Doctor's Review: Medicine on the Move

April 27, 2017

Mercurius/Hermes is often portrayed carrying a Caduceus with entwined double snakes.

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Medicine’s odd confusion over symbols

Caduceus or Asclepius? Why only one of them is correct

What is the correct symbol of medicine? Those in the know will likely gaze down their noses at anyone foolish enough to proclaim it the winged staff encircled by twin serpents, otherwise known as the Caduceus. The true symbol, these experts will point out, is the rod of Asclepius, the Greek god of medicine, depicted by a single snake ascending a staff. Why then the ubiquitous use of Caduceus across Canada and the US?

The rod of Asclepius has a rich history of association with medicine. Greek myth has it that Asclepius brandished the staff and pursued a career so successful he brought on the wrath of the gods. Indeed, things did not always go so smoothly for Asclepius, whose mortal mother Coronis, consort of Apollo, engaged in a dalliance while pregnant with Asclepius for which she was executed. While flames consumed her on the funeral pyre, Apollo took pity on his son and excised the boy by caesarean. Not being inclined towards parenting himself, Apollo then gave newly born Asclepius to the kind-hearted centaur Chiron, who instructed Asclepius in the art of medicine.

The leaf cure

According to one account, Asclepius acquired his affinity for serpents during a particularly tough case early in his career. Unable to cure the son of Minos, ruler of Crete, he was sealed into a room with the dying boy. When a snake slithered under the door, Asclepius killed it. Moments later, another snake made its way under the door and placed a leaf on the dead snake’s body, restoring it to life. Asclepius gave the leaf to the boy, who was cured.

Another theory has it that Asclepius adopted the rod and snake as his symbol because it depicted the treatment for the then common filarial worm Dracunculus medinensis aka “the fiery serpent,” a horrible parasite that crept around just below the skin and could only be extracted by trapping its front end and winding it slowly around a stick. The cure is much the same to this day, though somewhat more hygienic.

Before long, Asclepius became proficient at saving lives and this angered Hades, King of the Underworld, who complained to Zeus that his realm was being depopulated. Zeus thought Hades’ point a good one, and struck Asclepius down with a thunderbolt. Always the diplomat, Zeus soothed Apollo’s fury at the killing of his son with the tried-and-true Greek god’s panacea for murderous acts, placing the dead physician’s body among the stars as the constellation Ophiuchus or “the Serpent Holder.” Later, some sources say, Zeus resurrected Asclepius as a god to further mollify Apollo, though Asclepius was given strict instructions never to revive the dead without permission.

Asclepius’s influence on medicine did not end there. A cult of Asclepius sprang up and reached a zenith of popularity in the third century BCE, with over 500 temples spanning the ancient world from Scotland to Egypt and as far east as modern-day Iraq. The temples were a combination of health spas and religious centres that employed the help of non-venomous rat snakes in their healing rituals. Contemporary herpetologists think that the spread of the temples correlates with the population dispersion of the snake, now known popularly as the “aesculapian snake” and scientifically as zamenis longissimus.

Hippocrates himself is thought to have been trained as a priest at one such temple in Kos. And although the great Father of Western Medicine took a distinctly different direction, placing great value on experiential knowledge, he continued to honour his roots as an Asclepian. The Hippocratic oath makes this clear: “I swear by Apollo the physician, and Asklepios, and Hygea and Panacea [Asclepuis’s daughters], and all the gods and goddesses…”

Unfair swap?

Many historians are indignant at the thought that the venerable rod of Asclepius, with its origins in medicine and healing, might be swapped for the Caduceus, symbol of the god Hermes. Hermes, they say, is a rogue, a thief, a protector of perjurers and fraudulence. Possibly a fitting symbol after all, they sigh with irony, for a profession that has been plagued by lawsuits and demeaned for its commercial interests. But how exactly did the Caduceus find its way into modern medical iconography?

Printers are to blame, say some. They took a liking to the Caduceus in the 16th century, adopting it as a printer’s mark, perhaps regarding themselves as messengers of the printed word and diffusers of knowledge. The Caduceus does in fact resemble one of the oldest and best-known printer’s marks, the dolphin and anchor, used in 1502 by the Venetian printer Aldus Manutius. A proliferation of the Caduceus in books, some of them medical texts, may have given people an incorrect association.

The conflation of the rod of Asclepius and the Caduceus in people’s minds was much more likely to have occurred some time in the 1800s though, when the Caduceus was adopted by ambulance drivers and other medical workers for use on the battlefield. This purpose is derived from a myth that describes Hermes using his own winged staff to break up a fight between two serpents, thereby lending the symbol the connotations of peacemaking or neutrality. Ambulance drivers made their way through the battlefield without getting shot at by brandishing flags bearing Hermes’ staff.

Until 1902, most medical establishments used the rod of Asclepius to represent themselves. But that year, on the insistence of a single officer, the US Army Medical Corps adopted the Caduceus as its symbol, thereby cementing the image in the minds of many Americans and prompting its use in popular culture as a medical symbol. It is estimated that 76 percent of commercial healthcare organizations use the Caduceus symbol, while 62 percent of professional healthcare associations — the Canadian Medical Association and the World Health Organization, to name two — use the rod of Asclepius as their symbol.

So who was that insistent American officer, one might ask. No one can be sure, but there are two suspects. The first is Charles Ransom Reynolds, who graduated with an MD degree from the University of Pennsylvania in 1890. He entered the army as a contract surgeon in 1899. He would later go on to become the surgeon general in 1902. Perhaps, having been on the battlefield himself as a medical officer and used the Caduceus as a trustworthy form of protection, he felt a certain attachment to the symbol.

The other suspect is a Colonel John Van Rensselaer Hoff, who served 40 years in the United States Army Medical Corps. In 1887, the colonel took a “conspicuous part” in the formation of a hospital corps for the army and became the creator of the United States Field Hospital. This was a man who took his duties as a medical officer seriously. Speaking of his response to a battle at Wounded Knee in 1890, a fellow soldier says of then Captain Hoff and Lieutenant Glennan: “they did everything they could to alleviate the sufferings of the men, and exposed themselves to a storm of bullets while looking over the battlefield for the wounded. I have been in many a hard fight, but never saw doctors who performed their duties with so much zeal as these two did.” Of this same battle, it was said, “The Red Cross flag, held sacred in ordinary warfare, was shot full of holes, and the hospital corps were picked off as they kneeled over the wounded.” Little wonder, then, that Hoff would be particularly interested in a symbol that explicitly declared that the medical corps came in peace.

There may be more to this story, an intriguing subplot buried beneath the surface. In addition to his association with thieves and con artists, Hermes is the patron saint of yet another group whose credibility is sometimes questioned: alchemists. Hermeticism, a religious, philosophical and esoteric tradition affiliated with the ancient philosopher Hermes Trismegistus (“Thrice Great”) as well as with the god Hermes, often employs the Caduceus as its symbol. Hermetical concepts abound in Rosicrucianism, a secret society founded in late medieval Germany built on esoteric truths of the ancient past. Brothers of the Fraternity of the Rose Cross presented themselves as “mystic-philosopher-doctors” and were sent in mission throughout the world. Their top priority was, it is said, to cure the sick free of charge.

Colonel Van R. Hoff lived a long and varied life distinguished by a series of monumental acts of life-saving and disease prevention. He was one of the first Europeans to walk through the sacred buildings in China’s Forbidden City, and he witnessed the building of the Trans-Siberian Railway. Could it be that somewhere in his travels he learned of the Caduceus’s esoteric roots in Hermeticism, and grasping the true nature of the symbol, wished to bring it to the new world? If so, it can be said that he met with a certain degree of success. Just ask anyone, “What’s the symbol of medicine?” and that will be clear.

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