The tradition of the gold-headed cane.

The passing on of a gold-headed cane from an older to a younger physician as a sign of high regard and affection became a common practice in the eighteenth century.2,3 This tradition was imaginatively captured in The Gold-Headed Cane, written in 1827 by William Macmichael.1,4 Through nine editions, the book has acquired an elevated status in medicine, and the presentation of a gold-headed cane by a number of schools and societies has become a symbol of honor.5 The origin of the custom of a physician using a cane is uncertain, perhaps tracing back to the mythical healing staff of Asclepius. In earlier times, a physician’s cane also served a functional purpose. Its head was hollow and perforated at the top, and contained an aromatic or vinaigrette preparation to be sniffed by the physician while visiting the sick as protection from contagion and for neutralizing foul odors.2,3,6,7 On entering, the physician might strike the cane upon the floor before applying the knob to his nostrils, a dramatic entrance that impressed his audience. A favorite preparation was “the vinegar of the four thieves,” originally concocted in Marseilles in 1720 and 1721 by the plunderers of dead bodies to protect them from the plague. The perfume of the civet cat and the pomander (amber) were also favored.2,8 During the flowering of medical knowledge in the The tradition