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MEDICAL HISTORY MOSAIC
Hippocrates Asclepios Galen Vesalius ...
(Chiron Chiropractice ...)
(Humanism Ethics Primum Non Nocere Caviat Emptor ...)
Notes and Comments by W. Wertelecki, M.D.
The aspiration of Colleges of Medical Arts and Sciences is to capacitate prospective physicians to articulate artistically or at least as skilled artisans, therapies attuned to science in harmony with the uniqueness of each ailing person. The mosaic by Conrad A. Albrizio, gracing the lobby of the University Hospital in Mobile Alabama artfully articulates emblems and symbols of medical ideals and the legacy of pioneers of humanistic and ethical medicine.
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Intelligent landscape of the history and ideals of Medicine
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The central focus of the mosaic is on Hippocrates who illuminates the landscape with a lamp energized by a core idea articulated by Protagoras, famous as a teacher of virtues and who proposed that “man is the measure of all things”. This marked the departure of Medicine away from mysticism, theology and religion toward science and humanism. This aphorism shifted the attention by Greek thinkers toward the biologic, social, political and ethical nature of man. They became interested in why the human animal was unique for its penchant to seek cures, the worship health and aspirations to transcend self. The result of their pioneering inquiries gave rise to Philosophy, Ethics and Sciences and at their crossroad emerged Medicine. Inherently Medicine must harmoniously blend humanistic, scientific and ethical ideals to nurture the art of healing. Much of medical wisdom and prudence flows from Socrates, Plato, Aristotle, Hippocrates, Asklepios (Asklepius, Asklepios, Asculapius, Aesculapius, Aesculapios, Aeskulapios, Esculapio) and later Galen, Vesalius and other medical humanists like them. From the roots emerged the concept of a University of Medical Arts and Sciences, currently often reduced to Schools or Colleges of Medicine.
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Nearly contemporaries, the mortal Asculapius and Imhotep became deified as the
personifications of humanistic ethical Medicine. Both were seen as descendents of the God-sun (Apollo) and as ideals of wisdom and prudence.
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The two figures flanking Hippocrates are Aesuclaipus and Imhotep (Imhopt, Immutef). More distant are shown Galen and Vesalius. Galen is holding a skull and cogitating about comparative morphology, perhaps even about evolution. Vesalius is shown caring for a patient, perhaps as a reminder that those solely mesmerized by “basic” or “pure” medical sciences and untouched by clinical arts are medically underdeveloped. The same point emerges from the white outline of a surgeon integrating the quartet, Hippocrates, Asclepius, Galen and Vesalius. The “helping hands” or cheiro extended by the surgeon are a reminder that Aesculapius was trained by Cheiron to engage in Chiropractice. Surgery is put in practice in a “quirofano” or surgical operating rooms where surgeons apply their intelligence, knowledge, skills and experience enhanced by manual talents to demonstrate their mastery of Kheirurgia or Surgical Arts.
Galen, as physician to Emperor Marcus Aurelius, made the world aware of the Hippocratic Corpus compilation of medical arts and sciences. Centuries later, Vesalius updated the Hippocratic Corpus and became an emblem of the medical renaissance. The most constant element in the Hippocratic Corpus is the Hippocratic oath that begins with “I swear by Apollo and Ascelpius …” and conveys the “primum non nocere” or “first no harm” principle upon which Medical Ethics stands. Apollo in this oath and apologia stands as the father of Aesculapius and as Helios or the “enlightener” by truth, the master of music thus harmony as the central element of health and healing.
Aesculapius and Imhotep were virtually contemporaries and with passing time their reputations as healers reached legendary proportions. Their names became immortal and although conceived as mortals, both were elevated to demigods to be worshiped as personifications of Medicine, healing and compassion.
Aesculapius is shown holding a medical staff sustaining a single serpent and Imhotep is holding a scalpel and a plumb. Aesculapius knew that “harmony heals” and that “truth can blind or kill”, both aphorisms apply to Apollo who proclaimed these facts. Perhaps enthusiasts for “fact based medicine” often unbalanced by humanism may become apologetic after exploring the ideals inherent in Apollo and Aesculapius. The humanistic nature of Medicine is underscored by the simplicity of the Aesculapian medical staff, a simple unadorned walking stick. The staff represents authority and willingness to learn and share knowledge by engaging in “clinical staff rounds” and by pilgrimages to medical centers of excellence. The single serpent is an emblem of knowledge, wisdom and prudence. Jointly, the medical staff and serpent represent peripatetic humanistic physicians and should not be confused with the elaborate luxurious divine caduceus of Hermes or Mercury. His caduceus is adorned by wings and ribbons denoting his ethereal divinity and by two serpents representing fusion of dualities by divine powers. The duality of sex among mortals did not apply to Hermes. With Aphrodite Hermes had a son called Hermaphorditus who was both and neither a man or woman. As protector of thievery and Merchants, Mercury fostered the confluence of mercenary interests or deal making and upheld the motto “caviat emptor” or “consumer be aware” defining the pursuit of lucre. This is perhaps the most critical difference with the medical staff of Aesculapius where the single snake represents that physicians must solely be guided by what benefits their patient. When Aesculapius failed to adhere to this ethic and became interested in a bribe, Zeus dispatched him with a fulminating bolt.
The peacock, near the shoulder of Hippocrates, is an emblem of Aesculapian medical alertness now often found crowning Christian churches. When facing death, Socrates thoughts turned to Aesculapius and not to Hermes who as Psychopompos conducted the souls of the dead to the underworld. Plato notes in his “Phaedo” that Socrates alerted his disciples that “… we owe a cock to Aesculapius”. Socrates was convinced that the soul can triumph over death and chose to drink poison instead of seeing his soul whiter in silence as demanded as the price of his pardon. Physicians may ponder about those who can not silence their souls and in despair contemplate suicide or seek help from alcohol or other stronger thanatophoric altering drugs. As Psychopompos, Hermes relies on Hypnos and his twin Thanatos who offer hypnotic and deadly sleep. Morpheus, as the son of Salus, adds his talents as shaper of dreams. With their help, the souls of the dead reach oblivion in a state of deadly ataraxic imperturbability and painlessly enter the dark and silent realm of the underworld. The newest assistants of Pshychopompos are now illicit drug cartels fueling epidemic abuse of mind altering drugs providing stunned dying souls for Hermes to escort to Hades.
Another emblem of Medicine is Imhotep, once even better known than Aesculapius. He stands near an “Eye” representing vision and providence which in medical parlance is called prognosis. Imhotep like Asclepius, was seen as a descendant of the God-sun and is the first polymath, architect and most of all a physician remembered by name. Imhotep holds a scalpel and a plumb as signs of skill and knowledge. Endowed with aplomb and a plumbed character grounded in knowledge and embued with experience and esthetics, his vision stands realized to seen today. Above him is shown the Step Pyramid that stands among other unique creations in the Necropolis of Memphis he built some 4500 years ago. These emblems stress that akin to the Step Pyramid, knowledge materializes step by step, layer upon layer and that it plummets without a firm base grounded in facts. Perhaps these are the reasons why the Founding Fathers of the new nation of America used the same symbols for the Great Seal of the United States and the one dollar bill. They added the logo “Annuit Coeptis” used by Virgil for “nod of approval” and “Novus Ordum Seculorum” to stress an emerged new secular order. The 13 steps on a pyramid representing the founding colonies, crowned by the “eye of providence” and the logos seek to evoke confidence in America and its future.
The gap separating the Corpus Hippocraticus from the Renaissance is illustrated by the distance separating Galen from Vesalius. As the Eastern Roman Empire was weakened by religious conflicts with the Papacy, the Saracens became the inheritors of the Corpus Hippocraticus and Galenic Medicine while in Western Europe medicine entered the dark ages. Charlatans, mystics and alchemists obscured medicine by their pursuit of lucre and by merchandizing secret elixirs and magic love potions. It was then that these early pharmacists abandoned the staff of Aesculapius in favor of the caduceus of Hermes. Today these trades continue to be lucrative and are merchandized as over the counter medications. The formulations, then as now, remain hermetic secrets, an attitude contrary to the open formularies promoted by medical traditions. The dark ages abated as Saracen conquests and cultural influences injected Arab Galenic Medicine throughout Sicily, southern Italy and Spain. From the cities of Palermo Salerno, Naples, Cordoba and Toledo, Arab Galenic Medicine rapidly spread to Medical Universities in other free cities dotting the Italian peninsula. The vigor of the medical renaissance is evident from the life of Vesalius who, although a native from Brussels, traveled amply and was welcomed as a scholar and teacher by Universities in Pavia, Padua, Bologna, Leuven and Paris. Medical renaissance owes much to Fredrick II, the Hohenstaufen King of the Romans known as “stupor mundi” for his stupendous and astonishing humanism. Fredrick II did not believe in expelling the Saracens from Sicily as occurred in Spain nor did he believe in things that could not be explained by reason. It was he who forbade physicians from benefiting by acting as their own pharmacists, a tradition now challenged by the invasive merchandizing by pharmaceutical corporations. Rich corporations now offer material rewards to selected physicians who prescribe their newest and most expensive products with peculiar enthusiasm probably driven by pecuniary aspirations. Provocatively, investigators have shown that pharmaceutical, hospital and health care services corporations including the US Armed Forces favor Mercury’s caduceus as their emblem in contrast to physicians who retain their preference for the staff of Aesculapius.
Above the head of Aesculapius is shown an oracle, an emblem similar to four winged angels or tetramorphs decorating many Christian temples. Angels are vehicles linking mortals with deities and in medical terms, the mind with the conscience. Humanitarian clinicians understand the need to know how to denude “naked” facts from knotty nodes and asperities to convey an essence in manners and doses that will sustain hope and stimulate the will to heal and live. This challenge is also represented by the cobra on the head of Imhotep and under the feet of Hippocates denoting wisdom, alertness and prudence as a component of wise therapies.
At the feet of Aesculapius is shown a temple-hospital as a reminder that the ancient curative regimes emphasized the restoration of health by gymnastics, rest and sleep during which patients “incubated” their cures. This approach persists in Europe where “curords” offer “curative regimes” to those seeking to “cure” or invigorate their “health”.
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A stunned mother by the human life materializing in her matrix.
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Below the emblems of biochemistry and pharmacy are shown a mother and a glowing maternal matrix within which a child materialized. The mother seems stunned perhaps because of shattered myths that held the uterus to be a safe-heaven for the unborn. Only recently, it has became evident that drugs and other environmental factors can cause lethal or debilitating malformations. Now parents instead of asking the proverbial question, is “it” a “boy or girl”, ask if the baby is free of “birth defects”, a recently coined term by the March of Dimes Foundation. As pre-conception health promotion policies take hold, parents are made aware that nearly 50% of embryos face spontaneous early demise due to fatal malformations, a process referred to in medical parlance by another recently coined concept known as Terathanasia.
Below the mother and infant is depicted a “terminal care” scenario. It could be imagined that the patient embodies the “primum non nocere” principle, that the imaginary etiology of the illness are the noxious effects of rules delaying, rationing and distorting medical care and that the prognosis is grave. The therapy, according to some scholars, is to replace the commercialism of health services driven by a pursuit of profits by return to medical professionalism driven by a pursuit of cures and health. Such solution is known as “the third option” which conveys the notion that corporations and government have proven their incompetence to provide health care and that a return to “primum non nocere” medicine is the best alternative.
The mosaic by Albrizio shows his intelligence, skill and talent to harmoniously integrate complex landmarks of the history and ethics of medicine. The work is clearly the creation of an artisan and those beholders who find the mosaic to be provocative, that it penetrates across their membranes of memory and that provokes unpredictable feelings or ideas, could also call this creation a work of art. Many medical students who observed this mosaic now practice as medical artisans. Among them are those who were endowed with a spirit of a scholar and a will to learn from the psyche and soma of their patients. These physicians most likely practice clinical arts and also are the most likely to remember and find inspiration in the mosaic by Albrizio.
(Note: related overview) |
