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Sport as Medicine

Ideas of Health, Sport and Exercise

Health Fanatic

John Cooper Clarke (1978)

… Shadow boxing – punch the wall One-a-side football… what's the score… one-all Could have been a copper… too small Could have been a jockey… too tall Knees up, knees up… head the ball Nervous energy makes him tick He's a health fanatic… he makes you sick

This poem, written by the ‘punk poet’ John Cooper Clarke, the bard of Salford, encapsulated the reaction in some quarters to the health and fitness boom, and its increasing visibility, in the post-war period. However, concern with personal health and wellbeing has not been a new phenomenon. Moreover, the use of sport and physical activity as a form of preventive medicine has been a cornerstone regarding ideas over the attainment of health. In 1929 the New Health Society proposed ten ‘Health Rules’ and, at number ten, after advice on topics such as diet, internal and external cleanliness and sunlight, was exercise in which the individual was encouraged to, ‘Take out-of-door exercise every day. Also practice daily exercises for a few minutes every morning or evening, especially such as will bring into play the abdominal muscles’.1 This chapter is mainly concerned with how sport and exercise has been incorporated into ideas and debates over health from around 1800 in Western countries, but mainly in Britain. While attention is also given to voluntary activity and commercial entrepreneurs, the central focus is on how the state has played an ever more interventionist role in looking after the ‘fitness of the nation’. In charting the link between health and exercise, it aims to provide a broader political and cultural context for the relationship between sport and medicine. In addition, it highlights how ideas, such as eugenics, have not only shaped notions of health but also provided a basis for how medicine influenced sport.

By starting in 1800 the chapter provides a sense of how contemporary notions over health and exercise have paralleled wider developments in the origins and growth of state welfare provision and social policy more generally. The beginnings of industrialization – first in Britain and later in other Western countries – prompted a response by government and other sections of society to the economic, social and practical problems this posed.2 While the charting of this process maybe seen as having teleological overtones, the response by government needs to be understood in terms of its adaptation to prevailing circumstances. Each country developed its own distinctive pattern of welfare provision subject to that country's particular political and cultural traditions as well as through the acceptance or rejection of competing ideologies. National governments also adapted their own responses to the use of sport.

Early ideas of health and physical activity

Before looking more closely at the relationship between the state and fitness, it would be beneficial to ask what do we mean by ‘health’? There has never been a fixed definition for health and the term and the concept of health has constantly changed subject to its particular historical context. While health in the twenty-first century is bound up with science, in ancient Greece, for example, it was tied up with religious traditions. Klaus Bergoldt has argued that any definition is problematic and that health is not measurable. There is also the question of where health finishes and sickness starts, something which the World Health Organisaton's rather simplistic definition of health – ‘complete physical, mental and social wellbeing’ – fails to take into account as it only applies to a minority of relatively wealthy Europeans. Lugwig Borne was quoted as saying that, ‘There are a thousand illnesses, but only one health’.3 Not only is the idea of health subjective and dependent on an individual's perceptions of his or her own health, it is a social and cultural construction in which these perceptions are subject to a multiplicity of political influences and fluctuations. Defining health, therefore, can have important implications for the relationship between sport and medicine, especially in the twentieth century when the medical profession became a more powerful group and had the capacity to proclaim what was healthy and what was not. Before looking at the ‘modern’ era it would be useful to reflect on how earlier notions of health emerged and how sport and exercise were incorporated into them.

An early Graeco-Roman hygiene ideal was mens sana in coropore sano – a healthy mind in a healthy body – which was revived during the Victorian era and still has resonance today. An important part of this principle was, and continues to be, the promotion of the benefits of exercise and forms of physical activity. Plato, for example, while advocating moderate forms of exercise, was critical of extreme forms of gymnastics and dietetics, something that echoed modern medical concerns over competitive sport.4 Ideas of health were conditioned by both prevailing medical theories and notions of the body and its potential. Galen, the most famous physician of Antiquity, who practiced in Rome during the second century, also recommended regular exercise that would build up not only a healthy body but also a healthy mind. Galenic or humoural medical theory (the non-natural tradition) formed the basis for the Western tradition of medicine up to 1800 before the ascendancy of ‘orthodox’ or ‘scientific’ medicine.5 As Roberta Bivins has pointed out some writers argue that humouralism still informs current ideas of health and disease6 and the Galenic tradition within the relationship between sport and medicine persisted into the twentieth century.

Most Galenic therapies were intended to heal through altering the entire corporeal system simultaneously. In humoural theory both patient and healer shared the conviction that bodily health depended on maintaining a precarious balance of the body's four humours (i.e., fluid constituents): blood, phlegm, black bile and yellow bile. Humours were visible substances that could either emerge from a sick body or through medical intervention. These four substances existed in a dynamic equilibrium with each other as well as with external forces like climate, seasons and celestial spheres plus internal influences such as the ageing process and emotions.7 Any disturbances in health reflected disturbances in the humoural balance. Six non-naturals – air; food and drink; motion and rest; sleep and wake; excretions and retentions; passions of the mind – needed to be utilized in moderation in regard to quantity, quality, time and order because any excess would create an imbalance. As a consequence, the aim of healers of all varieties was to diagnose such imbalances and then to rectify them.8 These included physical interventions like bleeding, purging and vomiting, changes in diet and activity and complicated medical compounds as well as simple botanical remedies.9 Exercise, as part of activity and rest in the non-natural tradition, was incorporated in much of the early regimen, hygiene and preventative medicine literature, and was recommended as a form of treatment.10

Following the Renaissance and the ‘Scientific Revolution’,11 ‘rational’ theories competed with the traditional Galenic-based ideas of health as the body was increasingly compared to a machine (see also Chapter 4).12 In 1569 the German physician Hieronymus Mercurialis (1530–1606) published a guide to physical training that criticized the humoural tradition. Instead of disturbing the humours, Mercurialis argued that sport helped the body's metabolism. His manual, De Arte Gymnastica, detailed and assessed the dangers and utility of various exercises that included running, jumping, wrestling, boxing, riding, ball games and dancing, and remained a standard work on physical exercise for centuries.13 Physical exercise continued to be cited as necessary for good health and wellbeing with as much emphasis placed on its positive mental and moral benefits as on its physical ones. But to achieve this balance moderation – again a recurring theme down the centuries – was key. Francis Bacon (1560–1626) proposed that moderate exercise would toughen the body against illness but overdoing sport and gymnastics could have a detrimental effect.14 In 1764 the Swiss physician Johan Zimmerman had argued that a good state of mind was dependent on the air, diet and on sufficient physical exercise.15 The problem of mental health itself was becoming more ‘visible’ due to the growing number of asylums. Similarly, the Enlightenment thinker Jean-Jacques Rousseau advocated a natural approach to health in which man lived in tune with nature. He had a low opinion of medicines and believed that health and the constitution could be strengthened through manual labour and bodily exercise. In his book Émile (1762), he argued that men had to exercise both their minds and bodies and that those men who had lived longest were those who had taken most exercise.16

The emergence of public hygiene and physical culture

From the late eighteenth century ideas of the healthy body began to merge with the interests of the nation, and ignited the start of a mass physical culture. Driven by a common set of anxieties arising from industrialization, especially the condition of the masses in fast-growing urban centres, a public hygiene movement developed in Western nations that became increasingly secular and scientific in its nature.17 By the late eighteenth century, following the American and French revolutions, health had been declared a right of citizenship in which a social contract of health emerged between the modern state and its citizens.18 Moreover, through the rise of nationalism in the early 1800s, physical exercise was inculcated with a sense of the nation and seen as vital to the preparation for war – an idea that persisted up to the mid-1900s.19

The extent of public health provision and later the nature of its reform was dependent on factors such as the political culture within different countries and the pace and intensity of industrialization, as well as local factors.20 The experience of the French, for example, was paradoxical. While it created the modern public hygiene movement and is synonymous with centralization, the state played a limited role in public health.21 From the mid-nineteenth century, however, the state's health care role in most Western European countries grew substantially. This had been the result of a new public hygiene based partly on the influence of eugenics (see below) but also bacteriology, which brought new ideas about social welfare. During this period there was a shift from public health programmes that aimed to control disease to social medicine, which consisted of a wide range of policies that focussed on improving social conditions and providing health education and new medical services.22 To a certain extent, the application of physical culture to public health was part of this trend.

Physical culture itself took a number of forms. There had been a marked shift in ‘bodily practices’ across Europe between 1770 and 1820 from activities such as court tennis, epee fencing and military exercise to horse racing, boxing, football and gymnastics. During the nineteenth century, to crudely summarize, a struggle within physical culture emerged between modern sport and gymnastics.23 In Britain, and later America, physical exercise was expressed mainly through modern sport and especially team sports. In continental Europe indigenous gymnastics movements were deeply entrenched. However, by 1900 the British version had gained a foothold in Europe.

The nature of physical culture had been shaped by contemporary ideas concerning medicine and the body. These ideas included a revival of a forgotten body aesthetic: the muscular, symmetrical example of Ancient Greece, which was part of the emergence of classicism within Britain from the late eighteenth century. Greek statues in museums came to be viewed as ‘living examples of the perfection which the human form is capable of attaining’.24 The power of classical Greece continued to run strong in the imagination of the Western world deep into the twentieth century. This was not only evident in the architecture of state buildings but also through many of the staff of Western governments who were products of a classical education.25 A number of European physical training instructors, such as Johann Friedrich Simon, GusMuths and Gotliff Salzman, were similarly impressed, and their programmes were imbued with notions of the classical world, especially in Germany where the ‘Philanthropic Education’ movement emerged.26

While the application of sport and exercise to improve the health of populations was partly a response to concerns over a country's preparedness for war, the nature of physical culture itself was determined by national characteristics. In Prussia, gymnastics, or Turnen, had been born out of its defeat to the French at Jena in 1806. It was essentially a movement that was begun by Friedrich Ludwig Jahn who had proclaimed the benefits of Turnen for military readiness and the strengthening of the Germanic race. He saw the ‘Turner’ as the core of the army to drive out the French and in 1811 he constructed a Turnplatz with towers, platforms, ropes and rings. Inspired by his example and publications, Turnen spread throughout Germany. Jahn had been part of a movement that emerged in the late eighteenth century, which included both writers on physical exercise as well as philosophers, such as Friederich Schiller and Wilhelm von Humboldt, in which ideas of physical exercise and the healthy body were formed in the image of physical culture in Ancient Greece.27 Following years of suspicion by the political establishment, Turnen was institutionalized within German schools, and the Deutsche Turnerschaft (DT), founded in 1868, became a chauvinistic supporter of the German empire following the Franco-Prussian War.28 As a popular system of exercise, Turnen promoted a German philosophy of health, vigour and patriotic ethnic identity. By 1914 the DT had 1.4 million members, seven times as many who participated in modern sports.29

The Scandinavian gymnastics movement was based on the Ling system. In 1805 Per Henrik Ling, a Swede, had launched a system of exercise routines that were based on anatomical and physiological principles. Whereas Turnen placed a greater emphasis on athleticism, strength and agility through the use of parallel bars, Ling used movements to provide enhanced military dexterity for fencing or bayonet fighting. Ling's ideas formed the basis of Swedish remedial exercises (later called medical or remedial gymnastics), which would become part of the work of masseurs and physiotherapists.30 Both Turnen and Ling would be influential in the development of physical education in Britain and America.

The struggle for ascendancy between the physical education of the Germans and Swedes against the influence of modern sports like football invented by the British was most apparent in France. Initially, gymnastic societies flourished following France's defeat in 1871 as it was felt that physical training would contribute to national preparedness for any future war. Educational reformers were also patriots. In 1880 a law made gymnastic training – two hours of physical training and military exercises – compulsory in all public boys’ schools. In the 1880s, however, the young Baron Pierre de Coubertin became a convert to English sports. According to him, and perhaps contrary to evidence, French secondary schools had become too scholastic while the pupils of private schools were ‘narrow-chested, round-shouldered aesthetes’.31 He looked to the games culture of English public schools like Eton and the emphasis placed on manliness to rectify this situation.32 De Coubertin was imbued with both a keen sense of classicism and the potential physical and moral benefits of sport. These ideas would be the basis for his vision of ‘Olympism’ as a secular faith and the foundations for the formation of the International Olympic Committee in 1894.

British physical culture and the rise of public health

In the late eighteenth century British physical culture was built on sports such as pugilism and pedestrianism. Pedestrians, such as Foster Powell and Captain Barclay, won fame for their feats of endurance. Although physical culture was more commercial in its nature – mainly gambling – it highlighted contemporary fascination with the athletic body of Ancient Greece. Jackson's Rooms in Regency London, for example, was at the centre of British sport and were frequented by the nobility as well as members of the Cabinet and the Prince of Wales. Here they received a course of lessons from Gentleman John Jackson that included fencing and boxing. Jackson had been a champion of the prize ring and despite his lowly social status the elite of society admired his physical appearance. So much so that in 1797 and 1800 the Royal Academy commissioned portraits of him. This helped to fuel a growing pre-occupation with the physical appearance of the male body by the sporting elite, the Fancy, who began to dress in tight-fitting breeches to show their manliness and flaunt their well-muscled arms.33

While Britain was demilitarized compared to its Continental neighbours and did not have a standing army between 1815 and 1914, the army developed new attitudes towards physical training. Here the influence of Captain Phokion Heinrich Clias (1782–1854) was important. An American by birth, Clias had trained soldiers in Switzerland before becoming a captain in the British Army in 1822. Influenced by GusMuths and admired for his muscular physique, he was made superintendant of physical training at a number of military academies including Sandhurst. Clias placed an emphasis on medical gymnastics as well as remedial and hygienic exercises, and he wrote a number of exercise manuals for women.34 Archibald Maclaren was a successor to Clias. He had built gymnasiums and was also widely acknowledged as a written authority on ‘the scientific study of physical education’. In 1861 an army training school and a gymnasium were established at Aldershot and the following year his system was adopted in all military gymnasia. Maclaren's methods and writings popularized the use of dumb-bells, bar-bells, climbing ropes, horizontal bars, vaulting horses, and climbing walls, as well as running and free-standing exercises.35 Later, many of the physical training instructors in public schools had been in the army and had trained under the system developed by Maclaren.36

While British physical culture developed differently compared to Europe, health also became an obsession in Victorian Britain. Bruce Haley has claimed, that ‘No topic more occupied the Victorian mind than Health – not religion, or politics, or Improvement, or Darwinism’.37 The dominant idea, reflecting new attitudes towards mental wellbeing, was ‘total health or wholeness’.38 New attitudes to bodily discipline found receptive audiences in all areas of Victorian society and its institutions. Religion, for example, was an important source of recreation with churches playing an important part in setting up football and cricket clubs. In a new interpretation on the ideal of ‘muscular Christianity’, Daniel Erdozain has argued that in Victorian Britain evangelicalism itself was to be expressed through ‘active participation’ in sport and recreational activities as opposed to churches just being seen as sites of recreation.39

At public schools a cult of athleticism emerged around team games such as football and cricket. In 1864 the Clarendon Commission had commended the public schools, especially Rugby, for ‘their love of healthy sports and exercise’.40 It was felt that sport inculcated character formation and moral discipline as well as trying to root out the ‘problems’ of homosexuality and masturbation.41Football played at Rugby school was ascribed a set of moral values through Thomas Hughes's semi-autobiographical Tom Brown's Schooldays (1857). Schoolboy sport and literature generally during this era reflected wider Victorian culture in which ideas of health were transmitted through a radical conceptualization of the adolescent body.42 Following the Clarendon Commission, Rugby, under its headmaster, Thomas Arnold, became the model for the mid-Victorian public school and so its moral philosophy stretched far beyond the school. Not only were middle-class expectations of public school life shaped in part by Hughes's book but the sport of rugby itself became an ideology. These attitudes, combined with notions of muscular Christianity, were exported throughout the world where the game was played, especially in the British Empire, which adopted the Arnoldian model of public school life. In addition, the Rugby-style game flourished in an environment where sport at Ivy League universities was closely interwoven with the North American form of muscular Christianity.43

Public school values were also associated with patriotism imperialism, and war was regularly referred to as a form of sport.44 A ‘hegemonic masculinity’ emerged in which manliness was felt to imbue the ideal of a moral and civilized man. Victorian reformers like Charles Kingsley believed that games created ‘hardy, quick-thinking men’ who could run the Empire.45 Importantly, the attitudes of those who attended the public schools, such as doctors, were carried on into other areas of public life, including that of health.

In wider British society Holt has argued that the spread of amateurism within sport not only complemented the inculcation of the values of muscular Christianity but an amateur cult of the active body emerged that was shaped to a greater extent by the bodily requirement of work and health. The values of work inspired the idea of competition while those who advocated amateur values were influenced by medical and public opinion concerning health. As a result, amateurs advocated active participation over professional sport. Outdoors activities also combated changing work patterns, where growing numbers of middle class men spent their working lives sitting at a desk as well as the spread of the suburbs, which led to a reliance on the commuter train.46

Moreover, through a growing raft of public health legislation, the state took a greater interest in the health and fitness of the British people. The initial focus had been on sanitary reform but the state regularly intervened in areas such as food, drugs and the workplace, highlighted by the 1864 Factory Act.47 State interest also began to stretch to the application of physical activity to improve the health of the population. At the municipal level a host of parliamentary legislation, such as the 1846 Baths and Wash Houses Act, had allowed local authorities to use permissive powers that were aimed at ensuring basic standards of health by developing leisure amenities.48 Later, the 1878 Baths and Wash Houses Act enabled local authorities to build covered swimming pools, which now became places for physical recreation and sport.49

While sport was an important aspect of life for pupils at the public schools, physical culture spread only slowly into Britain's new mass education system. In 1866 there had been just over one million children attending schools in England but through the 1870 and 1880 Education Acts this had risen to 4.5 million in 1886. The passing of these acts gave a – potentially – more formal structure to physical training programmes in schools. By the late 1880s physical exercises, mainly in the form of gymnastic-based military drill, had become an established part of the timetable in many voluntary and government controlled board schools, although it was not compulsory at this stage.50 The main emphasis was on Swedish gymnastics but in 1900 the Board of Education had permitted organized games as a substitute for Ling-type drill or physical exercises, although it was not until 1906 that games were officially allowed in elementary schools.51 With the appointment of the first Chief Medical Officer, George Newman, in 1907, physical education was given a higher priority. Under that year's Education Act, a system of medical inspections was established and Newman saw PE as a cheap form of preventive medicine.52 In his annual report of 1909, Newman wrote that ‘physical exercises are now recognized to be a desirable and indeed a necessary part of the school curriculum’.53

The motivations behind these initiatives were both utilitarian and moral. Leisure was seen as part of a grander mission to build a new humane society of cultivated individuals.54 It was an example of the middle class paternalism that would be a constant theme in the politics of health and would continue through the twentieth century. This ‘grander mission’ was to be found within the voluntary sector in the shape of ‘rational recreation’. Alongside the provision of parks and baths, bourgeois reformers aimed to create a healthy, moral and orderly workforce through sport.55 Although Victorian reformers didn’t succeed, the idea of using sport as a tool for health purposes as well as a social service has continued to persist into the twenty-first century. In the mid-1880s a National Physical Recreation Society had been founded to promote physical recreation, especially gymnastics, among the working classes.56 Youth movements, like the Boys Brigade, established in 1883, the Church Lads’ Brigade (1892), the Boy Scouts (1908) and the Girl Guides (1910) all provided boys and girls with opportunities for outdoor activities.57 Similarly, schools’ football (soccer) developed through voluntary associations and in 1904 the English Schools Football Association was founded.58 Interestingly, reflecting the influence of classical Greece, some amateur football leagues in London were called the Isthmian League, the Spartan League and the Hellenic League while the premier amateur club was the Corinthians. In addition, from the second half of the nineteenth century, sports provision became a common aspect of welfare capitalism amongst some employers such as Cadbury's and Rowntree’s, albeit with mixed motivations.59

Underpinning much of the debate concerning physical fitness were contemporary anxieties over the health of national populations, caused by the population boom that had accompanied industrialization, and ultimately fears about racial degeneration. Debates around public health and health generally – including exercise – became increasingly informed through the widespread reception, if not wholesale acceptance, of eugenicist ideals.60Eugenics, first coined by Francis Galton in 1883, was based on ideas about heredity and evolution and aimed to address these fears over ‘race suicide’. A statistical as much as a biological and social science, eugenics had a broad appeal across all political classes. Although eugenics was applied in various contexts, the language of ‘struggle’ and ‘fitness’ and superior and inferior ‘types’ relating to both people and nations permeated social and political discourse.61 There were two strands. Positive eugenics aimed to achieve racial improvement through encouraging the fit to breed, and this thinking was behind initiatives such as ante-natal and baby clinics, while preventing breeding among the unfit was the goal of negative eugenics. Here it was argued that for the race to survive social amelioration should be abandoned in favour of selective breeding and the elimination of those who were eugenically deficient such as the sickly, the deformed and the demented. Policies were applied differently in different countries. Negative eugenics was taken to its most extreme form in Germany with the Final Solution while American states and even Sweden adopted compulsory sterilization laws.62

Latent fears amongst the upper and middle classes over national efficiency, race degeneration and ultimately Britain's imperial ambitions had crystallized during the Boer War. Not only were British forces defeated in its early stages by mostly volunteer farmers but when conscription was introduced (for the first time) over thirty-five per cent of male recruits, mainly from the masses, were found to be physically unfit for service.63 Eugenic fears had important implications for policies regarding the health of schoolchildren.64 The Inter-departmental Committee on Physical Deterioration had been set up after the conflict, although its recommendations in 1904 favoured environmental reforms rather than an overtly eugenicist solution. The reforms were mainly aimed at improving the physique of schoolchildren and included the medical inspection of schoolchildren, the feeding of children in elementary schools and physical exercise for all schoolchildren because of its ‘character-building qualities’. It also recommended that local education authorities should provide playgrounds and other indoor facilities. Ultimately, all policy initiatives were designed with the aim of ‘building an imperial race of healthy, fit workers and soldiers to defend the nation and empire’.65

Health and physical culture in the United States

Whereas in Western Europe there was a trend towards the bureaucratization and centralization of public health, in America the response was different. In the early nineteenth century a ‘rugged individualism’ prevailed and the persistence of Jacksonian democracy kept government to a minimum. Instead, any reform was dominated by local voluntary and philanthropic efforts and promoted by Puritan morality. In particular, it was felt that social cleanliness was next to godliness:66 ‘to follow the rules of hygiene was a moral act and a religious duty, and sanitary regeneration was a crusade to improve the poor’.67 In ante-bellum America there had been great concern for the physical degeneracy of the population, especially in the expanding towns and cities. Developments were built on the American self-help tradition with health being seen as a personal responsibility while concerns over the health of the population became part of a general reform movement. This was reflected by a growth in the popularity of prevention literature and hygiene instruction amongst medical practitioners.68 The American medical market also provided opportunities for entrepreneurs like the ‘botanic’ physician Samuel Thomson (1769–1843) whose herbal remedies were very popular in rural America.69

In America there had initially been a boom in physical training in the early years of the nineteenth century. However, due to a cholera epidemic in the early 1830s, the focus shifted to matters of nutrition, sanitation and public health.70 Migrants later introduced Turnen into America, although it would undergo a process of ‘Americanization’.71 The Civil War gave further impetus to matters of health by provoking an interest in calisthenics, gymnastics, physical training, outdoor activities and competitive sports. As well as the emergence of PE in colleges and high schools, a number of organizations were founded, such as the American Association for the Advancement of Physical Education in 1885, which devoted their attention to promoting health through exercise regimens and gymnastics.72 The idea that underpinned these movements resonated with that of muscular Christianity in England; that perfection of the body was an essential part of Christian morality and should, therefore, be kept free from disease.73 In the late 1800s physical education had begun to emerge as a professional field. Its development was assisted through the staging of various international expositions and world fairs, many of which hosted congresses and meetings on aspects of PE, bodily hygiene and physical training. At the 1876 Philadelphia Centennial Exhibition there was a section on the ‘Physical, Social and Moral Condition of Man while two years later there was a special section on gymnastics at Paris's International Exposition.74

During the Progressive era (1890–1920) public health became more national in its outlook. It was now supported by qualified public health workers who promoted an ethic of scientific management within social and political reform, which had coincided with the development of the bacteriological theory of disease.75 Anxieties over the health of the nation persisted, however, and were increasingly based on fears in America of ‘race suicide’ because of the perception of a dwindling in the Puritan stock. One response, from the mid-nineteenth century, was for schoolgirls to participate in calisthenic exercises, and from the 1890s their athletic opportunities increased. Physical educators justified the need for exercise and sport as a way to better develop women for the struggle for race survival (see Chapter 7).76

Through his own lifestyle, President Theodore Roosevelt embodied and popularized the philosophy of ‘strenuous life’. Roosevelt's outlook had been shaped by his experience as a frail and sickly young man who earned his ‘manliness’ from hunting and athletic sports. He later advocated the popular idea of sport as a form of rejuvenation for the neurasthenic and dyspeptic American male. Sports, especially team games such as football, rowing and baseball, and strength sports like boxing and wrestling became the preferred activities of the middle-class American male. Borrowing the ideals of English public schools, as well as developing young men physically, sport, it was said, developed character. Football was particularly important to Roosevelt. He placed the game at the heart of a young man's training for life, believing that this ‘manly game’ inculcated them with ‘virile virtues’ and acted as a preparation for the ‘rough work of the world’. However, his pursuit of the strenuous life was directed more towards his own class, in particular the Ivy League, than the nation as a whole.77 Through the craze for sport and physical culture in the American higher education system, and the success of American sportsmen at the first Olympic games, a change in the ideal body shape took place. The image of the svelte Greek athlete that had characterized the somatic ideal from antiquity through the Renaissance and up to the early nineteenth century was now being challenged. Instead, the Olympian examples of ‘American muscle and brawn, began to redefine the image of the well-developed male body’.78

The commercialization of physical culture

The creation of healthy citizenry was not limited to government action. From the late nineteenth century, commercial interests ‘turned the construction of the healthy body into a moral crusade and a vastly profitable industry’.79Ina Zweiniger-Bargielowska has argued that the emergence of a commercial physical culture reflected changing notions and meanings of ‘bodily discipline’. Not only were health and fitness important but because new ideas about body management were set in a modern urban industrial society, the pursuit of beauty was also part of wider discourses that were framed around patriotism, degeneration, eugenics and modernity.80

Commercial physical culture also highlighted a shift in emphasis in the responsibility from the state to the individual to pursue health and fitness. Chief amongst physical cultural entrepreneurs was the bodybuilder Eugen Sandow. Initially a fairground entertainer due to his physical strength, he built up a highly successful business through his world tours and publications from the 1890s.81 In advocating exercise, which included weight-training, Sandow invoked the rhetoric of deterioration and national efficiency: ‘Physical decadence or physical degeneracy will be almost invariably accompanied by mental and moral deterioration, for as Herbert Spencer said, “we must never forget that there is such a thing as physical morality.”’82

While Sandow represented a new distinctive Herculean body other physical culturalists advocated different lifestyles. Eustace Miles, a tennis player, rejected the Sandow ideal. Instead, he promoted a ‘hygienic regimen’ that was directed at the middle classes. It ‘combined mental health practices and vegetarianism – he had his own vegetarian restaurant – with exercises based on movement such as swimming, golf and tennis and activities like gardening.83 Similarly, I.P. Muller rejected the use of apparatus and the pursuit of an overly muscular body. Instead, with ‘15 minutes exercise a day’, he placed an emphasis on the pursuit of general health ‘in all the vital organic functions’ through a regimen that included daily exposure to fresh air and ‘brisk’ exercise.84

Another entrepreneur in this field was the American Bernarr Macfadden who advertised his own brand of physical culture through his magazine, Physical Culture, founded in 1899. He established several ‘healthoriums’ where he outlined his theories of ‘physcultopahy’. His aim was to allow people to develop ‘absolute purity of their blood through a regimen of exercise, fresh air, bland diet and no medicines’. Despite his reputation as an apostle of strength and fitness, he later earned notoriety for his unconventional attitudes towards sex. He was also an advocate of eugenics and as such national racism in which the aim of marriage was to produce healthy offspring for the sake of the nation.85

In addition to gymnastics and weight-training, swimming and its accompanying lifestyle became a feature of physical culture, especially in America and Australia. In fact, through the image and body of the champion Olympic swimmer Johnny Weissmuller, the American government attempted to export American culture in the form of sports goods. It also highlighted a growth in beach culture in Europe that the Americans strove to exploit.86 These developments contributed to the era of the ‘Body Beautiful’ and was further highlighted through the building of outdoor modernist lidos in Britain.87

Physical culture both complemented and was part of a wider international health and life reform movement that advocated exercise along with dietary reform such as vegetarianism, sun- and air-bathing plus personal cleanliness and temperance.88 In 1906 the Health and Strength League was formed in Britain, and its journal, Health and Strength, had a circulation of about 75,000 in 1909. The inter-war years were also marked by health and hygiene pressure groups, the most influential of which was the New Health Society.89 Launched by Sir William Arbuthnot Lane in 1925, its members included prominent politicians and industrialists such as Ramsay MacDonald and Alfred Mond. The society aimed to convert ‘a rapidly degenerating community’ from a C3 nation into an A1 nation. It generally eschewed environmental causes of degeneration and rather than a redistribution of wealth as the key to improve individual and racial health, the society emphasized Victorian moral character and self-discipline instead.90

Sport, fitness and the state in inter-war Europe

The fall-out from the Great War loomed large in European inter-war health policies. Fears of national decline continued and were reinforced by a long-term fall in birth-rates. ‘A new organic vision of society emerged’ within Europe based on a collective responsibility for welfare. The mixed economy of welfare that featured in this era provided the foundation for the establishment of classic welfare states after 1945.91 Interestingly, although perhaps unsurprisingly, the motivations of different states, whether totalitarian or liberal democracies, for promoting sport and exercise were remarkably similar: hygiene, preparedness for war and industrial production. Increasingly, however, totalitarian states began to appropriate sport for national prestige, which marked a demarcation from sport's previous function as an aid to national fitness.

In Fascist Italy the government imbued physical education with a military utility in which young people were understood as soldier-citizens. Physical education and sport was largely controlled through the establishment of the Opera Nazionale Dopolavoro (OND). Set up in 1926, it coordinated the after-work recreational activities of Italians. In addition, Mussolini himself was the personification of the fascist body. He was often depicted in the press riding horses, fencing, skiing and flying or even driving a racing car. ‘He was never afraid to display his body … he believed that a healthy and strong body was testimony to great effort.’ He also gave instructions that all fascist chiefs should keep fit through physical activity.92

It was during this period that modern sport displaced traditional gymnastics and workers’ sport as the leading form of physical culture in Europe. With the growth of international competition, sport provided a means of mediating between national and international identities and acting as a forum for nationalist rivalry.93 Yet this had not been an inevitable process. Following the revolution, Western sport had been rejected by the Soviet Union because of its bourgeois links. Initially the Bolsheviks attempted to build on the Russian legacy of fizkul'tura. Alongside Turnen and Sokol, fizkul'tura represented a third variation of the pre-1914 PE movement in Central and Eastern Europe. Fizkul'tura was proletarianized by the Soviets some of whom rejected competitive sport completely due to its association with capitalism while others felt that certain sports could be used in moderation to encourage the masses into a regimen of health and exercise. All agreed that ‘individualism, record-seeking and competitive habits were vices to be discouraged’. However, Soviet physical culture failed to take a grip amongst not only the domestic population but also communists worldwide. The Red Sport International (Sportintern) had been formed in 1921 to oversee an international proletarian sports culture as an alternative to both the workers’ sports system run by the Socialist Workers’ Sport International and Western sports bodies such as the International Olympic Committee. But Sportintern remained a marginal organization throughout its 16-year existence. Instead, the Supreme Council for Physical Culture, the main Soviet government body for sport, took a greater interest in Western sport because it offered greater opportunities for prestige on an international scale. Prefacing the Soviet Union's Olympic bow in 1952 was the council's decision in 1933 to sanction competition between Soviet athletes and those from non-workers’ clubs, which essentially meant an acceptance of the Western model of competitive, achievement-oriented sport. Back at home football became the national sport as Soviet attempts to develop a domestic and international system of physical culture lost out to a capitalist and elite-centred transnational sports culture.94

Nazi Germany similarly embraced a form of physical culture in modern sport that it had initially opposed. On the face of it, modern sport was inimical to Nazism because of its foreign origins and the threat of internationalism which it posed. Moreover, Turnen with its strong völkisch tradition continued to be an important strand of German physical culture and because the Nazis sought to control culture for the purposes of mass mobilization it offered the Nazis an opportunity to build ‘an autarkic cultural alternative’. Nevertheless, as Keys has pointed out, under Hitler Germany became a full member of the international sport community, highlighted by its staging of and the success of German athletes at the 1936 Olympics.95 Success at international sport was seen as an opportunity to vindicate the superiority of the Aryan race and the pursuit of success was woven into notions of racial hygiene that were a central part of the Nazi public health agenda. These ideas had been built on the promotion of social hygiene policies during Weimar with a focus on eugenic and racial issues pre-1933.96 Moreover, German attitudes to health and fitness were also highlighted through an emphasis on the natural body.97 It was in this context of racial hygiene that the Nazis developed a sports system, based on Italy's OND, through its policy of Gleichschaltung: the coordination and centralization of sports clubs and societies into a central programme, Kraft durch Freude (Strength through Joy) under the control of the Reichssportführer, Hans von Tschammer.98 Even the Deutsche Turnerschaft had to be incorporated into the centralized system. Gymnastics still heavily influenced PE but organized physical activities at all levels, including gender, were now defined in terms of service to the state and its drive towards militarization.99

The British state and national fitness

A British response to continental developments came in the form of the 1937 Physical Training and Recreation Act.100Zweiniger-Bargielowska has argued that the National Fitness Campaign, which was a product of the act, was important ‘because the cultivation of health and fitness, which had been advocated by physical culture promoters, life reform campaigners, public health professionals, and leaders of voluntary associations for decades, was finally elevated to the status of a major government policy’.101 The horrors of the First World War had proved a catalyst more generally for health initiatives by commercial and voluntary groups. In addition, central government played an increasing role in the administration of health policies. There was an extension of welfare reforms generally and in 1919 a Ministry of Health was established. It promised health policies on an integrated and national basis but due to the permissive nature of these policies much of the provision was a patchwork of un-coordinated services.102

Nevertheless, both central and local government had begun to devote more resources to sport and physical recreation to promote the virtues of healthy living. There was also a clearer demarcation between work and leisure, highlighted by legislation like the 1938 Holidays with Pay Act.103 A greater concern for open spaces at the municipal level led to an expansion of sporting facilities such as football and cricket pitches.104 Physical education continued to be seen as a form of preventive medicine as well as a cheap and effective way of promoting better health amongst schoolchildren. As a result, through the School Medical Service there was an – albeit uneven – expansion in the teaching of PE, the provision of improved recreational facilities for all age groups and installing gymnasium equipment in board schools.105 A closer relationship between central government and independent voluntary organizations developed in order to facilitate the public's greater access to recreational facilities. In 1925, for example, the National Playing Fields Association (NPFA) was founded as a charity to protect the UK's sports fields, recreation grounds and public open spaces. In 1935 it was given responsibility for nearly 500 fields that were presented to the nation by George V to mark his Silver Jubilee.106 Of greater significance was the formation of the Central Council of Physical Recreation (CCPR) through the prompting of the Board of Education in 1935.107 In 1936 the British Medical Association's Physical Education committee published a report that preached the message of a ‘healthy body means a healthy mind’, and was particularly concerned with the physical, mental and moral welfare of young people in an era of mass unemployment.108

The Physical Training Act had initially been a reaction to Britain's relatively poor performance and the strong showing by the host nation at the Berlin Olympics. There was also awareness that organizations such as Strength Through Joy were having a beneficial impact on the health of the German population. A National Fitness Council (NFC) was established but rather than a portent of militarism it needs to be seen in British context. As Zweiniger-Bargielowska has pointed out, ‘the concept was understood in a wider sense of good citizenship which depended on voluntary participation’.109 Essentially the NFC was tapping into the growth of sporting and outdoor activities during the thirties. The campaign had a mixture of activities. It included mass displays of physical culture such as one at the Festival of Youth in 1937 and annual ones by the Women's League of Health and Beauty as well as hundreds of local and regional demonstrations and festivals. Grants were also made available for the construction of sporting facilities and various other schemes, which were attractive to governing bodies of sports. The Amateur Athletic Association, for example, used Council funds to appoint a national coach. While historians have argued over its merits and success, the philosophy behind the NFC not only provided continuities regarding the relationship between sport and exercise and fitness this idea continued to have salience, albeit in a changing health and medical landscape.

Welfarism, individual health and the fitness boom

Dorothy Porter has argued that in post-war Europe a new universal vision of society emerged with the establishment of the ‘classic welfare state’, highlighting a larger role for the state in undertaking collective responsibility of welfare.110 There was a shift in the nature of health care provision from an emphasis on voluntarism towards compulsory state insurance and universal welfare provision. This process, however, in national terms was uneven. In France a comprehensive social security system was introduced in 1945, although voluntarism maintained a significant role in health care delivery due to the persistence of liberal values. The concept of universal comprehensive welfare policy was applied most vigorously in Sweden following the introduction of state insurance in 1955.111

The shift in provision was most pronounced in Britain. Here the balance of the mixed economy of voluntary and state welfare swung away from the liberal collectivism of the Edwardian period to a new philosophy of universalism by the Second World War, highlighted by the publication of the Beveridge Report (1942) and then the establishment of the National Health Service in 1948. In addition, these ideological shifts redefined the boundaries of citizenship. ‘The citizenship of voluntary service was replaced by a citizenship of rights to statutory relief in times of need’.112Bernard Harris has pointed out that, despite many disagreements between the main British political parties over the development of social policy after 1945, ‘there was still an underlying consensus concerning the role that the state might justifiably play in meeting social needs’.113 Following the Second World War the medical profession became more interested in the scientific link between health and physical activity. In 1953, in a landmark study, Jerry White et al established a positive link between exercise and health through a study of bus drivers and bus conductors. It found that the more active conductors had far less heart attacks than sedentary drivers. Similar conclusions were reached when comparing postal workers with civil servants.114 These findings provided a launch pad for further state intervention regarding the health of the nation.

While public health services grew, from the 1960s, there was also a greater pre-occupation with personal health; what Crawford has termed ‘healthism’.115 This drift towards individual lifestyles complemented what Berridge has identified as a new ideology in public health which stressed ‘individual responsibility for good health, lifestyle and behaviour.’116 In addition, this shift in the public health agenda was reinforced through publicity campaigns and a much greater visibility of doctors within the media giving expert opinion on medical and health matters. This approach, in combination with the growing use of evidence-based medicine, first came to public attention with the 1962 report of the Royal College of Physicians on smoking and the subsequent campaign to ban tobacco advertising.117 The ‘individualisation of health issues’ continued during the Thatcher administrations of the 1980s.118 As Zweiniger-Bargielowska has shown, however, the new emphasis on the individual drew on long-standing beliefs about health, stressing the value of a healthy lifestyle of diet, exercise and moderate living.119

Growing concerns with personal health had both reflected and shaped a rise in demand for alternative medicine. From the 1960s a counter culture emerged that challenged the ascendancy of orthodox medicine. It formed part of a general challenge to mainstream materialistic values in the Western world as well as a decline in deference throughout society. Importantly, the notion of ‘progress’, based on a scientific world, was demythologized. As a result, alternative lifestyles, such as meditation and mysticism, gained in popularity as a reaction to the perceived moral bankruptcy of Western material values.120 In addition to the greater demand for more ‘natural’ forms of health care like homeopathy, acupuncture, osteopathy and alternative practitioners such as herbalists, the holistic approach that underlies these therapies has challenged the very essence of orthodox medicine. One such alternative activity/therapy that enjoyed popularity was yoga. A ‘yogi's’ true concern with his/her body was a spiritual one with the ultimate objective the liberation of the soul with the universe. It originated in India and was popular amongst middle-class housewives, although yoga had actually gone through a process of modernization from around 1900.121

The popular health consciousness that pervaded Western culture in the 1970s was also accompanied by a fitness boom. In addition, an aggressive anti-smoking lobby emerged along with an expansion of popular health magazines as well as a proliferation of articles on health in newspapers and advertisements for health-related products. There was also a sharp increase in demand for health food items. The most emblematic activity from this period was jogging, something that was parodied in the film Forrest Gump (1994), and also portrayed more sensitively in the 1983 biopic of the Canadian charity runner Terry Fox (1958–81). The jogging boom was highlighted further by the inception of the London Marathon in 1981, and then by its growth in runners from 7,747 to 22,000 from 70,000 applications in 1985. In addition, the numbers playing football had increased.122 Elite sport itself was on television more often, acting as an advertisement for itself as well as health and fitness.

By 2000 consumer spending on sporting goods in the UK was £4 billion. During the 1990s the number of health and fitness clubs expanded by nearly a quarter and catered for a membership of 8.6 million people, generating an estimated £1.25 billion for the UK economy. Similarly, in Italy a keep fit culture emerged in which, like elsewhere, lifestyle as much as physical activity was being sold. From the late 1980s fitness clubs were advertised on television as ‘fashionable, modern places full of interesting people’. By 2000 nearly 4 million Italians frequented around 4,000 gyms and spent $1.4 billion a year on sports clothing. However, the USA remains the largest health and fitness market. In 1976 Americans spent $147 million on running shoes, rising to $471 million in 1982. Spending on sporting goods was worth $47.3 billion in 2002 and the US had over 22,000 commercial health clubs, more than in Germany, Italy, Spain, France and the UK combined.123 This Western capitalist fashion also began to penetrate the Iron Curtain from the 1970s. In the German Democratic Republic there was an emergence of Trendsport(fashionable sports) that included windsurfing, bodybuilding and jogging as well as increased gym membership. These activities had been imported partly through West German television and were part of wider international movements that included youth culture and a bourgeoning football fan culture.124 Even in communist East Germany, wellbeing was increasingly seen in individualistic terms.

Since the late twentieth century a fetishization of health has taken place, argues Dorothy Porter. First, body-building, which traces its roots back to Sandow and Macfadden, became more freakish as the aim of body-builders was to look ‘alien’. In addition to their bulk, they need to look ‘cut’ through a low fat diet. The taking of steroids and human growth hormones has been an important part of this sub-culture. Moreover, changes in body shape and the shift to a bulkier physique can also been seen through the changing covers of Marvel comics in which Superman has got bigger in order to reflect, and maintain, his status against mortal men. Second, an offspring of body-building was the goal of a ‘designer body’ with an emphasis on ‘shape’ rather than bulk and whose defining characteristic is sexual desirability; a central goal of the healthy body from the beginning of the twentieth century.125

International sport and the state

The post-1945 period was marked by a closer relationship between sport and the state amongst virtually all countries. The nature of this process though was reflected both by individual national political cultures and sporting rivalries created by the Cold War. Sport was now seen not just in terms of health by governments but it also became more closely linked with national prestige, especially after the Soviet Union's entry into the Olympics in 1952. In the Eastern Bloc mass physical cultural displays, which promoted an all-round physical and mental education, were swept away – in 1948 Sokol gymnastics were banned in Czechoslovakia and Poland – to be replaced by an emphasis on sporting excellence.

Anxieties over the health of populations, which were increasingly being shaped by the Cold War, still remained the main priority in the West but there was also a greater awareness of the sporting threat posed by communist nations. In 1961 the Canadian Federal Government’s, ‘An Act to Encourage Fitness and Amateur Sport’ had been stimulated by both poor levels of physical fitness and Canadian failure in international ice-hockey.126America's post-war sport policy initially revolved around the ideas of national physical fitness and mass participation. This policy was also linked to pre-war concerns over the problem of youth and anxieties over the fitness, both physical and mental, of boys and girls. The construction of adolescence as a life-stage had been partly established through the work of the American psychologist G. Stanley Hall. By the 1920s adolescence as a specific psychological and biological stage in the development of the child to adult had become firmly established in psychology.127 Physical education in American schools received greater prominence as did outdoor recreations such as summer camps. The playground movement also continued to expand and there was also a growth in other municipal activities and facilities where alongside better health, training children to become good citizens was also deemed important. In addition, throughout the Depression the value of sport and recreation for the psycho-social health of adolescents, especially boys, was continually repeated, something that reflected growing concerns over the perceived threat of juvenile delinquency.128 Following a report in 1953, which concluded that European children were fitter than their American counterparts, a President's Council on Youth Fitness was established three years later and further promoted under the Kennedy administration. However, national sporting prestige, in light of the rivalry with the Soviet Union, became a more pressing issue. There was a turn away from the use of sport as an instrument to promote national fitness, a process that culminated in the Amateur Sports Act of 1978.129

More generally in the West there was now a greater investment in sport for reasons of national prestige. In Western Europe France led its neighbours in its commitment to elite sport and was the first to establish a strong state-sport relationship. From the 1960s to the 1980s French sport adopted what Phil Dine has called a ‘middle way’ between the ‘big state’ Soviet model and the ‘small state’ model of Britain and America.130 Following the creation of the Fifth Republic in 1958 de Gaulle placed a greater emphasis on a stronger state.131 No longer a superpower, sport for de Gaulle offered an opportunity for France to regain international prestige. To rejuvenate the nation it relied on ‘rationalized athletic development to produce elite athletes’.

Following France's poor showing at the 1960 Olympics the desire for success was given greater priority. In 1963 Maurice Herzog was appointed Secretary of State for Youth and Sport with a substantial budget to promote both elite excellence and mass participation. The policy was top-down. It was thought that elite athletes would make ideal citizens, act as role models for the nation's youth and stimulate participation at grass-roots. France offered a contrast with the UK where although a Minister with responsibility for Sport was appointed in 1962 it was a junior position and was continually shuffled between government departments until the 1990s. The Gaullist tradition regarding sport was not only maintained but expanded upon by subsequent administrations and between 1973 and 1992 there was an even stronger emphasis on promoting excellence through institutional means rather than relying on patriotic rhetoric. At first France had shied away from the Eastern Bloc policy of providing athletes with state subsidies because of enduring anxieties over breaching the amateur ethic. However, this changed during the following decade. In 1975 there was a separation of elite sport from physical education and its mass participation ethos. That year the Mazeuad law (named after the Minister of Youth and Sport) gave official support to the preparation of elite athletes, including the provision of financial assistance and, for the first time, set a full national sports policy. The law created the National Institute of Sport and Physical Education (Institut National d'Éducation Physique et du Sport, (INSEP)). It was designed to train elite, young athletes to serve the state with the assistance of professional coaches, sports scientists and sports medics.132

The British government also took a greater interest in sport. However, the British response, like the French, reflected its own political culture. Initially, the voluntary-based administration of British sport changed little and continued to be heavily influenced by the traditional values of amateurism.133 Yet during the 1950s Britain shared similar anxieties with the French: loss of empire and diplomatic influence; a relative sporting decline; concerns over the health of the population and a bourgeoning youth culture. As a response to these concerns the CCPR set up the Wolfenden Committee in 1957. Not only was it concerned with elite sport but another of its aims was ‘promoting the general welfare of the community through sport, games and outdoor activities’. Its report was published in 1960.134

In some respects ‘Wolfenden’ was modern and forward thinking but in other ways there was continuity with the past in terms of how people saw sport's status. Wolfenden rejected the prospect of a Ministry of Sport on the grounds that it was at odds with the traditional volunteerism of British sport.135 But in 1965 a Sports Council was set up, receiving its royal charter in 1972. As a Quango (Quasi Autonomous Non-Governmental Organization) rather than an arm of the state, it operated on an arms-length basis from the government.136 In France there was not only more direct state involvement but also much greater financial investment, especially in elite sport.137

The Sports Council had two main responsibilities: to improve the fitness of the British people and to improve the performance of elite athletes.138 A ‘Sport for All’ campaign was launched to increase participation levels as well as a building programme for local sports facilities.139Sport for All can be seen as part of a wider drift towards what Virginia Berridge has termed a ‘militant healthism’ within public health.140 The 1970s was a period of sharp growth in leisure services and the leisure industry generally, which was accompanied by the emergence of a professional class of leisure managers. Sport and leisure centres became familiar sights in many British towns. In 1972 there had been 27 but by 1981 this figure had increased to 770.141 By the 1990s there was a shift in emphasis in the relationship between the state and sport, illustrated by two important government reports. Raising the Game (1995) was commissioned by the sport-loving John Major while in 2002 Game Plan reflected New Labour thinking on using sport in public-private partnerships to tackle health issues. In the bigger picture the sport and leisure industry now had important commercial significance. In 1997 it was the eleventh largest in the country, accounting for about £10 billion of annual consumer expenditure, employing 750,000 people and contributing £3.5 billion in tax revenues.142

There was a greater emphasis also placed on elite sport. When the Sports Council was set up it aimed to build up the broadest possible base of sporting participation, which it believed was related to athletic success. However, this approach proved to be hopelessly simplistic compared to the sophisticated scientific systems of the Soviet Union and its satellites (see Chapter 3). Later, based on the Australian Institute of Sport, Raising the Game had intended to set up a British Academy of Sport to cater for elite athletes.143 In 1995 the Sports Council was split into two: national Sports Councils like Sport England looked after the grass-roots while UK Sport was responsible for elite athletes. Extra funding came from the National Lottery, which had started the previous year, and these initiatives had come to fruition by the 2000 Olympics.

Conclusion

Ideas linking sport and physical exercise with health and wellbeing have been promoted throughout history. However, these ideas have also been shaped through changing notions of the human body and a wider political context. The whole notion of health has been mutable; contingent not only on its contemporary context but also changing expectations of what it means. Early ideas were linked to Galenic medicine in which the attainment of health was dependent on the body maintaining its equilibrium. However, more scientific theories emerged that regarded the body as a machine and could be studied at a cellular level. In the nineteenth century these rational understandings prompted a greater intervention by Western states in improving the health of the population, usually in preparation for war. Physical culture came to be seen as an important part of wider public health policies. It was given further impetus through the emergence of eugenics, which gave a scientific justification for discourses concerning national efficiency and race degeneration due to the poor health of the lower orders. To improve the fitness of the race, therefore, greater attention was paid to the use of sport and exercise. These concerns were also commercially exploited as the rhetoric of the healthy body was turned into a profitable industry. By the inter-war period the link between exercise and health was made by most Western states but followed most avidly by totalitarian regimes. Not only was exercise regarded as part of public health but international sport was also now seen in terms of national prestige. Post-war welfare states continued to pursue the link between physical exercise and health but there was also a shift towards more consumerist attitudes to health. A fitness boom individualized health and reflected an increasing emphasis on lifestyle choice.

What did this mean for the relationship between sport and medicine? Much of the advice dispensed regarding exercise and its benefits for health was predicated on the notion of moderation. It was thought that excessive physical activity would lead to ill-health. Competitive elite sport, however, was based on the idea of excess. As a result, it meant that scientific understandings of the body gained in improving health could be applied to enhancing athletic performance.

Medicine, Sport and the Body - Notes and Bibliography:

1. Ina Zweiniger-Bargielowska, Managing the Body: Beauty, Health, and Fitness in Britain, 1880–1939 (Oxford: Oxford University Press), pp. 170–1.

2. Harris 2004, p. xi.

3. Bergoldt 2008, pp. 1–6.

4. Ibid., pp. 55–6.

5. Nutton 1993, p. 281.

6. Bivins 2007, p. 12.

7. Human temperaments bear humoural names: choleric, melancholic, sanguine and phlegmatic.

8. Bivins, Alternative Medicine?, p. 9.

9. Ibid.

10. Jack W. Berryman, ‘Exercise and the Medical Tradition from Hippocrates through Antebellum America: A Review Essay’ in Berryman and Park (eds), p. 3.

11. For a critique of this period see Dear 2009.

12. Ibid., Chapters 7 and 8; Bergdolt, Wellbeing, p. 202; Porter 1997, p. 218; Bivins, Alternative Medicine?, p. 33.

13. Behringer 2009, p. 334.

14. Bergdolt, Wellbeing, p. 200.

15. Ibid., p. 229.

16. Ibid., pp. 236–7.

17. Harris, British Welfare State, pp. 16–19.

18. Porter 1999, p. 63.

19. Keys, Globalizing Sport, pp. 1–16.

20. Porter, Health, Civilization, pp. 97–110; Deborah Brunton, ‘Dealing with Disease in Populations: Public Health, 1830–1880’ in Brunton (ed.), pp. 196–204.

21. Ramsey 1994 pp. 45–118.

22. Paul Weindling, ‘From Germ Theory to Social Medicine: Public Health, 1880–1930’ in Brunton (ed.), p. 239.

23. See Schiller 2009, pp. 313–30.

24. Todd 1992, p. 7.

25. MacMillan 2001, p. 365.

26. Todd, ‘The Classical Ideal’, p. 7; Saure 2009, pp. 358–73.

27. Saure, ‘Beautiful Bodies’, pp. 358–73.

28. Eisenberg 1996, pp. 14–26. A Turnfeste was a very large gymnastic festival in which the Turnen performed mass gymnastic exercises along with listening to patriotic orations and pledging their allegiance to the Kaiser.

29. Kruger 1998, p. 80; Porter, Health, Civilization, p. 304.

30. Porter, Health, Civilization, p. 304; Barclay 1994, pp. 4–5.

31. Holt, Sport and the British, pp. 94–5.

32. Weber 1971, pp. 70–7.

33. Radford 2001, pp. 60–8.

34. Todd, ‘The Classical Ideal’, pp. 8–9.

35. McIntosh 2004.

36. Frank Galligan, ‘The History of Gymnastic Activity in the West Midlands, with special reference to Birmingham, from 1865 to 1918: With an analysis of military influences, secular and religious innovation and educational developments’ (Unpublished PhD thesis, Coventry University, 1999), p. 263.

37. Haley 1978, p. 3.

38. Haley, Healthy Body, pp. 19, 4; Holt, Sport and the British, p. 361.

39. Erdozain 2010.

40. Holt, Sport and the British, p. 76. Sport in the schools, however, was generally organized and ran by the boys.

41. Haley, Healthy Body, p. 167.

42. Times Higher Education, 26 March 2009, p. 48.

43. Collins 2009, pp. 1–21.

44. Holt, Sport and the British, pp. 74–88; Riedi 2006, p. 496.

45. Devitt 2004, pp. 1–13. Notions of masculinity though differed according to social context. While the working classes, for example, adopted many of the games of the elites, there was less acceptance of the attendant values associated with the games.

46. Holt, ‘The Amateur Body, pp. 352–69.

47. Harris, British Welfare State, pp. 104–24.

48. Hill, Sport, Leisure and Culture, pp. 165–6.

49. Parker 2001, pp. 54–67.

50. Hurt 1977, p. 176; Galligan, ‘Gymnastic Activity’, pp. 257–74.

51. Ibid., p. 189; Mason 1980, p. 125 n19.

52. Welshman 1996, pp. 32–4.

53. Welshman 1998, p. 56.

54. Hill, Sport, Leisure and Culture, p. 167.

55. Holt, Sport and the British, pp. 136–48. For other literature regarding rational recreation see Bailey 1987; Russell 1997, Chapters 2 and 3.

56. Mason, Association Football, p. 123 n6.

57. For a detailed study of the origins and motivations of these and similar organizations see Springhall 1977. Proctor 1998, pp. 105–6.

58. Mason, Association Football, pp. 82–7; Kerrigan 1994.

59. Munting 2003, pp. 45–63; Jones 1994, pp. 42–4.

60. James Moore, ‘The Fortunes of Eugenics’ in Brunton (ed.), pp. 266–97.

61. Zweiniger-Bargielowska, Managing the Body, p. 24.

62. Porter, Health, Civilization, pp. 166–73.

63. Jones, Social Policy, p. 77.

64. Searle 1971, pp. 54–67.

65. Zweiniger-Bargielowska, Managing the Body, pp. 72–3; Report of the Inter-Departmental Committee on Physical Deterioration 1903–4.

66. Porter, Health, Civilization, p. 147.

67. Porter, Greatest Benefit, p. 417.

68. Berryman, ‘Exercise’, pp. 35–6.

69. Green, Fit For America, pp. 6–7.

70. Todd, ‘The Classical Ideal’, p. 6.

71. Pfister 2009, pp. 1893–1925.

72. Roberta J. Park, ‘Physiologists, Physicians, and Physical Educators: Nineteenth-Century Biology and Exercise, Hygienic and Educative’ in Berryman and Park (eds), pp. 137–40.

73. Green, Fit for America, pp. 182–3.

74. Park, ‘Sharing, arguing’, pp. 519–48.

75. Porter, Health, Civilization, pp. 147–62.

76. Green, Fit for America, pp. 219–33.

77. Ibid., pp. 233–40; Oriard 1993, pp. 214–15.

78. Porter, Health, Civilization, p. 305.

79. Dorothy Porter, ‘The Healthy Body’ in Cooter and Pickstone (eds), p. 202.

80. Zweiniger-Bargielowska, Managing the Body, pp. 1–14.

81. Porter, Health, Civilization, p. 306.

82. Sandow 1919, pp. 282–3.

83. Zweiniger-Bargielowska, Managing the Body, pp. 36–50.

84. Ibid., pp. 46–50; Bonde 1991, pp. 347–69; Muller 1904.

85. Green, Fit For America, pp. 242–50. See also Jan Todd, ‘Bernarr Macfadden: Reformer of Feminine Form’ in Berryman and Park (eds), pp. 213–32.

86. Dyreson 2008, pp. 268–83.

87. Zweiniger-Bargielowska, Managing the Body, pp. 298–9.

88. Zweinigier-Bargielowska 2007, pp. 73–89; Porter, Health, Civilization, pp. 303–8.

89. Zweinigier-Bargielowska 2006, pp. 596–602.

90. Zweiniger-Bargielowska, Managing the Body, pp. 169–74.

91. Porter, Health, Civilization, p. 208.

92. Angela Teja, ‘Italian sport and international relations under fascism’ in Arnaud and Riordan (eds), pp. 147–70.

93. Keys, Globalizing Sport, p. 3.

94. Ibid., pp. 158–72; Katzer 2011, pp. 18–34.

95. Keys, Globalizing Sport, p. 115.

96. Porter, Health, Civilization, p. 193.

97. Jensen 2010.

98. Cole 2000, p. 54; Keys, Globalizing Sport, p. 125.

99. Keys, Globalizing Sport, pp. 125–6.

100. For a similar response amongst other countries in the British Empire see Macdonald 2011.

101. Zweiniger-Bargielowska, Managing the Body, pp. 329–30.

102. Hardy 2001, pp. 77–9.

103. Ibid., p. 108.

104. Jones 1987, p. 167; Cunningham 1990, p. 323.

105. Welshman, ‘Physical Education’, pp. 40, 64–5; Webster 1983, pp. 73–4.

106. Davies 2000, pp. 275–6.

107. It had been originally called the Central Council of Recreative Physical Training but this was changed to the Central Council of Physical Recreation in 1944.

108. Evans 1974, pp. 31, 39.

109. Zweiniger-Bargielowska, Managing the Body, p. 313.

110. Porter, Health, Civilization, p. 208.

111. Ibid., pp. 209–11.

112. Ibid., pp. 211–2.

113. Harris, British Welfare State, p. 303.

114. Lancet, 21 November 1953, pp. 1053–7.

115. Crawford 1980, pp. 365–88.

116. Berridge 2009, p. 361.

117. Virginia Berridge, ‘Medicine and the Public: The 1962 Report of the Royal College of Physicians and the New Public Health’, Bulletin of the History of Medicine, 81: (2007), pp. 286–311.

118. Berridge 1999, p. 88.

119. Zweiniger-Bargielowska, Managing the Body, passim.

120. Mike Saks, ‘Medicine and the Counter Culture’ in Cooter and Pickstone (eds), pp. 114–20. Roberta Bivins has argued that cross-cultural or alternative medicine never went away and these therapies have their origins in Ancient Egypt and Greece. Bivins, Alternative Medicine?, p. 171.

121. Phelan 1963, p. 23; Watt 2008, pp. 2287–8; Bivins, Alternative Medicine?, p. 79; Zweiniger-Bargielowska, Managing the Body, pp. 35–6.

122. Mason, Sport in Britain, pp. 83–4.

123. Smith Maguire 2008, p. 61; Frew 2005, pp. 161–2; Sassatelli 2000, pp. 396–7.

124. Braun 2009, pp. 414–28.

125. Porter, ‘Healthy Body’, pp. 212–15.

126. Mick Green, ‘Olympic Glory or Grassroots Development?: Sport Policy Priorities in Australia, Canada and the United Kingdom, 1960–2000’, IJHS, 24:7 (July 2007), p. 930.

127. Tinkler 2003, p. 241.

128. Park, ‘Setting the Scene’, pp. 1427–52.

129. Hunt 2007, pp. 798–800.

130. Dine 1998, p. 310.

131. For the relationship between sport and the state in the Third Republic (1870–1939) see Holt 1998, pp. 289–99.

132. Lindsay Sarah Krasnoff, ‘Resurrecting the nation: The evolution of French sports policy from de Gaulle to Mitterand’ in Tomlinson et al (eds), pp. 67–82.

133. Baker 1995, p. 101.

134. Polley 1998, p. 10.

135. Wolfenden Committee on Sport 1960–61, paragraphs 269–72.

136. For the even greater role of local government in British sport see Houlihan 1991, p. 51.

137. Krasnoff, ‘Resurrecting the nation’, pp. 67–82.

138. Bannister 1972, p. 712.

139. Holt 2000, p. 150. Sport for All was originally a European Commission initiative.

140. Berridge, Health and Society, p. 88.

141. Mason, Sport in Britain, p. 82. For the role of leisure centres in Northern Ireland see Holt and Mason, Sport in Britain, p. 189 n16; Hill, Sport, Leisure and Culture, pp. 173–4.

142. Holt and Mason, Sport in Britain, p. 166.

143. Ibid., pp. 154–5.