MEDICAL SYMBOLS: FACTS, ERRORS AND CONFUSION Gaby Frank, MD, FACP Associate Chief of Hospital Medicine Denver Health & Hospital Authority Assistant Professor of Medicine University of Colorado, School of Medicine
WHEN DID HERMES DEFEAT ASCLEPIUS? Moreover, with the help of which army?
OBJECTIVES • To review differences between Hermes and Asclepius • To review the definition of caduceus • To review the historical use of the caduceus in Medicine • To review the use of the caduceus by the US army • To review current medicine state in regards to caduceus use • To discuss appropriateness of Rod of Asclepius vs. Caduceus as a symbol of Medicine
HERMES- GREEK MERCURYROMAN • God of Commerce and Merchants • Messenger of the Gods • Magic wand between 2 snakes. • Multiple Hermes
PRE- HOMERIC HERMES • God of the Boundary-stone • God of roads and paths • God of the “agora” or marketplace • God of oratory • God of a fertility cult • Psycho-pomp • God of luck
ARCHAIC HERMES • 700 -500 BC. Homeric Hymns • Could “put people to sleep” • Messenger of the Gods • God of athletic contests • A trickster, a thief and a liar • Apollo gave him the Peter Paul Rubens. “Mercury and Argus”, saving Io from Hera.
TRADITIONAL HERMES • Becomes Hermes-Mercury • God of gymnasiums and athletes • Birth of at least 9 infants • Hermes “transplanted” Zeus muscles • Many attributes • Invented speech!
HERMESTHOTH • Greco-Egyptian. 5 th century BC. • Gods ran to Egypt in fear of Typhon • Scribe, heart and tongue of Ra. • Great ethics • Invented enemas, revived Horus • Creator of ALL arts and science.
Traditional Hermes Thoth • Wise, clever wise • Wise, knowledgeable wise • Inventive: crafts and • Inventive: arts and science objects • Liar, Trickster • Death: psycho-pomp • Messenger of the Gods • Sexually promiscuous • Caduceus • Grave judge of right and truth • Death: officiated souls judgment • Scribe of the Gods • Source of laws • Ibis
HERMES TRISMEGISTUS • Three-times Great • 2 nd-1 st century B. C. • Pseudo-Hermes trismegistus • Written by roman philosophers, • Between 3 rd – 4 th century
GREEK AESCULAPIUS ROMAN • Demi-God of Medicine? • The “ blameless physician”? • A Hero? Together with his sons • God of Medicine?
ASCLEPIUS DEIFICATION • Mycenaean inscriptions 1500 BC • Homer circa 900 BC, NO GOD but a HERO • Hesiod 700 BC DEMI-GOD • Pindar 520 -442 BC DEMI GOD • Progressive deification 500 BC-100 AD • Hellenistic Greece 420 BC. GOD • Pausianas 140 AD Roman.
ASCLEPIUS BIRTH AND DEATH As told by HESIOD. 700 BC As told by PINDAR. 520440 BC • Son of a GOD, and a mortal • Apollo and Coronis were lovers. • Apollo’s jealousy killed Coronis. • Rightful Apollo killed Coronis • Asclepius born by C-section • Asclepius accepted gold • Zeus killed Asclepius. • Post –Homeric Greece • Asclepius was destroyed because of his benevolence to mankind because he was greedy
WHAT’S IN THE NAME? • Askles: a tyrant of Epidaurus • Epios: Greek for gentleness, kindness, calmness • “kindness to all those suffering”. • “ To cut open” “ The mole. Hero”. • Etymology : pre-Greek Sebastiano Riccica, 1720. “Dream with Asclepius”. Academy Gallery, Venice, Italy
ASCLEPIUS’ FAMILY • Father: Apollo • Mother: Coronis • Wife: Epione, “epios” • Machaon: “Surgery” • Podalirius: “ Internal Medicine” • Hygeia: goddess of health. • Panacea: “ soothing simples” or remedies Asclepius and his family meet the sick. Unknown author. National Museum of Art. Athens.
HERMES AND ASCLEPIUS’ FAMILY • Daughters: Hygieia, Panacea, Meditrina, Aceso, Iaso, Aglaea • Sons: Machaon, Podalirius, Telesphoros, • Killed by Zeus with a Thunderbolt • Post-mortem God • Constellation Ophiuchus
JOHN WILLIAM WATERHOUSE. “ A SICK CHILD BROUGHT INTO THE TEMPLE OF ASCLEPIUS. 1877 SANCTUARY OF ASCLEPIUS, ALBANIA. BUILT III BC
ASCLEPIADS Asclepius • Lover of all people • Accessible to supplicants Asclepiads. Physicians • Hippocrates > the Asclepiad (Plato’s) > the leader of • Man-God • Killed for his compassion to the condemned • Dared to care for the outcast, regardless of the consequences the Asclepiads ( Aristotle’s) • Medicine: responsibility to care for the sick, even if placed the physician at danger. Despite social status, financial gain or personal risk
HERMES AND AESCULAPIUS RELATIONSHIP • Hermes was Aesculapius Uncle • Saved him from his death (some say) • Hermes thought to have married Hygeia (among many others) Hermes, a merchant, Aesculapius, Meditrine, Hygeia, Panacea. Engraved from an original in then Museum Pio Clemens in Rome Galerie Mythologique, Recueil de Monuments by Aubin Louis Millin, Paris 1811
ONE MORE COMPARISON HAD BEEN MADE…. Christianity Paganism
DEFINITION OF CADUCEUS • Caduceus: Latin word • From Greek word kerykeion • Herald’s wand • Non- Medical dictionaries: still Herald’s wand • . . ” figure whose basic structure consists of two serpents encircling a wand or rod”
THE CADUCEUS IN MEDICINE Caduceus of Royal College of Physicians of Edinburgh Butt’s caduceus Caius’ emblem Harvey’s caduceus Caduceus of the Royal College of Physicians, London. Caius
SIXTEENTH AND SEVENTEENTH CENTURY Similar coat of arms as 2 other Padua’s law students (1602) Sir William Butts Prudent in judgment John Caius President of the Royal College of Medicine 1555 -1571. “Authority should be exercised with gentleness and mercy”. Snakes> prudence. Replica given to ACP in 1954. William Harvey
CADUCEUS AS A PRINTER’S MARK Multiple American printer’s marks derived from Churchill’s. Medicine, Literis. Unbreakable bond unites Johann Froben’s printer’s mark. 1516. medical and nonmedical books John Churchill’s printer's mark. 1837. Medical books
CADUCEUS IN MILITARY • Sign for PEACE • Peloponnesian War 431 -404 B. C • Caduceator: non-combatant w/ message of peace. • Peace in Munster 1648 • peace of Nystadt 1721 • Ambassadors 18 th century: coat of arms.
ROD OF ASCLEPIUS- MILITARY MEDICAL CORPS France German WWI medical uniform South Africa UK Australi a Army Reserve Indian
MEDICAL DEPARTMENT OF US ARMY COAT OF ARMS- 12/10/1817 -12/02/1818 • Never had an official sanction • 20 stars, 13 strips (before Illinois became the 21 st state) • Stamped on an 1882 book “ Antiseptic Surgery”
US NAVY SURGEON’S UNIFORM 1826 -1832 • Staff of Aesculapius embroidered on the collar • “ of disproportionate size and probably the ugliest device ever worn”- Roddis, L. H. A short history of nautical medicine. 1941.
US MILITARY- HOSPITAL STEWARDCIVIL WAR 1851 -1887 US Army’s General Order no. 31. 06/12/1851, 10/31/1851
US ARMY MEDICAL OFFICER DISTINCTION 1840 MS- Medical Staff 1872 MD- Medical Department 1891 Shield. 13 stars + 13 strips. Rod of Asclepius
HOSPITAL CORPS-1887 RED CROSS on overcoats and blouses WHITE GENEVA CROSS on helmets, forage caps and side buttons
US ARMY HOSPITAL CORPS 1902 OFFICERS. Cross of the “Knights of St John”- Hospitallers ENLISTED Modified Maltese cross
1902. CAPTAIN FREDERICK P. REYNOLDS, ASSISTANT SURGEON US Letter to the Surgeon General, ARMY th March 20 , 1902 …”I wish particularly to call attention to the desirability of changing the insignia from the cross to the caduceus and to the adoption of Maroon as the color of the Corps in lieu if the Green now used. The Caduceus was for years the insignia of our Corps and it is inalienably associated with things medical. It is in use by several of the foreign powers, notably the English”……… Capt. Frederick P. Reynolds George Miller Sternberg
NO ……. ”the present insignia of the Medical Department (the Maltese cross) was adopeted after careful consideration, and is now generally recognized as indicating this corps…. ”
1902. CAPTAIN FREDERICK P. REYNOLDS, ASSISTANT SURGEON US Letter to the Surgeon General, ARMY June 14 th, 1902 …”I wish particularly to call attention to the desirability of changing the insignia from the cross to the caduceus and to the adoption of Maroon as the color of the Corps in lieu if the Green now used. The Caduceus was for years the insignia of our Corps and it is inalienably associated with things medical. It is in use by several of the foreign powers, notably the English”……… Capt. Frederick P. Reynolds William H Forwood
YES. . . . ”The Acting Surgeon General concurs in the opinion that a change in thepresent insignia as well as the green color trimming for the medical Corps of the Army is desirable. I am favorably impressed with the suggestions made by Capt Reynolds and Major Border…. . ” July 28 th, 1902
USE OF THE ROD OF ASCLEPIUS INSTEAD OF CADUCEUS • English medical corps: 1898 …. ” I have the honor to submit herewith a drawing suggesting a crest or emblem for the use of the medical • Prussian/ German : 1868 Department……… The cock of Aesculapius is the same as on the old emblem……. ” November 26 th, 1902 • French medical corps: 1798 Capt. Reynolds
INTERESTING LETTERS Dr. Gerhard 1909. JAMA • …” In the United States Army”. . ” the device of a surgeon is mercury’s wand……Carefully examining the literature on the subject of Mercury we learn many facts arguing against the use of this…emblem in the healing art. We shall see that I belongs strictly to commerce and trade” • “Whoever recommended its [caduceus]use as a medical emblem in this country has either been conducted by mercury, his titular deity, to join the souls of the dead in the world below, or is keeping unusually quiet” • …”A badge of neutrality appropriate to the medical officer as a noncombatant. . ” Colonel Hoff 1928 • “ has really no medical bearing whatever, and what significance it has is indeed not at all complimentary…. Whatever its real symbolism may be… the bearing is certainly not medical, and our use if the caduceus is therefore, not correct”. Lieutenant Colonel C. C. Mc. Culloch 1917.
20 TH CENTURY • 1902: US Army medical corps • 1910: AMA Rod of Asclepius as insignia • 1917: WWI Caduceus “exposed” • 1918: RAF caduceus in logo • Later: Korea, Paraguay, Iran • 1924: La Presse Medicale • 1924: AMA • Caduceus: doctor’s insignia for cars. • Rod of Asclepius: button/pin and Luxemburg (1962 > Asclepius) clasp • 1925: AMA dropped use of
LA PRESSE MEDICALE, 1924 “During the last war some of our confreres with an interest in antiquity have commented on the use of the caduceus of mercury used by the medical men in certain allied armies…. ”
CADUCEUS IN MEDICAL ORGANIZATIONS? AAMC AMA • Founded in 1847 • JAMA 1883 • Founded in 1876 • Caduceus insignia in 198788 • Changed logo recently
BOSTON MEDICAL AND SURGICAL JOURNAL “…advisable for physicians to adopt the caduceus, which has the approval of the AMA, as an emblem for the doctor’s car? For a number of years past it has been customary in this vicinity to display the green cross on white field, and before a change is made it would be well to be certain that the cross is unsatisfactory. The caduceus is a winged rod entwined by two serpents, and is the badge of Mercury, the god of commerce, and incidentally of thieves. If a change is desired, why not adopt the staff of the god of Medicine, Asclepius…” Dr. Henry Bowditch, Boston 1923
CADUCEUS APPEARANCE IN THE DICTIONARY France, UK, US Before 1903 After 1907 Non-Medical dictionaries (12) NO mention of its association with medicine 3/9 stated its association with medicine Medical Dictionaries (11) Not definition of caduceus AT ALL 5/8 reported its association with medicine Both medical and nonmedical dictionaries NO RELATIONSHIP 8/17 (47%) reported its association Chance of this difference NOT related to the introduction of caduceus as the emblem for the US Army Medical Corps in 1902 is 1: 1, 000
WHERE DO WE STAND NOW (LATE 20 TH CENTURY 1970 -80 S) AND HERE (USA)? N=242 Logo or insignia Rod of Asclepius Caduceus PROFESSIONAL MEDICAL ORGANIZATIONS 62 % 38 % COMMERCIAL MEDICAL ORGANIZATIONS HOSPITALS 24 % 76 % 38 hospitals out of 242 “medical organizations” analyzed Rod of Asclepius Caduceus 37% (14/38) 63% (24/38)
SUMMARY CADUCEUS’S ASSOCIATION TO MEDICINE DUE TO 1. Confusion 2. Lack of recognizing of traditional Hermes with other Hermes difference between 2 serpentine objects Although, many lay people may think this is appropriate, it seems unlikely that most medical people, if they understood the underlying meaning of this object, would find it suitable. Walter J. Friedlander.
QUESTIONS? ? Claude Lorrain. Asclepius reviving Hippolytus
BIBLIOGRAPHY 1. The Golden Wand of Medicine. A history of the caduceus Symbol in Medicine. W. J. Friedlander. 1992 2. 3. Asklepios: Ancient Hero of medical Caring. J. E Bailey. Annals of Internal Medicine 124 (2) 1996 The Symbol of Modern Medicine: Why one snake is more than two. RA Wilcox; EM Whitham. Annals of Internal Medicine 138 (8). 2003 4. Asclepius. The perfect discourse of Hermes trismegistus. Clement Salaman. 2010 5. The way of Hermes Sandro Botticelli: Aphrodite in La Primavera. 1492
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