample either. The A.M.A.'s Committee on Sports Medicine recently reported a negligible difference in comparative injury ratios, which were, incidentally, almost the same as those I reported in my historical study of the Jets. That A.M.A. analysis wasn't sophisticated enough to be definitive, however, because all the important variables weren't considered, such as dry turf versus wet, different parts of the country and climate, kinds of shoe used, various offensive formations, and [he smiled] loose or tight joints. I might prefer it in Shea Stadium for a more local reason, which is that the Mets, who control the field, forbid our playing there until the baseball season is over. Football churns up the turf, they say. So we're forced to play our exhibitions and opening games away from home, which is both demoralizing and dangerous. For another thing, we can't treat an injury ideally if we have to fly a patient back to New York. With artificial turf in Shea, the Jets could use it simultaneously with the Mets."

As an employee of management who ministers to the medical needs of individual players, the position of "team physician" implies divided loyalties. He is sometimes portrayed as repairing broken gladiators to do battle with the devouring lions for the pleasure of sadistic fans and the profits of avaricious owners. "The analogy is invalid," Nicholas impatiently replied. "First of all, there are no lions out there. Not only are athletes well paid, but they always have the choice of quitting. I accept that this sport can be destructive to the body, but you must remember that a man is going back to his freely chosen work. It is my job to help get him back. If a man can't indulge his chosen profession, or even his favorite avocation, he must suffer emotionally. I can cite cases. A great athlete, like Namath, will go out and risk further injury because he is a perfectionist who had a tremendous pride in performance. It's intrinsic in the character of the man. That's another reason why the analogy of gladiators is so ridiculous.

"To put me in the middle of a conflict between the players and management is also wrong. Their argument is primarily over salaries. The coach's object is winning games; mine is keeping the players fit. Every team doctor has a professional relationship to his players, who are individual patients. They are treated in confidence, and the privileged nature of a player's condition is retained only by me. When a player is injured, I issue a report to the team that estimates when he will be available. In this report, I will say only that a man is injured and describe that injury and then state whether it will require surgery. Before advising on an operation, I might also consider the demands of the team's schedule. But I won't go into secondary specifics, such as the degree of arthritis in his joints, that might jeopardize his relationship to the team. This is a professional judgment known only to the player." Only once, in his memory, did a Jet seek a second opinion from another doctor. As we were talking, the telephone rang. In response to a query Nicholas succinctly replied, "It sounds like you've done a super job; but unless you put him to sleep and stretch the hamstring, he's going to have a bad knee cap."

"Look at this," he said, reaching into file drawers that contain individual folders on every Jet past and present. Out of one, belonging to a star running back, he pulled a sheet of yellow paper dated August, 1966, which began: "I saw [Mr. Privileged and Confidential] and feel that he is improving steadily. However, his injury is a hard one to be completely objective about, since it represents a hyperextension of the knee on the inside and back. Since these injuries take about three weeks to heal, one can't really run hard and push off until the fourth week. His is now ten days old, and that means to me that he is going to miss the game against Buffalo as well as against Boston. I would predict that he'll probably be ready to play perhaps one or two periods against Buffalo in the third [week], but that after that he should be good enough to start the season."

After taking a call from the Rangers' trainer, concerning rehabilitative exercise equipment, Nicholas continues. "On the other hand, I work, like the players, for a football team whose goal is winning championships. The Super Bowl season was particularly thrilling to me, because three knees I repaired performed so superbly. Anything any of us can do to win games, within the rules, fulfills our contribution to the team. There was never been any pressure on me to declare a man fit who wasn't medically able before he was ready to play. By comparison, I've felt more pressure from everyone in rehabilitating a star actress who sprained her knee.

"If a player can't play, we can't force him. There are now established grievance procedures in this league to handle such disputes. My job is explaining the risks to any injured players—dangers beyond the normal hazards of the sport, but he must make the final decision, absolutely. The coach has a lot to do with this, of course—Weeb Ewbank isn't Vince Lombardi. On the other hand, we sometimes keep a player on the official injured list, even though he seems ready to return, because league rules allow us only forty-seven active players. If you activate him, someone must be cut from the team and that person might be him [the recovered injured player], especially if there are too many fit players already available for his position. In this case, the doctor decides when a man is ready to play and then the coach decides when he wants him for the team.

"What professional football needs, if you want my opinion, is a national advisory-regulatory board that would represent the interests of the fan in all sports both professional and amateur. Athletics are a major part of our culture, not only for the genuine pleasures of a good performance but ideals of courage and excellence. This commission would deal with such problems as franchise shifts, the blacking out of television programming, and cable transmission. It could say, for instance, that a franchise can't be moved out of a city, if doing so clearly wasn't in the common interest. Like other New York fans, I was terribly upset when both the baseball Giants and Dodgers moved to California. If football is knocked off public TV, something invaluable will be gone from the lives of millions of Americans who can't afford to go to the game or rent a cable."

It is also Nicholas's responsibility to give each player a very thorough pre-season physical examination. Those flunked at this point in 1971 numbered five, "including two rookies of promise." (Some go to other teams whose medical standards are different, especially regarding congenital anomalies.) "The flunk-rate is decreasing steadily," he declared. "At the end of the season, there is an assessment for the physical condition of the manpower to determine who needs surgery, who might be injury-prone, who has a career-ending injury, as well as to prepare off-season programs of exercise and, if necessary, medical care. Obviously, some men are going to need to be replaced because of a specific disability or infirmities caused by age. It is my reluctant duly to tell both the team and the player that he should retire. Even so, there have been over the years many active players whom I had earlier advised to quit. This last problem is not peculiar to pro-football. All athletes feel obliged to play through infirmity, much as doctors will ignore their colds and writers their headaches."

What might "malpractice" be, I wondered? "Negligent treatment, as with any patient, but this would have to be proved in course. The most common cause of potential negligence is medical failure to examine a player properly; a second is insufficient medical competence. That's why we have present at every game two doctors and a dentist, as well as specialized consultants on call; so that no one needs to make a decision outside of his competence. The best protection against malpractice is, of course, regular examination, which is why I went to Shea last Saturday as well as Sunday, Cal goes every Tuesday to examine those players who request it, and three players came here [to Lenox Hill] on Wednesday. The best defense against a possible suit is thoroughly recording the facts and keeping good records. The Jets spare no expense, you know, and never have I been told that a treatment prescribed was too expensive."

According to John Free, a knee operation, for instance, usually costs about $2500, which results from $700 for the operation itself, including post- and pre-procedures, and $1800 for ten days of hospitalization. All medical services—including hospitalization, medicines, surgical fees, private nurses, Joe Namath's ward guard, retainers to the three official doctors, consultancy fees—currently cost the club about $35,000 per year.

The expenses incurred by the Jets are minor compared to those of a nation in which, according to the US Dept. of Commerce, there were last year approximately seventeen million recreational injuries serious enough to require medical attention. Nicholas's own estimate is that half of those resulted from inadequately designed equipment or hazards for which protective equipment had been or could be designed. In both respects, injuries were thus easily preventable. "The injuries of professional athletes are just a tiny percentage of the overall problem," he noted over the ringing telephone. "A dislocated shoulder hurts just as much when it is sustained by casting a fishing rod as from running off-tackle against the Los Angeles Rams. Also, there were approximately 60,000 knee operations last year."

He attributes a million accidents per year to football games, compared to five hundred thousand for baseball, six hundred thousand for winter sports (skiing and skating), and a million from bicycles. "These are all epidemics that, like children's injuries from toys, have gone largely unrecognized by both foundation research and medical schools. With increasing leisure will come yet more recreation and, thus, yet more sports injuries.

What is to be done? He commends both Ralph Nader's exposure of dangerous toys and the federal law requiring, as of January 1972, that all newly manufactured eyeglasses be impact-resistant. He thinks baseball spikes should be redesigned and objects to making the trampoline mandatory in the physical-education programs of several states, even though it jeopardizes the neck, the back, the knees, etc. "It's a sport that should be negated in grade school unless the kid is equipped for it. Here, as in football, don't give up the game because of injuries, but improve both the equipment, as in flying or car-driving, and the general intelligence about its dangers." From his experience with professional athletes, he is drawing principles available not only to sub-professional sportsmen (and their doctors and coaches) but people in general. "I couldn't dream of what was involved in conditioning," he cites as one example, "until I got into sports medicine. You didn't learn this in medical school."

In addition to consulting with the U.S. Military Academy (at West Point) and eight separate high-school athletic programs, he is working to establish an emergency sports center, tied to an ambulance service, that would properly deliver to Lenox Hill any indigent N.Y.C. athlete whose injury would otherwise be neglected. "It's not implausible," he adds. "It could be easily arranged through, say, the Board of Education and its teachers. I think sports medicine is a community function; that's why it's for us as a community hospital. In a more general way, we must also treat more urgently those childhood injuries that might lead to arthritis and other illnesses prevalent in old age."

A further step in Nicholas's expansive vision is a new institution that would not only study the diagnosis and rehabilitation of sports injury but also disseminate this newly acquire information to the appropriate authorities. What he has in mind is not just a department of sports medicine, like those in the medical schools at Harvard, Cornell, and the University of Washington, but an elaborate "Institute of Sports Medicine and Athletic Trauma," located at Lenox Hill, which would have three separate divisions: statistical, clinical, and educational. The first would gather, collate, and analyze statistics in all injuries occurring in sports-recreational programs across the country. The assumption is that such knowledge could better inform subsequent preventive endeavors, not only publicizing newly discovered dangers but also identifying the need for certain kinds of protective equipment. The clinical division will concentrate on how the athlete's body functions, and malfunctions, especially through photographic studies, in both files and slides, of certain sports activities. Here the aim is "a complete library of sports motion that would be reviewed by study groups of other interested researchers." The training division would develop post-graduate courses for practicing physicians, as well as more extended programs for orthopedic residents desiring to specialize in sports medicine. "By all those endeavors we would, I think, be able to fulfill our main purpose, which is improving medical care at the source of injury. There's a lot of relevant information, you see, which we can't keep to ourselves. It has to go out there."