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Home , Aglaea, Asclepius, Caduceus, Coronis (mythology), Iaso, Panacea

aduceus C the staff of or Eric Vanderhooft, M.D.

The author (AΩA, University of Utah, 1988) is clinical assistant professor in the Department of Orthopedics at the University of Utah, and in private practice at the Salt Lake Orthopedic Clinic. He is also the clinical director of the University Orthopedic Rotation and Family Practice Residency Orthopedic Rotation at HCA St. Mark’s Hospital.

he staff entwined by a or serpents is ac- cepted as a common symbol of the medical pro- fession and health care industry. Unfortunately, twoT distinct images exist. The staff with a single be- longed to Asclepius, father of western . The staff with two entwined belonged to Hermes, the prince of thieves, and is more commonly seen. A review of 527 professional medical academies, asso- ciations, colleges, and societies revealed that 23 organiza- tions use the staff in their symbolism. The staff of Asclepius outnumbered that of Hermes nearly three-fold, 92 versus 3 organizations respectively.

Introduction has come to be considered the father of Western medicine, and, in the , a modification of the continues to be recited by graduat- ing medical students. It should therefore be no surprise that

Roman statue of Asclepius. © Mimmo Jodice/CORBIS.

The Pharos/Autumn 2004 our symbol for medicine, the , similarly is derived from Greek traditions. Greek healers such as Hippocrates be- lieved they were descended from Asclepius, the mythic phy- sician, and came to be known as Asklepiadai or Asclepiads, “sons of Asclepius.”1p6 Represented variously by the snake, cock, dog, and goat,1p28–32, 2, 3p258 the staff entwined by a single snake is the most recognized symbol of Asclepius. The staff of Asclepius was part of the crest of the U.S. Surgeon General’s office in the early nineteenth century, but it was replaced in 87 by the caduceus, the staff of Hermes, per- haps partly because of an aesthetic preference for the latter’s symmetry.4 Today both symbols are used by various medical organizations and are referred to as the caduceus. Mark P.O. Morford and Robert J. Lenardon state in Classical Mythology:

In the herald’s staff was known as the caduceum, derived from the Greek word keryx or herald, and his staff the kerykeion. Hermes, as divine messenger, was invariably depicted with the caduceus, which was represented as a staff with white ribbons or intertwined snakes. The white ribbons may have indicated the inviolability of his office. The image of intertwined snakes may have been drawn from the near eastern use of copulating snakes as a symbol of fertility, for Hermes was a fertility god. The staff of Hermes became con- fused with the staff of Asclepius because some stories about Asclepius involved snakes and the reptile has the ability to slough its old skin and seemingly be “reborn,” and so had felt sorrow for his unborn son and snatched the child associations with healing.5 Asclepius from his mother’s corpse, saving him from death. Apollo then handed Asclepius to the who While the modern practitioner associates fertility with the became his tutor and mentor.6 practice of medicine (through both childbirth and impotency), for the ancient Greeks, pregnancy was part of the natural order Son of (a Titan, also the father of ), Chiron and not treated as a medical condition. Carl Kerényi writes, was a wise physician whose pupils included Hercules, , “Women in labor were excluded from the sacred precinct and , as well as Asclepius.7p38–39 After receiving an incur- [Asclepieion, or sanitarium], for pregnancy is not an ailment able wound, Chiron gave his to and that calls for cure.”1p31 Thus, although Hermes and his staff died. Zeus turned Chiron into the constellation Sagittarius. have no relationship to the healing arts, his caduceus appears Through Chiron, Asclepius acquired the knowledge of sur- to have become more prominent than the staff of Asclepius in gery, the art of healing, and the use of drugs, love , representing the profession. and incantations. Ultimately, Asclepius was able to restore the dead to life through a magic made from the blood of Asclepius the , a gift from .* Leadbetter notes, In , Asclepius (meaning “cut up” or “turn round and round”—also Aesculapius, Aesclepius, or Asklepios) was a famous physician and son of Apollo, the sun god (as well * Ironically, it was Athena who created the , three sisters turned into hideous immortal beasts. The youngest of the three maid- as a god of prophecy, music, poetry, and healing, representing ens, , aroused the anger of the by courting reason and intellect). Asclepius’s mother , a princess in a temple consecrated to Athena. As punishment, Medusa was of , died when he was an infant, or, according to one transformed into a hideous creature with scales, bulging red eyes, related by Ron Leadbetter, was murdered. brazen wings and hands, and hissing snakes for hair. Anyone looking upon her face was immediately turned into stone. Her sisters, and , protested this punishment and were similarly changed. Coronis was unfaithful to Apollo, and , Apollo’s Using winged shoes and a sword provided by Hermes, the Greek twin sister, killed her for her unfaithfulness. Coronis was was able to decapitate Medusa by gazing at her reflection in a placed upon a funeral pyre. . . . As her body started to burn, bronze shield provided by Athena.7pp81, 132

The Pharos/Autumn 2004 23 Caduceus, the staff of Asclepius or Hermes

Legend tells that the blood of the Gorgon has a different Healing was a miracle brought about through the nightly di- effect depending from which side the blood was taken. If vine dreams of the sick, interpreted by the physicians. taken from the right side of the Gorgon, it has a miraculous There were many centers and schools of medicine, with tem- effect and is said to be able to bring the dead back to life, but ples built to Asclepius from Trikkis in Thessaly to the island of taken from the left side it is a deadly poison.6 Cos. Hippocrates plied his on the island of Cos. Following a plague from 295 to 293 B.C., the worship of Asclepius spread to . In adopting the cult of Asclepius, the Romans changed This power of ultimately resulted in his name to the Latin Aesculapius. Kerényi tells us, “It was only Asclepius’s own death. became alarmed at a mere in the days of Roman emperors, when healing lost its meaning mortal helping men evade death and complained to Zeus. In a as a divine event and Epidauros had become more of a climatic differing account, Asclepius offended Zeus by receiving pay- resort . . . that halls for expectant mothers and the dying were ment to bring Hippolytus back to life. The goddess Artemis built outside the sanctuary.”1p31 implored Asclepius to resurrect Hippolytus, a favorite of hers. Asclepius had five daughters: , , , Hygeia, In the eyes of Zeus, Asclepius’s action upset the natural order and . Hygeia (“Health”) and Panacea (“Cure-all”) were of the universe,3p251 and “with one swift action, the great Zeus both healers and their names are now embedded in medical sent down a killing both men.”6 jargon. Although angry at Asclepius’s in raising the dead, Asclepius is recognized as an “excellent physician” in Zeus still recognized the good Asclepius had brought to man- ’s , through his sons, the heroes and kind, and placed Asclepius among the stars, transforming him .8p95 But in this reference he is not divine, merely into the constellation (the serpent-bearer). another warrior king. The cult of Asclepius became very popular during the 300s B.C. Cult centers (known as an Asclepieion) were used Hermes by priests to cure the sick. Invalids also came to the shrines Like Apollo, Hermes ( to the Romans) was one of of Asclepius to find healing. The process of healing was the . He delivered messages for the gods and known as incubation. Physicians did not administer medicine. was also the god of travelers, roads, orators, commerce, and Nonpoisonous snakes were left in the dormitory where the thieves. The antics that led to his possession of the caduceus sick slept overnight on bare ground. During the night, patients are recounted in Homer’s Hymn to Hermes.5, 9 were supposedly visited by the god in a dream. Priests inter- preted the dreams and recommended remedies, or gave advice According to legend, Hermes was born in a cave on on how the patients could be cured with massage, or perhaps Mount in Arcadia. Zeus had impregnated at visits to the baths and gymnasiums. The snake endures to this the dead of night while all other gods slept. When dawn day as a symbol of the modern medical profession. broke amazingly he was born. Maia wrapped him in swad- Asclepius was worshipped throughout the Greek world, dling bands, then resting herself, fell fast asleep. Hermes, but his most famous sanctuary was located in in however, squirmed free and ran off to Thessaly. This is the northeastern . Kerényi tells us that, while where Apollo, his brother, grazed his cattle. Hermes stole a recognizing Asclepius’s Thessalian heritage, the Epidaurian number of the herd and drove them back to Greece. He hid gives a different account of his birth. them in a small grotto near to the city of Pylos and covered their tracks. Before returning to the cave he caught a tor- , a warlike king from Thessaly, and his daughter toise, killed it and removed its entrails. Using the intestines [Coronis], Apollo’s beloved, come to Epidauros when she is from a cow stolen from Apollo and the hollow tortoise shell, near childbirth. Here she abandons the child Asklepios on a he made the first . When he reached the cave he wrapped mountain, then known as the Mount of Myrtles, later on the himself back into the swaddling bands. When Apollo real- Mountain of the Teats. There the shepherd Aresthanas finds ized he had been robbed he protested to Maia that it had the child lying between a goat and a dog; the goat suckles the been Hermes who had taken his cattle. Maia looked to child and the dog guards him, all in a light so dazzling that Hermes and said it could not be, as he is still wrapped in the shepherd has to turn away as from a divine epiphany. At swaddling bands. Zeus the all powerful intervened saying the same moment a voice is heard, proclaiming over land he had been watching and Hermes should return the cattle and sea that the newborn babe will discover every cure for to Apollo. As the argument went on, Hermes began to play the sick and awaken the dead.1pp27–28 his lyre. The sweet music enchanted Apollo, and he offered Hermes to keep the cattle in exchange for the lyre. Apollo According to the poet Isyllos, the temple at Epidauros later became the grand master of the instrument, and it also marked the birthplace of Asclepius; except for this divine became one of his symbols. Later while Hermes watched birth, neither real birth nor death was allowed at Epidauros. over his herd he invented the pipes known as a syrinx

The Pharos/Autumn 2004 Medical symbolism The caduceus appears on letterhead, ambulances, and even soap dispensers, and, in both of its incarnations, has been adopted in our society as the symbol of medicine and health. Hermes’s staff seems to outnumber Asclepius’s; disconcerting considering that Hermes is the prince of thieves. The symbols of 646 professional medical academies, as- sociations, colleges, and societies were reviewed. Excluded were medical supply houses, ambulances, related groups, and other allied health care organizations. The sym- bols for 9 organizations of the 646 could not be found, leav- ing 527 organizations. Four hundred four organizations use unique symbols, such as the heart for cardiology and the tree of Andry for orthopedics, and do not use the caduceus. Of the remaining 23 organizations, 92 use the staff of Asclepius, including the American Medical Association, and 3 the staff of Hermes. Conversely, casual observation reveals that almost all health related products (e.g., antibacterial soaps, braces) use the staff of Hermes. Symbols may be simple accoutrements or may imply a deeper meaning reflecting a principle, philosophy, or concept difficult to verbalize succinctly. Hans Reichenbach, speaking of Bertrand Russell, writes, “Russell showed that the integers, the numbers , 2, 3, and so forth, can be defined in terms of the fundamental concepts of logic alone. It is obvious that such a proof could never have been given without the help of a symbolic notation; word language is too involved to express logical relations of this degree of complexity.”10pp221–22 Does the caduceus itself represent more than “word language” can express or is it a mere ornament selected because of aesthet- ics? Alfred North Whitehead notes,

The slightest survey of different epochs of civiliza- (-pipes), which he made from reeds. Hermes was also tion discloses great differences in their attitude towards credited with inventing the flute. Apollo also desired this in- symbolism. For example, during the medieval period in strument, so Hermes bartered with Apollo and received his Europe symbolism seemed to dominate men’s imaginations. golden which Hermes later used as his heralds staff. Architecture was symbolical, ceremonial was symbolic, (In other versions Zeus gave Hermes his heralds staff.)6 heraldry was symbolical. With the Reformation a reaction set in. Men tried to dispense with symbols as “fond things, The caduceus possessed magical powers over dreams, wak- vainly invented,” and concentrated on their direct apprehen- ing, and sleep. Placing it gently upon the eyes of the deceased, sion of the ultimate facts. Hermes accompanied the souls of the dead to the Underworld. But such symbolism is on the fringe of life. It has an un- The caduceus is believed to have derived from Babylonia and essential element in its constitution. The very fact that it can Mesopotamia where it was used as a symbol of fertility, the be acquired in one epoch and discarded in another epoch sun god, and wisdom; it was used in Greco-Roman times as testifies to its superficial nature. a symbol of peace. The imagery of a staff thrust between two There are deeper types of symbolism, in a sense artificial, fighting serpents to bring about peace gave rise to the use of and yet such that we could not get on without them.11p1 this symbol in ambassadorial positions. The Romans used the caduceus as a mark of neutrality, truce, or noncombatant Two millennia after Asclepius and Hippocrates, the medi- status in times of war; it was not associated in ancient times cal profession continues to use the caduceus as its symbol. with medicine, despite its association with death and the un- This western symbol has even been adopted by Chinese, derworld, neutrality, or fertility. Korean, and Japanese medical societies. Obviously, the

The Pharos/Autumn 2004 25 Caduceus, the staff of Asclepius or Hermes

caduceus portrays more than mere heraldry. For the serious New York: Oxford University Press; 200. www.classicalmythology.org. practitioner, it would be appropriate to reestablish the staff of 6. Encyclopedia Mythica. www.pantheon.org. Asclepius as the symbol of the health care profession. 7. Evslin B. Gods, Demigods and Demons: An Encyclopedia of Greek Mythology. New York: Scholastic Books; 975. Acknowledgement 8. Homer. The Iliad. Lattimore R, translator. Chicago: Univer- I thank G. F. Vanderhooft, M.D., for help in developing this sity of Chicago Press; 95. thesis. 9. Grant M, Hazel J. Who’s Who in Classical Mythology. Lon- don: Routledge; 994. References 0. Reichenbach H. The Rise of Scientific Philosophy. Berkeley . Kerényi C. Asklepios: Archetypal Image of the Physician’s (CA): University of California Press; 95. Existence. London: Thames and Hudson; 959. . Whitehead AN. Symbolism: Its Meaning and Effect. New 2. Carstiglioni A. A . Second edition. York: MacMillan; 927. Krumbhaar EB, translator. New York: Alfred A. Knopf; 958. 3. Jayne WA. The Healing Gods of Ancient Civilizations. New The author’s address is: Hyde Park (NY): University Books. Salt Lake Orthopedic Clinic 4. 998 Grolier Multimedia Encyclopedia. Grolier Interactive; 1160 East 3900 South, Suite 5000 998. Salt Lake City, Utah 84124 5. Morford M, Lenardon RJ. Classical Mythology. Sixth edition. E-mail: [email protected]

Palliative Bypass

Nothing for me to do, I remind myself. Wrath, wildly scattered About your abdomen, Stumbling, I run past your room. There are no tests to order. No incisions to make. No drains to place. My only calling, Is to sit by you. Yet, I bypassed you. Embracing routine, Procedures melt into each other. But I cannot find solace. With scalpel and suture useless Against time and space, I seek to find you. Time heavy as lead, Weighs on your pale face. Lightly, I sit by you, Dr. Khanna (AΩA, University of Rochester, 2002) is a resident in general at the University of Rochester School of Medicine. Waiting, as eternity whispers His address is: University of Rochester School of Medicine and Truth, peacefully, Dentistry, Department of Surgery, Box SURG, 60 Elmwood As you pass me by. Avenue, Rochester, New York 4630. E-mail: amit_khanna@urm c.rochester.edu. Amit Khanna, M.D., M.P.H.

The Pharos/Autumn 2004