 It's my pleasure to welcome you to the National Library of Medicine. We're pleased that you're here. I also want to thank those who worked on the creation of the program, our distinguished speakers as well. But before going further, I want to say to pay a special thanks to Kent Smith, who really has done 99% of the work for all of us to put this thing together, and I appreciate it very much. Of course, much of the things that work at NLM I can also attribute to his guiding hand. You'll notice that in the packet is a bibliography, a medical bibliography. In fact, it turns out an exceedingly medical bibliography. And I do want to say that, well, that tells us about rotator cuff tears and chondromalacia patelli and mountaineering tragedies. That's not the rationale for our meeting, at least it's not in my mind. And another thing, too, our bibliography looks as if it's a kind of taxonomy of sports, and that's not true either. NLM never organizes the knowledge of the world. It indexes the publications, the scientific publications of the world. So as a consequence of that, you'll notice that, at least in my opinion, many of the sporting activities that are so typical of Maryland don't really show up in indices. And I want to just say that we're not, as an institution, opposed to hiking, even rock climbing, mountaineering, rock scrambling, which is a Maryland activity. We're not opposed to horseback riding, including hacking, trail riding, steeple chaise, dressage and polo, which all of which are in superb abundance in Maryland, all of which are wonderful sports. Boating, which certainly Maryland is very justly famous for, and kayaking and water skiing and windsurfing and all of the, really the extraordinary variety of activities in which we Americans engage. Squash and lots of other ball games don't necessarily appear in the index. And I don't know that it matters whether they're in our index or our taxonomy, but I think it's wonderful that the people have that opportunity and that those sports are enjoyed and they're enjoyed for the fun of them. I will leave it to my medical colleagues to tell you if those kind of activities will prolong your life. I don't care myself. I think they're fun and worthy of engaging in them just for their own sake. There was one interesting thing in here, though, at least, well, maybe one or two, outside of the real medical hardcore. I came across a citation to Galen, whom we all in medicine know, and I suppose Revere, an Asiatic Greek physician of around 100 A.D., who was born in Pergamum, but whose numerous writings have come down to us through the ages. But I never had thought of Galen as the father of sports medicine, and here's an article in here that says, in fact, Galen is the father of sports medicine. Now, the rationale is that I hadn't thought of it that way either. It's known that Galen treated the gladiators. But in this article, they view him, I guess, probably rightly as the team physician for the gladiators of Pergamum and Rome, and in fact, had a four-year contract. And, you know, I guess if you were... There are pictures in there that compare the gladiator with his helmet and with his breastplate and so on, and then the modern football player with his helmet and his face mask, shoulder pads and so forth. I was thinking, if you were even with the skill and prowess of Dave Butz, whom you'll meet later in the show, if you were a gladiator in those days, going out to meet another such similarly built gladiator with a big spiked iron circle on the end of a chain, would you want a good team physician? I guess you would. In fact, I think even Dave would probably pray for a lot of rain in a short season. But Galen fixed them up. I want to bring us to a little scholarly beginning, a little very brief because you may even consider it the immoderate. But I want to bring to your attention what is sports? What is the just plain old dictionary definition of sports and athletes? Because they're kind of intertwined and I think we use them in a sometimes confusing way. Webster's second, my favorite, tells us that sports comes from a Middle English word, desport, desport. And that means that which diverts and makes mirth a pastime and amusement. That's the fundamental idea of a sporting activity, to be diverted from the ordinary work life into something different. The second definition, specifically some particular play, game or mode of amusement as a diversion in the field, is fouling, hunting, fishing, racing, games, especially athletic games and the like. And that brings up the question of the athlete. What in distinction is an athlete? Well, an athlete comes from a Greek word, athelion, which means to contend for a prize. So an athlete is one who contends for a prize in the public games. So he sets, he or she sets the very high benchmark for performance and for admiration. Now, notice that Coach Allen has just come in and so I want to be certain that we define a sportsman. And once again, our good old Webster II tells us that a sportsman is one who in sports is fair and generous, one who has recourse to nothing illegitimate, a good loser and a graceful winner. Now, Coach George Allen, Tracy Austin, Donna Diverona and Dave Butts are in fact marvelous examples of graceful winners. I don't think they know anything about that other activity. Athletics and medicine nowadays seem to me rather both to be held in high regard, rightly or wrongly. And I think it's often good to turn to the past for a counter-view. I often, when I want a contrasting, somewhat cynical, often little saucy view, go back to a wonderful writer, Finley Peter Dunn, who wrote a series of books and newspaper articles in 1900 to 1920 under the title Mr. Dooley. Mr. Dooley says and Mr. Dooley in Peace and War. I don't know what analogy to make. I guess he was kind of the Anne Landers of his time, a time when people read as well as stared at tubes. But he has the following view of, I'll pass along to you, of athletes and it comes along with a view of doctors, so stay tuned. Dooley's stuff was written in the dialect of the Irish immigrant, which in those days there were numerous, and numerous in sports as well. So with a Swedish background, I won't try to imitate an Irish brogue, but I'll just read it as it's written. Mr. Dooley said, in my younger days it was not considered respectable for it to be an athlete. An athlete was always a man that was not strong enough for work. Fractions drove him from school and the vagrancy laws drove him to baseball. So Mr. Dooley had that view of athletes, but it was counterbalanced by the following view of medicine and I'll give you this view that contrasts with the high regard that we hold it in, but maybe more than a grain of truth here. Dooley said the following. I think, said Mr. Dooley, that if the Christian scientists had some science and the doctors more Christianity, it wouldn't make any difference which you called in if you had a good nurse. Now it's my pleasure to introduce to you our first speaker, Dr. Yockel, who will talk to us about sports and culture. He in fact has a very great right to speak to us about both and I think you will be charmed as we were when we first met and heard him. His medical education began in Breslau in Germany. He subsequently had graduate degrees in both Germany and South Africa. He later immigrated to the United States. He's been a professor of sports medicine and professor of medicine and physiology. He's an Olympic athletic participant. He's chaired the medical survey team at the Olympics. He's had an incredibly long productive life and that has left him both with a high level view of medicine, sports and athletics, but also with the residual of a discipline life and science to do the studies, to do the writing, to do the books which will last for the ages. We're happy that he in a previous year was for a while a consultant to the National Library of Medicine and examined our own history of medicine collection to critique it for the question whether it was complete and needed additions to it and to leave some of his own thoughts with us. And for that we're very grateful. Without further ado, Professor Kjelkel. Dr. Lindberg, ladies and gentlemen, thank you very much for the introductory speech and for the great privilege to open today's lecture. With the establishment during our century of the sports movement, a new category of culture has been engendered. A prerequisite for the emergence of cultural phenomena in art music is the perfection of technique. The piano technique not today began with Bach and Haydn and Mozart, only after a high technical standard of performance was reached. I'll show you now that the sport as we know it now was discovered very late. I'll give you a few historical examples. The British Channel was crossed by a swimmer for the first time a hundred years ago. The mountains, Mont Blanc in this case, were ascended a hundred years ago. Queen Victoria made a comment and thought people who climbed the mountains are mad. She was quite upset about it. She was completely new. Balloon ascends new. For millennia nobody attempted that the first bicycle, that a bicycle in 1870, that's for the quality of life. An exercise class for women in 1800, 1920 the first competition in 80 meter hurdles for girls and a hundred years later. So I will tell you later on that a complete new type, a phenotype of women, of children, of aging people, of handicapped people emerged as a result of the development of the sports movement. Now today in America particularly spectator sports are the true theater of our day. That what we have seen last week in Paris, the Astrodome, the greatest danger confronting the contemporary sports movement is the commercial exploitation. If Johann Gutenberg invented printing today instead of in 1455 he would not have been allowed to present the world with this beautiful Bible but would have had to present commercials of soft drinks or worse, much worse, shown on television between rounds of boxing fights. Now let me say something here of great interest to the American scene. America came very late into the sporting world. In 1928 I was a candidate for the German Olympic team with the young students and it was the first time that a comprehensive study of the medical status of Olympic athletes was conducted. People realized we are a special sort of animal very different from the ordinary and no American physician came. We tried to in that time they were inviting, nobody came and it is one of the great merits of John Kennedy that he very early before he was small in published that article I was privileged at that time to contribute all the material with the Humphrey font and wanted SOS evidence at that time sport in America, only 1960 was not what it is now. Now here that was a sign all over Los Andes King's walking habit, rather 15 minibus, that was in 1960 and now what you have now that in every American city you can mobilize 10,000 people who run the marathon which is a pleasant sort of madness of course was completely unpredicted and it is largely due to John Kennedy that he was the one who advocated the sports movement as we have now. Now let me remind you that there has been in 1848 in the first wave of highly educated Germans came from Germany to America after the failure of the political effort to establish democratic parliamentary government. At that time was the Turner movement, Turner as you call it the monastic movement and all over America Gymnasia were built as a matter of fact Abraham Lincoln went with Carl Schultz who was the most prominent spokesman for the German immigrants after 1848 and that disappeared and with the two German wars it was the wrong thing to disappear of course. So Kennedy really at that time here there was a postal stamp in 1848 reminding 100 years ago the great thing but it's one of the great contributions of Kennedy lasting contributions that he really is the father of the popular sports movement in the United States. Now the prerequisites for the development of sport as we have it now is the availability of leisure good nutrition control of infections Olympic champions do not come from countries like Chad in Central Africa or Bangladesh. Now here I give you a brief reminder that the factory with children working for 8, 10, 12 hours in 1840 the British government published a white paper 1840 drawing for the first time attention to the shame of exploitation and maltreatment of children as a matter of fact we all owe a special debt of gratitude to the House of Commons for two unique performances. The one is the discussion in the early last century that resulted in abolition of slavery the second one the discussion in 1840, 1850 or that resulted in the abolition of child labour. Now this is a lot of people who had watched a golf tournament in Florida on a Wednesday afternoon unthinkable before 100 years ago that the masses of people could have leisure to spend time on a golf course walking pleasantly about an American phenomenon a great achievement of America to have created a wealthy middle class to which all of you belong you have time to spare but quite unthinkable in the middle of last century where only the rich aristocracy could afford to do sport. Nutrition became a science very late as a matter of fact the first Nobel Prize for a vitamin was given to Windows in 1928 and then came the war it was only a new generation really who would benefit from an optimal diet. It is a drawing by Goethe a very gifted man in many fields and he was minister in the small principality of Weimar of recruitment and he had measurements and we have in the archive Goethe archive in Weimar which I visited data on the height well there were miserable wars were sick a vitaminosis and now something like that was unimaginable that the girl today now Greek mythology thought of the goddesses as he had was supposed to look like that but he didn't only in the imagination of the artist in 1948 Anne Euron Bevan minister of health speaking in the House of Commons recalled that in his youth in the cold heart of Tredegar in Wales herces carrying small white coffins to the cemetery every family lost children and the point I want to make now in the context of my talk is that the control of the infectious diseases was the most important and effective prerequisite for the development of the sports movement here you have a few curves showing since 1900 the decline of Rubenka of enteric fever, tuberculosis something unimaginable in the middle and end of last century and the corresponding opposite is the explosive performance improvement in old sports this is a record in 1500 meter freestyle swimming since the beginning of the century as a matter of fact the 1500 meter freestyle swimmers today swim faster than Johnny Weismiller swim the 100 meters in the 1920s the enormous and explosive you could construct curves like that for every athletic event and let me tell you something else in the lifetime of the younger ones among you that comes to an end it's impossible to defend the statement that the record will always prove otherwise it could have saved us the NASA expenditure for the moon trip and waited for the high jump but let me repeat now so far the three chief causes of the athletic performance explosion which you have seen in your lifetime century are the abolition of child labor and the general humanization of the working process the conquest of hunger and the control of infections now three modifiable media of physical performances have been revealed by research and by a revolution in physiology we have found that the oxygen transport heart can be enormously altered by training second muscle on body bulk and third cerebral control of movement this is applied clinical physiology of which beginning of the century we knew practically nothing and a number of outstanding brains scientists have paved the way this is the great Otto Warburg the king of biochemistry who created biochemistry as a science as we now know it and he clarified the brain which oxygen is brought from the environmental air into the cell now in 1928 at the Olympic Games in Amsterdam which I mentioned to you where I was present as a participant and guinea pig for the medical examination X-ray pictures were taken and it was found that all athletes who excel in performances of endurance and swimming and skiing and running have very large heart on the left is a heart of the winner of the 10,000 meter contest and on the right is a short time athletic worker, a high jumper and a sprinter so it took us about 30 years to find out whether athletes' heart is a normal adaptive phenomenon or whether it is of any pathological significance the discussion is still going on today but there's no doubt whatsoever that the heart on the left is an optimally adapted heart and optimal also in terms of the epidemiology of the ischemic heart disease it's reversible you stop training and overeating and over smoking do nothing then the adaptation of the heart characterized by the large stroke volume will disappear and now today you have huge numbers of people participated in the endurance events in America this marathon running although it's regrettable that we have nothing else but marathon running the disappearance of the Turner movement of which I spoke before after 1848 is a great pity but nevertheless you have in every city in New York you have to limit the number of participants otherwise the traffic would break down all together and this is the Vasa ski race in Sweden 20,000 participants in 80 kilometers in incredible performance and about half of women the whole design of research into the transfer of chemical energy muscle into power performance outstanding person got very young Nobel Prize in 1923 one of my close mentors and friends early in my career and now he also was one of the main clarifiers to show what happened if a muscle on top on the left becomes big, the power training muscle can become very big to power training and at that time Rudolf Wirtcher who was a great German pathologist he postulated erroneously that the muscle would form under training large new numbers of muscle fibers and an Italian anatomist Morpogo proved for the first time that it is not true but each existing muscle fiber increases like you see on the right side so a powerful person like Arnold again only one only once I told you before the Greeks thought that the gods would look like that but it didn't only now that we get people like Arnold like that so we understand the nature of the muscular hypertrophy and the relationship of that hypertrophy to power he's not the most powerful man he's the most muscle packed and body building is an American phenomenon and it's a fast growing sport we get many women today participating I was last year in medicine square garden at the world championship for women body building 100 dollars per ticket you couldn't get in was sold out well a pleasant madness he was the great German neurosurgeon Autrich Pfoster one of the great geniuses of clinical neurophysiology to stimulate the brain and this is a skill performance I will talk now about skill in relation to cerebral control it was wonderful highly trained and artistically impressive young women in gymnastics and now let me say this on the left side this is a piece of the schematic presentation of the cerebral cortex and if you stimulate electrically the cortex which we can do during neurosurgical operation because the brain has no receptiveness for pain you can operate on the brain without involving pain of the patient and then the representation on the cortex is predominantly language and the hand monkey hasn't got it and those two are the medias of human culture without that we would be the same as we were two or three or five thousand years ago the monkey is the same today as it was in the Roman Colosseum when it was presented and it is the representation of the top level of the brain of control of language and hand that is the characteristic property of the human race now in highly trained people gymnast dancers ballet you get additional adaptive representation of the whole body the whole body serves as a medium of communication and skill so the schematic comparison on the left and the right of course a good athlete can also talk on you you may even play the piano I play the piano myself but he also has a great presentation an adaptive presentation and all the things I showed you so far oxygen transport power and the great integrative function of the nervous system are reversible if you are a great champion with 25 and you stop training you lose all the benefits what you have so the continuation of a life with the habit of training throughout life is a prerequisite for reaping the benefits of sport now I come now to the cultural significance of sport in the narrow sense of the great Kenneth Clark whom you know Lord Clark who died four years ago who was the greatest art connoisseur of our century you may have seen his wonderful series of films on civilization he was vice director of the British Broadcasting Corporation had access to the unparalleled facilities of photography and presentation of programs and he created the term iconophobia the condemnation of images which is a typical feature of modern art for the first time in our century in modern history the principle of now the first known example of iconophobia the rejection of history is the second the ten commandments very strange things shall not make any graven image of anything that is in heaven above on the earth beneath on the water under the earth why in a codex of moral behavior suddenly disappears is a mystery now that is a data picture showing an example the rejection of reignitability in modern art which was broken by sport as I will show you here you have the Raphael the ascension the church didn't care very much fortunately the church completely disregarded the second commandment Bertrand Russell very clever man remarked that Christian congregations the world over paid little attention to this admonition and continued making pictures altogether Russell added the ten commandments were quite often considered like questions old fashioned examination paper not more than six to be attempted the return of the second commandment in modern art 1880 1890 for the first time suddenly came out of the blue heaven the demand iconophobia don't write anything which is recognizable this is a picture which got a $50,000 at Tosby and pay 5 for it but there it is and then you have suddenly sport with a highly differentiation of sport you get the appearance of an aesthetic element which today is probably the most important artistic trend on the public scene there's a wonderful young East German girl got silver medal at the Olympic Games in 1980 and now by contrast this year by a German painter Hoffmann also got a prize for that it's completely incomprehensible this is out now you go to New York and the majority of great museums Guggenheim modern art would never take that one of the great romantic German school of the middle of last century that is taboo it's out now this picture was accepted for an exhibition in London before the artist was revealed that's him professor professor it declined in value after that professor Julian Huxley a very remarkable biologist he comes from a whole generation of Huxley Thomas Huxley was a young man of Darwin in 1840 and presented Darwin's idea before the Royal Society Julian Huxley was the director of the London Zoo and he started painting corner for chimpanzees and here you have the great artist and that is now this one by contrast this is a painting which got $50,000 the difference between the monkey painting and that are only for very expert people to assess I couldn't now the next point I want to make is that with the perfection of technique appear aesthetic facet performance this was in 1880 was on the front page of the London Times men jumped 50 feet now 50 feet is quite a lot it's not an ugly picture today that time it was sensational now you got somebody here 600 feet and certainly it has a certain quality the Corbusier the great Swiss architect made the point that by the use of modern materials you get automatically an aesthetic quality using steel ring cost concrete you can get structures which because of the use of certain technical innovations you get aesthetic results that were unknown before and the same applies in sport the top class performances have very often not always attribute of beauty like this we have now the appearance of Nadia was something which electrified in 1968 the whole world girls like that were unknown the artist of the 17th, 18th century painted big fat goddesses blubs which were really unpleasant if they would have known girls like that that would have been the goddesses of love and of anything industrious the prerequisite of art appeared in sport again in art it was abolished you couldn't hear this is the wonderful picture the two Torval and Dean who won the artistic ice skating competition in Sarajevo five years ago well they had ten years of training behind them industrious as a prerequisite of art was rediscovered by sport and abolished in the so called fine art this is Jackson Pollock who has a piece of paper on the floor and a pig's bladder with a hole in this squirt color on the picture and that is the price crowned result industriousness is out as a criterion in modern art so sport has rediscovered it and has gone back to the traditional ways sport is capable of engendering powers of transformation of bestowing glory upon youth of coming to the aid of the lame and the halt of removing the stigma of social inferiority and of giving assurance to the old facing death those are the great things that sport can do in which do not appear on TV in the evening where sport is a spirit of entertainment here are the great moral artistic possibilities inherent in sport now we had in our lifetime most lifetime of you are the appearance of new human phenotypes on the sporting thing new children new women new aging people new handicapped people that something completely new was unknown unexpected surprising appearance on the sporting scene now Boris a 17 winning women that was electrifying the whole world it was something very special not only the great performance of course the good tennis player but it was something radiating in a young 17 year old boy surprising winning women Steffi same with 15 years beating Navratilova quite surprising quite unexpected 50 years ago children at a lesson we have a journal at a lesson medicine they would fall into that category at a lesson medicine are the best in the world Katarina Queen of Germany here she is now President Reagan when he was in Berlin said they should tear down the wall she tore down the wall people admire East West she is the Queen of Germany undivided the appearance of youthful stars on the sports scene has precedence in the history of music Mozart at age 6 with Empress Maria Teresia you've seen it in Amadeus Mendelssohn with 10 old Goethe and the young Brahms appearing with Robert Clara Schumann and now in sport we get that back again something very special which youth had the potential capacity and sport brings it out now on the socially disadvantaged the story of Sugar Ray Leonard who was chosen sportsman of the year by sports illustrated on January 4, 1982 exemplifies the fifth new phenomenon which the contemporary sports movement has evolved victor of social disadvantage and abject poverty five years ago sports illustrated wrote Sugar Ray's girlfriend Jennifer Wilkinson applied for welfare to support the Sanjibu in the Atamizuri and then four years later looks like a British lord one of the great text player sport has this miraculous capacity of solving seemingly impossible unsolvable social problems this is Harold Connolly was born with a paralysis a plexus damaged to the left arm and he won the hammer throw at the Olympic Games in 1956 here is on top highly elevated from all of us he overcame a problem which looked unsolvable how can you solve you see the left arm the bum arm is ten centimeters shorter than the right he won the Olympic Games he overcame an unsolvable challenge here come to the end my time is limited a hundred year old Jew participating in the three day march to Jerusalem which is an annual event a mixture of a military manoeuvre and a religious festival a hundred years old born in Poland having witnessed all the barbarities which an old Jew could have their hears and Professor Dudley White was with me asking I said sir when you arrived were you not afraid of the strain of the three day march so the old man said to him well what better death can I have than die on the way to Jerusalem a philosopher now at the new version of what Holwein did in his Desolate said picture of the dance of death and I will finish my presentation by a quotation of St. Paul picture I gave you the time my departure is at hand I fought a good fight I finished the course I have kept the faith henceforth there is laid up for me a crown of righteousness thank you