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The White Coat by Always Acting in the New Media Editor Best Interest of Our Patients

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The White Coat by Always Acting in the New Media Editor Best Interest of Our Patients EDITOR’S NOTE Of White Coats and Stethoscopes Mark D. Hiatt Editor A WHITE COAT.THE COUNTRY DOCTOR’S BLACK BAG.ASTETHOSCOPE. Jonathan H. Lin Columbia University A snake-entwined staff. The oath of Hippocrates. The clinical acumen College of Physicians and Surgeons of Osler and the compassionate service of Schweitzer. These are the sym- Deputy Editor bols and personifications of our chosen profession. Li-Yu Huang, MHS Texas A&M University One symbol of medicine since antiquity has been the Aesculapian Health Science Center 1 College of Medicine staff. A glance through this journal will uncover the staff in the Senior Editors American Medical Association’s emblem, depicting a snake coiled Scott Gottlieb around the rough, knotty staff of the Greek physician Aesculapius. In Mount Sinai School of Medicine of the City University of New York this issue of MSJAMA, Nathan W. Williams explores the connection Sue Sun Yom, MA ON THE COVER between snakes and the art of healing across cultures; Judith Anne University of Pennsylvania School of Medicine Rounding Stanton introduces us to Aesculapius. Williams reveals that the ser- (construction paper pent can represent the forces of both healing and destruction. Stanton Associate Editors and colored tissue Michael J. Brenner demonstrates that society’s alternating praise and distrust of the medi- Northwestern University paper) by Daphne Medical School Cook, Case Western cal profession have been present throughout time and suggests that Mark D. Hiatt Reserve University. such ambivalence will continue. Wake Forest University School of Medicine Valerie A. Jones turns her attention to another Greek healer, Hip- Alison J. Huang, MPhil pocrates, who bestowed on modern medicine a legacy of ethical thought University of California San Francisco School of Medicine embodied in his famous oath. This pledge has become part of a new cer- Stefan C. Weiss emony that Jones describes in her discussion of a second inherited sym- Duke University School of Medicine bol of the profession—the physician’s white coat. Art Editor Timothy Lahey, MD, argues that we must preserve the purity of the Patricia Wong Stanford University School of Medicine meaning behind such symbols as the white coat by always acting in the New Media Editor best interest of our patients. Bryan K. Chan Stanford University School of Medicine By exploring the symbols that form and influence the culture of med- MSJAMA Staff icine, we hope to come closer to the heart of what it means to be a physician. Charlene Breedlove Managing Editor REFERENCE Juliana M. Walker Assistant Editor 1. Rakel RE. One snake or two? JAMA. 1985;253:2369. AMA-MSS Governing Council Subashini Daniel, Chairperson Gregory Johnson, Vice Chairperson 1999 Frank Netter Arts Contest for Medical Students Peter Watson, Delegate Peter Hazelton, JD, Alternate Delegate MSJAMA and Novartis Pharmaceuticals are pleased to announce an art Heather Linebarger, At-Large Officer competition for current medical students. Art in any media may be submit- Sanjay Saxena, Speaker ted. We welcome your best paintings, etchings, pencilworks, collages, Eric Shaw, Vice Speaker sculptures, and photographs. Send artwork as slides; photographs as large Jeffrey Towson, Student Trustee glossy prints; computer graphics on diskette in gif or jpg formats along Michael Bigelow, MD, PhD, with a printout. Entries must be clearly labeled with the artist’s identifica- Past Chairperson tion (name, e-mail and mailing addresses, telephone and fax numbers, MSJAMA is prepared by the MSJAMA editors medical school), title of the piece, media used, and the date of completion. and MSJAMA staff and is published monthly Entries will be returned if requested. Entries must not have been previously from September through May. It provides a forum for the news, ideas, and opinions that published in print or electronic format and must not have been submitted affect medical students and showcases student elsewhere during the review period. Winners will be selected based on writing, research, and artwork. The articles and composition and artistic quality and will be considered for publication on viewpoints in MSJAMA are not necessarily the policy of the AMA or JAMA. All submissions the MSJAMA cover. Novartis will award prizes of cash, Netter atlases, and must be the original unpublished work of interactive media for selected artworks. the author. Submitted work is subject to review and editing. Entries must be postmarked by May 24 and sent to: Address submissions and inquiries to: Frank Netter Arts Contest MSJAMA, Jonathan H. Lin, Editor, 630 W 168th St, Box 673, New York, NY c/o Patricia Wong, MSJAMA Art Editor 10032; phone (212) 568-1084; Escondido Village, Apt 2B e-mail: [email protected] Stanford, CA 94305 www.ama-assn.org/msjama Additional inquiries may be directed to Patricia Wong at (650) 497-1576. 474 JAMA, February 3, 1999—Vol 281, No. 5 ©1999 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 ESSAY Serpents, Staffs, and the Emblems of Medicine Nathan W. Williams, University of Colorado Health Sciences Center FOR MUCH OF RECORDED HISTORY, SERPENTS AND SERPENT- who was believed to deliver people from their difficulties, is staffs have been associated with the healing arts.1-4 One mod- often depicted with a snake.1 ern emblem of medicine, for example, is the single-serpented When twined around a staff, the serpent stands as a clearer staff of Aesculapius, the Greek god of healing. Although such symbol of the healing art. Staffs represent sacred trees. In Near serpentine symbolism is quite prevalent, many consider the Eastern cultures, these trees were viewed as a type of the cos- connection between serpents and medicine obscure. One in- mic axis connecting this world with the underworld and the terpretation is that just as the serpent represents the forces of heavens. The image of Trees of Life, central to ancient cre- life and death as a messenger between the earth’s surface and ation accounts, permeates modern culture. Spires and steeples the netherworld, the physician stands as an intermediary in are cultural remnants of this archetype. Mystical powers as the struggle between healing and destruction.1,2,5 well as practical applications were attributed to such staffs.3,5 Worshipped and feared in countless cultures, the serpent Aesculapius’ knotty staff, for example, assisted the god in his is a central figure in various accounts of the creation. The an- wanderings to serve humankind. It also served as a walking cient Mesopotamians portrayed their goddess staff for a priest or a crutch for the ailing.1 In Ishtar, the source of all life, as a snake. In Ori- To these ancient its support for those in search of healing, the ental, Hebrew, and Greek cultures, the ser- cultures, the Aesculapian staff differs from other deriva- pent was sometimes known as “the mother of serpent was a tives of sacred trees, including the mace, wand, all.” Some Hebrew scholars even believe the and scepter, that command subservience.4 name Eve to be derived from the word for ser- source of endless Strangely, in contrast to its beneficent as- pent. Similarly, the ancient Chinese depicted mediation on sociations, the snake has also represented de- our first parents with human upper bodies and the mystery of struction and death. Several ancient accounts entwined serpentine lower bodies.1 To these life and creation. portray the serpent as the enemy of life.1-3 The ancient cultures, the serpent was a source of serpent’s dual nature represented the struggle endless meditation on the mystery of life and creation. between life and death as well as the potential for resurrec- Not only did the serpent have the power to create life: it tion and immortality.1,2 As a creature that could travel be- also had the power to preserve life. The snake’s unique abil- tween the surface and the subterranean worlds with an un- ity to shed its old skin represents a triumph of self-renewal canny undulating motion, the serpent assumed the role as over aging. This metaphor is conveyed in a legend shared by messenger between this world and the underworld.1,2 several cultures, which states that God intended to tell hu- As symbols of life and death, serpents and their associated mans to cast off their old skins as they aged and to become staffs represent both the aspirations and dangers of medical young again, but the message was instead delivered to the ser- practice. When pursued with wisdom and beneficence, medi- pent.1,6 According to the Sumerian account, a serpent shed cine is often able to heal the ailing. However, the dark forces its skin after swallowing the “herb of new life” it had stolen of chaos and sickness may still triumph. Our modern serpen- from Gilgamesh.2 Similarly, blood from the right side of a ser- tine symbols, vestiges of ancient thought and culture, inform pentine monster, the Gorgon, gave Aesculapius the power of us that this struggle continues. resurrection, while blood from her left side was poison. With its seeming power over death, the serpent became a REFERENCES symbol of deliverance. Moses raised a bronze serpent on a staff 1. Russel FE. Snake Venom Poisoning. Philadelphia, Pa: JB Lippincott Co; 1980. upon which the afflicted might look and be healed (Numbers 2. Bunn JT. Origin of the caduceus motif. JAMA. 1967;202:615-619. 21:6-9). The blind Roman emperor Theodosius regained his 3. Metzer WS. The caduceus and the Aesculapian staff: ancient eastern origins, evolution, and western parallels. South Med J. 1989;82:743-748. sight when a serpent placed a stone on his eyes. Aesculapius 4. Geelhoed GW. The caduceus as a medical emblem: heritage or heresy? South assumed the form of a serpent to deliver a city from plague, Med J.
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