Walk Among Gods

Take a look at the letter I in the title of this magazine and you will notice that it is really a stylized version of the symbol of the physician the staff of Aesculapius. Walking into the University of Alberta hospital and gazing up at the wall, any passer-by will notice a sculpture of the same symbol, a tree-branch staff entwined by a single snake. Take a look in the hospital bookstore, or on television, or at the insignia of a multitude of medical organizations, though, and you will notice that the cadeuceus, a similar symbol which has wings and a second serpent, is also used to represent the profession of medicine.

Unfortunately, although both the staff of Aesculapius and the cadeuceus are in use, only one of them has a historical connection with the practice of medicine. The other is a symbol of certain qualities best left unassociated with the physician. A look into the origins of these icons shows that the true symbol of the physician is the staff of Aesculapius. The cadeuceus, with its wings and twin snakes, is an imposter which somehow managed to find a connection to medicine a connection which is unfounded and undesirable.

Although the specific origin of the cadeuceus is unknown, its beginnings can be traced back to Greek and Roman mythology. The cadeuceus began as the magical rod of the Greek messenger- god Hermes (or the Roman god, Mercury). More than a messenger, though, Hermes was a diplomat and an ambassador and was often believed to be a bringer of peace. In fact, the Romans used the cadeuceus as a symbol of peace, and described a myth in which Hermes (Mercury) threw his rod between two fighting snakes and stopped their battle, at which point they wrapped themselves around the wand. This ability to bring harmony out of hostility is one of the admirable traits of Hermes and it aided the god s reputation as a persuasive orator and bringer of good fortune.

Hermes, however, was also known as the deity of wealth and commerce, two areas which were recognized as involving a certain degree of dishonesty. In fact, many of Hermes deeds earned him a reputation as a crafty and promiscuous trickster and it was because of this that he was honored as the patron of thieves. The association of physicians with thievery through the adoption of Hermes cadeuceus as a medical symbol is undoubtedly undesirable and only those cynics who accuse physicians of an excessive interest in making money may find it appropriate. Unfortunately, there is one final significance of the cadeuceus that should appeal to no one and is horrifying when connected to the medical profession, for it was the duty of Hermes, cadeuceus in hand, to lead the souls of the dead to the underworld.

Ironically, despite the inappropriateness of his symbol in medicine, Hermes did play a small role in the origin of the true symbol of the physician. According to Greek myth, Apollo, the god of health, had a love affair with the mortal woman Coronis. Some time later he found out that she had been unfaithful and he had her slain with arrows only to discover that she was pregnant with his child. As Coronis lay on her funeral pyre, Hermes played the obstetrician (virtually his only medical act) and delivered the infant Aesculapius from her womb. The newborn demigod Aesculapius was then taken and trained by the Chirion, the healing-wise centaur. It is Aesculapius who then became the god of medicine and it is his staff which properly represents the physician.

Aesculapius staff is a rough hewn cypress branch entwined by a single snake, two elements common to his native home in the Greek isles. The thick staff of cypress represents strength and solidity perhaps in reference to the god or to the unwaivering ethic of the physician. The snake is a symbol of many things but probably embodied Aesculapius religious connection to the depths of the earth and symbolized his wisdom a wisdom which involved both extensive knowledge and prudent action.

Despite the mythical story of his birth, Aesculapius was mentioned in the writings of Homer as a mortal physician-hero who performed miraculous acts of healing on the battlefield. Later, although the application and selection process was not clearly defined, Aesculapius was awarded a divine rank as the god of medicine. His decendants and other followers of his teachings worshipped their new god and formed the cult of Asklepios. The cult spread throughout the Mediterranean and by the fourth century B.C., over three hundred Aesculapian temples served as medical centres equally devoted to healing as to the worship of their god. Hippocrates himself, the embodiment of the ideal physician, was educated as a member of the 20th generation of the cult of Aesculapius.

Despite the apparent clarity around the distinct origins and meaning of the cadeuceus and the staff of Aesculapius, they are both used commonly, and often interchangeably, every day. Just where this practice of ignorance and confusion began can be traced to two main sources. The first of these came in the 1500 s when printers began to use the cadeuceus as their insignia because they felt it symbolized their role as messengers and businessmen. That in itself was not a problem until several publishers of medical texts began prominently displaying the cadeuceus on the books given to students and doctors. Suddenly the distinction between a staff with a single snake and one with an extra serpent and wings was blurred.

This may have contributed to the second major faux pas in the history of medical symbolism. In 1902, a captain in the U.S. Army recommended that the Medical Corps adopt the cadeuceus as their insignia, partly because he felt it was more graceful and medically significant than the cross they had been using. Despite the attractive symmetry of the cadeuceus though, it is just not a symbol that should be, or ever historically was, associated with the practice of medicine.

It is disappointing that the ancient discipline of medicine, which values knowledge so highly, has failed to maintain the integrity of its one true symbol. Yet perhaps it does not matter that both the cadeuceus and the Aesculapian staff are both recognized as symbols of medicine, as long as people associate the symbols with the qualities that a physician should embody, rather than with the qualities of ancient Greek gods. However, even if it is our actions as physicians which defines the image of our profession, knowing and using the correct traditional symbol can only do good.