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HISTORICAL VIGNETTES IN VASCULAR SURGERY Norman M. Rich, MD, Section Editor
A contemporary perspective of the first aphorism of Hippocrates
George A. Antoniou, MD, PhD,a Stavros A. Antoniou, MD,b George S. Georgiadis, MD,c and Athanasios I. Antoniou, PhD,d Manchester, United Kingdom; Marburg, Germany; and Alexandroupolis and Komotini, Greece
Life is short, the Art long
—Hippocrates Aphorism is a term used to describe a truth of general import conveyed in a short and pithy sentence.1,2 It is usually spoken or written in a laconic and memorable form. An aphorism is literally a distinction or a definition and has been defined as a concise expression of doctrine or principle presenting an evident truth concerned with life or nature. Aphorisms are considered to have universal validity. In the words of the Oxford English Dictionary, aphorism signifies a concise statement of a principle in any science.3 The etymologic origin of the word dates back in the ancient Greek language (, aphorismos).4 It de- rives from the verb (aphorizo), which means to mark off, to divide, or to distinguish. The word (aphorizo) is a compound word consisting of the prefix (apo), which means from, and the verb (horizo), Fig. Relief depicting the God Amphiaraos (ancient Greek God, which means to define, to bound. patron of patients) treating a patient and the snake symbolizing the The earliest aphorisms were formulated by Hippo- God Apollon (dedicatory column of the age of Hippocrates; first crates, who expressed a long series of propositions concern- half of 4th century BC). ing disease and the art of healing and medicine. Celebrated as the Father of Medicine, Hippocrates was born on the Asclepius. He practiced holistically in several medical disci- Greek island of Cos around 460 BC, the golden age of plines, and his methods of prognosis and diagnosis, such as ancient Greece, and is thought to be descended from inspection, palpation, auscultation, and percussion, have 5 From the Department of Vascular and Endovascular Surgery, Manchester passed through the centuries to modern medicine. He Royal Infirmary, Central Manchester University Hospitals NHS Founda- changed the art of medical diagnosis by overlooking super- tion Trust, Manchestera; the Department of Visceral, Thoracic and Vas- b natural precepts and giving emphasis to observation-based cular Surgery, Philipps University Marburg, Marburg ; the Department methodology and enunciated and applied these principles of Vascular and Endovascular Surgery, Democritus University of Thrace, 6 Alexandroupolisc; and the Department of History and Ethnology, Dem- to human disease (Fig). Hippocrates asserted that the ocritus University of Thrace, Komotini.d doctor should use two distinct sources of knowledge—the Author conflict of interest: none. senses and intellect; furthermore, as a third tool, he pro- Correspondence: Athanasios I. Antoniou, PhD, Professor Emeritus of An- posed revelation or intuition.5 cient History, Souniou 11, 19001 Keratea Attikis, Athens, Greece (e-mail: [email protected]). In ancient times, medicine was an integral part of the The editors and reviewers of this article have no relevant financial relation- science of philosophy; thus, Hippocrates was a physician ships to disclose per the JVS policy that requires reviewers to decline and philosopher.7 Righteousness, ethics, honesty, and hu- review of any manuscript for which they may have a conflict of interest. man virtues characterized his medical teaching and prac- J Vasc Surg 2012;56:866-8 tice. The first part of the first aphorism of Hippocrates is a 0741-5214/$36.00 Copyright © 2012 by the Society for Vascular Surgery. quintet of epigrams that constitute the distillate of wisdom http://dx.doi.org/10.1016/j.jvs.2012.05.002 and experience.8-10 It can be interpreted as a fundamental 866 JOURNAL OF VASCULAR SURGERY Volume 56, Number 3 Antoniou et al 867 insight into the everlasting human endeavor to captivate actual type of treatment but also precisely in the right place the medical art and reminds us of the vulnerability of and precisely at the right time. “Opportunity fleeting” humanness. An assessment of its diachronic sequence and a literally means that the critical time is narrow. The phrase contemporary approach from the perspective of modern conveys the critical moments in a physician’s and, even medicine is being attempted. more, in a surgeon’s practice, that an instant decision has to be made. Actions are to be taken in those specific times FIRST APHORISM OF HIPPOCRATES: TEXT IN when expectations of efficacy are justified by the circum- ANCIENT GREEK AND ENGLISH stances and the evidence. Modern physicians are experienc- TRANSLATION ing now as ever in their practice the importance of instant Ὁ  ␣, ␦ ␣, ␦ ␣ , therapeutic interventions in the appropriate setting and the ␦ ␣ ␣, ␦ ␣ . ⌬ ␦ correct circumstances. The word (oxis) means sharp, ␣ ␦␣ ␣, ␣ intense, fast, and indicates a point in time and an instant ␣, ␣ ␣ ␣, ␣ . action. Life is short, the Art long; opportunity fleeting, exper- ... ␦ ␣ ␣ (experiment treacherous). iment treacherous, judgment difficult. The physician must The word ε ␣ (peira ϭ experience) originates from the be ready, not only to do his duty himself, but also to secure word ε␣ (peiromae), which means to try, to at- the cooperation of the patient, of the attendant and exter- tempt. Experience, along with knowledge, judgment, and nals.5 astuteness are essential tools a practitioner of medicine Another translation has been conveyed by Moses needs to possess to successfully proceed into the diagnostic Scholtz as follows11: process and provide patients with appropriate treatments. “Life is short and Art is long,” Says wise Hippocrates; In the early ages of the practice of medicine, Hippocrates Be cautious, and proceed with care, In dealing with disease. realized that previous clinical experience might be precari- Thy judgment and experience May fail you, as your skill; ous. The human body as a whole and its physiologic sys- Seek from thy patient and his nurse Their help and their tems are characterized by unfathomable variability and the good will. influence of genetic, environmental, and constitutive fac- tors, which make the course of disease and the response to CONTEMPORARY APPROACH AND ANALYSIS treatment unpredictable. Experience may be fallacious, and Ὁ  ␣ (life is short). These words sound like relying solely on previous experience can be hazardous. a saying with philosophic implications. The word ␣s ... ␦ ␣ (judgment difficult). means short in time, brief, as well as short in distance. The Reaching a solid conclusion about the correct diagnosis prefix “brachy-” appears in a number of medical terms, and and the appropriate method of treatment can be a hard task. medical professionals should be familiar with the terms Apart from knowledge, experience, and intelligence, being brachycephaly, brachydactyly, and brachytherapy. Apart able to have sound discretion and make a proper judgment from the shortness of lifespan, Hippocrates might have necessitates intuition. Because of the inherent weakness of wanted to express the fragility, uncertainty, and incom- human intellect, estimation and decision may be fallible. pleteness of life. These attributes, interwoven with human Judging patient prognosis and outcome of disease can be life, have sustained through the centuries, despite techno- precarious, even in the era of modern medicine, that ad- logic advancements and ongoing medical progress. vanced diagnostic imaging and laboratory examinations ... ␦ ␣ (the Art long). Short and long may give us a more precise picture of the patient’s condition are adjunctive attributes. The life of an individual person is and stage of disease. Physicians very often encounter dismal short and limited in relation to the perfection that an art indications, yet the patient recovers, whereas at other times entails. The word (techne) means more than an art; it when a favorable outcome is heralded, prognostic expecta- includes craft, trade and science in its meaning. It originates tions never come true. etymologically from the ancient Greek word (tikto), ⌬ ␦ ␣ ␦␣ which means give birth, create, and has been in interna- ␣, ␣ ␣, ␣ ␣␣, tional use constituting the root of the word technology. ␣ ε (The physician must be ready, not only to do The word ␣`(-)(macros) means very large in scope his duty himself, but also to secure the cooperation of the or scale. The Art of Medicine is long in relation to the rest patient, of the attendant and externals). The physician of the arts, and life of a single person would not be long must not only provide the needed treatment to the sick; enough for the medical science to be comprehended and solely making diagnoses, administering medications or per- perfection to be attained. Hippocrates’ perception of the forming medical interventions is a part only of the holistic vastness of the medical science can be appreciated more care the patient should be provided with. The physician than 2000 years later, when subspecialization has evolved should show affection, kindness, patience, and understand- through constant medical advances and progress, in order ing, like the subsequent doctors Kosmas and Damianos, for knowledge and expertise to be obtained and assimi- who lived in Byzantine times, did. Hippocrates emphasized lated. the importance of the patient’s involvement and participa- ... ␦ ␣ (opportunity fleeting). Medical tion in the therapeutic process if optimum outcomes are to intervention has to be appropriate not only in terms of the be achieved. Furthermore, the physician must be able to JOURNAL OF VASCULAR SURGERY 868 Antoniou et al September 2012 hold the confidence of the patient and those beside him. He A clear paradigm of medical practice, to which the must not only be prepared to do the right himself but also meanings of the first Hippocratic aphorism can be imple- to make the patient, the attendants, and the externals mented, may be found in vascular surgery. Its ever-expand- cooperate.9 The patient and all those about him should be ing field, with the evolution of endovascular techniques, content with doing with what is sufficient for the health of open surgical reconstructions, and multifaceted manage- the patient to be attained. In modern times, this aspect of ment of the vascular patient, reflects the length of the art. care has been substituted by psychologic support programs Thus, the modern vascular surgeon should possess specific embedded in advanced health care systems. The external expertise. The nature of vascular disease necessitates careful environment and circumstances all have to contribute to clinical judgment. A wide range of skills and competences, the patient’s health, and it is the responsibility of the like those introduced by Hippocrates, should be con- physician to remove all external impediments that prevent scripted to effectively handle the vascular disease. Experi- healing of the sick and to create appropriate conditions for ence, astuteness, intuition, and knowledge based on cur- treatment. This holistic patient care was realized by Hippo- rent evidence are all required to promptly select the crates more than 2000 years ago and is implemented in “fleeting” opportunity to treat the vascular patient. Fur- modern medical practice with the contributions of health thermore, the holistic patient care introduced by Hippo- professionals and specialists, such as physiotherapists, occu- crates is represented by the multidisciplinary approach of pational therapists, and health visitors. modern vascular practice and the trilateral relationship of the patient, the treating physician and the surrounding DISCUSSION environment. Aphorisms have a poetic merit, and some analysts have considered them to be part of poetry in their own right. The REFERENCES first aphorism of Hippocrates, in its original form, has a harmonic composition, resembling a poem. Aphorisms are 1. Shaw Q. On aphorisms. Br J Gen Pract 2009;59:954-5. formed in the context of scientific, philosophic, and artistic 2. The Free Dictionary. Aphorism. Available at: http://www.thefreedic- tionary.com/Aphorisms. works. Studying these Hippocratic words, an insight into 3. Chandler ET, Bloomfield RL. Aphorisms: wisdom for all seasons. 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