Comprehension of Emblems of Medicine Among Medical Students of Rawalpindi

Journal of Rawalpindi Medical College; 2019;23(S-1):7-11

Original Article Comprehension of Emblems of Medicine among Medical Students of Rawalpindi

Rija Kunwar1, Rumaisa Maryam1, Nadia Khalid1, Tehzeeb ul Hassan2, Bareera3 1 Students of 2nd year MBBS RMU 2 Head of Anatomy Department RMU 3 House Officer at RMU & Allied Hospitals

Abstract Awareness of the true origins and the symbolism of the emblems is lacking in the medical fraternity. Background: The Caduceus is the popular Keywords: Rod of Asclepius, Caduceus representation of medicine. However, major health organizations and regulatory bodies such as the WHO use a different symbol- the Rod of Asclepius Introduction in their logo. Two snakes twirling around a straight staff, the Materials and Methods: This cross-sectional Caduceus, is used to represent hospitals, prescriptions, study was undertaken in Rawalpindi Medical clinics, colleges, and also in medical journals. This College after approval from Institutional Review symbol is used either as an emblem or as part of their Forum. The study population consisted of equal logo.1 In Pakistan and elsewhere, this symbol is on the percentage of medical students from all the academic windshields of many doctors. It is also used as a trade years of Rawalpindi Medical College. mark of many pharmaceutical companies. This symbol The data was collected using the technique of is often mistakenly used as a emblem of medicine stratified random sampling. Stratification was done instead of the Rod of Asclepius which is just a single based on both gender and academic years of the serpent around a staff. The Caduceus is the symbol of study. A pre-tested semi-structured questionnaire commerce, theft and mischief.9 Its use in modern was administered to them. The data was analysed medicine dates back to late 19th and early 20th century using SPSS version 23. Information regarding the when someone in the US introduced this as a symbol symbols was assessed. For all categorical variables of Medical Corps due to its repeated mistaken use like gender, academic year, representation etc. elsewhere in the country.10-12,17. Being in vogue, other frequencies along with percentages were calculated. countries followed suite.1,2,3,4 The true medical symbol Results: Only 19.3% of students knew that is the Rod of Asclepius which is a single serpent Rod of Asclepius was the true symbol of medicine. entwined on a staff. The serpent is used to represent Most of the students (52%) thought that the health and rejuvenation.7 The serpent sheds off its old Caduceus was the true symbol of medicine. 23.3% skin in a process known as ecdysis or moulting; this is responded by stating that both were the emblems of reflected in the work of a physician who deals with life medicine while some (5.5%) students responded that and death, sickness and health and also signifies the none of them represented medicine. mechanism of pharmaceutical drugs which could Regarding Rod of Asclepius, only 38.39% of the either restore or torment the user depending upon students stated correctly that it represented medicine dosage.2,5 and healing, while majority of students (50.89%) stated that it represented danger and death followed by hospitals (6.25%) and commerce (4.46%). For the Caduceus, only (9.82%) knew that it represented commerce while the majority of students (61.6%) stated that it represented medicine and healing followed by danger and death (17.0%) and hospitals (11.6%). Conclusions: There is very little awareness about the rod of Asclepius and most institutions have adopted a logo based on the Caduceus.

7 Journal of Rawalpindi Medical College; 2019;23(S-1): 7-11

. In China, dried bodies of about 30 species of snakes consisted of equal percentage of medical students from are still using as Chinese medicines8.Asclepian snakes all the academic years of Rawalpindi Medical College. were non-venomous snakes that were used in healing The data was collected using the technique of stratified rituals.2,3 In Islamic14 and Biblical scriptures13,16, the random sampling. Stratification was done based on snake and the staff represent the miracle of Huzrat both gender and academic years of the study. The Musa A.S. (Moses) by which he tried to guide the participants were briefed about the nature of study, followers of pharaoh to the right path of life.5,16 consent was taken and a pre-tested semi-structured The staff with a single serpent represents the time questionnaire was administered to them. The when Asclepius had a very difficult patient, he information pertaining to the usage of medical logos consulted a snake for advice and the patient was was asked. Their representation and significance was cured. The snake had crawled onto Asclepius staff so assessed and lastly they were questioned about which that it could talk head to head with him as an equal symbol, they thought truly represented medicine. when talking.13,16 The data was analysed using SPSS version 23. The original Hippocratic oath used to start as,” I swear Information regarding the symbols was assessed. For by Apollo Physician and Asclepius and Hygieia and all categorical variables like gender, academic year, Panaceia and all the gods and goddesses, making them representation etc. frequencies along with percentages my witnesses, that I will fulfil according to my ability were calculated. and judgment this oath and this covenant”13 In 1990, a survey was done in the US and it was found Results that 62% of the professional associations used the Rod The response rate was 100% (400 out of 400). The of Asclepius while 37% used the Caduceus and 76% of subjects mean (SD) age was 20.93 (1.673). Students 7,18. commercial organizations used the Caduceus. In a were divided equally with 80 (20%) students from study published in 2014 in India, they found out only each year. 50% of the participants were males and 50 6% of health professionals knew about the correct use % females. 1 of these medical symbols Only 19.3% of students knew that Rod of Asclepius This confusion related to medical symbology has also was the true symbol of medicine. Most of the students been cited in various newspapers. The existing (52%) thought that the Caduceus was the true symbol literature regarding the correct use of medical symbols of medicine. 23.3% responded by stating that both is grossly deficient (Pakistan included). were the emblems of medicine while some (5.5%) Our study aims to assess the primary knowledge of students responded that none of them represented medical students of Rawalpindi Medical University medicine (cumulative percentage =100%). When asked regarding these two commonly used symbols about what these symbols are used to represent now The purpose of our study is not to belittle the choice of days, for the Rod of Asclepius only 38.39% of the Caduceus in our healthcare system but to reclaim a students were able to state correctly that it represented part of the rich heritage of the medical profession, medicine and healing, while majority of students regarding correct representation of the medical field. (50.89%) stated that it represented danger and death 6 WHO has been using the rod of Asclepius since 1948, followed by hospitals (6.25% )and commerce (4.46%). health organizations in most of the other countries like the American Medical Association (AMA)19 and others have corrected their logos ever since.18 By this study we will be able to see the perception of students regarding the symbols.

The objective of this study was to assess the primary knowledge of medical students of Rawalpindi Medical University regarding two main medical logos currently in practice in the global community.

Materials and Methods This cross-sectional study was undertaken in Rawalpindi Medical College after approval from Institutional Review Forum. The study population

Journal of Rawalpindi Medical College; 2019;23(S-1): 7-11

It was found that male students (10.25%) knew more about the correct logo of medicine i.e. Rod of Asclepius than the female students (9.00 %) as shown in the following graph.

Discussion In Pakistan, Government medical colleges are held in high esteem. Out of the 42 Government medical colleges 23 had emblems based on or a variation of the Caduceus, i.e they had two entwined serpents appearing in their logo, 9 had unique logos not featuring a serpent and not based either on the The students were further quizzed on the constituents caduceus or the rod of Asclepius, only 10 had a single of the logos. The serpent in the rod of Asclepius was entwined serpent in its emblem based on the rod of thought to represent poison and harm (43%) diseases Asclepius. (31.5%) regeneration (17.8%) and religious beliefs (7.8%), while in the caduceus the response was The purpose of this study is to correct the flawed regeneration (36.5%), diseases (26%), poison and harm assumption about the choice of Caduceus as a medical (23%) and religious beliefs (7.8%) by the students. emblem. Caduceus, the symbol of „commerce‟17 has It was seen that first year (4.00%), second year (4.00%) been used wrongly all along. The true symbol is the and third year (4.50%) knew more about correct “Rod of Asclepius” which represents “health and emblem i.e. the rod of Asclepius than the fourth year rejuvenation”7.The vital support of Rod of Asclepius is (3.00%) and final year (3.00%) students as shown in the its historic association for millennia with medicine, an following graph. approximate of 2400 years1.In contrast, Caduceus enjoys the inappropriate popularization because of its adoption by the U.S Army medical corps at the beginning of 20th century.17,18

This study was carried out at Rawalpindi Medical University, Rawalpindi with a response rate of 100%. This study showed that (19.3%) students had the knowledge about true symbol in contrast to (6%) in a study held in India1 and (52%) thought Caduceus was the true symbol. (23.3%) had notion that both were the true symbol. This is similar to another study in which prior knowledge about the symbols was assessed1.This study focused only on Caduceus and Rod of Asclepius

Journal of Rawalpindi Medical College; 2019;23(S-1): 7-11 in contrast to another study that also included the Red Acknowledgement: 1 Cross and the Rx symbols. The authors would like to thank the medical students for participating in this study, Dr Sana Tariq, Dr Faiza The study found that (38.39%) students stated Mujeeb and Dr Tehzeeb ul Hassan for their correctly that Rod of Asclepius represents “healing” unconditional help and Professor Dr Umar who and only (9.82%) that Caduceus represents provided such an encouraging research forum to the “commerce”. Majority (61%) chose Caduceus as a students. representative of medicine and healing” whereas (50.89%) considered Rod of Asclepius as a symbol of “danger and death”. References 1. Anil Shetty,Shraddha Shetty,Oliver Dsouza,Medical The serpent in the rod of Asclepius was thought to symbols in practice:Myths vs Reality. J Clin Diagn Res. 2014; 8:12-14 represent poison and harm (43%) diseases (31.5%) 2. Wikipedia contributors. Caduceus as a symbol of regeneration (17.8%)and religious beliefs (7.8%), while medicine. Wikipedia, The Free Encyclopedia. December in the caduceus the response was regeneration (36.5%), 23, 2017, 15:21 UTC. Available at: https://en.wikipedia.org/w/index.php?title=Caduceus diseases (26%), poison and harm (23%)and religious _as_a_symbol_of_medicine& oldid=816769507. beliefs (7.8%) by the students. Accessed January 3, 2018. 3. Despommier DD. People, Parasites, and Plowshares: The Staff in the rod of Asclepius was thought to Learning from Our Body's Most Terrifying Invaders. Columbia University Press; 2013 Jul 16. represent power (30.8%) Greek myths (25.5%) wisdom 4. Sulmasy DP. A balm for Gilead: meditations on (24.5%)and patient (19.3%), while in the caduceus the spirituality and the healing arts. Georgetown response was power (34.5%), wisdom (27.5%), Greek University Press; 2006 Sep 20. myths (23%)and patient (14.8%) by the students. 5. Wikipedia contributors. "Rod of Asclepius." Wikipedia, The Free Encyclopedia. Wikipedia, The Free It was seen that first year (4.00%), second year (4.00%) Encyclopedia, 22 Jan. 2018 and third year (4.50%) knew more about correct 6. © Copyright World Health Organization (WHO), 2018. emblem i.e. the rod of Asclepius than the fourth year All Rights Reserved. (3rd February 2018). Retrieved from (3.00%) and final year (3.00%) students. http://www.who.int/about/licensing/emblem/en/ 7. Friedlander WJ. The Golden Wand of Medicine: A It was found that male students (10.25%) knew more History of the Caduceus symbol in medicine. ABC-CLIO; about the correct logo of medicine i.e. Rod of 1992. 8. 8.Okuda J, Kiyokawa R. Snake as a symbol in medicine Asclepius than the female students (9.00%). and pharmacy-a historical study. Yakushigaku zasshi. 2000; 35(1):25-40. The intention of the study is not to disparage the 9. Shin YJ. A history of Korean Medical Association's emblem: the caduceus of Asklepios and Hermes. choice of Caduceus or to belittle its importance but to Uisahak. 2007; 16(1):21-35. set right the historical context and to reclaim a part of 10. Sacks AC, Michels R. Caduceus and Asclepius: History rich heritage of medicine, regarding the use of of an error. Am J Psychiatry. 2012; 169(5):464. Asclepius sign. 11. Wilcox RA, Whitham EM. The symbol of modern medicine: why one snake is more than two. Ann Intern Conclusion: Med. 2003; 138(8):673-7. There is very little awareness about the rod of 12. Ratzan RM. Knots. JAMA. 1981 May 1; 245(17):1730- 1. Asclepius and most institutions have adopted a logo 13. Edelstein The Hippocratic Oath: Text, Translation, and based on the Caduceus. Awareness of the true origins Interpretation, Baltimore, Johns Hopkins Press, 1994 and the symbolism of the emblems is lacking in the 14. Zatz A. Star of Life. Rescue-EMS Magazine, Jul./Aug. medical fraternity. Medical institutions using symbol 1992. 15. Peters FE. A reader on classical Islam. Princeton of commerce,the Caduceus, in their logo should University Press; 1993 Dec 27. replace it with true symbol of medicine,Rod of 16. Antoniou SA, Antoniou GA, Learney R, Granderath FA, Asclepius so as epitomize the true essence of medicine. Antoniou AI. The rod and the serpent: history’s ultimate healing symbol. World J Surg. 2011; 35(1):217-21. 17. Wilcox RA, Whitham EM. The symbol of modern medicine: why one snake is more than two. Ann Intern Med. 2003; 138(8):673-7. 18. Grainger B. A survey of symbols of medicine and veterinary medicine. Proceeeds of the 8th International Congress on Medical Librarianship; 8th International

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Congress on Medical Librarianship; July 2-5, 2000; Retrieved from London, UK. 2000. Jul 05, http://www.amednews.com/article/20050620/opinio 19. Copyright © 2005 American Medical Association. All n/306209958/4/ rights reserved. The symbol for a new AMA: Medicine for the 21st century [Internet]. [Cited June 20, 2005].