Mr President of the International Olympic Academies, Distinguished Directors, Ladies and Gentlemen; it is a distinct honor and a great pleasure indeed to return to the magic of Ancient Olympia on the occasion of the 11th International Session for Directors of the National Olympic Academies.
I am grateful to President Kouvelos for the invitation to speak on “Medicine and the Olympic Games of Antiquity.”
I shall discuss today athleticism and the profound influence sport exerted on the evolution of the healing arts of classical Greece.
I shall also argue that the unique ethical, philosophical and clinical profile of ancient Hellenic Medicine is not a random event in the history of civilisation but the direct consequence of a culture that indulges in nature, excels in competitive sport, cultivates reason and respects the individual.
Imagine now that you are visitor to the city of Athens in the year 380 B.C. the year of the 100th Olympiad about to take place on the very grounds that we stand today; the year when Xenophon of Aigai – of the Royal city of Macedon – will be crowned with the olive wreath for his victory in the pankration.
Imagine for a moment that on a crisp spring morning you are standing on the Acropolis. In the distance you can see Plato’s Academy, the famous gymnasium of Athens, where the youth of the day have begun their training in preparation for the forthcoming Olympic Games. You turn south and in the distance you see the glittering Aegean Sea, the witness of the battle of Salamis, when democracy triumphed over despotism; and a few streets away an orator is putting the final touches to his speech to be delivered shortly at Olympia. This is what he writes:
> _“…now the founders of our great festivals are justly praised for handing down to us a custom by which, having proclaimed a truce and resolved our pending quarrels, we come together in one place, where, as we make our prayers and sacrifices in common, we are reminded of the kinship which exists among us and are made to feel more kindly towards each other for the future, reviving our old friendships and establishing new ties…”_ – Isocrates (in Panegyricos)
Written in 380 B.C., the ideals of Isocrates’ (436-338 B.C.) speech are still reverberating at the opening ceremonies of contemporary Olympiads and are as appealing and elusive to humanity today, as they were two millennia ago, to the Hellenes congregating at Elis for the greatest celebration of their world. Isocrates’ _Panegyricos_, although in praise of Athens, captures also the political dimension of the Olympiad as a Pan-Hellenic institution in the conscience of Hellas.
Aware of the repercussions of an Olympic victory, Philip of Macedon competes in the equestrian events and erects the _Φιλίππειον_ to commemorate his victory; a valuable instrument of his political and dynastic ambitions for hegemony over the rest of Greece. The ruins of this building can still be seen by the modern visitor of ancient Olympia.
### The Sporting Ethos
Perhaps no other passage of Greek literature reflects the ethos of sportsmanship and the values of Ancient Greece than Homer’s account of Odysseus’ involvement in the Phaeacian games.
> “…One can see you are no sportsman, your mind is on profit…”
This is how Prince Euryalus talks to Odysseus who, exhausted from his sea voyage, declines the invitation to join the athletic games of the Phaeacians. Insulted, Odysseus leaps to his feet, picks up the biggest discus of all, a huge weight, and throws it overshooting all other marks. It is this spirit of sportsmanship and an aversion to profit – pecuniary or otherwise – that is the core of the Olympic ideal and so central to the culture of ancient Greece. Homer, of course, has good reasons to describe this episode in these colors; he is the Educator of Hellas.
A natural environment that permits outdoor activities throughout the year facilitates sportsmanship that becomes an essential element in the life of the Ancient Greek.
A society developing – in the words of Hippocrates – _in privileged climatic conditions_, learns to respect the individual, becomes increasingly detached from theosophy and superstition and cultivates reason; this passionately naturalist culture, enjoys a liberal religion of gods with human weaknesses and humor and cares largely for excellence on earth and little for afterlife.
Excellence develops with the athletic and intellectual pursuits of the youth in the gymnasia of the _polis_ and is ultimately glorified in Pan-Hellenic festivals, the most celebrated of which was held at Olympia. Medicine emerges in parallel and in the service of these activities.
### Philosophy and Sport
Originally the gymnasia were places where the young men would exercise in athletics naked (_γσμνοί_). This, in fact, is the derivation of the word for the modern gymnast exercising on bars. Gradually, as the symmetrical and harmonious training of body and mind became the educational concern of the state, the gymnasia became places of learning and intellectual pursuit.
The _Academy_ and _Lyceum_ in Athens where **Plato** (427-347 BC) and **Aristotle** (384-322 BC) taught were the two most famous gymnasia that influenced in a profound way the whole of the Greek civilisation.
**Aristotle** is known in our universities as a philosopher and naturalist, not as a doctor. He is however familiar with medicine through his father **Nicomachos**, the Royal Physician to **Philip of Macedon** and he is interested in the anatomy and function of living organisms in broad biological terms.
From Aristotle and the lesser known _Hippias of Elis_ we have the early catalogues of the names of Olympic victors. **Koroibos of Elis** was the first man to win the stadion race at the first Olympiad in 776 BC. His name has been associated with the beginning of the Olympic Games.
### Function of the Officials
Aristotle tells us about the tasks of _gymnastai_ and _paidotribai_, the officials in the gymnasia, who were responsible for the training of athletes.
Other officials, the _ἀλείπται_ or _anointers_, were responsible for anointing with oil the athletes who were about to exercise. This initially simple task developed gradually into methodical massaging and eventually into a speciality that was concerned with many aspects of hygiene and athletic routine.
Thus the _ἀλείπται_ gradually became known as _ἰατραλείπται_ (healer-anointers), or doctors of hygiene _ὑγιεινοί ἰατροί_. These interesting paramedics – we shall call them _athliatroi_ – greatly promoted dietetics and the art of caring for orthopaedic injuries and other commonplace traumata in the gymnasia.
Among the best known _athliatroi_ are **Herodicos of Selybria** and **Ikkos of Taras**, men of broad education otherwise known as sophists, who were particularly concerned with athletic hygiene. Ikkos himself may have won the pentathlon in 444 BC at Olympia. Professional rivalries between _athliatroi_ and the more orthodox therapists of the Hippocratic and Galenic tradition were inevitable.
The Hippocratic corpus consists of 72 treatises; there are copious references within the Corpus to the words _gymnastics_, _exercise_, _diets_, _athletes_ etc. However no references were found to _Olympia_, _Olympiad_ or _Olympionices_ (Olympic victor).
**Hippocrates** (460 BC) distinguishes between gymnastics and medicine in the treatise, _On the places of man_ (ΠΔΡΙ ΣΟΠΩΝ ΣΩΝ ΚΑΣΑ ΑΝΘΡΩΠΟΝ) (***Γσμναζηική δὲ καὶ ἱηηρική ὑπενανηία πέθσκεν…***); “Gymnastics and medicine,” we read, “are by their nature opposite, for gymnastics have no need to cause changes [in the human body] but medicine has. For changes are not needed in the state of a healthy individual, but this is necessary in the patient.”
In the treatise _On joints_ (ΠΔΡΙ ΑΡΘΡΩΝ), Hippocrates makes a clear distinction between properly trained doctors, “iatroi”, and those “lesser experts,” as he puts it, who frequent the wrestling rings (***ηὸ ηοιοῦηο δὲ ποιῆζαι μεηρίως ἐπιηήδειος ἄν ηις εἴη ηῶν ἀμθί παλαίζηρῃ εἰθηζμένων***). Elsewhere in the same treatise he advises on a method of reducing a shoulder dislocation, “a method simple and useful in the palaistra” (***Αὗηαι δὲ αἱ ἐμβολαί πᾶζαι καηά παλαίζηρην εὔτρηζηοί εἰζιν.***)
### Special Diets
There are stories about Olympic athletes who achieved high performances and ultimately their victories on special diets. One athlete is known to have had a diet of dried figs and another gave up cheese for large quantities of meat. We do not know the reasons for this choice. In the treatise _On Ancient Medicine_ (ΠΔΡΙ ΑΡΥΑΙΗ ΙΗΣΡΙΚΗ) Hippocrates discusses extensively the impact of various foods on well being and we find an elaborate reference to the intolerance of cheese which can be “a wicked food” (***πονηρόν βρῶμα***) for some people, whereas others tolerate it well and for them can be an excellent nutrient.
Some six centuries later, the celebrated Physician **Galen of Pergamum** (129 – 200 AD) and a scholiast of Hippocrates, is concerned with similar issues. The Olympic Games continued uninterrupted to his time and gymnastics, hygiene and athletics were still very much part of everyday life of the Hellenic and Roman world.
In a treatise with the title, “Is health a matter of medicine or gymnastics?” (ΓΑΛΗΝΟΤ ΠΡΟ ΘΡΑ ΤΒΟΤΛΟΝ ΒΙΒΛΙΟΝ, ΠΟΣΔΡΟΝ ΙΑΣΡΙΚΗ Η ΓΤΜΝΑ ΣΙΚΗ Δ ΣΙ ΣΟ ΤΓΙΔΙΝΟΝ) addressed to his friend Thrasyboulos, Galen cannot hide his distaste towards the athletes’ trainers. “The most unfortunate of the athletes,” he writes, “who never won a victory, suddenly decide to call themselves gymnastai. Even worse some of them attempt to write and argue about massage and wellbeing or health or exercises”. In another treatise, _Protrepticos_, an “Exhortation on the art,” (ΓΑΛΗΝΟΤ ΠΡΟΣΡΕΠΣΙΚΟ ΛΟΓΟ ΕΠΙ ΣΑ ΣΕΧΝΑ) he addresses the question, does the athlete’s life benefit himself or the state? He makes a case against the athletes and quotes **Euripides** who, in his usual tragic mood, calls the athletes “The worst evil of Greece”. In the same work Galen derides **Milon of Kroton**, a celebrated Olympic victor who allegedly won the olive wreath seven times.
This extraordinary athlete had an extraordinary end. He tried to cut open with his hands a tree trunk. The tree closed up and trapped his hands. He could not free himself and in the evening he was torn to pieces by wild beasts. “A silly man,” says Galen. “but what else can one expect from an athlete?” (Ἐδήλωζε δὲ καὶ ἡ ηελεσηή ηἀνδρός, ὅπως ἦν ἀνόηηος)
Galen is not an impartial witness. He is attacking the athletes probably because he despises their trainers, who interfere in medical matters. He is also unfair to Milon who, apart from his astonishing athletic achievements, was an educated man and a disciple of Pythagoras.
Galen refers to the Olympiad in his book on “Periods.” “Some early physicians,” he writes, “mention that paroxysms of certain diseases happen periodically, but they do not explain what the name period means.” He goes on to give a definition of the Olympic period relevant to medicine in chronological terms.
In another treatise, “On the composition of medicines” (ΠΔΡΙ ΤΝΘΔ ΔΩ ΦΑΡΜΑΚΩΝ ΣΩΝ ΚΑΣΑ ΣΟΠΟΤ ΒΙΒΛΙΟΝ Γ), he refers to “the brown medicament of the Olympionice, (Φαιὸν τὸ τοῦ Ὀλσμπιονίκοσ ἐπιγραφόμενον) that promptly relieves great pains and chemoses.” The prescription is obviously not his, because he eagerly states his modification by two additions to the previously described components. It was possible to resurrect Galen’s ointment at the Chelsea School of Pharmacy with the kind help of Dr Jolliffe and Mr Burt. The ointment contains cadmium? (***Καδμείας κεκασμένης καὶ πεπλσμένης δρατμὰς ή***), opium, antimony, zinc oxide, frankincense, aloe indica, saffron, myrrh and a raw egg.
Galen’s medicament had to be really good if it were to be of any use, for injuries in the Olympic Games, particularly in the body contact events, were serious. There were no silver or bronze medallists in those days. Only one of the contestants in each event could win, the rest were losers. The competition for the olive wreath among the athletes was fierce, and casualties frequent and occasionally fatal.
### Deaths and Injuries
We know of at least two boxers who were responsible for the death of their opponents-**Diognetos of Crete**, and **Cleomedes of Astypalaia** who subsequently went mad. The judges denied the latter his victory, not because he killed his opponent but because he broke the rules of the contest. Fatalities were recognised risks in sporting competitions and athletes who accidentally caused the death of their opponent during an Olympic contest were normally immune from prosecution.
Boxers tried to protect themselves during training by wearing ear-protectors called ἀμφωτίδες or ἐπωτίδες. However, these circular pieces of thick leather or metal, fastened around the head and jaw, were not allowed during the actual contest when the most punishing injuries were taking place. Fractured noses, cut eyes and torn ears were common. Derisory epithets of boxers such as “Cauliflower Ears” (Ωτοθλαδίας) have survived in the literature.
Yet, all was not ugly in boxing in those days. We hear of a certain **Melankomas** who was “as healthy and unmarked as a runner” because of his unique style and tactics. His biographer **Dio Chrysostomon** tells us that Melankomas, a favourite of the crowds, used to exhaust his opponents by continually changing position without ever receiving or striking a blow. His movements were simple, light and graceful. He won numerous competitions in various Pan-Hellenic festivals and may have won an Olympic victory during the 206th Olympiad (45 AD).
### The Pankration
Athletes suffered even more devastating injuries during the Pankration, an event combining wrestling and boxing. **Plato** comments on it “as a contest combining imperfect wrestling with imperfect boxing”. The only things that were forbidden during this contest were “biting and gouging”. We hear of **Arrichion of Phigaeleia**, a Pankatiast (the word means all-powerful), who won his victory posthumously. He was captured by his opponent in a terrible hold that was strangling him. In a desperate attempt to free himself, Arrichion seized the foot of his opponent and crashed it, dislocating the ankle. The other man, unable to bear the pain, raised his hand in the signal of a withdrawal, while Arrichion breathed his last at the same moment; he won the victory not because he died, but because his opponent gave up.
Injuries from spectacular falls during the popular horse and chariot races must have added to medical emergencies.
The soil of Olympia may have claimed several victims with tetanus. This disease was well recognised at the time of Hippocrates and is thoroughly described in the Corpus, but we have no written accounts of tetanus episodes relating to Olympic athletes.
Another possible cause of injuries may have been accidents from the throwing of javelins and the discus. Tradition has it that **Oxylos**, the founder of Elis, the Greek province where Olympia is, left his country because he accidentally killed his brother **Thermios** while throwing the discus.
### Sanitation and Medical Services During the Games
Heat, dust, a limited supply of water, rudimentary sanitation and those Mediterranean insects that are determined to spoil the enjoyment of ancient and modern visitors to Olympia, must have added to morbidity among the thousands of participants in the games. The overwhelming majority of visitors slept in the open air or in tents, and for food and drink depended on itinerant caterers.
**Pausanias**, a traveller and writer of the second century AD, gives us an idea of the problem with insects. “They say,” he writes, “that when Heracles was sacrificing at Olympia he was badly pestered by flies, so he invented or was taught by someone the sacrifice to Ζεύς Απομύιος [Zeus the averter of flies]. The Eleans are said to sacrifice to Zeus Apomyios in the same way to drive away the flies from Olympia.”
Zeus cannot have been very effective, however willing to help. The gastrointestinal nuisances, that even in our days can turn the vacations of the most sophisticated of travellers into a disaster, must have been common among the spectators and on occasions may have stolen the Olympic crown from the better man. Nevertheless we have no information about any major epidemics.
We know that among the officials at Olympia a doctor was included during the games. It is unlikely, however, that comprehensive medical services were available to cope with all emergencies; the place must have been a paradise for wandering quacks and healers who were prepared to offer their skills to a massive clientele, returning every four years for the most popular spectacle of the ancient Hellenic world. Under the punishing sun of Olympia the most common medical emergency was probably sunstroke. Philostratos wrote that athletes had to be strong enough “to endure and to be burnt”, implying that they should be able to withstand the great heat at Olympia.
**Thales of Miletos**, one of the wise men of ancient Greece, is believed to have died at Olympia from sunstroke.
### An Honorable End
Intense emotion and heat must have contributed to the death of the famous boxer **Diagoras of Rhodes**. There is a moving story of how this popular athlete, three times Olympic victor, met his end.
He watched his two sons win the Boxing and Pankration events during the 83rd Olympiad. His victorious sons received their crowns and in a magnanimous gesture approached their father, placed the olive wreaths on his head, and carried him triumphantly on their shoulders around the stadium. No mortal could stand the overwhelming emotion of such glory and pride. Diagoras bent his head and died happily on the shoulders of his Olympian sons. This was in 448 BC.
By 261 AD, the last official record of the Olympic Games, times were different.
Soon there would be no place for athletics in the new ethos and social order that an austere monotheism was about to establish. An earthquake destroyed most of the buildings of ancient Olympia around 300 AD, and several decades later the edict of Emperor Theodosios banned all pagan cults and effectively put an end to the festivals at Elis.
The salvationist spirit of the new order was now marching on and the beautiful statues of Olympic gods and victors were soon to be replaced by the ascetic icons of Byzantium. The Olympic Games, and with them medicine, went into a long period of hibernation from which they were revived only in recent times.
### References and Further Reading
ΓΑΛΗΝΟΤ ΑΠΑΝΣΑ: Gottlob Carolus K, ed. Ιn KUHN MEDICI. Lipsiae, 1821-1829 All Volumes as cited in text.
Green RB, A translation of Galen’s Hygiene (De Sanite Tuenda). Springfield, Illinois: Charles C. Thomas, 1951
Finley MI, Pleket HW. The Olympic games – the first thousand years. Book Club Associates. London. 1976.
The Olympic games through the ages. Ekdotike Athenon SA Athens. 1976.
Sarton G. Galen of Pergamon. University of Kansas Press, 1954.
Gardiner EN. Athletics of the ancient world. Oxford: Clarendon Press, 1955.
ΙΠΠΟΚΡΑΣΗ ΑΠΑΝΤΑ ΤΑ ΕΡΓΑ. Ποσρναρόποσλος Γ.Κ. Εκδ. Μαρηίνος Α. ΑΘΗΝΑΙ 1971. Με αναθορές ζηο κείμενο.
ΙΣΟΡΙΑ ΣΟΤ ΕΛΛΗΝΙΚΟΤ ΕΘΝΟΤ. Κλαζζικός Ελληνιζμός Σόμοι Γ1 & Γ2 ΕΚΔΟΣΙΚΗ ΑΘΗΝΩΝ. ΑΘΗΝΑΙ 1972.
Homer The Odyssey Translated by E.V. Rieu
I am grateful to Ekdotike Athenon SA for permission to quote passages from their book “The Olympic games through the ages,” particularly the translation of Isocrates’ _Panegyricos_. Also to Chatto and Windus Ltd for quotations from “The Olympic games – the first thousand years,” by M.I. Finley and H. W. Pleket.
My special thanks are due to the Department of Medical Illustration at Westminster Hospital for the preparation of the slides for this presentation and pictures from exhibits at the British Museum, included in earlier publications of this article.
Dr. Jolliffe and Mr. Burt of the Chelsea School of Pharmacy offered valuable help in resurrecting Galen’s “ointment of the Olympic victor.”
There have been several earlier versions of this article which was first published in the journal, _History of Medicine_, Vol. 9, No. 1, 1981 and subsequently in _The Greek Review_ (copyright 1982 – world rights reserved). Also in the Journal, UPDATE, June 1, 1983.
“Medicine and the Olympic Games of Antiquity” was the keynote address at the Opening Ceremony of the _1st International Medical Olympiad_ held in 1996 at the Asclepieion of Kos under the High Patronage of the President of The Hellenic Republic. This Olympiad was organized by Professor Spyros Marketos Editor of the Proceedings.
A version of this lecture was delivered at the Annual General Meeting of the Hunterian Society in London in 1997. The text is included in the Hunterian Society Transactions, Session 1996-1997; Volume LV: 117-125.