High Court Of Justice Before MR. JusTicE McNAm and a jury Judgment was entered for the defendants in this action by Mr. John Hector Bolam against Friern Hospital Management Com- mittee claiming damages for alleged negli- gence in electro-convulsive therapy (E.C.T.) treatment administered to the plaintiff on August 23, 1954. The plaintiff alleged that the defendants were negligent in failing to take pre- cautions against the risk of injury. The defendants denied negligence. Mr. N. R. Fox-Andrews, Q.C. and Mr. Roger Ormrod appeared for the plaintiff; Mr. James Stirling, Q.C., and Mr. E. Sutcliffe for the defendants. S'UMMING-UP MR. JusricE McNAnt, summing up to the jury, said that when the case was opened andl they were told the really tragic story of the plaintiff's sufferings and experience, they must inevitably have been moved to pity and compassion, but, as counsel had rightly told them, they were entitled to give damages only if the defendants had been proved guilty of negligence. The case must be looked at in its proper perspective. They had been told by one doctor that he had had one acetabular fracture in 50,000 cases, and it was clear that the particular injury sustained by the plaintiff was one of extreme rarity. ENORMOUS BENEFIT TO HUMlANiTY Whereas some years ago when a patient went into a mental institution afflicted with mental illness, which it was agreed was one of the most terrible ills from which humanity suffered, he had very little hope of recovery and could only expect to be carefully and kindly treated until merciful death released him from his sufferings, to-day, according to the evidence, the posi- tion had changed. Practitioners from lead- ing hospitals had put before them quite staggering figures. To-day a man suffering from some particular types of mental dis- order had a real chance of recovery. One doctor had said that in his view that was due almost entirely to physical methods of treatment, of which E.C.T. was the most importanL In approaching this case. and considering whether negligence was proved against the defendant hospital, they must bear in mind the enormous benefits con- ferred upon unfortunate men and women by this form of treatment. NO STANDARD TECHINIQUE The use of E.C.T. had been progressive, and they (the jury) might think that even to-day there was no standard, settled tech- nique on all points with which all com- petent doctors would agree. The doctors called as witnesses had mentioned in turn the different techniques they used. Some used restraining sheets, some relaxant drugs, some manual control; but the final question was, whether or not Dr. Allfrey, in following the practice which he had learnt and had been shown at Friern, was negligent in failing to use relaxant drugs, or, when he was not using relaxant drugs, in failing to exercise any restraint beyond arranging for the plaintiff's shoulders to be held, his chin supported, and a pillow placed behind his back. A professional man was not guilty of negligence if he acted in accordance with a practice which was accepted by a com- petent body of professional men skilled in that, particular art, merely because there was a body of opinion which took the contrary view. That did not mean that a medical man could obstinately and pig- headedly carry on some technique if it was proved contrary to substantially the whola body of medical opinion. It was not essential for the jury to decide which of the practices was the better. They must remember also that August. 1954, was not February 1957. and they must not look with 1957 spectacles at what had happened in 1954. SHOULD WARNING HAVE BEEN GIVEN ? As to the allegation that the defendants were negligent in not warning the plaintiff of the risks involved in the treatment, two questions arose: first, did good medical practice require that a warning should be given to a patient before receiving E.CT. treatment ? Secondly, if a warning should have been given, and was not, what differ- ence would it have made, and were they (the jury) satisfied that the plaintiff, if told of the risks. would have refused to take them ? Did the defendants' practice. to say very little and wait for questions, faU below the standard required by competent professional opinion; would it or would it not have been right to warn ? They might well think that a doctor, when dealing with a mentally sick man and having a strong belief that his patient's only hope was AFCT., should not be criticized if he did not stress the dangers, which he believed to be minimal, involved in that treatment. If they thought that the warning ought to have been given. then the only person who could answer the second question. whether it would have made any difference, was the plaintiff. He (his Lordship) had been wait- ing for the plaintiff to be asked that ques- tion, but it had not been put to him, and it would be mere speculation on their part to decide what his answer might have been. He might weU have said that. rather than continue in his condition, he would take the treatment with the risks involved. Unless the plaintiff had satisfied them that he would not have taken the treatment if he had been wamed they might well think that there was nothing in that point. BALANCING THE RIlSKS The defendants said that, balancing what they believed to be a remote risk of frac- ture against the remote risk of mortality. they decided not to use relagants except in special cases. Was it open, on the whole of the evidence, to say that the mere failure to give relaxants was negligent ? All the witnesses had agreed that there was a firm body of opinion against the use of relax- ants as a routine, although one, Dr. Randell, preferred to take the risk of re- laxants and eliminate the risk of fracture. As to the use of restraint, there again the defendants said that there were two schools of thought, the one they adhered to being that if a patient was held down the risk of fracture was in fact increased, and they had accordingly since 1951 adopted a new technique of leaving the patient's limbs free. It was interesting, as showing the diversity of practice, that Dr. Page at the Three Counties Hospital treated his patients in bed controlled to some extent by the coverings, but it was not right to take that as condemning the practice adopted by the defendants. Referring in conclusion to the remarks of Lord Justice Denning in Roe v. Minister of Health ([1955] 2 Q.B. 66) his Lord- ship said that medical science had conferred great benefits on mankind but those benefits were attended by risks and we could not take the benefits without the risks. After a retirement of about half an hour the jury returned a verdict for the defen- dants but added that they would like to express their sympathy for the plaintiff in his terrible injuries and hoped that some organization would help to alleviate his position. His LositismP said that no doubt their observations would be taken into account in the proper quarters. MR. STIRLING said that he understood that the plaintiff was a legally assisted person and in the circumstances he did not ask for any effective order for costs but, as a matter of form. he asked for a suspended order. His LORDSHIP said that judgment would be entered for the defendants with costs, no taxation to take place until further order. Solicitors.-Messrs. Pennington and Son; Messrs. J. Tickle & Co. HIGH COURT OF JUSTICE QUEEN'S BENCH DIVISION PHYSICAL WAY OF TREATING MENTAL ILLS VINDICATED: INJURED MAN LOSES BOLAM v. FRIERN HOSP1TAL MANAGEMENT COMMflTEE