The Talented Dr. Knox

Lisa Rosner, PhD, author of today’s guest blog, will present “The True and Horrid Story of the Burke and Hare Anatomy Murders” at our October 18th festival, Art, Anatomy, and the Body: Vesalius 500.

Engraving of Dr. Robert Knox. From our online collection The Resurrectionists.

Engraving of Dr. Robert Knox. From our online collection The Resurrectionists.

Dr. Robert Knox, the anatomist whose cadaver purchases kept William Burke and William Hare in the murder business, has always been an enigma. Born in Edinburgh, Scotland, he served in the army and studied in Paris before returning home to set up a private anatomical school. He taught hundreds of students, lecturing twice a day in addition to holding separate dissection classes. He was curator of the surgical museum, wrote articles on human and comparative anatomy for scientific societies, and was in the process of seeing several books on anatomy through publication. His supporters claimed he knew nothing about the murders; his detractors argued that he simply turned his blind eye—for he had lost an eye to smallpox as a child.

Plate II in Knox's Man: His Structure and Physiology, shown flat and with lifted parts. Click to enlarge.

Plate II in Knox’s Man: His Structure and Physiology, shown flat and with lifted parts. Click to enlarge.

What we can see, using the extensive collection of Robert Knox materials in the New York Academy of Medicine Library, is just how talented an anatomist Robert Knox was. His edition of Hippolyte Cloquet’s A System of Anatomy is more than just a translation: it is instead a critical analysis of contemporary anatomical knowledge, enriched by examples from Knox’s own research and teaching. The same is true of his edition of Friedrich Tiedemann’s The Plates of the Human Arteries, prepared with two of his students, Thomas Wharton Jones and Edward Mitchell. The catalogue he prepared for the anatomical and pathological museum of the Royal College of Surgeons of Edinburgh is filled with his detailed insights: on anomalies of the biceps flexor cubiti, on the precise position relative of a fatal brain tumor, and on popliteal aneurism. Knox discussed the implications of these, and many more of his anatomical and surgical observations, in several series of articles for the London Medical Gazette. We can follow his teaching methods in The Edinburgh Dissector, the handbook he wrote for the use of his dissecting classes. “Nobody could ever say that he gave a dry lecture, or one that was not specially instructive,” reported his former student, Henry Lonsdale. Even in the midst of the detailed description that makes up most of the Edinburgh Dissector, Knox’s love of his subject shines through, as in his description of the bones of the foot, which “when well formed yields in beauty and perfection to no part in the human body.”

Could such a passionate observer of all subjects anatomical really have missed the fact that sixteen of his own “subjects” had been murdered? Contemporaries from Home Secretary Sir Robert Peel (founder of the London Metropolitan Police) to the Edinburgh evening papers refused to believe it and called for wider investigation. On the advice of legal counsel, Knox refused to answer any questions—just as he had refused to ask any, his professional rivals muttered darkly, when presented with Burke’s and Hare’s murder victims. There was no real case against him, and there are no records of any deliberations by the prosecuting attorneys. We will probably never know what Knox knew or when he knew it.

"Execution of the notorious William Burke the murderer, who supplied Dr. Knox with subjects." Engraved print in The Resurrectionists collection. Click to enlarge.

“Execution of the notorious William Burke the murderer, who supplied Dr. Knox with subjects.” Engraved print in The Resurrectionists collection. Click to enlarge.

The anatomical career of the talented Dr. Knox survived the Burke and Hare scandal, but it did not long survive the change in medical teaching and practices that followed it. He had a second career as a public teacher and lecturer: his books A Manual of Artistic Anatomy and Great Artists and Great Anatomists: A Biographical and Philosophical Study sold very well. But he never achieved the academic position he had striven for, and his research agenda, like his sixteen most famous subjects, died at the hands of Burke and Hare.

For more on Robert Knox and the Burke and Hare murders, visit our online collection, The Resurrectionists.

Registration Open for Vesalius 500 Workshops

Registration is now open for our hands-on art and anatomy workshops, presented as part of our Vesalius 500 celebrations on October 18, 2014. Create your own articulated anatomical figure or “exquisite corpse” at the Gladys Brooks Book & Paper Conservation Laboratory; learn Renaissance drawing techniques with medical illustrator Marie Dauenheimer; or explore the anatomy and art of the hand with physical anthropologist Sam Dunlap.

Spaces are strictly limited so register soon. Registration at one of the workshops includes free entry to the Festival. You can register for the Festival (without workshop attendance) here.

From the Cradle to the Grave: Session One: The Cradle

Moveable baby and female pelvis from one of NYAM’s 19th century obstetrics texts, Dr. K. Shibata's Geburtschülfliche Taschen-Phantom, or the Obstetrical Pocket-Phantom.

Moveable baby and female pelvis from one of NYAM’s 19th century obstetrics texts, Dr. K. Shibata’s Geburtschülfliche Taschen-Phantom (Obstetrical Pocket-Phantom).

Working with NYAM’s conservation team, celebrate Vesalius’s life with a hands-on workshop producing your own articulated anatomical figures in the Gladys Brooks Book & Paper Conservation Laboratory.

Time: 11am-1pm
Cost: $55
Includes: All materials, and free entry to the Festival.
Maximum participants: 12
Register here

During the morning’s Cradle workshop, we will construct paper facsimiles of a moveable baby and female pelvis from one of NYAM’s 19th century obstetrics texts, Geburtschülfliche Taschen-Phantom (or the Obstetrical Pocket-Phantom). The book was written by Dr. K. Shibata, a Japanese author studying in Germany, and was published first in German before being translated into English and Japanese.

Participants will have time to make at least one paper baby and pelvis, which can be produced as paper dolls or magnets.

From the Cradle to the Grave: Session Two: The Grave

An exquisite corpse made by staff of the Gladys Brooks Book & Paper Conservation Laboratory.

An exquisite corpse made by staff of the Gladys Brooks Book & Paper Conservation Laboratory.

Working with our conservation team, celebrate Vesalius’s life with a hands-on workshop producing your own “exquisite corpse” in the Gladys Brooks Book & Paper Conservation Laboratory.

Time: 2:30pm-4:30pm
Cost: $55
Includes: All materials, and free entry to the Festival.
Maximum participants: 12
Register here

During the afternoon’s Grave workshop, we focus on producing a Vesalian-themed exquisite (or rotating) corpse. Loosely based on the surrealist parlor game in which a picture was collectively created by assembling unrelated images, this workshop will employ a special, rotating binding structure and mix-matched facsimile images from NYAM’s rare book collections to allow students to create their own unique, moveable pieces of art.

Renaissance Illustration Techniques Workshop with Marie Dauenheimer, Medical Illustrator

Students at medical illustrator Marie Dauenheimer's workshop at last fall's Festival.

Students at medical illustrator Marie Dauenheimer’s workshop at last fall’s Festival.

Time: 10am-1pm
Cost: $85
Includes: All materials, and free entry to the Festival.
Maximum participants: 15
Register here

Artists and anatomists passionate about unlocking the mysteries of the human body drove anatomical investigation during the Renaissance. Anatomical illustrations of startling power vividly described and represented the inner workings of the human form. Leonardo da Vinci’s notebooks were among the most magnificent, merging scientific investigation and beautifully observed drawing.

Students will have the opportunity to learn and apply the techniques used by Renaissance artists to illustrate anatomical specimens. Using dip and technical pens, various inks and prepared paper students will investigate, discover, and draw osteology, models, and dissected specimens from various views creating an anatomical plate.

Understanding the Hand, physical anthropology workshop with Sam Dunlap, Ph.D.

Dr Sam Dunlop leading a workshop at last year's Festival.

Dr Sam Dunlop leading a workshop at last year’s Festival.

Time: 2:30pm-5:30pm
Cost: $75
Includes: All materials, and free entry to the Festival.
Maximum participants: 15
Register here

The hand as an expression of the mind and personality is second only to the face in the Renaissance tradition of dissection and illustration that continues to inform both art and science. Basic anatomical dissection, illustration, and knowledge continue to be fundamental in many fields from evolutionary biology to surgery, medical training, and forensic science. This workshop will offer participants the opportunity to explore the human hand and its anatomy, which will be demonstrated with at least three dissections.  Opossum (Didelphis virginiana) and orangutan (Pongo pygmaeus) forelimbs will be available along with other comparative skeletal material. We will discuss hand evolution, embryology, and anatomy, and the artistic importance of the hand since its appearance in the upper palaeolithic cave art. We will also analyze the hand illustrations of da Vinci, Vesalius, Rembrandt, and artists up to and including the abstract expressionists.

Aseptic Surgery: Innovation circa 1900

By Paul Theerman, Associate Director, Center for the History of Medicine and Public Health

In the middle of the 19th century, the greatest surgical innovation was anesthesia. In the time that the television show The Knick is set, around 1900, the greatest surgical innovation was aseptic, or sterile, surgery. Anesthesia allowed for longer and steadier operations; aseptic surgery allowed for more successful ones. It changed surgical techniques, training, procedures, and equipment alike.

Sterile dressings. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Sterile dressings. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

The Knick shows first the techniques not of aseptic surgery, but of antiseptic surgery—that is, surgery under conditions designed to combat germs. Spraying the operating room with carbolic acid, and dipping beards in the same chemical, were two such techniques. Aseptic surgery went farther, creating surgical conditions without germs. Thus aseptic surgery led to sterilizing instruments; swabbing down patients; robing, masking, and gloving surgeons; and dressing wounds with sterile dressings. Such procedures began in the 1880s, and by the early 1900s were becoming more and more standard.

Our colleague Jim Edmonson of the Dittrick Museum of Medical History in Cleveland, Ohio, has explored the effect of aseptic surgery on medical instruments and instrument making. Aseptic surgery led to the sale and use of instrument sterilizers, of sterile gauze and cotton, and most especially of instruments designed to be readily and effectively sterilized, as well as inexpensively made. Thus metal soon replaced the wooden and ivory handles of surgical instruments. Jim quotes a Chicago surgeon, Nicholas Senn, in 1902:

All attempts at ornamentation have been abandoned . . . . The modern surgical instruments are made as plain and smooth as possible. Knives and retractors are made of one piece of steel, all niches and crevices being avoided wherever possible. Scissors and forceps are made so that the two parts may be readily separated and joined again.1

Scalpels. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Scalpels. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

To take care of scissors and forceps, German instrument makers developed the “Aseptic Pin Lock,” patented in the United States by Paul Henger of Stuttgart in 1892.2 This design allowed the device to be easily disassembled, sterilized, and then reassembled. Since the pieces could also be mass-produced rather than handcrafted, these instruments swept through the market, dominating from the 1890s to the 1930s. The idea of aseptic surgery pushed innovation throughout the whole of the surgical enterprise.

We show here images of the equipment of aseptic surgery, taken from Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). One of the images is of “Halsted’s Plain Hemostatic Forceps,” developed by William Halsted, the surgeon on whom The Knick’s Dr. Thackery is based, and designed to clamp blood vessels to control the loss of blood during surgery.

Thermal sterilization. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Thermal sterilization. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Sterilizers. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Sterilizers. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Forceps. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Forceps. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Sterilized gauze. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Sterilized gauze. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

References

1. James M. Edmonson, American Surgical Instruments: The History of Their Manufacture and a Directory of Instrument Makers to 1900 (San Francisco: Norman Publishing, 1997), p. 14, quoting Nicholas Senn, Practical Surgery for the General Practitioner.

2. Idib, p. 137, and figure 170. U.S. Patent 474,130, issued May 3, 1892. You can also see this at the U.S. Patent and Trademark site: http://www.uspto.gov/patents/process/search/

Global Celebrations of Vesalius’s 500th Birthday

By Lisa O’Sullivan, Director, Center for the History of Medicine and Public Health

From the frontispiece of Vesalius’ Fabrica.

Not in New York? Plan a trip and attend our “Art, Anatomy, and the Body: Vesalius 500” Festival on October 18! You can read our guest curator Riva Lehrer’s thoughts on the Festival here, and get a sneak peak of a virtual dissection demonstration by Kriota Willberg; and Brandy Schillace on Naissance Macabre; as well as more information about Vesalius and his Fabrica. Keep an eye out for more Vesalius 500 guest posts to come.

But, much as we’d like to see you here on October 18, you don’t have to be in New York to celebrate Vesalius’ 500th birthday.

We always welcome visitors to make an appointment to visit our rare book reading room and examine our copies of the Fabrica and its companion volume, the Epitome (in addition to the rest of our collection). Those elsewhere can find beautiful colored digital versions of the Fabrica from the University of Basel Library and the Epitome at University of Cambridge Library’s digital library. The publishers of the new English language edition of the Fabrica also have some wonderful material online.

In addition, there are multiple birthday celebrations for Vesalius across the globe this year. Travelers can visit Leuven for the Unravelling the Body. The Theatre of Anatomy at the Leuven Museum, or the international conference Towards the Authority of Vesalius: Representations of the Human Body in Antiquity, the Middle Ages and the Renaissance (Dec 3–5); join the Vesalius Continuum Conference on Zakynthos, the Ionian Island on which Vesalius died (Sept 4–8 ); visit Down to the Bones: Celebrating 500 Years of Innovation (Jul 11–Oct 9) at the University of Utah libraries; see Discovering the Human Body at Anatomical Museum in Basel, as well as the only existing skeleton known to have been dissected by Vesalius (Sept 12–Mar 2015) and explore Vesalius and His Worlds: Medical Illustration during the Renaissance at the Huntington library (Dec 12–13). Vesalius was born on Dec 31, 1514; if the events of 2014 were not enough, keep an eye out for the St. Louis meeting celebrating Vesalius in 2015 (Feb 26-28). (Apologies to anyone whose event we’ve missed! The Karger Fabrica site has a great, and constantly updated list of Vesalius 500 events.)

Looking for Health Information Online? Don’t start with Google.

By Johanna Goldberg, Information Services Librarian

This is the first of an occasional series of blogs featuring research tips from NYAM librarians.

We’ve all done it: You leave the doctor’s office and want to know more information about a new diagnosis or other health concern. So you go to your high-tech device of choice and search the Internet.

A NYAM Librarian conducts a PubMed search.

A NYAM librarian conducts a search in PubMed.

 

 

 

 

 

 

 

 

 

According to the latest Pew Internet research on the topic, 72% of Internet users went online to find health information in the past year. Of these people, 77% started by using a search engine.¹

But a general Internet search may not be the best way to find high quality health information online.

As we all know, anyone can put information online. Just because something is on a web page does not make it reliable. Fortunately, there are excellent sites that present a wide range of trustworthy health information.

When I look for health information online, I usually start with one of the following sites. If they link to other sources, I know the pages have been vetted:

MedlinePlus
This National Library of Medicine site provides authoritative information from government agencies and nonprofit organizations. It includes a very helpful drug and supplements guide.

HealthFinder
Health information from the U. S. Department of Health and Human Services.

Centers for Disease Control and Prevention
The CDC is especially helpful when looking for trends and statistics.

National Institutes of Health
Each NIH Institute offers a wealth of consumer health information related to its area of interest.

There are other excellent options listed on our recommended resources page under the tab “Public and Consumer Health.”

Sometimes you do need to use a search engine. As I teach my Junior Fellows students, there are questions you need to ask to assess information found online:

1. WHO wrote it? Is it an organization or an individual? What is the person or organization’s bias?

2. WHAT makes them “an expert”? What kind of organization is it? Is it written by a patient? A healthcare professional working in the field? Is there a scientific or medical advisory board assessing the information?

3. WHERE is the author located? Is the website .org, .edu, .com, .gov? Each type of site has its own reasons for sharing information.

4. WHEN was the page last updated or reviewed? Health information can change quickly. The more current, the better.

5. WHY is the information on the Internet? Is the author trying to sell a product or service or raise money? Is it there to help patients and caregivers?

6. HOW does it look? Is it easy to read? Are there lots of advertisements? Are things spelled correctly? Does it make you uncomfortable in some way?

Want to know more about evaluating online health information? MedlinePlus has you covered.

1. Pew Internet: Health (23 April 2013) Retrieved May 22, 2013, from http://www.pewinternet.org/Commentary/2011/November/Pew-Internet-Health.aspx

Mother Eve’s Pudding Redux

Image

By Erin Albritton, Head of the Gladys Brooks Book & Paper Conservation Laboratory

Last month, we kicked off National Poetry Month by sharing a rhyming recipe for Eve’s Pudding from our manuscript collection. Although charming, the recipe lacked the level of specificity to which most modern cooks have become accustomed. To solve this problem, cooking teacher and food historian Steve Schmidt (who will be delivering NYAM’s Friends of the Rare Book Room lecture on May 23rd) was kind enough to send along the following adaptation, together with a recipe for Cold Sweet Sauce that is scrumptious when drizzled over the top:

For the pudding:
3/4 cup (3 ounces) fine dry bread crumbs, plus a handful for coating the basin or bowl
1/3 cup plus 1 tablespoon (3 ounces) sugar
1 Tbsp all-purpose flour
1 tsp grated or ground nutmeg
1/2 tsp ground cinnamon
1/2 tsp salt
3 medium (about 1 1/4 pounds) firm, dry apples, such as Golden Delicious
2/3 cup (3 ounces) currants
3 large eggs, beaten until light and frothy
6 Tbsp (3 ounces) unsalted butter, melted and cooled
1 Tbsp strained fresh lemon juice

For the Cold Sweet Sauce:
1 stick of butter
2/3 cup confectioners’ sugar
1-2 Tbsp of brandy or lemon juice
A pinch of nutmeg

Very generously grease a 5- to 6-cup heatproof bowl or pudding basin with butter or solid vegetable shortening. Sprinkle the inside of the bowl with a handful of dry bread crumbs, tilt the bowl in all directions until coated and then tap the excess crumbs out.

Mix the 3/4 cup crumbs, sugar, flour, nutmeg, cinnamon, and salt in a bowl. Peel the apples and grate on the shredding plate of a box grater down to the cores. Stir the apples and currants into the crumb mixture, then the beaten eggs, then the melted butter and lemon juice. Pack the mixture into the prepared bowl, cover tightly with foil, set an upside-down plate on top of the foil, and steam the pudding for 3 hours in sufficient simmering water to reach halfway up the sides of the bow

While the pudding is steaming, make sauce by melting butter and whisking in sugar, brandy and nutmeg. Remove the pudding from the pot and let rest 15 minutes before unmolding. Drizzle (or drench!) with sauce and enjoy.

Below is a photo essay documenting one staff member’s kitchen adventure making this recipe (click to enlarge and open photo gallery). The next time you’ve got a couple of hours and find yourself craving a delicious dessert (with a bit of history), give Eve’s Pudding a try . . . you’ll be glad you did!

What Is Health Literacy?

By Johanna Goldberg, Information Services Librarian

In a 1940 pamphlet from our collection, “Give the Doctor a Break: The Low-Down on Group Practice and ‘Sickroom Charm’,” Floyd Burrows, M.D., advocates for the continued importance of the general practitioner, writing:

“There is an art in establishing prompt obedience to directions; in obtaining the wholehearted cooperation of a patient; in imparting and in getting adopted useful health information and instruction; in winning the confidence of frightened children; in understanding comprehensively the discouraging problems of the aged, while sympathetically ministering to them; in entering strange homes and quickly achieving a commanding confidence among those present in one’s ability to cope successfully with any emergency which has arisen.”

Dr. Burrows likely never heard the term “health literacy” during his lifetime. But in this excerpt, he lays down aspects of health literacy—clear explanations to patients to improve their compliance, imparting medical knowledge—as a significant part of a physician’s job.

October is Health Literacy Month. In 2000, the United States Department of Health and Human Services (HSS) defined health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,” issues of note in 1940 that remain prominent today.

In 2010, the Office of Disease Prevention and Health Promotion of the HSS released the National Action Plan to Improve Health Literacy. Citing a George Washington University publication, it estimates the costs of health illiteracy at $106 to $236 billion dollars annually, representing an increase in hospital visits, a decrease in preventive care, and poor chronic disease management.

As the National Action Plan states, “The greatest opportunities for reducing health disparities are in empowering individuals and changing the health system to meet their needs.”

The New York Academy of Medicine Library plays a role in boosting health literacy, in part through the Junior Fellows program. Together, NYAM’s Library and Office of School Health Programs teach New York City middle and high school students to conduct secondary health research and develop independent projects on health topics. They learn how to find and evaluate health information and build a vocabulary necessary for understanding complex public health issues. The 2012-2013 class of Junior Fellows will start their research in early November. You can read about successes of last year’s Fellows here.

A 2011-2012 Junior Fellow shares her research.

For a more in-depth explanation of health literacy, visit this National Network of Libraries of Medicine webpage.

Snakes in Medicine: Slippery Symbolism

By Lisa O’Sullivan, Director

Image of Hygieia and Asclepius with staff and snake between them, accompanied by dogs, representing watchfulness.

Bas-relief of Hygeia and Asclepius overlooking our main entrance on 103rd St. Our 1926 building features numerous emblems and mythological figures associated with medicine. In this figure, father and daughter have the figure of the staff and snake between them, and are accompanied by dogs, representing watchfulness.

The snake in our blog header is a reference to Hygieia, the Greek goddess of health, cleanliness, and sanitation. Hygieia was often symbolized by a snake drinking from a bowl and was shown in sculptures and images with a serpent entwined around her. Her father was Asclepius, the god of medicine, generally depicted carrying a staff with a snake coiled around it. Snakes were introduced in Asclepian temples across the classical world, for use in healing rituals, and have remained associated with medicine in many ways since that time.

Brass snake inlaid on foyer floor

Our snake in-situ on our foyer floor, one of a series of inlaid figures with a connection to the practice of medicine over time.

As Walter J. Friedlander describes in his 1992 The Golden Wand of Medicine, the staff of Asclepius remained the primary symbol of medicine in the West until the 16th century, when examples of the caduceus began to be associated with medicine. The caduceus shows two snakes entwined around each other and a central staff, often with wings, and was associated with the god Hermes, especially as a symbol of commerce and trade. It was only in the late 19th century that the caduceus began to be widely accepted as a symbol of medicine. Friedlander suggests that this emerged in part from the use of the caduceus as a printer’s mark by medical publishers.

A wooden caduceus symbol shown in NYAM rare book reading room

A caduceus symbol in the NYAM rare book reading room

Most significant for the use of the caduceus as a medical symbol in the 20th century was the United States Army’s General Order Number 81, July 17, 1902. Included in its new regulations concerning army uniforms was the instruction that the new Medical Department insignia would be a gold or gilt caduceus. Subsequent arguments about the symbolism of the caduceus interpreted its elements in medical terms. For example, the rod represented power, the wings intelligence and activity, and the serpents wisdom and healing. Others argued that its use should be understood more in the traditional sense associated with Hermes, symbolizing a noncombatant messenger or envoy.

Despite initial objections to the appropriation of the symbol, the caduceus is now widely used as a symbol of medical practice, while Hygieia’s bowl continues to be particularly associated with the practice of pharmacy.