Editorial: Caduceus—or Asklepian?

Kos is the birthplace of Hippokrates (circa 460–377 BC), the father of medicine. I visited the island near the end of a bare-boat sailing adventure to the Turkish Aegean and the Greek Dodecanese islands. For me and the other physicians on board, Kos truly was the highlight of the trip because it was the site of the first "teaching hospital," the Temple of Asklepios.

Situated amidst a pine forest, the temple has spectacular views of the Aegean and is cooled by a steady trade wind. The first of its three courtyards was originally surrounded by hospital rooms, baths, and dormitories for visiting athletes (the first sports medicine complex). On the third level at the temple proper, Hippokrates held court, teaching his students. He cared for all patients regardless of their rank or status and was supported by donations from wealthy patrons. Indeed, the temple complex contains a small financial office that was used to process such donations.

And so we come to Asklepios and the import of one snake versus two as a symbol of the medical profession. Who was Asklepios? He may have been a real physician and is first mentioned in the Iliad, where Homer depicts him as the ideal Greek physician.² He later appears in Greek mythology as the son of Apollo, who ironically was both the god of physicians and the sender of disease.

The myth of Asklepios holds that he was the son of Apollo and his mortal mistress, Coronis. Apollo killed Coronis in a fit of jealous rage but discovered that she was pregnant as he placed her body on a funeral pyre.³ He then delivered the infant-a son-via the first cesarean section and placed him in the care of the centaur Chiron, to be raised and trained as a healer.³ As Asklepios' skills grew, so did his reputation as a kind and gentle healer able to relieve pain and cure disease. Ultimately, his skills became so great that he was able to prevent death and restore the dead to life. This enraged Zeus, who viewed him as a rival of the gods and struck him down with a thunderbolt. (Quite a metaphor for the rise and current precarious state of American medicine, isn't it?)

After his death, Asklepios was worshiped as a god. The cult of Asklepios (the Roman Aesculapius) proliferated such that by the time of Galen (129-216 AD), hundreds of temples-called Asklepieions-had been erected. The temple on Kos contains statues to both Asklepios and his daughter, Hygieia, the goddess of health. Indeed, the Hippocratic oath begins with "I swear by Apollo Physician, and Asklepios and Hygieia ...".⁴