Ars longa, vita brevis

Hippocrates' work hits mark with modern physicians 

Hippocrates’ work hits mark with modern physicians 

Hippocrates, the Greek physician, often referred to as the Father of Medicine, began his medical textbook titled “The Aphorismi” with the following preamble that is typically only partially quoted and almost universally misinterpreted:

Ὁ βίος βραχύς,

ἡ δὲ τέχνη μακρή,

ὁ δὲ καιρὸς ὀξύς,

ἡ δὲ πεῖρα σφαλερή,

ἡ δὲ κρίσις χαλεπή.

Life is short,

and art long,

opportunity fleeting,

experimentations perilous,

and judgment difficult.

The first two lines are well-known, and commonly cited by people my age. They are spoken at certain times, such as at the end of a long day while sharing a nice bottle of wine. They are meant to communicate along the lines that one should try to enjoy life while it lasts.  Sort of like “eat drink and be merry, for tomorrow we may die.” Others have interpreted the two lines as saying that while our time on this earth is short, works of art can endure for much longer.

Previously by Dr. McDonnell: Dust yourself off 

Reading the whole passage and knowing that Hippocrates was speaking to his fellow physicians and students of medicine makes it clear that this is not about some philosophical statement about the transcendence of music or poetry.

The meaning of “life is short” is clear, but the statement about art being long is a reference to the long amount of time required for a physician to master his (or her) art or craft.  This will resonate with today’s physicians, who are all too aware of the many, many years of study and delayed gratification required to one day become board-certified.

Similarly, we physicians today use the phrase “state of the art” when we talk about surgical techniques or advanced medical therapies, and we are not referring to painting or music. One scholar suggests that Hippocrates was telling us that “it takes a long time to master our medical knowledge and technical expertise, and then we have a relatively short time left to put that skill to use.”¹ Those two or three decades of practice represent our “opportunity fleeting.”

As someone who has been engaged in clinical trials of ophthalmic medications and surgical devices for two or three decades, I have a special affection for the line that speaks to the risks of human subjects research: “experimentations perilous.” My sense is that many centuries ago, when medical science was rudimentary and there were no Institutional Review Boards, it was indeed extremely perilous to have a physician experiment with one’s health.  

Related: 

The concluding line-“and judgment difficult” -is beautiful in its understatement and makes me think of the times in a physician’s career when there is no clear scientific data to guide the care of a patient, but a number of options with different potential pros and cons.  In those situations the physician or surgeon has to take responsibility for making a judgment regarding the best path forward for his or her patient.  Taken as a whole, my assessment of this work by Hippocrates is that he is speaking to his audience and alerting them to some key challenges that a physician must face.    

Of note, recent work by Pierre Delecto, an obscure and controversial scholar of ancient Greek working in Baltimore, suggests that fading of the ink over more than two millennia resulted in the final line of this introductory paragraph having been overlooked until now. The addition of this sixth line, heretofore unknown, truly underscores Hippocrates’ remarkable knowledge of medical practice:

Life is short,

and art long,

opportunity fleeting,

experimentations perilous,

and judgment difficult,

and getting reasonable and timely payment from the insurance companies impossible.

References:

1. https://www.phrases.org.uk/meanings/ars-longa-vita-brevis.html