Gaby Frank, MD, FACP

Associate Chief of Hospital Medicine

Denver Health & Hospital Authority

Assistant Professor of Medicine

University of Colorado, School of Medicine

MEDICAL SYMBOLS:FACTS, ERRORS AND CONFUSION

Moreover, with the help of which army?

WHEN DID HERMES DEFEAT ASCLEPIUS?

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 Mercury- Roman

• 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 caduceus 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!

Hermes-Thoth

• Greco-Egyptian. 5th 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.

• Wisest of all gods.

• Wise, knowledgeable wise

• Inventive: arts and science

• Grave judge of right and truth

• Death: officiated souls judgment

• Scribe of the Gods

• Source of laws

• Ibis

• Wise, clever wise

• Inventive: crafts and objects

• Liar, Trickster

• Death: psycho-pomp

• Messenger of the Gods

• Sexually promiscuous

• Caduceus

Traditional Hermes Thoth

Hermes Trismegistus

• Three-times Great

• 2nd-1st century B.C.

• Pseudo-Hermes trismegistus

• Written by roman philosophers,

• Between 3rd – 4th century

• Alchemy created by Hermes3

Asclepius- GreekAesculapius - Roman

• Demi-God of Medicine?

• The “ blameless physician”?

• A Hero? Together with his sons

• God of Medicine?

• 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 DEIFICATION

• Apollo and Coronis were lovers.

• Rightful Apollo killed Coronis

• Asclepius accepted gold

• Post –Homeric Greece

• Asclepius was destroyed because he

was greedy

• Son of a GOD, and a mortal

• Apollo’s jealousy killed Coronis.

• Asclepius born by C-section

• Zeus killed Asclepius.

• Asclepius was destroyed because of

his benevolence to mankind

ASCLEPIUS BIRTH AND DEATH

As told by HESIOD. 700 BC As told by PINDAR. 520-440BC

• 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

WHAT’S IN THE NAME?

Sebastiano Riccica, 1720. “Dream with Asclepius”. Academy Gallery, Venice, Italy

• Father: Apollo

• Mother: Coronis

• Wife: Epione, “epios”

• Machaon: “Surgery”

• Podalirius: “ Internal Medicine”

• Hygeia: goddess of health.

• Panacea: “ soothing simples” or remedies

ASCLEPIUS’ FAMILY

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

• Hippocrates > the Asclepiad (Plato’s)

> the leader of 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

• Altruistic art

• Lover of all people

• Accessible to supplicants

• Man-God

• Killed for his compassion to the

condemned

• Dared to care for the outcast, regardless

of the consequences

ASCLEPIADS

Asclepius Asclepiads- Physicians

• Hermes was Aesculapius

Uncle

• Saved him from his death

(some say)

• Hermes thought to have

married Hygeia (among

many others)

HERMES AND AESCULAPIUS RELATIONSHIP

Hermes, a merchant, Aesculapius, Meditrine, Hygeia, Panacea. Engraved from an original in the 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

• 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”

DEFINITION OF CADUCEUS

THE CADUCEUS IN MEDICINE

Caius’ emblem

Butt’s caduceus

Harvey’s caduceus

Caduceus of Royal College of Physicians of Edinburgh

Caduceus of the Royal College of Physicians, London. Caius

SIXTEENTH AND SEVENTEENTH CENTURY

John Caius

Sir William Butts

William Harvey

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.

Prudent in judgment

Similar coat of arms as 2 other Padua’s law students (1602)

CADUCEUS AS A PRINTER’S MARK

Johann Froben’s printer’s mark. 1516. medical and non- medical books

John Churchill’s printer's mark. 1837. Medical books

Multiple American printer’s marks derived from Churchill’s.

Medicine, Literis. Unbreakable bond unites

• 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 18th century: coat of arms.

CADUCEUS IN MILITARY

ROD OF ASCLEPIUS- MILITARY MEDICAL CORPS

France German WWI medical uniform

Indian

UK

Australia

Army Reserve

South Africa

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 21st state)

• Stamped on an 1882 book “

Antiseptic Surgery”

• 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 NAVY SURGEON’S UNIFORM1826-1832

US MILITARY- HOSPITAL STEWARD- CIVIL WAR1851-1887

US Army’s General Order no. 31. 06/12/1851, 10/31/1851

US ARMY MEDICAL OFFICER DISTINCTION

1840MS- Medical Staff

1891Shield. 13 stars + 13 strips.

Rod of Asclepius

1872MD- Medical Department

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 ARMY

Letter to the Surgeon General,

March 20th, 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 ARMY

Letter to the Surgeon General,

June 14th, 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 28th, 1902

• English medical corps: 1898

• Prussian/ German : 1868

• French medical corps: 1798

….” I have the honor to submit herewith a drawing suggesting a crest or emblem for the use of the

medical Department……… The cock of Aesculapius is the same as on the old emblem…….” November 26th, 1902

Capt. Reynolds

USE OF THE ROD OF ASCLEPIUS INSTEAD OF CADUCEUS

• …” 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”

INTERESTING LETTERS

Dr. Gerhard 1909. JAMA • …”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. McCulloch 1917.

• 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 and

Luxemburg (1962 > Asclepius)

• 1924: La Presse Medicale

• 1924: AMA

• Caduceus: doctor’s insignia for cars.

• Rod of Asclepius: button/pin clasp

• 1925: AMA dropped use of caduceus

20TH CENTURY

“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….”

LA PRESSE MEDICALE, 1924

CADUCEUS IN MEDICAL ORGANIZATIONS?

AAMC AMA

• Founded in 1876• Caduceus insignia

in 1987-88• Changed logo

recently

• Founded in 1847• JAMA 1883

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 non-medical 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 20TH CENTURY 1970-80S) AND HERE (USA)?N=242

Logo or insignia Rod of Asclepius Caduceus

PROFESSIONAL MEDICAL ORGANIZATIONS

62 % 38 %

COMMERCIAL MEDICAL ORGANIZATIONS

24 % 76 %

HOSPITALS Rod of Asclepius Caduceus

38 hospitals out of 242 “medical organizations” analyzed

37% (14/38) 63% (24/38)

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.

SUMMARY

CADUCEUS’S ASSOCIATION TO MEDICINE DUE TO

1. Confusion of traditional Hermes with other Hermes

2. Lack of recognizingdifference between 2 serpentine objects

QUESTIONS??

Claude Lorrain. Asclepius reviving Hippolytus

BIBLIOGRAPHY1. The Golden Wand of Medicine. A history of the caduceus Symbol in Medicine. W.J. Friedlander. 1992

2. Asklepios: Ancient Hero of medical Caring. J.E Bailey. Annals of Internal Medicine 124 (2) 1996

3. 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