I was chatting with a friend (a non-physician) when he brought up the caduceus.
“What?" he asked, seeing the confusion on my face. "Don’t you know the symbol of your own profession?”
The question took me by surprise. I don't think I'd ever heard the word "caduceus" spoken aloud. (For the record, it's pronounced ka-DOO-shus.)
While lecturers had touched on the subject in medical school, I could no longer remember exactly what it represented. All I could recall was that it might have something to do with extracting Guinea worms from blisters by coiling them around a stick. But shouldn't such a ubiquitous symbol have more substance behind it?
So with Google as my guide, I undertook a crash course in caduceus history. It's a fascinating story rooted in timeless mythology. And weirdly enough, it includes a controversy that reflects modern-day tensions in healthcare.
The Caduceus of Hermes
"Caduceus" derives from the Greek word kērukeion meaning “herald’s staff.” In the ancient world, heralds were messengers who brought news that something was about to happen.
The caduceus symbol now used in medicine was first wielded by Hermes, messenger of the Greek gods. It's composed of a staff with two serpents twisted around it, topped with a round knob flanked by wings. (Hermes and his Roman equivalent Mercury are often depicted with winged shoes and helmets to underscore their celerity.)
Historically, Hermes and his caduceus didn't have much to do with medicine, health or healing. Instead, worshippers regarded him as a patron of merchants, commerce and negotiation. Being a herald, he's also the embodiment of expression, eloquence and delivery of information. This association later led to several printers adopting his caduceus as a symbol, most notably Johann Froben in Switzerland and John Churchill in England.
That being said, a few loose associations have been proposed between the caduceus of Hermes and medicine. For example, the symbol appears on some notable medical works of the Middle Ages, including those of Paracelcius, physician-philosopher and father of toxicology. However, it also appears in many non-medical texts issued by the same publisher (Froben). A more plausible explanation: the caduceus was the printer's symbol, not the author's.
So why did the commerical caduceus become the emblem of the decidedly non-commercial medical profession? Most likely, it was mistaken for a more fitting symbol, the serpant staff of Asclepius.
The Staff of Asclepius
Asclepius was the Greek god of medicine and healing. (His name comes from the word Asklepios, to be cut open.) Like Hermes, he's often depicted with a staff. The difference: his is coiled by a single snake and doesn't have wings on top.
Asclepius was the son of the sun god Apollo (also regarded as a healer). Asclepius was educated in medicine by a centaur. According to legend, he performed a good deed for a snake, which then shared certain secrets of healing with him. (The ancient Greeks believed snakes to be both wise and capable of self-resurrection, probably because they periodically shed their skin.)
As a physician, Asclepius became so effective that he single-handedly caused a population explosion. To restore the natural order, Zeus killed him with a thunderbolt.
Around 300 B.C., a cult of Asclepius worshippers sprung up. Its temples, known as Asclepions, were sanctuaries of healing that attracted many pilgrims. Priests of Asclepius used snakes in many of their rituals and treatments. When not in service, these snakes freely roamed the temple grounds, sharing the dorms and living quarters with the patients.
Physicians and attendants serving Asclepius were known as his theraputae (original meaning: servants of the god). Their membership included both Hippocrates and Galen.
Controversy in America
So which serpent staff triumphed as the symbol of medicine and why?
If you look at the world as a whole, you'll see both symbols, with the staff being more common. But in America, the caduceus predominates, and has for over 100 years.
Use of the caduceus in the United States can be traced back to many origins. In the late 19th century, the surgeon general chose it to adorn the seal of the U.S. Marine Hospital Service (later the U.S. Public Health Service). The exact reasons for this decision are unclear. However, the caduceus arguably complemented the bureau's origins in maritime commerce.
A few decades later in 1902, the U.S. Army Medical Department caused a kerfuffle by adopting the caduceus as its symbol. It's reasoning: the caduceus conveyed neutrality, underscoring the healer's position as a noncombatant. The department's physician officers, many of whom would have preferred something more overtly medical, argued against this change. The administration responded by pointing out that physicians made up a minority of department personnel. The caduceus was therefore more inclusive while still representing the spirit of the corps.
After the Army's adoption of the caduceus, the U.S. Navy Hospital Corps and American Medical Association followed suit. However, just a few years later, the AMA changed its emblem to the rod of Asclepius.
From a historical perspective, I think it's pretty clear that the staff of Asclepius is the true symbol of our profession. It's more than a little ironic that it's been usurped by the symbol of commerce — something the medical profession actively seeks entanglement with.
This divide appears to persist in modern usage. In the early 90s, physician and historian Walter Friedlander found that U.S. healthcare logos portrayed the caduceus much more frequently than the staff. What's more, commerical entities were more likely than professional ones to choose the caduceus as their symbol.
Lest I overstate my case, I don't believe any organization has adopted the caduceus out of malice or greed. (Friendlander's best guess was that this preference was more cosmetic than symbolic.)
That being said, isn't it strange that the only developed country that treats healthcare as a privilege (rather than a right) has replaced the symbol of healing with the symbol of commerce — however unintentionally?
At the end of the day, it's a fun history lesson mixed with a little food for thought. I think most of us in healthcare look forward to the day when we provide excellent care to all in need — no matter the symbol on the hospital door.
[Image credit: "Caduceus. Detail of Giuseppe Moretti's 1922 Bronze 'Hygeia' Memorial to World War Medical Personnel (Pittsburgh, PA)" by Jim Kuhn licensed under CC BY 2.0]