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Why the Hippocratic ideals are dead

BMJ 2002; 324 doi: (Published 15 June 2002) Cite this as: BMJ 2002;324:1463

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The origin of "Primum non nocere"

Once and again, with annoying frequency, the phrase "Primum non
nocere" is attributed to Hippocrates, and even included frivolously in the
Oath. Occasionally the famous injuction has been made a creature of Galen.

According to Worthington Hooker(1), the more distinguished American
medical ethicist of the 19th century, the credit must go to the Parisian
pathologist and clinician Auguste François Chomel (1788-1858), the
successor of Läennec in the chair of medical pathology, and the preceptor
of Pierre Louis. Apparently, the axiom was part of Chomel's oral teaching.

The historical circumstances surrounding the coining of this
relatively modern but intemporal expression, are brilliantly described by
Sharpe and Faden (2): it was a time of conflict, when the aggressiveness
of traditional therapists clashed with the abstentionism of the believers
in the healing capacities of natural processes.

Gonzalo Herranz, M.D.
University of Navarre, Pamplona, Spain

1. Hooker W. Physician and Patient. New York: Baker and

2. Sharpe VA, Faden AI. Medical harm. Historical, Conceptual, and
Ethical Dimensions of Iatrogenic Illness. Cambridge, UK: Cambridge
University Press, 1998:42.

Competing interests: No competing interests

01 September 2002
Gonzalo Herranz
Professor of Medical Ethics
School of Medicine, University of Navarre, Pamplona, Spain