University of Michigan Medical and Nursing School - Aequanimitas Yearbook (Ann Arbor, MI)

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One Snake or Two Athenian coins dated from the third century B.C. show on the reverse a short staff with a single serpent coiled about it and on the obverse, the head of Aesklapius CAcsculapius in the Roman traditionb. Therefore there can be no doubt that the authentic Aesculapian emblem is a rough wooden cane of variable length, more or less loosely entwined by a serpent with its head upper- most. l l However, the familiar and popular emblem of medicine is not this Aesculapian staff and serpent, but rather the caduceus. This is ordinarily depicted as a short, slender wand, knobbed at its upper end, bearing two extended wings attached near the top, and symmetrically entwined by two small serpents whose heads, uppermost, stretch toward one another. I4 Richard Lewis The Latin etm'uceus is derived from the Greek kwfykeiml and originally from lcwfyx, a herald, the derivative thus meaning a heralds wand. ln Babylonian and Assyrian literature, Ningizzida for Ningish- zidal, a deity of fertilization and fruitfulness, but also of healing, functions as messenger of the Mother Goddess, Ishtar, to awaken life and vegetation in the springtime. This harbinger and proto- type of the Greek Hermes and the Roman Mercury is depicted with a symbol consisting of a rod, two snakes symmetrically twined around it, and two winged quadrupeds in prohle at the edges. Omit the quadrupeds but leave the wings, and the tpyical caduceus with two snakes appears. Even caducei from Egyptian tradition show two snakes. Thus the caduceus with two snakes far antedates that with one snake and should take precedence. On the other hand, those who wish to relate modern medicine directly to Hippocratic foundations may prefer one snake and no wings. As is true in the mythology of all peoples and is apparent in our own stories of johnny Appleseed and Paul Bunyon, all deities derive multiple functions from numerous traditions and legends. Hermes, it seems, was the messenger of Zeus, the patron of fertility in plants and animals, the god of wind and air, patron of commerce on land and sea, god of roads and travellers, god of robbers, thieves and traitors, and guide of souls to Hades, In his earliest days he was also a god of the home and hearth, and as such had some healing attributes, Often he bears a caduceus symbolic in his several functions. The snake symbolized many ideas-wisdom, prudence, health, long life fimplied in the rejuvenation evident in his ecdysisl and also for anything in or under the ground. So Hermes carried the snakes when he escorted the dead to the lower regions. Interesting in this connection is that the Etruscan god of the underworld, Aite Ca corruption of the Greek Hades? held in his hand a simple rod around which one snake twined itself. What was a Hippocratic caduceus to the Greeks was a Plutonic caduceus to the Etruseans. lt has been almost universally agreed that the authentic and traditional emblem of medicine is the symbol of the Greek patron god of healing, a rough staff and a single serpent. How- ever, a provincial criticism of the caduceus with two snakes is improper. The medical mind thinks of symbols as having a one- to-one relationship with the objects they represent, such as a chemical symbol. However, those who study the nonscientihc aspects of sym- bolism assume automatically that any symbol may have multiple interpretations and that any concept may be expressed in a variety of symbols. Thus, attempts to introduce this nonscientific use of symbolism should expect to encounter the considerable solipism ofthe medical profession.

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Answer the Questioner-Not Simply the Question Glenn W. Geelhoed A frequently discussed dilemma in medical ethics is the ques- tion How much should the patient be told? . When a patient asks a question regarding his health status and future, what should form the limits ofthe reply? The inconsistencies in policy regard- ing the approach to this problem reside, I believe, in an incorrect focus. It is not the question that should be addressed in reply, but the questioner. In interchange of professional information with colleagues, there is an orientation of simply the facts, Ma'm -answer the question: no more, no less. From this crisp communication an attitude is carried over to the patient that the patient's disembod- ied question is an entity in itself. But questions do not ask them- selves, they arise from the needs of persons. He who focuses on the question and looks no further into the need that gave rise to it has not satisfied that need, and is often deceived as to what in- formation exchange occurs. In the interpersonal communication that constitutes the pa- tient-doctor relationship, questions nearly always are not what they seem. What man, no matter what his medical sophistication, who has fretted for weeks in frightened insomnia wants a light- lipped reply to his heavy-hearted query I wonder if the rectal bleeding l've been having is serious? Few of us pour out our whole soul to anyone on nrst encounter, particularly in a hospi- tal. Some of us know from personal experience that the complaints we bring to professional attention are often the most trivial de- tails overlying our gravest obsessions. But in consulting the phy- sician, it is hoped that the unasked question will be answered or that the healer will draw out unacknowledged fear and comfort the sufferer. A simply affirmative or negative reply is obviously the last bit of information sought when a patient with advanced disease asks with a grim smile, 'fWell doctor, will I live? He is asking the physician for hope, pleading that the sting may be taken away, and looking for compassionate comfort in his failing struggle with an irrational heartless disease. Similarly translated, the desparate young girl who approaches a physician after a dozen subterfuges with the plea 'fl want an abortion is really pleading I need help. Specific demand for medical services is often an intellec- tualization covering fear of helplessness, the underlying plea being to do what is best to help the questioner. The greatest teachers and physicians have always been aware of the distinction between the superficial question asked and the deeper level of the person's need in asking it. The Socratic meth- od was essentially an unmasking of the reasons why questions were asked to illumine the underlying real conflict that prompted the abstract question. Christ saw beyond the questions brought to him so that his followers went away illumined, not merely with a reply. And when sophisticated leaders asked a carefully formu- lated captious question, he ignored the question posed but replied to the deeper conflict, thereby answering both, for: they mar- velled at his answer. l The questions asked of a physician are not always candid ones because of the mixed feelings the patient holds in respect to his encounter with the physician: The attitude of the patient approaching the doctor must always be tinged-for the most part unconciouslyAwith distaste and dread: its deepest desire will tend to be comfort and relief rather than cure, and its faith and expectation will be directed towards some magical exhibition of these boons. Do not let yourselves believe that however smoothly concealed by education, by rea- son, and by confidential frankness these strong elements may be, they are ever in any circumstances altogether absent.-2 And, there is this additional bonus for the physician respon- sive to the needs that give rise to the questions: too many ques- tions cannot be answered, every questioner can. l. Matthew 20:26, for Mark 12:17, or Luke 20:26.J 2. Wilfred Trotter in Harrison et al, Principles of I nternal Medicine, 1962, p. 4. 13

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Progress Withering's patient Dropsical sick ventured- yet fearing the long shadows the winding path the tangled brush into the dark forest of medieval England and came out well. O mystic age And Withering looked and saw cardamon and chamomile arnica gamboge spider web and valerian pareira brava gum ammoniac guaiacum shavings myrrh and foxglove aloes rhubarb clematis and tincture of bark white vitriol tartar of vitriol sal martis theriac and mithridate O dark time. But Withering? Withering thought, and pottered, and tested, and measured. Robert A. Green, M.D. My patient Asthmatic sick came, yet confident to the shining tower monument of scienc today and came out well. O sparkling world And I looked and saw epinephrine and susphrine and aminophylline sodium iodide and ether in oil. Tetracycline and penicillin and streptomycin. Hartman's sodium bicarbonate potassium chloride water and sugar. Bronchoscopy and oxygen and hydrocortisone. O golden age! e, of order, of reason l