The Hippocratic Oath and the phrase it never contained
"First, do no harm" is often presented as a line from the Hippocratic Oath. The classical oath contains promises about avoiding harm, but it does not contain that familiar four-word sentence. Wikipedia's account states that the original text has no expression corresponding to "first" or "primum." A related ethical commitment appears in the ancient document, while the exact slogan has a separate and uncertain history.
The Hippocratic Oath was written in Ancient Greek, and Wikipedia dates its composition between the 5th and 3rd centuries BC. It belongs to the Hippocratic Corpus and is traditionally associated with Hippocrates, although its authorship is disputed. Its opening invokes healing deities as witnesses to a physician's commitment. NOVA's version names Apollo Physician, Asclepius, Hygieia, and Panaceia, along with all the gods and goddesses. The classical text begins with this invocation, followed by obligations to the physician's teacher.
The classical translation reproduced by PBS NOVA was made by Ludwig Edelstein. NOVA credits it to The Hippocratic Oath: Text, Translation, and Interpretation, published by Johns Hopkins Press in 1943. Its treatment clause pairs the benefit of the sick with a promise to "keep them from harm and injustice." A later clause concerns entering houses for the sick person's benefit and avoiding intentional injustice. Neither clause says that avoiding harm comes first.
The Hippocratic Oath also describes obligations to the person who taught the profession. In Edelstein's version, the teacher is placed on a level with the physician's parents. The text discusses financial support for the teacher and teaching specified family members without a fee. It also includes a promise of confidentiality about matters encountered both during treatment and outside it. It closes by contrasting the honor associated with fulfilling the oath with the consequences of violating it. These passages show how much broader the document is than the short slogan.
A related line appears in Epidemics, Book I, another work in the Hippocratic collection. Francis Adams's translation says the physician has two objects in view concerning disease: "to do good or to do no harm." Project Gutenberg reproduces that passage in The Genuine Works of Hippocrates. Doing good appears before avoiding harm, and the conjunction offers an alternative. The passage supplies an ancient parallel to the idea, but it does not supply "first" or make the slogan part of the Hippocratic Oath.
A later printed discussion appears in Worthington Hooker's Physician and Patient. The book's title page names Baker and Scribner in New York as publisher and gives the year 1849. Hooker's preface is dated June of the same year. Hooker quoted Elisha Bartlett's discussion of Chomel, calling the principle "the golden axiom of Chomel." In that passage, doing good is described as the second law of therapeutics, and the first is not doing harm. This records how the priority was described in a published text in 1849.
Hooker identifies Bartlett immediately after quoting the axiom. The wording he quotes is a longer sentence about two laws of therapeutics; it does not contain the standard Latin expression or the familiar four-word English slogan. His preface addresses both the medical profession and the wider community. The same volume also reproduces the American Medical Association's Code of Medical Ethics in an appendix. Hooker explicitly identifies the association as the body that adopted the code, connecting the book with another contemporary statement of professional duties.
Cedric M. Smith examined another attribution in an article published in The Journal of Clinical Pharmacology in April 2005. As Wikipedia summarizes his research, the expression and an associated Latin form were attributed to Thomas Sydenham in Thomas Inman's 1860 book Foundation for a New Theory and Practice of Medicine. Sydenham lived from 1624 to 1689, so that attribution appeared long after his lifetime. Wikipedia describes the expression's origins as uncertain. Smith's reported finding identifies an attribution in print; it does not establish that Sydenham coined the saying.
Later ethical documents have their own wording and dates. The American Medical Association records that it adopted its Code of Medical Ethics in 1847. The World Medical Association's Declaration of Geneva was adopted in September 1948, according to the declaration reproduced in African Health Sciences on PubMed Central. That reproduction includes amendments through October 2017. It begins with a pledge of service to humanity and makes the patient's health and well-being the physician's first consideration. This language belongs to the declaration, a separate document with its own history.
The Hippocratic Oath, the passage in Epidemics, and later statements about harm share related concerns. They are different texts. The original oath contains promises to avoid harming patients, but the familiar sentence "First, do no harm" does not appear in it. The precise origin of that slogan remains uncertain.
- Wikipedia, Hippocratic Oath — en.wikipedia.org
- PBS NOVA, The Hippocratic Oath: Classical Version (Ludwig Edelstein, 1943) — www.pbs.org
- Hippocrates, The Genuine Works of Hippocrates, vol. 1, translated by Francis Adams (Epidemics, Book I; Project Gutenberg) — www.gutenberg.org
- Worthington Hooker, Physician and Patient (1849; Project Gutenberg) — www.gutenberg.org
- Wikipedia, Primum non nocere — en.wikipedia.org
- American Medical Association, AMA Marks 175th Anniversary (2022) — www.ama-assn.org
- World Medical Association Declaration of Geneva, African Health Sciences (2017; PubMed Central) — pmc.ncbi.nlm.nih.gov