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SPORTS AND SOCIETY

SPORTS : A HISTORICAL PERSPECTIVE WITH SPECIAL REFERENCE TO EASTERN EUROPE

– Written by Biljana Lazovic Popovic,

Important milestones in the develop- SPORTS MEDICINE HISTORY: THE from magic, religion and philosophy ment of sports medicine in eastern European BEGINNINGS and established it as a profession, basing countries are closely linked to the social and Many sources indicate that classical its practice on objective observations political background of the time, as well as Egyptian, Greek and Roman and emphasising the -patient sports-related science. At the beginning were well aware of the beneficial effects relationship. Today his postulate is more of the 20th century, after the First World of physical on the body and relevant than ever: “eating alone will not War, medicine focused on the preservation mind. The 5th century Greek physician keep a man well, he must also take exercise” of health and the prevention of disease. In Herodicus (500 BCE), a former teacher and “food and exercise, while possessing this context, physicians emphasised the of Hippocrates, regarded as the original opposite qualities, yet work together to importance of exercise and gave attention to pioneer of sports medicine, was a physician produce health”. It can also be proven that ideas of fitness and health, not only among who practiced dietetic medicine and contemporary Greek medicine was as closely the general population, but also for the utilised the therapeutic effects of exercise. linked to the training and competitions of young, fit male body – an unusual patient Herodicus devoted the majority of his time ancient as modern sports medicine group, usually only encountered in sports to recommending exercise to aid recovery is to present-day athletes. The physician or military medicine. At the same time, from athletic and gymnastic . Celsus (25 BCE to 50 CE), also known as physical activity was becoming fashionable Hippocrates (460 to 370 BCE) is the earliest the ‘Latin Hippocrates’ postulated that and the sports medicine specialisation known physician and recognised as the medicine was a triad of emphasis between began to prescribe exercise as medicine. father of medicine. He dissociated medicine dietetics, pharmacology and , with

574 Image: Historical sporting artefacts on display at the International Sports Fair in Belgrade, 2015.

dietetics becoming a composite of food and and the following centuries, numerous of the , including: metabolism, fluid consumption, exercise, bathing and scientists investigated the different roles of respiration, circulation, , muscular relaxation. The most important physician of physical exercise. At the beginning of the work and altitude physiology. the Roman Empire was Galen (131 to 201 CE), 17th century, Italian physician Girolamo By the end of the 19th century, parallel a Greek physician to the gladiators and the Mercuriale (1530 to 1606), wrote ‘De Arte to the Industrial Revolution – which had Roman Emperor Marcus Aurelius. He was Gymnastica’, which is now considered the provided the motive and means to create the first physician to document his medical first book of sports medicine, containing new tools and mechanisms – specific observations and is known as the founder of the principles of physical . Pierre- equipment and support devices were experimental medicine. He stated that “the Jean-Georges Cabanis (1757 to 1808), a developed. These devices and equipment form of exercise deserving our attention French doctor and physiologist, provided enabled the next phase in the development is therefore that which has the capacity to a systematic description of the human of medical support to sportspeople and provide health of the body, harmony of the organism and its sources of energy and healthcare for amateur and professional part and virtue in the soul and these things proposed that the development of sports athletes. In 1883, the first manual ergometer are true of the exercise with the small ball”. in Europe increased the development of was built and 6 years later, the first Since Galen’s time, doctors have not only and vice versa. Jan treadmill. In 1896, the first bicycle ergometer been treating sports injuries, but have also Evangelista Purkyne (1787 to 1869), a Czech was presented at the World Exhibition of been instructing and preparing athletes. anatomist and physiologist, presented the Technical Achievements in Paris, . It was not before the 17th and 18th favourable effect of physical training on In 1911, Claude Gordon Douglas centuries that doctors and scientists human health. Nathan Zuntz (1847 to 1920), constructed a gasbag which could store again referred to this wealth of ancient a German physiologist and a pioneer of expired air for complex analysis of the knowledge, which at last became the modern altitude physiology and aviation metabolic changes in the under subject of scientific research. During these medicine, published studies on the biology the influence of defined physical effort and

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to determine physical working capacity. countries. The expression ‘sports doctor’ was BUILDING STRUCTURES, ORGANI-SATIONS This and other new inventions made it used officially for the first time in Berlin, AND INSTITUTIONS possible to study the human organism’s in 1913. The First World War (1914 The Association Internationale Médico- reaction to physical efforts and to determine to 1918) interrupted the development of Sportive (AIMS) was established in Sent its physical ability. The first sports medical sports medicine in Europe for more than Moritz, in 1928, with Wilhelm laboratory for anthropological, functional 10 years. However, the period between the Knoll from Switzerland serving as the first and radiological examinations, managed two world wars was absolutely crucial in president and Arthur Mallwitz the first by Arthur Mallwitz, was established during it's formation. August Bier (1861 to 1949) secretary general. The association was the First International Hygiene Exhibition, and Arthur Mallwitz (1880 to 1968), both established to exchange information and in Dresden, Germany in 1911. During German doctors, gave their first lectures experience related to research and practice that exhibition, which was open for 6 in sports medicine at Berlin University in in sports medicine. In the same year, months, the visitors could – under medical 1919. Arthur Mallwitz is considered the during the 9th Summer Olympic Games, in supervision – check their physical ability founder of modern sports medicine. August Amsterdam, the First AIMS International based on parameters obtained before and Bier was a director of the Akademie für Congress of Sports Medicine was organised, after . und Leibeserziehung (Academy for with participation from more than 30 Exercise and Physical Training) in Berlin, countries. This presented an opportunity to SPORT FOR ALL AND THE MODERN HISTORY latterly called the Hohenlychen , study a large quantity of athlete health data. OF SPORTS MEDICINE which became the first sports medicine The first AIMS statute determined three The First German Congress of the in Germany. Its director goals: Scientific Investigation of Sports and (1897 to 1948) became the first professor 1. Promotion of scientific research in Physical Education was organised in of sports medicine in Berlin, expanding the fields of biology, psychology and Oberhof, Germany in 1912. The topics Bier’s methods and adopting an academic , covered included: ‘the importance of approach to sports medicine and awarding 2. promotion of medical research projects physical education with a hygienic degrees. At the same time, Arlie V. Bock associated with athletes’ training and view’, ‘women and physical ability’ and (1888 to 1984), a researcher at the Harvard competition and ‘the impact of regular exercise on the in the USA, was pioneering 3. organisation of international sports cardiovascular system’ among others. At the field of blood research, especially in medicine congresses. the same time, the German Committee for relation to exercise physiology. Archibald V. In 1934, AIMS changed its name to the Scientific Research of Sports and Physical Hill (1886 to 1977), an English physiologist, International Federation of Sports Medicine Education was established. This was the first (jointly) won the Nobel Prize in physiology (Fédération Internationale de Médécine national organisation of sports medicine in in 1922 for explaining the production of heat du Sport – FIMS). FIMS started as a mostly the world. Sports medicine organisations and mechanical work in muscles in high- European organisation, but later, from weren't founded until decades later in other performance athletics. the 1960s to the 1980s, it grew to include

The First World War (1914 to 1918) interrupted the development of sports medicine in Europe for more than 10 years. However, the period between the two world wars was absolutely crucial in its formation

576 countries from all five continents. Today, was in Belgrade, Yugoslavia in 1954 and the societies of sports medicine and sports FIMS consisits of continental and national 12th International FIMS Congress and the science facilities. sports medicine associations, multinational 30th Anniversary of FIMS was in Moscow, • Promote the importance of physical groups and individual members. It is the USSR in 1958. Since 1963, FIMS has organised activity and exercise for the prevention, biggest federation of national medical FIMS European Congresses, in addition to treatment and rehabilitation of illness associations in the world, with hundreds the international ones – which changed and . of thousands of medical doctors and their name into the FIMS World Congress in • Exchange scientific results and other professionals from different fields 1966. Since the 1980s, FIMS has developed experiences in the field of sports of sports medicine. The primary aims of relations with other institutions and medicine. FIMS are to promote scientific research and countries throughout the world. The first • Work on joint research projects, the development of sports medicine all over the joint meeting of FIMS and the World Health creation of licensed sports medicine world and to help athletes to achieve optimal Organisation was held in Cologne, Germany centres and promotion of ethical competition ability by maximising their in 1994. In 2003, FIMS celebrated 75 years of principles in sports medicine. genetic potential, health, nutrition, quality of its existence in all five continents. medical protection and training. It organises The second important sports medicine MODERN SPORTS MEDICINE IN EASTERN courses, international congresses, publishes organisation is the European Federation EUROPE scientific information related to sports of Sports Medicine Associations (EFSMA), One organisation played a key role in medicine and promotes contact between which was founded in Porto, in promoting sports medicine and spreading sports medicine specialists throughout the 1997. Its goals are to: the spirit of physical education in Eastern world. The 1st FIMS European Congress was • Establish sports medicine as a specialty Europe. This was a youth sport and organised in Prague, Czechoslovakia in 1963. in Europe. gymnastics movement called The Sokol. The During the 20th century, international FIMS • Develop and co-ordinate training and Sokol was founded in 1862 in Prague (then congresses were organised throughout teaching of sports medicine at relevant part of the Austro-Hungarian Empire) by Europe. For example, the 7th International educational institutions. Miroslav Tyrs and Jindrich Funger. Miroslav FIMS Congress was organised in Prague in • Create a pan-European forum to co- Tyrs (1832 to 1884), a Czech art historian 1948, the 10th International FIMS Congress ordinate activities between European and sports administrator, introduced new

Image: Yugoslavian National Football Team. Library of Argentine Football Associationat at the first World Championship in 1930. Public Domain.

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Although the terms of the sports facilities in East Germany were 'sportarzt' and found to have been destroyed or used for other purposes, such as emergency and refugee lodgings and agrarian facilities. 'sportmedizin' were not Nevertheless, sports medicine curricula were set up by various facilities of physical used in German before education for sport students and trainers in 1946. In the same year, Friedrich Wilhelm the last century, their University in Berlin introduced sports- medicine teaching in the form of a class called ‘sport biology’. In 1950, the Ministry area of concern and their of Health created a department of sports medicine and issued a decree stating that issues are among the sports medalists had to be examined by a doctor. Thus, the necessity for doctors with sports medicine experience arose and such oldest in medicine examinations were introduced as a paid ‘additional activity’. Also in 1950, a decade- gymnastic exercises and terminology. The the auspices of the European Federation of old demand that ‘every doctor (be) a sports Sokol established a versatile programme sports associations. The 15th and last Balkan doctor’ was reaffirmed by prominent of physical, moral and intellectual training Sports Medicine Congress was held in sports medicine professor Arno Arnold. He for the nation. It was the first physical Bucharest, Romania in 2008. believed that sports medicine should be education organisation in the Austro- Germany may be considered the cradle a mandatory examination subject in the Hungarian Empire at a time of political of sports medicine worldwide. In 2012, study of medicine. This created a pathway freedom in the 1860s. It gre from 2000 the country celebrated 100 years of sports for the introduction of lectures in sports members in 1863 to over a million members medicine – the first congress of the German medicine or sports-related topics as a in the period between the two world wars. Committee Scientific Investigation ofpart of other subjects at the six medical The Sokol festival, held for the first time in Physical Activity was held in Oberhof in university faculties in East Germany 1882, was a mass gymnastic festival. The 1912 and the Committee for the Scientific (Deutsche Demokratische Republik – DDR) Sokol movement gained popularity in most Investigation of Sports and Physical Exercise and three medical academies (Erfurt, of the Slavic countries, including: , was founded in the same year. The main Dresden and Magdeburg), starting in Serbia, , (, ), topics of this first sports medicine meeting the late 1950s. The German College of , etc. It established the were: Physical Culture (Deutsche Hochschule für basis for the 20th century development of • Influence of constant exercise on heart Körperkultur) was founded in 1950, with a widely accepted approach of applying function, a Sports Medicine Department included science to sport, rather than regarding it as a • overtraining, from the outset. In addition to teaching mere leisure or entertainment activity. • sports and doping, sports medicine, the department was also During the FIMS Congress of Sports • evaluation of physiological characte- in charge of student health. In 1961, the Medicine held in Romania in 1969, the ristics in different types of sports, Institute for Sports Medicine was founded, Turkish representative Dr Necati Akgn • sport and sexuality, followed by the Faculty of Natural Sciences proposed the establishment of a Sports • women in sport and and Sports Medicine in 1962. The Kreischa Medicine Association of the Balkans (BSMA). • practical experiences during the Rehabilitation Centre (near Dresden) was The BSMA was established in 1971 providing Olympic Games. affiliated to the Institute in 1962. This Centre links between sports medicine doctors Although the terms ‘sportarzt’ and evolved into the Central Institute for Sports from Bulgaria, Greece, Romania, ‘sportmedizin’ were not used in German Medical Services in 1968. In Leipzig, as well and Yugoslavia. Later, the association also before the last century, their area of concern as in Kreischa, there were courses and included Albania, Bulgaria, Cyprus, Greece, and their issues are among the oldest in advanced seminars in sports medicine with Macedonia, Romania, Moldova, Serbia and medicine. Only a few years later, in 1924, national and international participants. Turkey. The 1st Balkan Congress of Sports the German Federation for the Promotion of The teaching was primarily by doctors with Medicine was held in Athens, Greece in 1972. Physical Exercise was founded. In the same sports medicine experience at out- and Unfortunately, due to the large number of year, the first journal of sports medicine in-patient health services and university annual sports medicine conferences and Der Sportarzt (The Sports Physician) was facilities. The Research Institute for Physical numerous historical and political reasons, published and, starting in 1925, an annual Education and Sports (FKS) was founded in the BSMA Executive Committee decided to sports medicine congress was organised. 1969 to meet the high-performance sports freeze its activities and focus on work under After the Second World War, about 60 percent goals of the DDR. It was a combination of

578 the research facility and a major part of well-known university teachers strongly the Soviet system of , physical the Institute for Sports Medicine of the opposed the decision. culture and sports. In the Soviet Union, sub- German University for Physical Education In the USSR, the term ‘vrachebnyi kontrol’ departments, laboratories and departments in Leipzig. The FKS was the only institution (medical supervision) was sometimes of sports medicine were organised in for high-performance sports research in used instead of the term sports medicine. the 1920s and 1930s at scientific research the DDR and employed more than 600 Modern sports medicine started to develop institutes and educational institutes of people until it was closed down in 1990. As in the countries of the former Soviet physical culture. Dispensaries and stations a result of the successful work at the FKS, Union at the end of 19th century. Ivan for medical supervision of all categories sport-specific ergometers were introduced Mikhaylovich Sechenov (1829 to 1905), the of physical culturists and athletes were for a variety of sports by 1974. Among these father of Russian physiology, explained how established in the 1940s. There were more were the current channel for swimming the partial pressure of oxygen in the alveoli than 300 dispensaries and about 1500 and the tiltable treadmill for cross-country changes with barometric pressure. At the stations in 1975. The USSR Federation of skiing. With the establishment of Sports- end of the19th century, Russian army doctors Sports Medicine was founded in 1946 and Medical Consultation Centres in 1952 and performed comprehensive assessments became a member of FIMS in 1952. It was the introduction of the sports medicine of the fitness of soldiers at high altitude represented at international congresses on specialisation in 1963, the sports medicine and studied procedures for improving sports medicine sponsored by FIMS. The management system became a centralised acclimatisation. The development of sports All-Union Society of Medical Supervision state-organised structure. Until the end medicine in the USSR was closely linked to and Kinesitherapy of the USSR Ministry of the 1950s, county sports doctors from the work of N.A. Semashko, V.N. Moshkov, of Public Health was founded in 1961 and health services had advised and assessed V.V. Gorenevskii, B.A. Ivanovskii, I.M. the Kiev Scientific Research Institute of those participating in sport. However, from Sarkizov-Serazini, I.A. Kriachko, S.P. Letunov, Medical Problems in Physical Culture and 1970, they were assigned clearly defined R.E. Motylianskaia and others. These Sports was founded in 1967. Laboratory responsibilities in order to establish a individuals laid the scientific foundation groups on different aspects of sports high-performance sports system. The of sports medicine as an integral part of medicine were created in the 1970s at many county sports doctors became responsible for the extensive care of young aspiring athletes enrolled in the training centres. Every activity in high-performance sport was kept strictly secret. Political party leaders and sports directors recognised the significance of athletic achievement for the international reputation of their country, so no expense was spared in upholding the impressive success of the DDR sports on the world stage. Preparations in some sports for the Olympic Games in 1972 in Munich included particular ‘supportive measures’ – as doping was euphemistically called. The DDR and its sports managers had always officially recognised the Anti-Doping Charter and doctors were not forced to carry out the measures imposed by the Sports Leagues, but anyone who refused could be certain of being judged unsuitable for employment in high-performance sports. These activities cast a shadow over the previously progressive and successful sports medicine work done in the state. By 1990, there were around 1800 people employed in the Sports Medical Department, 350 of them specialists in sports medicine. At the end of 1990, the Sports Medical Department was closed as a centralised institution by the Federal Ministry of Finance for the reunified Germany, although some of the doctors and Image: Historical sporting artefacts on display at the International Sports Fair in Belgrade, 2015.

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The Sokol established the basis for the 20th century development of a widely accepted approach of applying science to sport, rather than regarding it as a mere leisure or entertainment activity

scientific research institutes of the USSR common psychology and psychology was opened within the Clinic for Internal Academy of Medical Sciences. Research in of physical exercise at different ages, Medicine at the Medical Faculty University sports medicine was co-ordinated by the common pedagogy and education by in Belgrade, under the leadership of Professor Commissions for Medical Problems in Sports means of physical exercise. Vojislav Arnovljevic. The first doctor from and in Physical Culture. As an educational 4. Organisation of physical training: Yugoslavia to specialise in sports medicine discipline, sports medicine was part of the modern organisation of physical was Vojin Smodlaka, who studied at the curricula at institutes of physical culture, training in the world, legal matters Centre of Sports Medicine at the Academy of medical institutes and pedagogical higher concerning the organisation of physical Physical Culture in Berlin in 1937. As early as educational institutions with departments training, the concept of organised camps, 1940, Sports Medicine was introduced as an of physical education. summer sports activities, children's optional course, led by Dr Smodlaka, at the Bulgaria started its first formal playgrounds, fairs, competitions etc., Faculty of Medicine in Belgrade. After the institution for physical education in 1942 construction and equipping of facilities Second World War, in 1945, sports medicine as a higher school for physical education. for exercising, knowledge of exercise teaching was introduced at the Federal Today, the same school exists as the equipment and apparatus. Institute of Sports Culture in Belgrade (today National Sports Academy ‘Vassil Levski’. It In 1967, the higher school for physical – Faculty of Sport and Physical Culture) and played a significant role in establishing the education was divided into the Sports- the Department of Sports Medicine was foundations of methodology and a multi- pedagogical faculty and the faculty for mass established within the Medical Association disciplinary approach to sports in Bulgaria. health and healing physical culture. Twelve of Serbia. Soon after, in 1952, the Institute The school had four departments: departments replaced the four old ones, for Sports Medicine was founded within 1. Health sciences: anatomy, biology, including general hygiene and hygiene the Yugoslav Institute for Physical Culture anthropology, general physiology for physical exercise, medical surveillance, and Sports Medicine. A year later, in 1953, and physiology of physical exercise, study of the physical development of the the Sports Institute of Vojvodina (today – general hygiene and hygiene of human body and anthropometry. This was the Regional Institute for Sports and Sports physical exercise, first aid, correctional the beginning of important work completed Medicine) was established in Novi Sad. The gymnastics and massage. over the following decades aimed at Sports Healthcare Centre was opened in 2. Physical education: history of physical providing professional support to Bulgarian Belgrade in 1957. In 1965, the Section of Sports education, theory of physical exercise, athletes in the field sports medicine. Medicine was established in Novi Sad within methods of physical exercise (including The development of sports medicine in the Society of Physicians of Vojvodina, a part practice). former Yugoslavia began when a group of of Serbian Medical Society. Today, the Section 3. General education: general knowledge doctors began to organise athlete health and of Sports is a part of Serbian Medical Society. of Bulgaria (language, literature, sport facility hygiene in Belgrade in 1930. In A crowning moment in the development ethics, history, culture and geography), 1936 the first sports outpatient department of sports medicine in Serbia was the

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Modern sports medicine started to develop in the graduation of the first specialist. Medical doctor Miodrag Petrovic passed the exam countries of the former in sports medicine in 1966, thus paving the way for generations of sports medicine Soviet Union at the end of specialists who gave enormous support to the success of Yugoslavian athletes during the 19th century. the 1970s and 1980s. In 1975, Yugoslavian karateka and Professor Vladimir Jorga became the head of the World Karate Federation, established by the Health Commission (Medical Board) and Further Reading 6 years later an international symposium of sports medicine ‘Medical and Biological 1. Berg A, König D. History of sports medicine 11. Arndt K-H. Tradition [verpflichtet – 100 Characteristics of Karate Training’ was in Germany with special reference to Jahre organisierte Sportmedizin]. Dtsch Z held in Belgrade. In 1977, the Congress of the University of Freiburg. Eur J of Sport Sportmed 2012; 63:1-3. International Federation of Sport Medicine Science 2002; 2:1-7. 12. Nolte CE. The Sokol in the Czech Lands to was organised in Belgrade. The Sports 2. Berryman JW. Out of Many, One: A 1914: training for the nation. New York: Medicine Association of Serbia (SMAS) History of the American College of Sports Palgrave Macmillan 2002. was founded in 1995 as an association of Medicine. Champaign (IL): Human 13. Gippenreiter E, West JB. High altitude specialists in sports medicine, doctors of Kinetics 1995. medicine and physiology in the former other specialties, as well as other experts 3. Jonas S, Phillips EM. ACSM's Exercise is Soviet Union. Aviat Space Environ Med engaged in healthcare and improvement of Medicine: A Clinician’s Guide to Exercise 1996; 67:576-584. participants in sports and recreation. The Prescription. Philadelphia: Lippincott 14. Rohdewald S. Yugoslavian sport and the goals of the SMAS are: Williams & Wilkins 2009. challenges of its recent historiography. J • Education through training courses, 4. Berryman. Exercise is Medicine: a Sport Hist 2011; 38:387-395. publishing activity and organisation historical perspective. Curr Sports Med of regular conferences in the fields of Rep 2010; 9:195-201. sports medicine and as well as dietary supplements. 5. Georgoulis AD, Kiapidou IS, Velogianni • Developing and promoting technical L, Sterigiou N, Boland A. Herodicus, the and scientific practices. father of sports medicine. Knee Surg • Providing adequate healthcare to all Sports Traumatol Arthrosc 1997; 15:315- athletes. 318. • Protecting the professional interests 6. Tipton CM. The history of "Exercise Is and rights of doctors and medical staff Medicine" in ancient civilizations. Adv involved in sports medicine Physiol Educ 2014; 38:109-117. • Issuing certificates and licenses 7. Berryman JW. The art of medicine, motion • Co-operating with other national and rest: Galen on exercise and health. associations of sports medicine. Lancet 2010; 380:210-211. The SMAS is a member of the EFSMA 8. Waddington I. The development of sports and FIMS and has held the Serbian medicine. Soc Sport J 1996; 13:176-196. Congress of Sports Science and Sports Medicine every 2 years since 2003. 9. Ergen E, Pigozzi F, N. Bachl N, Dickhuth HH. Biljana Lazovic Popovic M.D. Sports medicine: a European perspective. The first Serbian Congress on Dietary Assistant Professor Supplements was held in 2007 and is also Historical roots, definitions and scope. J University Clinical Hospital Center – held biennially. In 2015, the first Serbian Sports Med Phys Fitness 2006; 46:167-175. Zemun Medicine Conference 10. Cruse JM. : the Belgrade, Serbia was held in Belgrade, in partnership with metamorphosis of scientific medicine in the Serbian Institute of Sports and Sports the ever-present past. Am J Med Sci 1999; Medicine and Aspetar. 318:171-180. Contact: [email protected]

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