HISTÓRIA DA MEDICINA [ENGLISH]
THE MEDICAL SYMBOL AND THE GUINEA WORM
The medical symbol known as the staff of Asclepius consists of a staff with a serpent coiled around it (Fig. 1).
worship of Asclepius as the god of medicine began in ancient Greece and
spread throughout Europe. He is believed to have been a famous
doctor from Thessaly in Greece who actually existed at some time in the
twelfth century B.C., later being deified in Greek mythology. According
to legend, Asclepius was the son of the god Apollo and a young mortal
named Coronis, the daughter of Phlegyas, the king of Thessaly.
Apollo was the god of medicine, music and the arts, having also other
attributes as oracle of Delphis to keep him busy. After becoming
pregnant with Apollo’s child, Coronis fell in love with a young man
called Ischys. A white crow informed Apollo of the love affair
which made the god so angry that he changed the color of the bird to
black and decided to seek vengeance through his sister Artemis, by
convincing her to shoot Coronis with a poisoned arrow. When
Coronis’ body was on the funeral pyre, ready for cremation, Apollo
remembered she was carrying his offspring and removed the child by means
of a caesarean section handing it over to Chiron, a centaur, to be
In Greek mythology the centaurs were hybrid beings, half men half horses
that lived in the mountains of Thessaly. Chiron, unlike other
centaurs, as well as being endowed with great strength was also kind and
wise, and had cared for other Greek mythological figures such as Jason,
hero of the Argonauts, Heracles (Hercules) and also Achilles, the
Trojan War hero.
Asclepius inherited his father’s vocation for healing and learned from
Chiron how to handle medicinal plants. He became a famous doctor,
eventually married and had the following children: Podalirius, Macaon,
Hygeia, Panacea, Aegle, Acesius and Iaso. Podalirius and Macaon took
part in the war against Troy and are mentioned by Homer in the
Iliad. Hygeia and Panacea who worked with their father are well
known names in the medical field: Hygiene in the prevention of diseases
and panacea as the cure for all illnesses. Unfortunately,
Asclepius overstepped the limits of medicine by bringing the dead back
to life for which he was punished by Zeus who struck him dead with a
thunderbolt. Apollo begged Zeus to deify Asclepius who
then became the god of medicine. The worship of Asclepius spread across
Greece and throughout the Roman Empire and other regions. Temples
called Asclepions were built where the sick were treated by the
Asclepiades, who were half priest and half doctor and applied rational
therapeutic methods together with religious practices (Hart, 2000).
Archaeological findings from the temples of Asclepius, such as statues
and ancient coins all show the god holding the staff with the
serpent. The meaning of each of these elements has given rise to
controversy. Three interpretations of the staff have been
considered plausible: the representation of the tree of life, the symbol
of authority and power (to cure) and last but not least support and
defense for walking since doctors then were itinerant and traveled long
distances on foot. In regard to the serpent there is an easier
explanation as this animal has always fascinated different peoples and
civilizations in connection with the power to preserve life. The
ability to form a circle with its own body is seen as a symbol of
eternity and its periodic change of skin as a sign of
rejuvenation. Since it is a chtonic being capable of living both
on the surface and underground it is supposed to have access to both the
visible and invisible worlds. It is also associated with cunning,
caution and wisdom. The serpent is often seen with other gods
such as Athens, Hera, Demeter and Hermes (and their Roman equivalents).
The worship of Asclepius was at its height around the third century A.D.
when Christian domination banned the pagan gods, causing the staff of
Asclepius to practically disappear until the sixteenth century when it
resurfaced as the universal symbol of medicine. The symbol
of Hermes called the caduceus with two serpents and wings at the top,
has been mistakenly used in the USA as the symbol of medicine when it
is, in fact, the symbol of commerce. In recent years, more
precisely during the last decade, an odd interpretation of the symbol of
medicine appeared, more in line with popular culture, associating it to
the parasitosis caused by the Dracunculus medinensis nematode,
popularly known as guinea worm, medina worm or serpent worm.
This nematode has a complex biological cycle. The larvae, in an aquatic
environment, infect a microscopic crustacean of the copepod class.
The animal host, man included, is infected by drinking water
contaminated by the infected crustaceans. Once in the stomach, the
crustaceans die freeing the larvae that are resistant to the gastric
juices. The larvae go through the intestinal wall entering the
abdominal cavity and lymphatic system. Over the next six weeks
they move toward the subcutaneous tissue. One year later the
larvae have reached adulthood. The males, more slender than the
females, die while these survive in the subcutaneous tissue as elongated
worms, moving slowing, preferably, in the direction of the lower
members. After some time the worm produces a skin ulcer through
which it extrudes its proximal end. As the ulcer is very painful
the patient tends to bathe it looking for relief. This is when the
worm expels larvae through its mouth contaminating the water that will,
in turn infect new crustaceans, closing the biological cycle. An
abscess is formed in the site after the death of the worm.
Extraction of the living worm is possible before ulceration by the
following process: An incision is made in the skin just ahead of the
worm which will soon surface. A small rod, such as a matchstick is
then used to carefully and progressively coil the worm. The rod must be
turned gently over a period of days until the worm is completely
removed (fig. 2).
has existed since times immemorial, having been detected in Egyptian
mummies. The therapeutic procedure described above is traditional
and its source is not known. Lately the stick with the nematode
coiled around it has been considered the origin of the staff of
Asclepius. The medical symbol would then be reduced to serving as
nothing more than publicity on the part of the doctor, informing his
ability to extract subcutaneous parasites. This imaginative
interpretation, as mentioned above, is recent. The Internet is
flooded with articles on the subject published over the last decade,
some of them repeating what others have already mentioned. The
oldest record found is from 2002 and refers to an article published by
Doctor Keith Thomas Blayney from New Zealand. This article
entitled "The Caduceus vs. the Staff of Asclepius" was published on-line
at the site http://drblayney.com/Asclepius.ht having undergone a
revision in 2005. There is no bibliography in the article and Blanley
only suggests that the probable origin of the symbol of medicine is the
procedure for treatment of dracunculiasis. Blainey published his
theory in the Alternative Journal of Nursing July 2007, Issue 14, page
4. And he is cited as the bibliographic source in Wikipedia and other
publications broadcasted by the Internet.
30 sites mentioning the same story have been revised, most of them
without bibliographic references using expressions such as “some
scholars believe”, “it is accepted that”, “it is assumed” and so
on. Of the thirty sites, 17 show the publication date, six being
from 2011, indicating current interest in the subject.
Is Dr. Blayney the creator of this absurd interpretation of the origin
of the symbol of medicine or has some historian before him suggested
this idea? What documentation is there to prove it? Are we facing a case
of pure imagination?
Classical and modern historians such as Dipgen (1932), Laignel-Lavastine
(1936), Castiglioni (1947), Major (1954), Sigerist (1961), Garrison
(1966), Lain Entralgo (1971) and so many others have never referred to
this possibility and neither have authors of specialized studies
on Asclepius and the symbol of medicine. Emma and Ludwig Edelstein made a
thorough survey of all the Greco-Roman literature referring to
Asclepius. They found 861 references, none of them so much as
hinting that there might be any connection between the staff of
Asclepius and the treatment of dracunculiasis. Other recent works,
such as the book Asclepius the God of Medicine, by Gerald Hart,
published in 2000 say nothing of this novelty that is being proclaimed
as the truth.
Visiting Greece in 1987 and also in 1996 to take part in the 35th
International Conference on the History of Medicine held on the island
of Kos, I had the opportunity of going on guided tours to the ruins of
the temples of Asclepius in Epidaurus and in Kos. On neither of
these occasions was any reference made to this probable origin of the
symbol of medicine, the same occurring in the temple of Asclepius in
Pergamon in Turkey. I was recently informed that tourist guides
have included this version in their narratives to visitors*.
Something similar may happen to this bizarre explanation as happened to
Hermes’ caduceus which has been mistakenly accepted as the symbol of
medicine. It is to be feared that in spite of this new interpretation
being no more than speculation and not based on historical fact, it may
spread and be accepted permanently. We will then see the staff of
Asclepius reduced to a matchstick and the serpent to no more than a
* According to Dr. Luiz Rassi Jr., who has recently been to Greece.
1. Hart, G.D. – Asclepius the God of Medicine. Royal Society of Medicine, 2000.
2. Dipgen, P. - Historia de la Medicina (trad.). Barcelona, 1932
3. Laignel-Lavastine. - Histoire Générale de la Médecine, de la Pharmacie, de l’Art
dentaire e de l’Art vétérinaire. Paris, Albin Michel Ed., 1936.
4. Castiglione, A. – Historia da Medicina (trad.). São Paulo, Cia. Ed. Nacional, 1947
5. Major, R.H. – A History of Medicine. Oxford, Blackwell Scientific Publ., 1954.
6. Sigerist, H.E – A History of Medicine. Oxford University Press, 1961.
7. Garrison, F. – Historia de la Medicina, 4ª. ed. (trad.), México, 1966.
8. Entralgo, L – Historia Universal de la Medicina. Barcelona, Salvat Ed., 1971.
9. Edelstein, E.J., Edelstein, L. – Asclepius. Collection and
interpretation of the testimonies. Baltimore, The Johns Hopkins
University Press, 1998.
Note: In Portuguese the name Asclépio has been spelled in a
number of different ways: Asclépio, Asclépios Asclepius,
Asklepio, Asklepios, Asklepiós, Asklepius. I have used the
simplest that is also used by the Academia Brasleira de Letras.
Translator’s note: Likewise in English, the name Asclepius can also be
spelled Asculapius, Aesculapius (Latin) and Asklepius (Greek).
Joffre Marcondes de Rezende
Prof. Emérito da Fac. de Medicina da Univ. Federal de Goiás