Caduceus as a symbol of medicine
Encyclopedia
The caduceus
Caduceus
The caduceus is the staff carried by Hermes in Greek mythology. The same staff was also borne by heralds in general, for example by Iris, the messenger of Hera. It is a short staff entwined by two serpents, sometimes surmounted by wings...

, the traditional symbol of Hermes
Hermes
Hermes is the great messenger of the gods in Greek mythology and a guide to the Underworld. Hermes was born on Mount Kyllini in Arcadia. An Olympian god, he is also the patron of boundaries and of the travelers who cross them, of shepherds and cowherds, of the cunning of thieves, of orators and...

 featuring two snakes around an often winged staff, is often mistakenly used as a symbol of medicine, especially in the United States of America. The two-snake caduceus design has ancient and consistent associations with commerce, eloquence, trickery and negotiation. Association of the caduceus with medicine can be traced to the Renaissance, where it was often associated with alchemy
Alchemy
Alchemy is an influential philosophical tradition whose early practitioners’ claims to profound powers were known from antiquity. The defining objectives of alchemy are varied; these include the creation of the fabled philosopher's stone possessing powers including the capability of turning base...

 and wisdom.

The modern use of the caduceus as a symbol of medicine became established in the United States in the late 19th and early 20th century as a result of documented mistakes, misunderstandings and confusion.

Early use in a possible medical context

While there is ample historical evidence of the use of the caduceus or herald's staff to represent Hermes
Hermes
Hermes is the great messenger of the gods in Greek mythology and a guide to the Underworld. Hermes was born on Mount Kyllini in Arcadia. An Olympian god, he is also the patron of boundaries and of the travelers who cross them, of shepherds and cowherds, of the cunning of thieves, of orators and...

 or Mercury
Mercury (mythology)
Mercury was a messenger who wore winged sandals, and a god of trade, the son of Maia Maiestas and Jupiter in Roman mythology. His name is related to the Latin word merx , mercari , and merces...

 (and by extension commerce and negotiation), early evidence of any symbolic association between the caduceus and medicine or medical practice is scarce and ambiguous.

The Guildhall
Guildhall, London
The Guildhall is a building in the City of London, off Gresham and Basinghall streets, in the wards of Bassishaw and Cheap. It has been used as a town hall for several hundred years, and is still the ceremonial and administrative centre of the City of London and its Corporation...

 Museum in London holds a 3rd Century oculist's (an archaic term for a specialist eye physician or ophthalmologist) seal with caduceus symbols both top and bottom. The seal was apparently used to mark preparations of eye medicine. It is believed likely that rather than being evidence of a medical association per se, this is rather an allusion to the words of the Greek poet Homer
Homer
In the Western classical tradition Homer , is the author of the Iliad and the Odyssey, and is revered as the greatest ancient Greek epic poet. These epics lie at the beginning of the Western canon of literature, and have had an enormous influence on the history of literature.When he lived is...

 who described the caduceus as "possessing the ability to charm the eyes of men", which of course relates to the business of an oculist.

Friedlander proposed that early association of the caduceus with medicine might have derived from the association of Hermes Trismegistus ("Thrice-Great Hermes") with early chemistry and medicine as aspects of alchemy as an esoteric practice. He notes however, that "although these various factors may link Hermes/Mercury, along with his caduceus, with alchemical medicine, they may just as well link all the other non-medical aspects of alchemy with Hermes/Mercury and the caduceus."

Beginning with the 16th century there is limited evidence of the use of the caduceus in what is arguably a medical context. However, this evidence is also ambiguous. In some cases it is clear that the caduceus symbolized wisdom, without any specific medical connotations.

The caduceus appears in a general medical context in the printer's vignette
Vignette (graphic design)
Vignettes, in graphic design, are decorative designs usually in books, used both to separate sections or chapters and to decorate borders.In Descriptive, or Analytical Bibliography for the hand-press period a vignette refers to an engraved design printed using a copper-plate press, on a page that...

 used by the Swiss medical printer Johann Frobenius (1460–1527), who depicted the staff entwined with serpents and surmounted by a dove, with a biblical epigraph in Greek, "Be ye therefore wise as serpents and harmless as doves" (Matthew 10:16, here in the KJV translation), in keeping with the connotations of the caduceus as a symbol of messengers and publishers based on the association of Hermes or Mercury with eloquence and negotiation. Friedlander observed that Frobenius could hardly be considered a medical printer, as had previously been asserted, noting that a review of 257 of the works bearing this printer's imprimatur only one was related to medicine. Similar use of the caduceus in printers marks continues to the present day, with companies including F. A. Davis Company
F. A. Davis Company
F.A. Davis Company is a publishing firm headquartered in Philadelphia, Pennsylvania, founded by F. A. Davis . Davis publishes mostly textbooks and reference books for the medical, nursing, and health-related professions fields.-History:Frank Allston Davis was an American businessman and...

 still using the symbol as an element of their imprimatur.

There are a few other examples of use in this period. It may have been used as a symbol by Sir William Butts, physician to Henry VIII. Similarly, physician John Caius
John Caius
John Caius , also known as Johannes Caius, was an English physician, and second founder of the present Gonville and Caius College, Cambridge.-Early years:...

, founder of Caius College, Cambridge, and at the time President of the Royal College of Physicians
Royal College of Physicians
The Royal College of Physicians of London was founded in 1518 as the College of Physicians by royal charter of King Henry VIII in 1518 - the first medical institution in England to receive a royal charter...

, during official visits to his eponymous college, had carried before him a silver caduceus on a cushion, and later presented this artefact to the college, where it remains in the College's possession. This use was adduced by the medical historian (and primary apologist for the use of the caduceus in a medical context) Fielding Garrison to support his argument that the caduceus was used as a symbol of medicine as far back as the 16th Century. However, as Friedlander noted, "what Caius used was a non-specific herald's wand, rather than the caduceus of Hermes." In support of this assertion he quotes Caius's own words on why he chose a herald's wand as a symbol, making it clear that he chose it as a symbol of prudence. This same passage was also earlier referenced by Engle in refuting Garrison's claim. Engle and Friedlander are not the only ones to have noted that the use of the Caduceus by Caius had nothing to do with supposed medical symbolism; as indicated in a publication produced by the Royal College of Physicians itself: "[…] by introducing the caduceus into the ceremony of the College of Physicians, Caius unintentionally added to the confusion between the two emblems for later times, when few people understand the visual signs with which he was so familiar."

In support of the idea that the caduceus had a long-standing association with medicine, Garrison also mentioned the fact that the English medical printer Churchill used the symbol as an imprimatur, beginning some time around 1844. Friedlander has examined this subject in detail, and shows that Churchill was well aware that the rod of Asclepius was the accepted symbol of medicine. He is, it seems, inclined to think that the adoption of the caduceus in this context probably had something to do with the relation between publishing and the role of Mercury as a messenger and scribe. He notes, however
In any case, in Great Britain, as late as 1854, the distinction between the rod of Asclepius and the caduceus as symbols of two very different professions was apparently still quite clear. In his article On Tradesmen's Signs of London A.H. Burkitt notes that among the very old symbols still used in London at that time, which were based on associations between pagan gods and professions, "we find Mercury, or his caduceus, appropriate in trade, as indicating expedition. Esculapius, his Serpent and staff, or his cock, for professors of the healing art"

Adoption by the US military

Widespread confusion regarding the supposed medical significance of the caduceus appears to have arisen as a result of events in the United States that occurred roughly in the second half of the 19th Century. As pointed out by Garrison, the Caduceus had appeared on the chevrons of Army hospital stewards as early as 1856 (William K. Emerson indicates the insignia was adopted earlier, in 1851). It has been asserted that this was a result of ignorance or misinterpretation regarding the pre-existing designation of the rod of Asclepius
Rod of Asclepius
The rod of Asclepius , also known as the asklepian, is an ancient symbol associated with astrology, the Greek god Asclepius, and with medicine and healing. It consists of a serpent entwined around a staff. The name of the symbol derives from its early and widespread association with Asclepius, the...

 by the Surgeon General of the United States
Surgeon General of the United States
The Surgeon General of the United States is the operational head of the Public Health Service Commissioned Corps and thus the leading spokesperson on matters of public health in the federal government...

 for this purpose. It is worth noting that hospital stewards were not physicians; they played a supporting role preparing drugs for surgeons, supervising nurses and cooks, maintaining accounting and medical records, and in emergencies sometimes performed minor surgery or provided prescriptions.

Later, in 1871, the Surgeon General designated the caduceus as the seal of the Marine Hospital Service (destined to become the U.S. Public Health Service in 1889). Gershen states that the change was for aesthetic reasons, whereas Friedlander states the caduceus was adopted by the Marine Hospital Service "because of its relationship with merchant seamen and the maritime industry".

The caduceus was formally adopted by the Medical Department of the United States Army
United States Army
The United States Army is the main branch of the United States Armed Forces responsible for land-based military operations. It is the largest and oldest established branch of the U.S. military, and is one of seven U.S. uniformed services...

 in 1902 and was added to the uniforms of Army medical officers. According to Friedlander, this was brought about by one Captain Frederick P. Reynolds, although Bernice Engle states "the use of the caduceus in our army I believe to be due chiefly to the late Colonel Hoff, who has emphasized the suitability of the caduceus as an emblem of neutrality. Reynolds had the idea rejected several times by the Surgeon General, but persuaded the new incumbent — Brig. Gen. William H. Forwood
William H. Forwood
William Henry Forwood was a surgeon from Brandywine Hundred, Delaware, who served in the Union Army during the American Civil War and eventually as Surgeon General of the United States Army from June 8, 1902 until September 7, 1902.-During the war:Forwood attended Crozier Academy in Chester,...

 — to adopt it. This resulted in considerable controversy.

The Army and Navy Register of 28 June 1902 discusses the argument, which reflects the fact that a number of medical officers were unhappy with the choice. The article editor claims that the symbol was not chosen for its medical connotations and proposes the following symbolic interpretation: "the rod represents power, the serpents stand for wisdom and the two wings imply diligence and activity, qualities which are undoubtedly possessed by our Medical officers." The editor also points out that the majority of Medical Corps personnel are not even doctors. According to this line of reasoning, the caduceus was never intended to be a symbol of medicine. The inconsistency was noticed several years later by the librarian to the Surgeon General
Library of the Surgeon General's Office
The Library of the Surgeon General's Office, later called the Army Medical Library, was the institutional medical literature repository of the U.S...

, but for reasons which are not entirely clear, the symbol was not changed.

Considerable light is shed on this confusion by an anonymous letter republished by Emerson, a historian of United States Army insignia and uniforms. He indicates that the April 1924 issue of The Military Surgeon printed a review of an earlier article that appeared in the Presse Medicale in which the author stated "There is nothing in history to justify the use of the caduceus as the emblem of the physician […] it is most unfortunate that the 'confusion' exists." In an anonymous rebuttal contained in a letter to the editor published three months later in The Military Surgeon it was claimed that the late Col. John R. van Hoff was a member of the board that selected the emblem ("if he was not the one who was chiefly instrumental in its adoption"). In the letter to the editor reproduced by Emerson, the anonymous author claims
According to this view the caduceus was not intended to be a medical symbol (and, though explained differently, this reflects the view advanced by the editor commenting in The Army and Navy Register of 28 June 1902 discussed above). Nevertheless, after World War I the caduceus was employed as an emblem by both the Army Medical Department and the Navy Hospital Corps. Even the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...

 used the symbol for a time, but in 1912, after considerable discussion, the caduceus was abandoned by the AMA and the rod of Asclepius
Rod of Asclepius
The rod of Asclepius , also known as the asklepian, is an ancient symbol associated with astrology, the Greek god Asclepius, and with medicine and healing. It consists of a serpent entwined around a staff. The name of the symbol derives from its early and widespread association with Asclepius, the...

 was adopted instead.

This shift back to use of the rod of Asclepius to symbolize medicine can also be seen in the United States military. The Army Medical Corps, having popularised the caduceus, whilst retaining the caduceus for its own plaque and insignia, is now part of the Army Medical Department
Army Medical Department (United States)
The Army Medical Department of the U.S. Army – known as the AMEDD – comprises the Army's six medical Special Branches of officers and medical enlisted soldiers. It was established as the "Army Hospital" in July 1775 to coordinate the medical care required by the Continental Army during the...

, which has since adopted the Rod of Asclepius as its main symbol. Furthermore, when the U.S. Air Force designed new medical insignia, it also adopted the rod of Asclepius.

Contemporary views

Despite widespread acceptance of the caduceus as a medical symbol in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

, it has been observed that the rod of Asclepius has "the more ancient and authentic claim to be the emblem of medicine". Most attempts to defend its use in a medical context date from the last quarter of the 19th century through the first quarter of the 20th, and have been characterized as "based on flimsy and pseudo-historical research".

In a survey of 242 logos used by organizations related to health or medicine, Friedlander found that professional associations were more likely to display the rod of Asclepius (62%), while organizations with a commercial focus were more likely to use the caduceus (76%). Hospitals were an exception (37% used a staff of Asclepius whereas 63% used a caduceus). Friedlander felt it likely that this might reflect the fact that "professional medical organizations have more often sought a real understanding of the meaning of the two symbols whereas commercial organizations have been less interested in the historical basis of their logo or insignia and more concerned with how well a certain symbol will be recognized by the iconographically unsophisticated audience they are trying to attract to their wares."

The use of the caduceus in a medical context has long been frowned upon by many professionals, academics and others who are familiar with the historical significance of both symbols. This has occasioned impassioned remarks by those frustrated with the continuing confusion.
It has been observed that the caduceus is particularly inappropriate for use as a medical symbol due to its long associations with the Greek god Hermes
Hermes
Hermes is the great messenger of the gods in Greek mythology and a guide to the Underworld. Hermes was born on Mount Kyllini in Arcadia. An Olympian god, he is also the patron of boundaries and of the travelers who cross them, of shepherds and cowherds, of the cunning of thieves, of orators and...

, who was patron of commerce and traders as well as thieves, liars, and gamblers.
On the other hand, it has also been remarked – not without considerable irony – that commercial aims in medicine, especially in North America, make the caduceus an appropriate symbol, at least for some physicians.
Others are unapologetic about the association of medicine with commerce, recognizing the importance of "advertising essential for competitive marketing", and suggesting that it is up to individual physicians to choose between the two symbols, based on their own views about what associations are appropriate.

In North America, there are calls to clarify the symbol and to move to a uniform use of the rod of Asclepius. For example, the director of communications of the Minnesota Medical Association
Minnesota Medical Association
Minnesota Medical Association is a professional association representing physicians, residents, and medical students, working together for a healthy Minnesota. With more than 11,000 members, the MMA is a powerful advocate on health care issues at the State Capitol and in Washington D.C...

 is quoted as saying, "If it's got wings on it, it's not really the symbol of medicine; some may find it hard to believe, but it's true. It's something like using the logo for the National Rifle Association
National Rifle Association
The National Rifle Association of America is an American non-profit 501 civil rights organization which advocates for the protection of the Second Amendment of the United States Bill of Rights and the promotion of firearm ownership rights as well as marksmanship, firearm safety, and the protection...

 when referring to the Audubon Society".

However, Andrew Weil, a proponent of alternative medicine, has suggested that the caduceus is appropriate as a medical symbol "because it embodies an esoteric truth that must be grasped to gain practical control over the shifting forces that determine health and illness."

See also

  • Caduceus
    Caduceus
    The caduceus is the staff carried by Hermes in Greek mythology. The same staff was also borne by heralds in general, for example by Iris, the messenger of Hera. It is a short staff entwined by two serpents, sometimes surmounted by wings...

  • Rod of Asclepius
    Rod of Asclepius
    The rod of Asclepius , also known as the asklepian, is an ancient symbol associated with astrology, the Greek god Asclepius, and with medicine and healing. It consists of a serpent entwined around a staff. The name of the symbol derives from its early and widespread association with Asclepius, the...

  • Aaron's rod
    Aaron's rod
    Aaron's rod refers to any of the staves carried by Moses' brother, Aaron, in the Old Testament of the Bible. The Bible tells how, along with Moses' rod, Aaron's rod was endowed with miraculous power during the Plagues of Egypt which preceded the Exodus...

  • Bowl of Hygieia
    Bowl of Hygieia
    Bowl of Hygieia is one of the symbols of pharmacy. Hygieia was the Greek goddess of health.- Usage of symbol by pharmaceutical associations :...

  • Nehushtan
    Nehushtan
    The Nehushtan , in the Hebrew Bible, was a sacred object in the form of a snake of brass upon a pole.The priestly source of the Torah says that Moses used a 'fiery serpent' to cure the Israelites from snakebites...

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