The First Aphorism of Hippocrates

THE FIRST APHORISM OF HIPPOCRATES DICKINSON W. RICHARDS, M.D.* Life is short, the art long, opportunityfleeting, experiment treacherous,judgment difficult. This quintet ofepigrams, as everyone knows, forms the first part ofthe First Aphorism of Hippocrates. It sets forth, as a background for the teaching ofthe practice ofmedicine, the difficulties and the hazards which the physician must face. The beginning is as impressive as it is famous—the gently fatalistic contrast between life and "art," stated with simplicity and clearness. The last three epigrams are sound doctrine also, but these are not as clear; partly, no doubt, because the translations of them differ considerably from one version to another, but partly because they seem disconnected, with no consistent or logicalsequence from one to another. Can there be something more, still to be found, in this notable passage? Would it be permissible even at this late date in history to survey once more the First Aphorism of Hippocrates to discover, if we can, some more coherent thought and stronger meaning? In its original form it is a beautiful composition, so regular, so equal in its parts, that it is almost a poem that can be scanned: ? ßios ß?a??? ? d? t???? µa??? ò d? ?a???? ???? ? d? pe??a sfa?e?? ? d? ???s?? ?a?ep? ò ßios ß?a???. The life short.—Here is a saying that has been uttered, very likely, by every priest, prophet, or philosopher since human history * First Medical (Columbia University) Division, Bellevue Hospital, and the Department ofMedicine , Columbia University College ofPhysicians and Surgeons, New York, New York. The author expresses his acknowledgment to Dr. André Cournand, who helped to complete the thought in this briefessay. 61 began. But Hippocrates was as much aware ofthis as we are. He simply states here his premise as his account begins, and he finds in it a profound generality which will pervade the whole. It gives the setting in which we all are, its uncertainty, its incompleteness. It is the somber cloud that overhangs the scene that is to be played before us. ? d? t???? µa???. And the art long.—The word that concerns us here is t????, techné. This familiar word form is used by all of us in one combination or another a thousand times a day, and rightly so. It means art, and much more: art, craft, science, and trade, all in one; here the whole technological and educational apparatus that go to make up the practicing physician. This is long, as Hippocrates knew, and as we know, very well. The process reaches farther back than we can remember, and on ahead to the end ofour days. And life is short. There is no turning back. Have we still time, in these short years, tojustify so long a preparation ? ? d? ?a???? ????. And the right time but an instant.—?a????, kairós, means fit, suitable, appropriate, precisely the right place, precisely the right time. Hippocrates makes frequent use of kairós; also its opposite, akairós, to designate something unsuitable or ill-timed, ????, oxús, is another powerful and striking word. It means sharp, keen, pointed, or quick, a point in time, an instant. The whole phrase, then, describes and comprehends those critical moments of decision that face us so often in the practice ofmedicine. One day, one hour, one instant too soon or too late, and all is lost. One remembers many such times; it is late at night, the moment is now, and I must decide. ? d? pe??a sfa?e??. And the trial precarious.—The word pe??a, peira, is not "experiment" in the modern sense. Hippocrates was not an experimental scientist, he was an observer and a doer, discerning, effective, practical , the supreme clinician. The word comes from pe????, to try or to attempt. So pe??a is simply a trial of any kind: medicine, or other treatment, in clinical practice. The next word is sf??e??, sphaleré, and this gives us a momentary lightness of touch. The word comes from sf????, which was a term in Greek wresding and meant to trip up, to tumble someone on the ground. So sfa?e?? means slippery, stumbling , precarious. Hippocrates liked this word, and it was thus that in his direct...