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 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 wesley (at) eastridges (dot) com.

references on the subject:

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

by Cedric M. Smith, MD, FCP,
cms23 at
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.

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