Things you don't learn in medical school: Caduceus.

It is a known fact that every symbol has a unique meaning. In that case what does this unique symbol, Caduceus, which is used, in various forms and modifications, by many medical organizations mean? Is it just a custom or does it have a deeper meaning? The story of this medical symbol started way back in 1400 BC, travelled through time, has undergone many changes, misconceptions and has finally reached the present state. Here we have tried to give you a glimpse of how it has evolved over time, what it actually means, what have we interpreted and what can we learn from it.

There are certain things that will not be taught in medical schools, and it is usually learnt out of our own interests. The Caduceus is one of them. Being in the medical profession for so many years, have we ever thought what that symbol that we wear on our coats, print on our prescription pads and textbooks, stand for? So let us get reminded of some of the long forgotten facts in medicine. The worthiness of the medical symbol has been debated for a long time.[1] If you observe closely there are two symbols that are used to represent medicine as seen in Figure 1.[2] One is the Caduceus, and the other is the Rod of Asclepius. Caduceus is a symbol with a short staff entwined by two serpents, sometimes surmounted by wings while the Rod of Asclepius is the one with a single snake.[3] The similarity between both these symbols is the snake.

Figure 1

Left side image is the Rod of Asclepius while the right side image is the caduceus

Why A Snake?

Have you ever wondered why is a snake, which is a symbol of destruction[4] used ironically as a symbol of healing? Well, the answer lies deep sown in history when Moses, around 1400 BC, used the bronze serpent erected on the pole to cure the people who were bitten by snakes.[5] The other reasons why serpent has been used is the shedding of the skin that indicated longevity and immortality. The snake's ability to change from a lethargic stage to one of rapid activity symbolized the power to convalesce from an illness.[2] Charas and Martyn (1673) subjected the viper[6] to innumerable experimental investigations and concluded they were valuable remedies for itch, erysipelas, measles, smallpox, leprosy and were a valuable adjunct to the production of a beautiful skin.[6] Hence, the snake has been a powerful symbol of healing itself.[7]

The snake mentioned in the symbol is an Aesculapian snake which belongs to the family Colubridae. Its zoological name Elaphe longissima. Smooth, glossy, and slender, the snake has a uniformly brown back with a streak of darker color behind the eyes. The snake's belly is yellowish or whitish and has ridged scales that catch easily on rough surfaces[8] (like that of a pole or staff).

Which of These?

The confusion starts with the use of Caduceus and Rod of Asclepius. The Caduceus is a symbol of Hermes or Mercury in Greek and Roman mythology. Caduceus symbol is identified with thieves, merchants, and messengers, and Mercury is said to be a patron of thieves and outlaws, not a desirable protector of physicians.[8] The symbol originated when Mercury once attempted to stop a fight between two snakes by throwing his rod at them, whereupon they twined themselves around the rod, and the symbol was born.[289] The Rod of Asclepius belongs to Aesculapius, who was the revered Greek god of healing.

When Did We Get it Wrong?

The modern use of staff of Aesculapius started when The American Medical Association had the staff of Aesculapius as its symbol in 1910. The Royal Army Medical Corp, French Military Service, and other medical organizations had done the same. Even today the World Health Organization, Medical Council of India symbols have the staff of Aesculapius in them. US Army Medical Corps, the Public Health Service, and the US Marine Hospital however use the Caduceus largely as a result of the adoption of the Caduceus as its insignia by the US Army Medical Corps in 1902.[10] Thus, it symbolizes administrative emblem, implying neutral and noncombatant status.[11]

How Many of Us Really Know the Truth?

In 1990, a survey was done in the US and it was found that 62% of the professional associations used the Rod of Aesculapius while 37% used the Caduceus and 76% of commercial organizations used the Caduceus.[12]

Can It Be Related to A Disease?

Does any disease that can be treated by a stick come to your mind? Yes, it is none other than Dracunculus medinensis the guinea worm. This is potentially a disease that can be treated with the stick that was also one of the reasons why the medical symbol originated.[13]

Conclusion

The use of the symbol is very ironical as how can destructive creatures used to represent a healing purpose. The answer lies in the snakes characters of, skin shedding representing immortal life, sudden change in activity emphasizing transit from sickness to cure, early use in the bible, and most important of all it was used by Asclepius who is the god of healing.