Primum non nocere

Above all, do no harm!

First, do no harm.

Who created that basic principle of medical practice?

This, one of the most basic and oft repeated quotations in medical lore, is generally attributed to Hippocrates. However, as Tom Duncan, M.D. (tdun4807 at aol.com) noted in personal correspondence, Hippocrates didn't say it exactly that way, and certainly not in latin.

The correspondence and references below illustrate the uncertain origin of the phrase. Suffice it to say almost all doctors today know this caution that we not impose a treatment on a patient that has good expected benefits until we also know that it does not have detrimental effects that outweigh the good.

Here below are the references we have found to the saying. I'll let you decided who you believe coined the phrase. If anyone knows more specifics, please e-mail your insight to .

references on the subject:

from Familiar Medical Quotations

edited by Maurice B Strauss, pub. by Little, Brown and Company, p. 625:

As to diseases, make a habit of two things -- to help, or at least to do no harm.: written by Hippocrates in Epidemics, Bk. I, Sect. XI (tr. by W.H.S. Jones)

from the Joint Commission (on Accreditation of Healthcare Organizations) LEXIKON Dictionary of Health Care Terms, Organizations, and Acronyms for the Era of Reform

by Margaret R. O'Leary, MD and a team of Joint Commission experts, JCAHO, One Renaissance Boulevard, Oakbrook Terrace, Illinois

Hippocratic oath: A statement, attributed to the ancient Greek physician Hippocrates, that serves as an ethical guide for physicians and is incorporated into the graduation ceremonies at many medical schools. The duties "to do no harm" and of confidentiality are based in the Hippocratic oath. It reads as follows:; " I swear by Apollo the physician, by Aesculapius, Hygeia, and Panacea, and I take to witness all the gods, and all the goddesses, to keep according to my ability and my judgment the following Oath: To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; to look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone, the precepts and the instruction. I will prescribe regimen for the good of my patients according to my ability and by judgement and never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners (specialists in this art). In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction, and especially from the pleasures of love with women or with men, be they free or slaves. All that may come to my knowledge in the exercise of my profession or outside of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."

from Origin and Uses of Primum Non Nocere - Above All, Do No Harm!

by Cedric M. Smith, MD, FCP,
cms23 at buffalo.edu
published in J. Clin Pharmacol 2005; 45:371-377

This is the most comprehensive answer I've seen to the question. Dr. Smith writes:

The specific expression, and its specific associated Latin, has been traced back to an attribution to Thomas Sydenham (1624-1689) in a book by T. Inman (1860). The book by Inman, and his attribution, was reviewed by ‘H.H.’ in the American Journal of Medical Science in the same year. A well-known American surgeon, L.A. Stimson used the expression in 1879 and again in 1906 (in the same journal). That it was in common use is apparent from later mentions, such as by the prominent obstretician J. Whitridge Williams in 1911, and the detailed description of its use in a popular book by Morris Fishbein in 1930. The article also reviews the various uses and limitations of the now popular aphorism.

responses:

Both Dr. Duncan and another note that Osler popularized the particular phrase, but Dr. Cedric M. Smith did not find it in his search of Dr. Osler's writings..

John Morrison jdmorrison (at) fuse.net notes "never do harm to anyone" from the Hippocratic oath translates into latin as, "aut ne offendas," a different verb from noceo.
Dr. William P. Weitzel, M.D. (wweitzel (at) mem.po.com)in Lexington, KY wrote a letter to the editor of The Wall Street Journal 11/25/96 that "Primum non nocere" is attributed to the Roman physician, Galen.
The Cornell University Library (libkiosk( at )cornell.edu) sent the following interesting discussion thread in February 1999. The post is from the Feb. 1999 archives at the web site for the Sci-Med-Tech discussion list.
Re: QUERY: Primum non nocere (4) Author: "Harry M. Marks, H-SCI-MED-TECH" (smt( at )h-net.msu.edu) Date: Fri, 5 Feb 1999 14:04:47 -0500 Reply-To: "H-NET List on the History of Science, Medicine, and Technology" (H-SCI-MED-TECH( at )H-NET.MSU.EDU) Sender: "H-NET List on the History of Science, Medicine, and Technology" (H-SCI-MED-TECH( at )H-NET.MSU.EDU) Robert Baker (bakerr( at )union.edu) writes: To the best of my knowledge the exact source of the Latin is unknown. The line probably originates, not from the Oath (and is not in the major Latin versions of the Oath) but from Epidemics. In the W.H.S. Jones Loeb Classical Library translation the lines in question read: Declare the past, diagnose the present, foretell the future; practise these acts. As to diseases, make a habit of two things--to help, or at lest TO DO NO HARM. This passage was quoted in the Latin language commentary literature--although I do not know of anyone who has figured out which was the earliest or the most influential commentator to highlight this passage. Cheers Bob Baker Bob Baker bakerr at union.edu Professor Robert Baker Department of Philosophy Union College Schenectady, New York 12308 Phone: 518-388-6215 Fax: 518-388-6462 ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Jack Eckert (jack_eckert at hms.harvard.edu) writes: Dear Dr. Stone: We've been doing some wading through old reference files here at the Countway Library, and I happened to recall there was a file about this particular question. If you can get a hold of the following, it might help: Sandulescu, C. "Primum non nocere: philological commentaries on a medical aphorism" Acta Antiqua Hungarica, v. 13 (1965): 359-368. I have a photocopy of this article if you are unable to obtain it elsewhere. Our reference file also contains a 1985 letter from Jody Rubin, a member of the Classics faculty at the University of Pennsylvania (at least at that time) about the phrase. Dr. Rubin states: "As to why the phrase was passed down in Latin rather than the original Greek, it should be remembered that the knowledge of Greek died out in Europe in the Middle Ages. Hippocrates was read and copied in Latin by monks and physicians alike. When the Hippocratic writings were first printed in the fifteenth century, they appeared in Latin translations. The first book of the Epidemics, which contains the maxim in question, was not known in medieval Europe. It was not printed until the sixteenth century, when all seven books of the Epidemics were issued in a Latin translation." You might also want to send your inquiry out on the Caduceus-L list to reach the history of the health sciences group who may have some additional information. Please contact me if you need additional information on this matter. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Stephen Greenberg (GREENBES at mail.nlm.nih.gov) writes: It's not from the oath: it comes from _Epidemics_, Book 1, Section 11 (in the Loeb Classics edition). Obviously, that's in Greek. The Hippocratic corpus has a rather tortured history, and it's hard to say when any of it first appeared in Latin. Stephen Greenberg History of Medicine Division National Library of Medicine ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Laurel Graham (l-graham at nwu.edu) writes: John Morrison jdmorrison at fuse.net notes "never do harm to anyone" from the Hippocratic oath translates into latin as, "aut ne offendas," a different verb from noceo. Dr. William P. Weitzel, M.D. in Lexington, KY wrote a letter to the editor of The Wall Street Journal 11/25/96 that "Primum non nocere" is attributed to the Roman physician, Galen. Laurel Graham Northwestern University, Evanston, IL. USA l-graham at nwu.edu Send comments and questions to H-Net Webstaff Copyright © 1995-99, H-Net, Humanities & Social Sciences OnLine Click Here for an Internet Citation Guide.

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