Primum non nocere
is a Latin
Latin is an Italic language originally spoken in Latium and Ancient Rome. It, along with most European languages, is a descendant of the ancient Proto-Indo-European language. Although it is considered a dead language, a number of scholars and members of the Christian clergy speak it fluently, and...

 phrase that means "First, do no harm". The phrase is sometimes recorded as .

Nonmaleficence, which derives from the maxim, is one of the principal precepts of medical ethics
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...

 that all medical students are taught in medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...

 and is a fundamental principle for emergency medical services
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...

 around the world. Another way to state it is that "given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good." It reminds the physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 and other health care providers that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.


The origin of the phrase is uncertain. The Hippocratic Oath
Hippocratic Oath
The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...

 includes the promise "to abstain from doing harm" but does not include the precise phrase. Perhaps the closest approximation in the Hippocratic Corpus
Hippocratic Corpus
The Hippocratic Corpus , or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings...

 is in Epidemics(see ): "The physician must...have two special objects in view with regard to disease, namely, to do good or to do no harm" (Bk. I, Sect. 11, trans. Adams).

According to Gonzalo Herranz, Professor of Medical Ethics at the University of Navarre, Primum non nocere was introduced into American and British medical culture by Worthington Hooker
Worthington Hooker
Worthington Hooker was an American physician, born in Springfield, Massachusetts. Worthington Hooker School in New Haven, Connecticut is named after him....

 in his 1847 book, Physician and Patient. Hooker attributed it to the Paris
Paris is the capital and largest city in France, situated on the river Seine, in northern France, at the heart of the Île-de-France region...

ian pathologist and clinician Auguste François Chomel
Auguste François Chomel
Auguste François Chomel was a French pathologist who was born in Paris. He was a professor at the Hôpital de la Charité in Paris, and in 1827 succeeded René Laënnec as chair of clinical medicine of the Faculté de Paris.Chomel was an important member of the pathological anatomy movement of early...

 (1788–1858), the successor of Läennec
René Laennec
René-Théophile-Hyacinthe Laennec was a French physician. He invented the stethoscope in 1816, while working at the Hôpital Necker and pioneered its use in diagnosing various chest conditions....

 in the chair of medical pathology, and the preceptor of Pierre Louis
Pierre Charles Alexandre Louis
Pierre Charles Alexandre Louis was a French physician, known for introducing the use of the "numerical method" in the field of medicine — i.e., the concept that knowledge about a disease, its history, clinical presentation and treatment, could be derived from aggregated patient data.Louis became...

. Apparently, the axiom was part of Chomel's oral teaching.

However, close examination reveals that Hooker did not use the specific expression or the traditional Latin phrase. A detailed investigation of the origins of the aphorism
An aphorism is an original thought, spoken or written in a laconic and memorable form.The term was first used in the Aphorisms of Hippocrates...

 was reported by the clinical pharmacologist Cedric M. Smith in the April 2005 issue of the Journal of Clinical Pharmacology. It addresses the questions of the origin and chronology of appearance of the maxim. Rather than being of ancient origin as usually assumed, the specific expression, and its even more distinctive associated Latin phrase, has been traced back to an attribution to Thomas Sydenham
Thomas Sydenham
Thomas Sydenham was an English physician. He was born at Wynford Eagle in Dorset, where his father was a gentleman of property. His brother was Colonel William Sydenham. Thomas fought for the Parliament throughout the English Civil War, and, at its end, resumed his medical studies at Oxford...

 (1624–1689) in a book by Thomas Inman
Thomas Inman
Thomas Inman was a house-surgeon to the Liverpool Royal Infirmary. In his lifetime he had numerous medical papers published. Perhaps most notably, however, he was an amateur mythologist, and as such had several non-medical papers published, including Ancient Pagan and Modern Christian Symbolism,...

 (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 prominent American surgeon, L.A. Stimson, used the expression in 1879 and again in 1906 (in the same journal). That it was in common use by the turn of the century is apparent from later mentions, such as by the prominent obstetrician
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...

 J. Whitridge Williams in 1911, as well as detailed discussion of its use in a popular book authored by Dr. Morris Fishbein, the long-time editor of the Journal of the American Medical Association
Journal of the American Medical Association
The Journal of the American Medical Association is a weekly, peer-reviewed, medical journal, published by the American Medical Association. Beginning in July 2011, the editor in chief will be Howard C. Bauchner, vice chairman of pediatrics at Boston University’s School of Medicine, replacing ...

in 1930.

The article also reviews the various uses of the now popular aphorism, its limitations as a moral injunction, as well as the increasing frequency of its use not only in medical but other contexts as well.

External links

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