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THE ANCIENT GREEK ORIGINS OF SPORTS MEDICINE

D. W. MASTERSON, D.L.C., M.Sc.

Director of Physical Education, University of Salford

INTRODUCTION

The history of physical education shows sport andmedicine to have a long-standing and close relationship(Dixon et al. 1957). Indeed, if one takes into accountthe participation of doctors of medicine on nationalteams and the sporting reputations of some hospitals andmedical faculties, a sympathy for sport seems to bealmost a tradition of the medical profession. Perhaps theassociation of health with physical activity, or acommon interest in the function of the human body isthe reason for this link, but, whatever the cause, it seemsat odds with the histories of sport and medicine thatSports Medicine as a specialist field should appear so lateon the medical scene. The first international congress ofsports medicine was held in 1928, but the FederationInternationale de Medico-Sportive et Scientifique(FIMS) was not formed until 1933. The British Asso-ciation of Sport and Medicine was not established until1953 and its counterpart in the US, the American Col-lege of Sports Medicine, not until 1954.

It would seem reasonably safe, therefore, to claimthat most practitioners regard Sports Medicine as 'some-thing new'. After all, it has been only in the last yearthat the subject has acquired the respectability due to arecognised study within the field of Physical Medicine.And yet, if one examines carefully its early history, theclaim that scientific medicine arose from the practice ofsport - in particular from the athletic activities ofancient Greece - is not without some, if only conjec-tural, foundation.

HIPPOCRATES AND GREEK ATHLETICS

A contemporary of Socrates, Hippocrates (469-399BC) is considered to be the 'Father of Medicine'. He isthe most famous of all the Greek physicians, yetthe oneabout whom we know least. He was born on the islandof Kos, but during his lifetime he travelled throughoutthe Greek world of the 5th century, eventually dying atLarissa in Northern Greece. He is thought to have beenan army physician at one time. His theories of medicinehave been described by Plato, Aristotle and Meno, butthe works that bear his name do not conform to thedescriptions given by these philosophers. The attributionof the Corpus Hippocraticum is a matter of considerabledispute. Certainly Hippocrates could not have written all70 volumes which form this heterogenous collectionbrought together in Alexandria around 300 BC. Some ofthe works predate Hippocrates. Others, like parts of the

Iliad, were written perhaps a hundred years after thedeath of the author to whom they are attributed.

W. H. S. Jones, the editor of the Loeb edition ofHippocrates, believes the Father of Medicine to havebeen the author of only five of the volumes. viz.

The PrognosticRegimen in Acute DiseasesOn FracturesOn JointsEpidemics I, II and IlIl

On the other hand, Wake (1966) excludes Epidemicsin the belief that these works do not conform to thestyle of the other volumes. Amongst other things styleinvolves the distribution of sentence lengths and theproportion of short to long sentences. It can be identi-fied by using statistical methods. Wake maintains thatthe attribution of Epidemics to Hippocrates is based onthe frequency of 'favourite' nouns but, as vocabulary isdetermined by subject matter, this method is not re-liable.

From examinations of the content of the first fourworks, Wake has proposed that the author (who may ormay not have been Hippocrates) was a bone-setter ratherthan a physician. Moreover, he believes the Father ofMedicine to have been predominently concerned withathletic injuries. Note for example what Hippocrates hasto say about injury to the spine:

"But the outward curvatures, due to falls, usuallyoccur when the patient comes down on his but-tocks or falls on his shoulders".

Or about the hip:

"When the head of the thigh bone is dislocatedfrom the hip it is dislocated in one of four ways,far more frequently inwards; and, of the others themost frequent is outwards. Dislocation backwardsand forwards occurs, but it is rare."

This appears to be the opposite of modern experienceand both quotations point toward injuries that werelikely to have occurred in Greek wrestling and pankra-tion.

That Hippocrates specialised in athletic injuries isfurther suggested by those injuries to the head that are

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described in the books on Fractures and Joints. It wouldbe expected that an army physician would have beenconcerned more with injuries received from weapons,but the descriptions to be found in these volumes focuson dislocations, fractures of the lower jaw, broken nosesand similar injuries. Neither the town nor the militarylife of the period would have yielded the high propor-tion of bone setting and dislocation to warrant theauthor's dwelling on such injuries. But the heavy eventsof Greek athletics, especially boxing, were likely to havebeen the cause of numerous injuries of this kind, andwere possibly the reason for Hippocrates' concentrationupon them.

WRESTLING, PANCRATION AND BOXING INANCIENT GREECE

In the fifth century BC Greeks spent much of theirtime in the palaestra, or wrestling school. These institu-tions were numerous in Greek cities up to the end ofImperial Rome and a Greek would have joined apalaestra as readily as a young man today would join aclub. Plato provides a description of the middle-agedSocrates and the young Alcibiades engaging in bouts ofwrestling with each other as readily as today they wouldplay a game of billiards or a round of golf (Warmingtonand Rouse, 1956).

Without doubt, wrestling was the most popular sportamongst the athletes. A match was held for the best ofthree falls, a fall being determined when the shoulders ofone of the contestants touched the ground, but where amodern contest is divided into rounds, in ancient timesthe bout was continuous and even after a fall the com-batants re-engaged immediately.

Various terms were used to describe specific tech-niques (Harris, 1964). For example, wrestling 'akro-cheirizomai' was a style used when the struggle wascommenced, or conducted at arms length. Hands, wristsor arms only were grasped and attempts to throw theopponent were made by sudden twists. Leontiskos, ofMessene, was described by Pausanias as having won twovictories at Olympia (456 and 452 BC) by using thistechnique to bend his opponent's fingers backwards(Pausanias, 1971). Harris suggests that this wrestlerbroke his opponent's fingers, thereby preventing himfrom continuing to wrestle and, as similar incidents arenot reported in subsequent literature, the ploy was pro-bably made illegal.

Homer provides a vivid account of a match betweenAias and Odysseus:

"The third bold game Achilles next demands,And calls the wrestlers to the level sands:A massive tripod for the victor lies,Of twice six oxen its reputed price;

And next, the loser's spirits to restore,A female captive valued but at four.Scarce did the chief the vigorous strife propose,When tower-like Aias and Odysseus rose.Amid the ring each nervous rival stands,Embracing rigid with implicit hands:Close locked above, their heads and arms are mixed,Below their planted feet at distance fixed:Like two strong rafters which the builder forms,Proof of the wintry winds and howling storms,Their tops connected, but at wider spaceFix'd on the centre stands their solid base;Now to the grasp each manly body bends;The humid sweat from every pore descends;Their bones resound with blows; sides, shoulders, thighsSwell to each grip and bloody tumous rise ...."

Fig. 1. Wrestlers. Detail of kouros base in bas-relief. (6th cent.BC) Nat. Arch. Mus., Athens.

Fig. 1, an Archaic bas-relief, vividly illustrates Pope'stranslation of this passage from the twenty-third book ofThe Iliad.

Milo, of Croton - a town famous for it's athletes -

was the most renowned of all Greek wrestlers. He wonfive successive Olympic crowns from 536 to 520 BC. Aswell as these victories he won many others at Delphi,Corinth and Nemea.

Pankration was the only other sport practised in thepalaestra. It has been desc; ibed as a mixture of boging,wrestling and judo, a kind of scientific unarmed combat.Its object was to bring an opponent to a point where hewas compelled to admit defeat, which he signified byholding up his arm. Locks and strangleholds were there-fore permitted, but biting and gouging were forbidden.Vase painting and sculpture of pankratiasts indicate thatthe sport may have resembled karate, but unlike com-petitions in this martial art, the combats of AncientGreece did not require blows to be 'pulled'. Arrichion,of Phigaleia, was the most famous of the 6th centurypankratiasts. He won three times at Olympia in 572, 568



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and 564 BC. On the last occasion his opponent leapedupon his back, scissors his waist with his legs, hooking afoot behind each of Arrichion's knees from inside hislegs. At the same time he applied a stranglehold andbegan to throttle the champion. With his last gasp,Arrichion threw himself sideways, simultaneously flex-ing a knee to grip one of his opponent's feet and then,by violently extending his hip, he dislocated the trappedankle. His opponent threw up an arm to signify submis-sion, but the cumulative effect of the stranglehold andthe cost of his last effort proved fatal to the champion.Nevertheless, it is recorded that the judges awarded hima posthumous victory and his Elean compatriotscrowned the dead body (Harris 1964). Pankration wasalways a favourite amongst spectators. Pindar wroteeight odes celebrating victors in this event.

The rules for boxing were drawn up about 688 BC.Each protagonist attempted to force his opponent toadmit defeat or to knock him out and the bout con-tinued uninterrupted until this happened. There were noweight divisions, so size and strength was all important.The Aeneid provides a vivid description of a matchbetween Epeus and Euryalus. The latter receives a dread-ful blow that drops him 'nerveless and extended' to theground and Virgil describes the picture of the boxerbeing dragged from the ring by his friends:

"Nodding, his head hangs down his shoulder o'er:His mouth and nostrils pour the clotted gore:Wrapt round in mists he lies, and lost to thought;His friends receive the bowl, too dearly bought."

In the early competitions boxers wore soft leatherthongs designed not to inflict injury but to protect thefingers. In training they wore large soft pads calledsphairai (spheres) to allow vigorous combat but avoiddamage. To this end they also wore ear-guards (fig. 8)which Plutarch considered more suitable for children inthe proximity of a bout to prevent them from hearingthe bad language that frequently accompanied the sport!The soft thongs were ultimately replaced by the 'sharpthongs'. These comprised a thin inner glove to which apad of hard leather was intricately bound. The thongingwas carried up the forearm over a separate piece ofsheepskin which was used, like the wrist-bandage sometennis players wear today, as a device to wipe sweatquickly away from the brows.

SPORTS INJURIES IN GREEK ATHLETIC ART

The Pugilist by Apollonius, fig. 2, displays not onlythe structure and binding of the sharp thongs but alsoreveals the injuries suffered by the boxers of the firstcentury BC. The face is scarred, the nose has beenbroken and the frontal and zygomatic bones have alsobeen fractured at some time. Both ears are swollen. Thehead of another pugilist, Satyros, by Silanion, fig. 3,

Fig. 2. The Pugilist by Apoilonio& (1st cent. BC) Terme Mus.,Rome.

displays similar injuries, but where the statue by Apoll-onius portrays some nobility, the unkempt hair, beardand sullen expression of Satyros are more indicative ofthe brutality to which the sport had descended by Hel-lenistic times.

No doubt many injuries occurred in athletics. Someare described in the literature but few are illustrated inthe plastic arts. One of the distinctions between theblack and red figure vase painting of athletic subjects isthat the former style illustrated competition whilst thelatter shows scenes of training. But it is in the latter stylethat an example of injury in pancration is depicted. Fig.4, reproduces a scene of two pancratiasts in action.Blood pours from the nose of one of the contestants,who also bears the imprint of a bloodstained hand on hisback. Unfortunately, although these details can be seenin the original they are faint and reproduce badly. Forclarity a line illustration of the scene has to substitute inthis article.

It is not surprising that injury should have been rarelydepicted in athletic art of the fifth century, for this was



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The Cauliflower Ear

From the Archaic (700-500 BC) to the Hellenistic(320 BC -+) period the bruised ear was the identifyingsign of an athlete. It was, therefore, the most frequentlydepicted athletic injury in the sculpture and painting ofAncient Greece. It is evident in a sixth century head inthe Jacobsen Collection in Copenhagen. That both earsin this work are crushed has lead experts to conclude thehead to be that of a boxer, but Hyde (1923) maintainsthat the swollen ear was representative of athletes ingeneral, for it was a realistic professional characteristic.Nevertheless, it seems strange to find crushed ears onworks that seek to portray physical perfection. For thesculptor to have incorporated such disfigurements intothe otherwise ideal features of the boxer wearing earguards, fig. 5, seems almost uncanny.

~ ~ ~~~~~~~~ ......... ....... .. ..

Fig. 3. Satyros the Pugilistby Silanion. (4th cent hC) Nat Arch.Mus., Athens.

Fig. 4. Pancration. Frag. Attk kylix. (6th cent. BC) Berlin.

the period when art was dominated by a search for theideal. The works of Ageladas Polyklitos and Myronsought to portray men not as they were, but as theyshould be. Thus it was that the physiognomy of a workof athletic art of this period did not display distortionarising from injury. One feature, however, was excludedfrom this search for perfection. It was the swollen ear.

Fig. 5. Head of Boxer Wearing Ear Guards. (4th cent. BC) Nat.Mus., Stockholm.

The cauliflower ear appeared in many early and lateClassic works. Agias, the pancratiast, fig. 6, and theApoxyomenos, both by Lysippos display this feature. Sodoes the Lansdowne Herakles by Scopas.



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Fig. 6. Agias the Pancratiast by Lysippos (4th cent. BC) NatArch. Mus, Delphi.

Of course, swollen ears were common in Hellenisticworks, even on boy boxers, fig. 7. They also appear onrepresentations of gods and demigods. Herakles is fre-quently shown with such an ear and the gods Ares andDiomede, who practised gymnastics and wrestling, alsodisplay this abnormality. Yet, it seems that bruised earswere something to be avoided if possible. Ear guards, fig.8, were used in training and boxing skill also served assome protection. Plato used the term for cauliflower earslightingly, to describe those who imitated Spartancustoms for the Spartans never boxed scientifically butfought with bare fists and without rules.

Medicine and Athletic Training in Ancient Greece

If Hippocrates was expert in athletic injuries much ofhis knowledge would have come from Herodocus, who isdescribed as not only a trainer of athletes, but also thedoctor from whom Hippocrates learned his art. In theRepublic Plato refers to Herodocus as "an athletictrainer whose health failed and who proceeded to makefirst and foremost himself, and then many others afterhim, miserable by a combination of medicine andphysical training". Plato also informs us that it was not

Fig 7. Boy Boxer. (1st cent BC) Nat. Mus, Istanbul.

until Herodocus that "doctors made use of the modernmethods of nursing disease."

Trainers of athletes occupied an important place inGreek society. They prepared their charges both physi-



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1r'I

Fig. 8. Boxer Wearing Ear Guards (4th cent. BC) Met. Mus. Art,Rogers Fund 1917, New York.

cally and psychologically, taught skills and supervisedexercise and diet. Their methods are described byvarious writers and it seems clear that they were wellaware of systems that are relatively new to moderntraining methods (Young, 1973). They realised thevalue of progressive resistance exercise. For example,Milo, of Croton, previously mentioned as a five timesOlympic victor, trained by carrying a bull around a fieldeach day from its birth until it was four years old!Incidentally, Milo's daughter is said to have married thedoctor Democedes who has been called the earliestknown practitioner in a national health service for hewas employed by the island of Aegina as a public physi-cian. He was, however, lured to Athens by an offer ofhigher pay and subsequently tempted by a yet largersalary to move to the island of Samos. Unfortunately,this island fell to the invaders during the first Persian warand Democedes was taken as a slave to Susa where heimpressed Darius by reducing the king's dislocated ankleafter native doctors had failed to do so. No doubtDemocedes had had plenty of experience of such acci-dents for, as Milo's son-in-law, he must have accom-panied the famous athlete to many athletic contests.

Trainers also supervised the diet of their athletes. Inearly days this was a simple regimen of porridge, cheese,figs and meal cakes. Meat was only eaten occasionally.

Towards the middle of the fifth century BC a meat dietwas introduced by Stymphalos, an ex-athlete who hadwon two Olympic victories in the long-distance race.Another story attributes the philosopher Pythagoras ofCroton as the instigator of a meat diet for Eurymenes ofSamos, an athlete he is said to have trained (Harris,1964). This claim may be considered more than a littledubious as a meat diet was contrary to the Pythagoreanadvocacy of vegetarianism.

However, enormous quantities of meat were eaten.Milo is reputed to have consumed 20 lbs of meat, 20 lbsof bread and 18 pints of wine in a day. If this were truehe should have earned a medal just for getting up fromthe tablet

Gardiner (1930) states that the science of gymnasticswas closely connected with that of medicine, but Philo-stratos (107-244 AD) accused medical science of codd-ling athletes and being responsible for the decline ofathletics. He maintained that it was practice to gorgeathletes with food, thereby making gluttons of them.Effects of this overfeeding were bourne out by Euripideswho denied any merit to athletic training, saying of itthat:

"Of all the countless evils throughout Hellas noneis worse than the race of athletes ... Slaves oftheir belly and their jaw they know not how tolive well. In youth they strut about in splendour,the idols of the city, but when bitter old agecomes they are cast aside like worn-out cloaks. Iblame the custom of the Hellenes who gather tosee such men honouring useless pleasures."

Plutarch was even more caustic, ascribing to trainersand coaches the belief that intelligent conversation atmeals spoiled the food and gave the diners a headache!

The ancient link between medicine and sport is saidto be best examplified in Galen (130-201 AD). Hiswritings on the value of exercise and hygiene are oftentaken to be the first scientific works of this kind. But aclose relationship between athletics and medical practicecan be found 700 years before De Sanitate Tuenda andmay be traced to the Father of Medicine himself. SportsMedicine might therefore be said to be not the newest,but the oldest branch of medicine in the field.

REFERENCES

DIXON, J. G., McINTOSH, P. C., MUNROW, A. D. and WILLETTS, R. F. (1957). Landmarks in the History ofPhysical Education. Routledge and Kegan Paul. London. 204-206.

EURIPIDES, Autolycus.

GARDINER, E. N. (1930).Athleticsof theAncientWorld. OUP. London. 89.



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HAR R IS, H. A., (1964). Greek Athletes and Athletics. Hutchinson. London. 207-208.

HARRIS, H. A., Op. cit., IV. 103.

HARRIS, H. A., Ibid. IV. 108.

HARRIS, H. A., Op. cit., VIII. 172.

HYDE, W. W. (1923). Olympic Victor Monuments and Greek Athletic Art Washington.

PAUSANIAS, (1971). Guide to Greece, Vol. II, Bk. V, 4 (3), Penguin. Harmondsworth. 295.

PH I LOSTRATUS, (1 955). On gymnastics. I n: Robinson, R. S. Sources for the History of Greek A thletics. Cinci nnati.228.

PLATO, (1956). Symposium. In: Warmington, H. and Rouse, P. G. (Eds) Great Dialogues of Plato, Ill. Mentor,London. 217.

PLATO, Gorgias, 515c.

PLATO, Republic, 111, 2. 406.

PLUTARCH, Moralia. 38b. 706a.

WAKE, W. C. (29th December, 1966). Who was Hippocrates? The Listener. 968.

YOUNG, A. J. (1973) Learn from the ancient coaches. Report of 13th Session of International Olympic Academy.Athens. 101-112.



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