6/16/2017 WhitehousevJordan[1980]UKHL12(17December1980)

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JISCBAILII_CASE_TORT

ParliamentaryArchives,
HL/PO/JU/18/240

DieMercurii17Decembris1980

UponReportfromtheAppellateCommitteetowhom
wasreferredtheCauseWhitehouse(AssistedPerson)
(suingbyhismotherandnextfriendEileenWhitehouse)
againstJordanandothers,ThattheCommitteehad
heardCounselaswellonMondaythe27th,Tuesday
the28th,Wednesdaythe29th,andThursdaythe30th
daysofOctoberlastasonMondaythe3rddayof
NovemberlastuponthePetitionandAppealofStuart
CharlesWhitehouseofEastLeigh,RowneyGreen
Lane,RowneyGreen,AlvechurchintheCountyof
WorcesterprayingthatthematteroftheOrdersetforth
intheSchedulethereto,namelyanOrderofHer
Majesty'sCourtofAppealofthe5thdayofDecember
1979mightbereviewedbeforeHerMajestytheQueen
inHerCourtofParliamentandthatthesaidOrder
mightbereversed,variedoralteredorthatthe
Petitionermighthavesuchotherreliefinthepremises
astoHerMajestytheQueeninHerCourtofParliament
mightseemmeetasalsoupontheCaseofJ.A.Jordan
andtheBoardofGovernorsoftheUnitedBirmingham
HospitalsBoardlodgedinanswertothesaidAppeal
anddueconsiderationhadthisdayofwhatwasoffered
oneithersideinthisCause:
ItisOrderedandAdjudged,bytheLordsSpiritual
andTemporalintheCourtofParliamentofHer
MajestytheQueenassembled,ThatthesaidOrderof
HerMajesty'sCourtofAppeal(CivilDivision)ofthe
5thdayofDecember1979complainedofinthesaid
Appealbe,andthesameishereby,Affirmedandthat
thesaidPetitionandAppealbe,andthesameishereby,
dismissedthisHouse:anditisfurtherOrdered,That
theAppellant'sCostsinthisHousebetaxedin
accordancewiththeprovisionsofschedule2tothe
LegalAidAct1974.

Whitehouse(A.P.)(suingbyhismotherandnextfriendEileenWhitehouse)(Appellant)v.Jordanand
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Whitehouse(A.P.)(suingbyhismotherandnextfriendEileenWhitehouse)(Appellant)v.Jordanand
others(Respondents).

DieJovis19Februarii1981

AfterhearingCounselfortheRespondentsandfor
theLawSocietyonaQuestionofCostsoutoftheLegal
AidFund:
ItisOrdered,bytheLordsSpiritualandTemporal
intheCourtofParliamentofHerMajestytheQueen
assembled,ThattheFirstandSecondRespondents'
CostsintheCourtofAppealandinthisHousebepaid
outoftheLegalAidFundpursuanttoSection13ofthe
LegalAidAct1974,theamountofsuchlastmentioned
CoststobecertifiedbytheClerkoftheParliaments.

HOUSEOFLORDS

WHITEHOUSE(A.P.)(SUINGBYHISMOTHERAND
NEXTFRIENDEILEENWHITEHOUSE)(APPELLANT)
v.
JORDANANDOTHERS(RESPONDENTS)

LordWilberforce
LordEdmundDavies
LordFraserofTullybelton
LordRussellofKillowen
LordBridgeofHarwich

LordWilberforce
MyLords,
StuartWhitehouseisaboynowagedten:hewasbornon7thJanuary
1970,withseverebraindamage.Inthesecircumstances,tragicforhimand
forhismother,thisactionhasbeenbrought,byhismotherasnextfriend,
inwhichheclaimsthatthedamagetohisbrainwascausedbythe
professionalnegligenceofMr.J.A.JordanwhowasSeniorRegistraratthe
hospitalatBirminghamwherethebirthtookplace.Therewereoriginally
alsoclaimsagainstProfessorMcLaren,theconsultantinchargeofthe
MaternityUnittowhichMr.Jordanbelonged,andalsoagainstthehospital
onitsownaccount.Butthesehavedisappearedandthehospital,more
exactlytheWestMidlandRegionalHealthAuthority,remainsinthecase
onlyasvicariouslyresponsibleforanyliabilitywhichmaybeestablished
againstMr.Jordan.
Alargenumberofclaimshavebeenmadesincetheeventmostofwhich
havenowbeeneliminatedorwithdrawn.Thenegligenceultimatelycharged
againstMr.Jordanisthatinthecourseofcarryingouta"trialofforceps
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"delivery",hepulledtoolongandtoostronglyuponthechild's
head,therebycausingthebraindamage.ThetrialJudge,aftera

trialofelevendaysinwhicheminentmedicalexpertswerecalledon
eachside,andnumerousissueswerecanvassed,reachedtheconclusion
whichheexpressedinamostcarefuljudgment,thattheplaintiffhasmade
goodhiscase:heawarded100,000damages.Hisdecisionwasreversed
byamajorityoftheCourtofAppeal(LordDenningM.R.andLawtonL.J.,
DonaldsonL.J.dissenting)whichrefusedleavetoappealtothisHouse.
Leavewas,however,grantedbyanAppealCommittee.Theessentialand
verydifficultquestionthereforehastobefacedwhether,onapurequestion
offact,theCourtofAppealwasjustifiedinreversingthedecisionofthe
trialjudge.

MyLords,Ineednotelaborateupontheprinciplesoflawwhichhaveto
beapplied.First,itisnecessary,inordertoestablishliabilityof,andto
obtainanawardofcompensationagainst,adoctororahospitalthatthere
hasbeennegligenceinlaw.Thereisinthisfieldnoliabilitywithoutproof
offault.Secondly,therearestrictlimitationsuponthispowerofanappeal
courttoreversethedecisionofthejudgeonanissueoffact.Thesehave
beenwellandclearlystatednotablybyLordSumnerinTheHontestroom
[1927]A.C.37,andbytheCourtofAppealinTheGlannibanta(1876)
1P.D.283,287.TheCourtofAppealhadthemfullyinmind.Themain
reasonwhy,intheabsenceofanerroroflaw,thejudgmentofthetrial
judgecallsfortheutmostrespect,isthathehasseenandheardthe
witnesses,often,asinthiscase,includingtherivalparties(themother
andMr.Jordan).Thestrengthofthisconsiderationwillvaryfromcase
tocaseaccordingasconclusionshavetobereachedastocredibility,or
basedondemeanour.Inthepresentcasetheyexistbutarenotcompelling.
Aviewhadtobeandwasexpressedastothecredibilityofthemother:she
was,generally,foundtobeincapable,intheunderstandablecircumstances,
ofgivingreliablypreciseevidence,butthereremainsaquestionwhether,
thoughwhatshesaidwasunacceptable,somethingofevidentiaryvalue
canbeextractedfromit.OnthisIconsiderthattheCourtofAppealwas
entitledtoformanopinion.
AstotheevidenceofMr.Jordan,noquestionofcredibilityarose:there
wasnodoubtthathewastellingthetruthashesawit.Thejudgedidnot

expressdisbeliefofhisaccount:whathedidwastoappraiseitinrelation
tosuchotherevidenceaswasavailable:thishewasentitledtodo,butthe
CourtofAppeal,whileboundtoattachgreatweighttothejudge'sviews,
wasabletoevaluateitforitself.
Thirdly,therewastheevidenceofProfessorMcLaren.Ithinkthathis
demeanourinthewitnessboxmusthavehadaninfluenceuponthejudge's
views,andthiscallsforcompleterespect.ButasIshallhopetoshow,
theultimateconclusiontobedrawndependsmuchmoreuponthesetting
inwhichhisevidencewasgiven,andtherelationwhichitmustbethought
tohavetotheeventswhichoccurred.
Lastly,thereweretheexpertwitnesses.Thejudgewasentitledtobe
impressedbythewayinwhicheachofthemgaveevidence,buthegave
noindicationhowthisfactorbalancedout.Intheend,astothestandard
ofskilltobeexpectedofMr.Jordan,therewaslittledifferenceofopinion:
suchastherewasrelatedtowhattheyrespectivelythoughtMr.Jordan

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hadactuallydone.Thisbringsusbacktotheprimaryissue,astowhat
reallyhappenedinthecriticaltwentyfiveminutes.
Theappealbroughtout,veryclearlytomymind,thattheissuedoesnot
dependupontheendlessrefinementsforexampleonthemeaningof
"impaction"oftheexperts,butupononeissue:what,ifany,evidence
ofnegligencewasprovidedby(a)theevidenceofthemother(b)thereport
andevidenceofProfessorMcLaren(c)theevidenceofMr.Jordan.
Unfortunatelythesolutionofthisissueremainsoneofimmensedifficulty.
Mr.JordanwasatthetimeaSeniorRegistrar,ofnearconsultantstatus,
esteemedbyhisprofessionalcolleagues.Thereisnoquestionbutthathe
broughttheutmostcaretobearuponMrs.Whitehouse'slabouranddelivery.
Ifhewasnegligentatall,thisconsistedinadeparture,inananxious
situation,fromastandardacceptedbytheprofessionatthetime.Putvery
briefly,itwassaidtolieincontinuingtractionwiththeforcepsafteran
obstructionhadbeenencounteredsothatthebaby'sheadbecame
"impacted":Ishallnotexplainthiswordatthisstage.Itisobviousthat
theerror,iferrortherewas,laycentrallyintheareaoftheexerciseof
expertjudgmentandexperiencedoperation.Mr.Jordanwasamember
oftheobstetricalunitatthehospitalheadedbyProfessorMcLaren,which
hadahighreputation:ProfessorMcLarenhimselfwasadistinguished
obstetrician,unfortunatelyillatthetimeofthebirth.
Mrs.Whitehousewasacceptedasthirtyyearsofage:thiswasherfirst
baby.Shewassmall,only4ft.101/2in.inheight.Shewasadifficult,nervous
andattimesaggressivepatient.Shewasunable,orrefused,toagreeto
vaginalexaminationduringherpregnancy,ortohavetakenalateral
Xray,thoughurgedtodosobyProfessorMcLaren.Theseprocesses
wouldhavehelpedtodiscovertheexactshapeofthepelvis.Itisfairto
saythatwhenMr.Jordancameonthescene,hewasnotgreatlyhandicapped
bythis,becauseMrs.Whitehousewasatthattimeunderepiduralanaesthetic,
andhewasabletoexaminehervaginally.However,hehadnotthe
advantageofaccuratemeasurementsofthepelvisoroftheischialspines.
Ineedsaylittleabouttheprenatalhistoryofthecase.Itisfullytold
inthejudgmentsofthetrialjudgeandtheMasteroftheRolls.The
motherwasseenbyanumberofdoctorsinthecourseofherpregnancy
includingProfessorMcLarenandMr.Jordan.Idonotthinkthatany
criticismcanbemadeofwhattheydid.Shewasidentifiedclearlyas
likelytobeadifficultcase:on31stDecember1969ProfessorMcLaren
recordedthathethoughttheoutletwastightandthatatrialoflabour
wouldbeneeded.Thismeansthatlabourwouldbepermittedtostartand
toproceedunderclosesupervisioninordertoseewhethertheheadcould,
withsafety,proceeddownthebirthcanal.
Mrs.Whitehousewasadmittedtothehospitalat0200hourson6th
January1970hermembraneshavingrupturedshortlybefore.Thevertex
wasrecordedasengagedat0230,andthiswasconfirmedbyMr.Kelly,
ofconsultantstatus,at1000hrs.Henoted"fairsizedbaby".

Soatthispointwehaveasmallwoman,anxiousanddistressed,awaiting
ababy,forheronthelargeside,withtheheadinafavourableposition
andengagedinthepelvisnotedasbeingprobablyacasefor"trialof
labour".At1130shewasgivenanepiduralanaestheticwhichwould
preventherfromfeelingpainandprobablyfromsensationbelowthewaist.

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At1830shewasseenbyDr.Skinner.Heexaminedhervaginallyand
abdominally.Hereported"vertexengaged,foetalheartsatisfactory...
pelvisseemsadequate".
Nowcomestheperiodcriticalforthiscase.At2330Mr.Jordan,who
wasnotonduty,cametotalktoDr.Skinner.Onhisradiocommunicator
thelatterwastoldthatMrs.Whitehousewasfullydilated.Dr.Skinner
thoughtthatthiswasacaseforamoreseniormanthanhe,andMr.Jordan
agreedtogo:hesawherat2330andexaminedherabdominallyand
vaginally.Hereadthenotesonthecase,which,astheabovesummary
shows,informedhimpreciselyofwhathehadtodealwith:adifficult
casecallingforgreatcare.
HemadeadetailednotewhichIneednotcopyinfull.Itgaveallthe
necessarymedicaldetails.Against"pelvis"hewrote"smallgynaecoid"
(i.e.,ofappropriatefemaleshape)andthen"Normaldeliveryoutofthe
"question".
Hedecidedtoembarkonatrialofforcepsanddidsoat2345.The
fullexpressionforthisis"trialofforcepsdelivery"which,astheevidence
showedbeyonddoubt,meansthattheoperatortriestoseewhetherwith
theuseofforcepsadeliverypervaginamispossible.Thisinvolvestwo
things,firsttentativeanddelicatehandlingatleastatthestartsecondthe
necessityofcontinuouslyreviewingprogresswiththeobligationtostop
tractionifitappearsthatdeliverypervaginamcannotbeproceededwith
withoutrisk.ThendeliverywilltakeplacebyCaesareansection.
Twothingsmustbesaidatthisstage.Firstthoughfortheplaintiff
itwasatonetimeotherwisecontendedthedecisiontotryforvaginal
deliveryratherthangoatoncetoaCaesareansectionwasunquestionably
therightandcorrectprocedure,inordertoavoidifpossibletheriskto
themotherinevitablyinvolvedinsection.Secondly,fortheplaintiffan
attemptwasmadetodrawalinebetweentrialofforceps,ontheonehand,
anddeliverybyforcepsontheother,andtomakeacasethatMr.Jordan
was,unjustifiably,proceedingtothelatter.This,tomymind,completely
failed.Thereisnosuchclearcutdistinction.Atrialofforceps(delivery)
iswhatitsays:itisanattemptatdeliveryaccompaniedbythetwospecial
conditionsIhavementioned.Therecanbenodoubtthatthisiswhat
Mr.Jordanwasattempting.Itakewhathappenedfromhisnotes.Under
"summaryofreasonsforoperation"hewrote:
"Trialofforcepsunderepiduralanaesthetic.Lowersegment
"CaesareansectionunderG.A."
Then:
"(1)Forcepsbegunat23.45,6.1.70.
"HeadrotatedtoOA(withKiellands.Noproblem."(Kiellands
isakindofforcepsusedbysomeoperatorstorotatethehead.This
procedurewascorrect.)
"Averytightfit.Noepisiotomy."(Cuttingoftheperineum.)
"Afterpullingwith5or6contractionsitwasobviousthatvaginal
"deliverywouldbetootraumaticsoCaesareansection."
HethenrecordedtheCaesareanwhicheveryoneagreeswasimpeccably
performedintwominutes.Henoted"noapparent(vaginal)trauma".
Tocompletethehistory,thebaby,extractedapparentlyunharmed,was
handedovertothepaediatricians,foundapnoeic,andmadetobreathe
afterthirtyfiveminutes,bywhichtimeirretrievablebraindamagehad
occurred.

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Here,withonepossibleexception,isarecordofabirthcarriedoutwith
allcorrectprocedures,with,asunhappilyoccursinthebestmanaged

hospitalsandthebestmedicalcare,tragicresults.Thepossibleexception
liesinthereferenceinMr.Jordan'sownreportto"pullingwithfiveor
sixcontractions".DidMr.Jordanpassthelimitsofprofessional
competenceeitherincontinuingtractiontoolong,orinpullingtoohard?
Thatisthewholeissue.Asdirectevidencefrompersonspresentthere
wastheevidenceofMr.Jordan,Mrs.WhitehouseandDr.Skinner.There
wasnowardsisterpresentandthetwoattendingmidwivescouldnotbe
traced.AsindirectevidencetherewasareportfromProfessorMcLaren
madetotheHospitalAdministratorsometimebetween22ndJanuaryand
10thMarch1970,baseduponhisreadingofthenotes,aconferencewith
Mr.Jordan,andhisownexperience.Ontopofthistherewasexpert
evidenceoneachsideastowhatMr.Jordanoughttohavedone,andas
tothecorrectnessofwhathedid.Whatisclearisthat,inatrialof
forceps,theoperatorshouldnotattempttopullpastanobstruction,orat
leastnotpastabonyobstruction.DidMr.Jordandothis?
MyLords,atthispointitisvitaltorecallthatwearenothereentitled
toretrythecase.Wehaveindeedreadalmostthewholeofthetranscripted
evidence.Butitisnotforustosayhowwewouldhavedecidedthecase
attrial.Whatwecanproperlydoistoexaminethejudge'sfindingsand
toreachaconclusion,difficultthoughthismaybe,whethertheycan
reasonablybesupportedontheevidencerecognisinghisadvantagesand,
asfairlyaswecan,hisdifficultiesandwhethertheCourtofAppealwas
justifiedinreversingthem.
Onepointmustbeputoutoftheway:waswhateveroccurredatthe
birthcausativeofthebraindamageinitselfaverydifficultquestion?The
babywasapparentlyundamagedatbirth:braindamagedoesoccurforno
ascertainablereason,andinnormalbirths.Manyalternativeswere
considered.Thejudgewasabletofindanddidsothattheprobability
wasthatthedamageoccurredbetween2345and0010onthe6th/7th
January,i.e.duringtheperiodinwhichtheforcepswereused.Whether
I,oranyotherjudge,wouldhavereachedthesameconclusionisnothere
orthere:thefindinghadevidencetosupportitandcannotbedisturbed.
Itdoesnotofitself,ofcourse,provethatthedamagearosefromlackof
skill:thatisapointwhichmustbeindependentlydecided.
Therewerethreecriticalpiecesofevidence.
First,therewastheevidenceofthemotherintheabstractthebest
persontoknowexactlywhathappened.Intheconcrete,thesituationwas
otherwise.Shehadbeeninlabourfornearlytwentyfourhours:recorded
asdistressed:therehadbeenvomiting:shewasforunderstandable
reasonsconnectedwithherfamilyintenselyanxiousandtense:shewasin
aconditionoflackofconfidenceinthemedicalprocedure.Shewasunder
epiduralanaesthetic,soinhibitedfromfeelingunlessveryimpreciselywhat
wasgoingon.Intheseconditionsshetestifiedasfollows:[whentheforceps
wereapplied]"Itfeltlikeadeadenedelectricshockthatliftedmyhipsoff
"thetableupoffthebed".Thisisalsowhatshetoldtheeminent
professorswhoonthisbasispreparedtheirreportfortheplaintiff.Butthe
judgeinevitablydidnotacceptthis.Nowitnessregardeditas
possibleanytractionmusthavebeendownwards.Dr.Skinner,whowas
standingbyhersidethewholetime,saidthatnothinglikethisoccurredhe
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wouldhaveseenitandrememberedit"foritsfantasticness".Withall

allowanceforprofessionalloyaltythisevidenceistoostrongtobetotally
discounted.But,thoughrejectingthisaccount,thejudgedidmakesome
useofit:hesaid"itcouldbethatshewaspulledtowardsthebottomof
"thedeliverybeddependingupontheamountofforceused".Butthis

doesnotprovethatexcessiveforcewasused,andthatiswhatisrequired.
Again,inthecrucialconclusorypartofhisjudgmenthesays:
"ThoughMrs.Whitehouse'sdescriptionofwhatoccurredtoher
"whentheforcepswereappliedmaynotbeexactinitsclinicaldetail,
"Ibelieveher,insofarasherdescriptioncanbetakentobe
"understood,asapullingofhertowardthebottomofthedelivery
"bedinamannerandwithsuchforceastobeinconsistentwithatrial
"offorcepsproperlycarriedout."

ButImustagreewiththemajorityoftheCourtofAppealthatIcannot
acceptthisasadefensiblefinding.Aprocessbywhich,afterrejectingthe
accountgivenbyawitnessanditwasmorethaninexact"inclinical
"detail"thataccountisreconstructedsoastobeevidencenotofa
generalcharacter,butofapreciseandcriticaldegreeoftractionsupposedto
differfromwhatwouldhavebeenquiteproper,seemstomewithall
respecttobeillegitimate.Ifexcessivetractionisotherwiseproved,her
evidencemightbeconsistentwiththat,butitcannotbeuseditselfas
evidenceofthatexcess.IthinkthattheCourtofAppealwasquiteright
todiscardthisfinding.Inthistheywereunanimous.
ThenextpieceofevidenceconsistsofMr.Jordan'sowntestimony.He
wasexaminedandcrossexaminedatlength.Inhisjudgmentthejudge
madecomparativelylittlereferencetothisevidence,relyingmuchmore
heavilyonthesecondhandevidenceofProfessorMcLaren.Formyself,
IwouldregardMr.Jordan'sfirsthandaccountofthematterasofcardinal
importance.Partsofit,indeed,mayberegardedasthemostsolid
evidenceagainsthim.Ihaveanxiouslyconsidereditwiththereservations
properinacasewhenamanisdefendinghimselfagainstaseriousclaim.
Thetenorofit,readasawhole,wasthatthiswasaverytightfitthat
withthefirstfewpullsmade(correctly)withthecontractionssome
progresswasmade.Withthefifthpullherealisedthathewasnotmaking
progress:hetriedoncemoretoseeifhecouldeasetheheadpastwhatmight
beminimalobstruction.Failingthis,hethoughtthatdeliverypervaginam,
thoughpossible,wouldbetootraumaticandthataCaesareansectionwas
needed.Withaviewtothisheeasedtheheadslightlyupwardswiththe
forceps.
Theattackonthiswasreallytwofold.First,itwastosaythat
Mr.Jordanpulledtoohard.Therewasnodirectevidenceofthisexcept
thatofthemotherwhichIhavealreadydiscussed.Dr.Skinnerthough
Iquiteacceptthatnottoomuchweightcanbeplacedonhisdescription
saidthathehadneverever(sic)seenMr.Jordanviolentlypullforcepsin
hislife.
Then,andthiswasthecriticalpoint,itwassaidthatMr.Jordantriedto
pullpastabonyobstructionwhichwouldbecontrarytothebestmedical
practiceandgotthehead"wedged"or"stuck"or"impacted".In
hisjudgmentthejudgequotedthispassage:
"Q.PerhapsIshouldendbyaskingyouthis:"didyoutryto
"pullpastanybonypart?A.Mytrialbyforcepswastoovercome

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"whatmaybeminimalobstructionsoonedid,asitwere,passthe
"leveloftheischialspines.
"Q.Thequestionwasnotwellphrased.Didyoutrytopull
"despitethem?A.No."
Hiscommentonitisthat"perhapssomecluewasgivenby[it]".
Butifthefirstanswerissomewhatobscure,thesecondisaplaindenial
thathetriedtopulldespite(i.e.overanyresistanceof)theischialspines.
Iwouldcomparewiththishisfinalanswergiveninreplytothelearned
judge:
"Mr.JusticeBush:Mr.Jordan,onthataspectofitthatyouhave
"beentalkingabout,whatwasitthatmadeyoubelievethattocontinue
"thetractionmightbeharmfultothebaby?A.Becauseoneis
"awarefromtheverynatureoftheforcepsdeliverythatthereissome
"resistance,andtheaimofatrialofforcepsistoeasethebabypast
"whateverresistancetheremaybe,whetheritisthepelvicfloororthe
"sidewallsofthepelvis,andyoupullslowlyandtentativelyandthen
"youformanimpressionthattocontinuewiththatrateofprogress
"maytaketoolong,ortoomuchtraction,andIthinkthatisall."
Otherpassagesexisttothesameeffect.AndwhatIthinkMr.Jordanis
tryingtoexplainisthat,inatrialofforceps,theoperator,whohastowork
onfeel,andinstinct,andexperience,isbythenatureofthingsalways

workingagainstresistance,justbecauseofthenarrownessandirregular
shapeofthebirthcanal.Thishehastodo,withofcoursecare,anda
marginofsafety.Whathemustnotdo,andwhatMr.Jordandeniesthat
hedid,wastopullpastabonyobstruction:thenhemuststop.
Thisleadsontotheissueofwhethertheheadwas"stuck"or"wedged".
SofarasMr.Jordanisconcernedhefirmlydeniedthatiteverwas.It
wouldnot,withoutrisk,goanyfurther,butthatwasall.Attheendhewas
ablewithoutdifficultytopushitbackupalittleinpreparationforthe
Caesarean.Ithinkthatitispossibletocarrythispointfurther.SirJohn
Dewhurst,ProfessoratQueenCharlotte'sHospitalandatChelseaHospital
forWomen,andtheauthorofanimportantbookIntegratedObstetrics,
gaveevidenceafterMr.Jordanandafterhearingthelatter'sevidencean
advantagenotpossessedbytheplaintiff'switnesses.Hefoundnothing
wrongintheprocedurewhichMr.Jordanhadfollowed,includingtheresort
tofiveorsixpulls.
Ireachtheconclusion,then,thatheretootheCourtofAppeal,particularly
LawtonL.J.,werejustifiedintakingcontrarytotheviewofthe
judgeMr.Jordan'sevidenceasevidencethathedidnotgetthehead
wedgedorstuck.
SofinallythereisProfessorMcLaren'sreportandevidence,onwhich
thejudgeplacedmuchreliance.Ihaveexplainedthathisreportwas
preparedonthebasisofthehospitalnotesandofconferencewith
Mr.Jordan.ItisthereforeevidenceagainstMr.Jordan,totheextent,and
onlytotheextent,thatitmaybetakentoincorporateMr.Jordan'saccount
atthetimetohissuperior.Itmustbeborneinmindthatitwaswritten
inordertoansweralongletterofcomplaintsbyMr.Whitehouseastothe
conductofthebirth,oneofhiscomplaintsrelatingtothepullsexertedby
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Mr.Jordan.ThetenorofthereportwastomaintainthatMrs.Whitehouse
hadreceivedcorrectandskilledtreatmentandthatnoblameattachedto
anyoneforthesadresultwhichfollowed.Thoughthiswasthepurpose

ofthereportitwassaidthatneverthelessit"letthecatoutofthebag"in
tworespectsrevelatoryofafailureofskillbyMr.Jordan.

Inacriticalpassagehewrote:
"Atrialofforcepswascarriedoutunderepiduralanaesthesiathe
"headrotatingwitheasewithKiellandsforceps.Descent,however,
"didnotfollowtractionandintheinterestofthechildtheheadwas
"disimpactedpriortospeedydeliverybyCaesareansection.However,
"therewasneedtoswitchfromepiduraltogeneralanaestheticfor
"section".
Thefirstpointiseasilydisposedof."Descentdidnotfollowtraction"
isclearlyastatementreferringtothewholeoftheprocessandismerely
sayingthatthetractiondidnotextractthebaby.Itcannotbereadas
saying,asfortheplaintiffitwassoughttosay,thatnomovementwhatever
tookplace.Itleadstonoconclusion.
Thesecondpointismoredifficult.Itrelatestotheword"disimpacted".
Thisinvolves,itissaid,thattheheadwas"impacted"and"impacted"
means"wedgedorstuck".ThisprovesthereforethatMr.Jordanpulled
toohard.Itshouldbenotedthatacopyofthisreportwassentto
Mr.Jordanwhodidnotcommentontheword:hemusttherefore,itis
said,betakentohaveagreedwithit.
Manyhoursofevidenceweredevotedtothisword.ProfessorMcLaren
himselftriedtoexplainitawayheshouldnothaveusedithedidnot
meantoconveythattheheadrequiredtobe"unstuck"orthatitwas
stuck.Hepointedout,justly,thatthereportreferredto"atentative
"attemptatforceps"..."theacceptedobstetricaltechniqueoftentative
"trialofforceps"..."satisfactorytrialoflabour".Allofthiswas
inconsistentwithgettingthehead"wedged".Butwhatdidhemeanby
thewordusedthreetimes?

Therewasnounanimityamongtheexpertsastothemeaningofthe
word"impacted".Thedictionarymeaningis:
"Denotingafoetusthat,becauseofitslargesizeornarrowingof
"thepelviccanal,hasbecomewedgedandincapableofspontaneous
"advanceorrecession".[Steadman'sMedicalDictionary].
Noreferencehere,beitnoted,totheresultofforce.
SirJohnStallworthydidnotdisagreewiththis.

SirJohnPeel:
"Ithinkthatanimpactedheadisonethatdoesnotmoveeitherup
"ordownwithoutfurtherforceorexertionbeingapplied.Eitherwith
"forcepsinpullingitdownorthefingerspullingitup".
SirJohnDewhurst:
"ItisnotatermIuseinmymedicalpractice,no.Ithinkitis
"capableofbeingusedinvariousways.Isupposeperhapsonereason

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"whyIneveruseitisimpactioninthesensesolidlywedgedhasalmost
"disappearedfrommedicalpracticeinthiscountry".
DameJosephineBarnes:
"Imeantheheadisinapositionwhereitcannotgoanyfurtheron".
Sothereisnounanimity,orevenbalanceofopinion,thatimpactionis
somethingwhichoccursfromorisevidenceofexcessiveorunprofessional
pulling.Itisacondition,whichmayarisefrommanycauses.
Thelearnedjudge'sconclusionwas"IfinditdifficulttoacceptProfessor
"McLaren'sexplanationofhisuseoftheword'impacted'"andthis
wasacriticalfindingagainstMr.Jordan.ButwithrespectIthinkthat
themassofmedicalevidencehadledhimtofocusonaninessential
question.Theargumentwasnotaboutthemeaningofaword,butabout
whatMr.Jordandid.Mr.Jordangaveacompleteanddetailedaccount
ofwhathedid.Heproceededtothepointwhenthebabywouldgono
further.Hedeniedthatitwas"stuck".Hesaidthatheeasilypushed
itup.Allofthiswasconsistentwithsoundmedicalpractice,andwitha
possibleuseoftheterminology.IfProfessorMcLarenhadthought,after
discussingthecasewithMr.Jordan,thatsomethinghadgonewrong,and
thattheheadhadbecomewedgedthroughexcessiveforce,itisincredible
that,inthecontextofawhollydisculpatoryreport,hewouldhaveused
awordmeaning"wedgedbyforce"withoutsomeexplanation.Itis
quitesimpletosupposethatthewordwasusedtorefertotheroutine
actioninpreparationforCaesareansection.
Inmyopinion,theCourtofAppealwasjustifiedinconcludingthat
this,togetherwiththeevidenceofMrs.Whitehousewhichformedthemain
pillarsofthejudgment,wasnotnearlyofsufficientstrengthtoleadtoa
findingofprofessionalnegligence.
MyLords,Icould,butwillnotcommentonotheraspectsoftheevidence.
Iam,formyself,nothappyaboutthemannerinwhichthejudgeusedthe
evidenceaboutthefoetalheartbeat:Iunderstandthatothersofyour
Lordshipsmayenlargeuponthispoint.Attheendofitall,uponthe
singleissuewhetherduringthecriticalhalfhourMr.Jordandeparted
fromhisownhighstandardofprofessionalcompetence,Ifindthejudgments
oftheMasteroftheRollsandofLawtonL.J.convincing,andappreciative
asIamaswerethemembersoftheCourtofAppealofthejudge'scare
andclarity,Imustagreethatthisisacasewhereanappealcourtcanand
shouldinterfere.
Onefinalword.IhavetosaythatIfeelsomeconcernastothemanner
inwhichpartoftheexpertevidencecalledfortheplaintiffcametobe
organisedThismatterwasdiscussedintheCourtofAppealand
commentedonbytheMasteroftheRolls.Whilesomedegreeofconsulta
tionbetweenexpertsandlegaladvisersisentirelyproper,itisnecessary
thatexpertevidencepresentedtothecourtshouldbe,andshouldbeseen

tobe,theindependentproductoftheexpert,uninfluencedastoformor
contentbytheexigenciesoflitigation.Totheextentthatitisnot,the
evidenceislikelytobenotonlyincorrectbutselfdefeating.
Iwoulddismisstheappeal.

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LordEdmundDavies
MyLords,
Ihavewrestledlongandhardoverthisappeal.Theevidenceatthe
trialoccupiedelevendays,andthejudgmentdeliveredtendayslaterby
Bush,J.,isamodelofclarityandcare.Butthefactthatthisawardof
100,000tothegrosslydisabledinfantplaintiffwasreversedbyamajority
attheconclusionofafourdayshearingintheCourtofAppealandthat
theappealtothisHouseoccupiedfivedaysshouldservetodemonstrate
thatdifficultissuesareinvolved.
Igratefullyadoptthenarrativeofsalientfactspreparedbymynoble
andlearnedfriend,LordWilberforce,andIshalladdlittletoit.There
aroseanacuteconflictonmanypointsandbetweenbothlayandexpert
witnesses.Ithaslongbeensettledlawthat,whenthedecisionofatrial
judgeisbasedsubstantiallyonhisassessmentofthequalityandcredibility
ofwitnesses,anappellatecourt"must,inordertoreverse,notmerely
"entertaindoubtswhetherthedecisionbelowisright,butbeconvinced
"thatitiswrong"(TheJulia(1860)14MooPC210,perLordKingsdown
at235).Andthatissoirrespectiveofwhetherornotthetrialjudgemade
anyobservationwithregardtocredibility(ClarkevEdinburgh&District
TramwaysCo.1919S.C.(H.L.)35,perLordShawat36).
Certainimportantmattersarenotindoubt.Thefirst(asthelearned
judgehimselfstressed)isthatthedeliveryofabraindamagedbabydoes
notnecessarilyconnotenegligencebyanyone,forsuchamisfortunecan
inexplicablyoccurincircumstanceswheretherearenogroundsfor
suspectinganylackofproperskill.Again,althoughtheobdurateattitude
ofMrs.Whitehouseduringherpregnancyhadcreatedalackofinformation
regardingthedimensionsofherbirthcanal,beforeMr.Jordanstarted
evenanexploratorypullonthefoetushecontemporaneouslynotedthat
hewasconfrontedby"averytightfit",asituationwhichDameJosephine
Barnesdescribedas"certainlyahighriskcase"andonewhichSirJohn
Dewhurstsaidwouldhaveoccasionedhim"considerableconcern".On
theotherhand,itwasunchallengedthatMr.Jordanwasrighttouse
forceps,for,althoughvaginaldeliverybycontractionalonewasoutofthe
question,itwasinadvisabletoproceeddirectlytoCaesareansection.
Theprincipalquestionscallingfordecisionare:(a)Inwhatmanner
didMr.Jordanusetheforceps,and(b)wasthatmannerconsistentwith
thedegreeofskillwhichamemberofhisprofessionisrequiredbylawto
exercise?Surprisingthoughitisatthislatestageinthedevelopmentof
thelawofnegligence,counselforMr.Jordanpersistedinsubmittingthat
hisclientshouldbecompletelyexculpatedweretheanswertoquestion(b),
"Well,atworsthewasguiltyofanerrorofclinicaljudgment".My
Lords,itishightimethattheunacceptabilityofsuchananswerbefinally
exposed.Tosaythatasurgeoncommittedanerrorofclinicaljudgment
iswhollyambiguous,for,whilesomesucherrorsmaybecompletely
consistentwiththedueexerciseofprofessionalskill,otheractsoromissions
inthecourseofexercising"clinicaljudgment"maybesoglaringlybelow
properstandardsastomakeafindingofnegligenceinevitable.Indeed,
Ishouldhaveregardedthisasatruismwereitnotthat,despitetheexposure
ofthe"falseantithesis"byDonaldsonLJ.inhisdissentingjudgment,
learnedcounselfortherespondentsadheredtoitbeforeyourLordships.
Butdoctorsandsurgeonsfallintonospeciallegalcategory,and,to
avoidanyfuturedisputationofasimilarkind,Iwouldhaveitaccepted
thatthetruedoctrinewasenunciatedandbynomeansforthefirsttime

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byMcNairJ.inBolamv.FriernHospitalManagementCommittee[1957]

1W.L.R.,582,at586inthefollowingwords,whichwereappliedbythe
PrivyCouncilinChinKeowv.GovernmentofMalaysia[1967]1W.L.R.
813:

"Whereyougetasituationwhichinvolvestheuseofsomespecial
"skillorcompetence,thenthetestastowhethertherehasbeen
"negligenceornotisnotthetestofthemanonthetopofaClapham
"omnibus,becauseshehasnotgotthisspecialskill.Thetestisthe
"standardoftheordinaryskilledmanexercisingandprofessingto
"havethatspecialskill".
Ifasurgeonfailstomeasureuptothatstandardinanyrespect("clinical
"judgment"orotherwise),hehasbeennegligentandshouldbeso
adjudged.
Mr.Jordansaidthat,inthesituationconfrontinghim,heembarkedon
atrialofforceps,itsobjectbeingtoestablishwhethertherewasany
disproportionorobstructioninthebirthcanalsufficienttoputatriska
vaginaldelivery.Trialofforcepsneedstobecarriedoutgentlyand
tentatively,"progressbeingobservedwhenreasonabletractionisexerted",
asSirJohnDewhurst,adefencewitness,putit.Ifprogressisachieved,
theprocessofpullingwithcontractions,openingtheforcepswhena
contractionceases,thenapplyingthemagainwiththenextcontraction
continuesuntil(inMr.Jordan'swords)"suchtimeasthebabywas
"deliveredor(asinthiscase)itbecameapparentthatfurtherattemptat
"deliverymaybeunwise".Heacceptedthatduringthetrialofforceps
thesurgeonisnotembarkingonadelivery,butmerelyexploringthe
possibilityofvaginaldeliverybeingachieved,andthat,"Beforeunder
"takingmidforcepsdelivery,thephysician'sclinicaljudgmentmustpermit
"himtoconcludeunequivocallythathecaninfactdeliverthebaby
"safelypervaginam,andthatthismethodofdeliveryplacedlessriskto
"themotherandbabythanCaesareansection".
HowfarhadMr.Jordanproceededbeforeheabandonedthenotionof
avaginaldeliveryanddecideduponaCaesareansection?Hesaidhehad
pulledwithfiveorsixcontractions,andformedtheviewthattheheadwas
makingsatisfactoryprogressafterthefirstfourpulls.Therecameafifth
pullwithpossiblyno"movement".Whenasked,"Whatconceivable
"factorcantherebewhichwouldstopyouonthefifth?",hissignificant
replywas"Thespines",i.e.theischia.Alittlelaterhesaid,"IfIgot
"difficultyonthefifth,thenIwouldconfirmitonthesixth".Asked
howinsuchcircumstanceshecouldjustifypullingyetoncemore,Mr.
Jordananswered:
"Whatonewantstoknowis,isthereatthisparticularmoment
"andthisisthecrucialpartasfarasthetrialofforcepsisconcerned
"orwouldthislittleextrapressureortractiondeliverthishead
"pastthatbonyobstructionornot?Inthesecircumstances,realising
"thatthiswasthepointatwhichthedecisionhadtobemadefinally,
"astocontinueorgoback,itisjustifiedtoseewhetherornota
"littlemorealittleextratractionwithothercontractionswould
"beenoughtoovercometheresistanceoneisfeeling".
Thatanswerhastobeconsideredinthelightofthedirectiveinawork
preparedbySirJohnDewhurstthat:
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"Noobstructionbelowthehead.
"Thisisanabsoluterule.Theheadshouldneverbepulledpastan
"areaofobstruction.Caesareansectionisindicated".
Mr.Jordaninsistedthathistrialofforcepsterminatedatthestagewhen
thefactorofthesafetyofthebabyarose,althoughheentertainednodoubt
thatvaginaldeliverycouldhavebeenachieved.Astothis,andthecase
generally,theconclusionofthelearnedjudgewasexpressedinthisway:
"IamdoubtfulwhetherMr.Jordanwasinfactundertakinga
"trialofforceps,asopposedtoanattemptatvaginaldeliverywhich
"failed,andinthecourseofwhichthebabywaswedged,stuck,or
"jammed,andwhichonanyone'sviewofthematterwouldbe

10

"unjustified.However,inanyevent,ifitwereatrialofforceps
"thenhepulledtoohardandtoolong,sothatthefoetusbecame
"wedgedorstuck.Ingettingitwedgedorstuck,orunwedgedor
"unstuck,Mr.Jordancausedasphyxiawhichinitsturncausedthe
"cerebralpalsy.InthisrespectMr.Jordanfellbelowtheveryhigh
"standardofprofessionalcompetencethatthelawrequiresofhim."
Inthelightoftheconflictingevidence,isthataconclusiontowhichthe
experiencedtrialjudgewasentitledtoarrive?Withthesingleexception
ofDameJosephineBarnes,themedicalwitnessesonbothsidesagreethat,
asthejudgeputit,"...ifinfactthetrialofforcepsproceededtothe
"lengthswherethefoetalheadwaswedgedorstuckandhadtobe
"unwedgedorunstuckwiththeuseofforce,thenunprofessionalforce
"wouldhavebeenused,bothingettingitwedgedandinhavingto
"unwedgeit".Hisobservationsonthiscardinalissuebeganwiththe
evidencegivenbythemother,andhedealtwithitinthisway:
"AccordingtoMrs.Whitehouse,whentheforcepswereapplied,
"'Ifeltlikeadeadenedelectricshockthatliftedmyhipsoffthe
"'table',andshedescribedherbuttocksandhipsbeingliftedoffthe
"table.Thiscannotbeanaccuratedescription,sincethepullis
"downwards,butitcouldbethatshewaspulledtowardsthebottom
"ofthedeliverybed,dependingupontheamountofforceused.She
"wasalittlewomananditwouldbeaquestionofdegreewhether
"thisindicatedinitselftheuseofexcessiveforce."
WhenSirJohnStallworthy,aplaintiff'switness,wascrossexaminedto
establishthatthemotherwouldnotbeliftedoffthebed,hesaid:"What
"veryfrequentlyhappens,andIwouldhavethoughtIdon'tknowwhat
"probablyhappenedfromherdescriptionwaswiththeforcepsshewas
"pulleddowntotheendofthebed.Sheisasmallwomananditwasa
"bigbaby,anditwouldhavebeenperfectlyreasonablewithanordinary,
"successfulforcepsdeliveryforthistohavehappened".Buttwocomments
onthatevidencearecalledfor:(1)Wearenothereconcernedwithan
accomplishedforcepsdelivery,butwithwhatwasdescribedasatrialof
forcepswhichwasabandonedatastagewhenitwasstillopentoMr.Jordan
tochangehismindandproceedtoaCaesareansection.(2)Dr.Skinner,
whowasstandingnearbyintheoperatingtheatrewhenthebabywas
delivered,saidthatMr.Jordanneverwentfurtherthantrialofforceps.
Headdedthattherewasnoviolentpulling,andspokeofthe"fantasticness"
oftheallegationofMrs.Whitehousebeingliftedoffthebed.Thatdoes
notintermsnegativeadownwardpull,butitcontrovertstheuseofforce
beyondthatcustomaryinatrialofforceps.
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Regardingthisimportantmatterthelearnedjudgesaid:
"ThoughMrs.Whitehouse'sdescriptionofwhatoccurredtoher
"whentheforcepswereappliedmaynotbeexactinitsclinicaldetail,
"Ibelieveher,insofarasherdescriptioncanbetakentobeunderstood,
"asapullingofhertowardthebottomofthedeliverybedina
"mannerandwithsuchforceastobeinconsistentwithatrialof
"forcepsproperlycarriedout".
MyLords,Ihavesomedifficultyinfollowinghowanythingin
Mrs.Whitehouse'stestimonycouldbe"understood"inthesenseadopted
bythelearnedjudge.Shewastheonlywitnesswhoindirecttermsspoke
adverselyofthedegreeofforceexertedbyMr.Jordan,andhehadfound
herunreliableinseveralrespects.Oncemorethelearnedjudgerejected
herevidence,thistimeinrelationtowhathappenedwhentheforcepswere
applied.Initsplacehe"believed"anaccountwhich,whiletoadegreein
conformitywithwhatSirJohnStallworthysaidcouldhappeninforceps
delivery,wasonewhichsheherselfdidnotadvance.Itwasaccordingly
notsuchafindingasanappellatecourt,lackingthejudge'sadvantageof
seeingandhearingthewitnesses,isnormallyobligedtoleaveundisturbed.
Itwasintruthafindingwithoutanevidentialbasis.
Iturntoconsideranothermatterwhichundoubtedlyoperatedpowerfully
onthejudge'smind,andwhich,indeed,hedescribedas"perhapsthe

11

"strongestpieceofevidencethatsomethinguntowardwasdone..."
Ithasperplexedmeperhapsmorethananyotherpartofthisworrying
case,andIentertainnostrongconvictionevennowthatIhavereached
therightconclusionaboutit.Ihaveinmindthereportpreparedby
ProfessorMcLaren,headoftheUnitandhimselfadefendanttothese
proceedingsuntiltheywerediscontinuedagainsthiminMarch1976.He
draftedthereportafterdiscussionswithMr.Jordanwhichbeganafewdays
afterthebabywasdelivered.EachknewthatMrs.Whitehousewasvery
upsetandangry,andonJanuary22nd1970therearrivedaletterfromher
husbandmakinggravecomplaintsagainsttheUnitstaff.Thehospital
administratorthereforecalledforareport,andthisledtodiscussionson
pointswhichboththeProfessorandMr.Jordanrealisedwereof"the
"utmostimportance".Itwasinthelightofthesediscussionsandthe
hospitalnotesthatProfessorMcLarenpreparedhisundatedreport,and,in
duecourse,showedittoMr.Jordanbeforesubmittingittothehospital
administratoronMarch10th.Judgingfromthetimefactor,accordingly,
itdoesnotappeartohavebeenhastilyprepared.Itcan,Ithink,befairly
describedasinsomerespectsanodddocumentforapersonwiththe
professionalexperienceandsophisticationofProfessorMcLarentohave
prepared,andforMr.Jordan,inhisturn,tohavepassedwithout
amendment.Certainlyonecanwellunderstandthelearnedjudgebeing
verytroubledbyit.But,havingsaidthat,whatisbeyonddoubtisthat
thereportsetouttobewhollyexculpatoryofMr.Jordanandofthe
entirehospitalstaff.Thus,itrefersto"thiswellconductedtrialoflabour
"offorceps",toMrs.Whitehouses's"firstclassobstetriccare",andit
concluded,"Weacceptnocriticismorimplicationthatintermsofbeing
"humane,orintechnicalskills,weneglectedMrs.Whitehouse".Yetthe
learnedjudgefounditpossibletoconcludethatthereportwasactually
confirmatoryofthechargeofnegligencemadeagainstMr.Jordan,and
thismainlyonthestrengthoftheinclusionthereinofthefollowing
observations:
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1."Atrialofforcepswascarriedoutunderepiduralanaesthesia
"...Descent,however,didnotfollowtraction,andintheinterestof
"thechildtheheadwasdisimpactedpriortospeedydeliveryby
"CaesareanSection".
2.Inrelationtothefoetushavingsustainedacerebralhaemorrhage,
"Itcouldbethatacongenitalweaknessofabloodvesselexisted,so
"thatthefixingoftheheadinthepelvisanditsdisimpactionfor
"CaesareanSectionledtoaleakingofbloodintheskull".
3."PossiblyatCaesareanSectionthedisimpactionoftheheadwas
"criticalandcerebralhaemorrhagefollowed."(Myemphasisaddedin
eachcase.)
Formypart,Icannotattachsignificancetotheobservationthat,"Descent
"...didnotfollowtraction",asitistheplaintiff'sowncasethatdescent
toapointtherecertainlywas.Butatthetrial,intheCourtofAppeal,
andagaininthisHousemanyhourswerespentconsideringthemuchmore
importantmatterofthethreefolduseoftheword"disimpaction".Is
"impaction"itsconverseandwhatsituationoractiondoeseachword
connote?Mr.Jordanhimself,incommonwithseveraloftheexpert
witnesses,acceptedasaccuratetheSteadmanMedicalDictionarymeaning
of"impacted"as
"Denotingafoetusthat,becauseofitslargesizeornarrowingof
"thepelviccanal,hasbecomewedgedandincapableofspontaneous
"advanceorrecession."
ProfessorMcLaren,too,acceptedthatithadthegenerallyaccepted
meaningof"stuck",butheaverredthathisrepeateduseof"disimpaction"
hadnorelationtounstickingorunwedging,orfixationoranystateof
immovability.Heapologisedforhismisuseoflanguageandexplainedthat
inhisvocabulary"disimpaction"involvesnomorethanagentlepushing
oftheheadupwardswithonefingerbeforeproceedingtoaCaesarean
section.

12

MyLords,thepointisimportantinthelightoftheexpertevidence
supportiveoftheviewthat,iftheheadofthefoetushadbecomesostuck
astocauseasphyxia,excessiveforcehadbeenused.Iremainmystified
why,inthedraftingofwhatwasknowntobeanextremelyimportant
report,itsauthorshouldhaveusedinthesenseclaimedbyhimavariant
oftheword"impaction"whichinmedicalsciencehassuchadifferent
meaning,andwhyMr.Jordan(whowasfamiliarwiththatacceptedmeaning)
shouldhaveallowed"disimpaction"togoforwardwithoutcomment.

IcouldwellunderstandtheMcLarenreporttakingtheformitdidwere
theversionofeventsthenintendedtobeadvancedthatMr.Jordanhad
gonepastthetrialofforcepsstageandhaddecideduponvaginaldelivery
thathehadproceededwithproperskilltoimplementthatdecisionupto
thestagewhenhecouldwithsafetygonofurtherandthereforeturnedto
Caesareansectionandthatthemisfortunewhichoccurreddidnotarise
fromanynegligenceonhispart.Butthedefencepresentedtothejudge
wasthatMr.Jordanneverwentbeyondatrialofforceps.Itistruethat,
ifallgoeswell,theremaybenoclearlineofdemarcationbetweentrial
offorcepsandactualdeliverybyforceps,theonemergingintotheother.
Butthatisnottosaythattheredoesnotarise,howeverfleetingly,astage
whentheoperatorhastoconsiderwhetherhecansafelygofurther.At
onetime,however,Mr.Jordanreferredinevidencetohis"attemptat
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"forcepsdelivery,followedbyCaesareansection",andinhispleaded
defenceitwasexpresslyadmittedthathe"attemptedbutabandoneda

"forcepsdeliveryandthenproceededtodelivertheplaintiffbyCaesarean
"section",anadmissionwhichhislearnedcounseltoldthisHousewas
duetoanoversightandshouldnothavebeenmade.Itcouldwellbe
thatitwasonthebasisofsuchmaterialthatthelearnedtrialjudge

expressedhimselfas"doubtfulwhetherMr.Jordanwasinfactundertaking
"atrialofforceps,asopposedtoanattemptatvaginaldeliverywhich
"failed...".

Butthepointisafineone,anditshouldnotofitselfleadtothe
condemnationofthedefendant.Inhisdissentingjudgment,Donaldson
LJ.concludedthattheevidenceofMrs.Whitehousebeing"pulleddown
"towardsthebottomofthebed,inthesensethatherbodywasmoved"
couldnotberight,andheadded:
"But,havingsaidthat,Istillhavetodecidewhetherthejudge's
"conclusionwaswrong,andIamnotsatisfiedthatitwas.Reading
"thejudgmentasawhole,itseemstomethatMrs.Whitehouse's
"evidencewastreatedasnomorethanconsistentwith,or,atmost,
"confirmatoryofProfessorMcLaren'sreport,andthatevenifMr.
"JusticeBushhadputherevidenceononeside,hewouldstillhave
"reachedthesameconclusion".

Ifthatisright,aswithrespectitseemstobe,theoutcomeofthese
proceedingswasregardedbythelearnedjudgeasfinallyturningonthe
useofoneword.Idaresaythatattimesevengreaterissueshaveturned
onless.Butthatwordcannotproperlybeconsideredoutofcontext,and
IagainstressthatthewholedriftofthelengthyMcLarenreportwasthat
theWhitehousebabyhadbeendeliveredinaccordancewiththehighest
professionalstandards.Suchbeingthesetting,toholdthatthethreefold
useof"disimpaction"shouldberegardedasestablishingthatthecomplete
oppositewasthetruthis,inmyjudgment,toimposeonitanexcessive
andinsupportableburden.

Such,atleast,ismyconclusionaboutthisdistressingcase.Ithas
evidentlycausedmegreaterdifficultythanithasanyofmynobleand
learnedbrethren.ButIhaveatlastfoundmyselfimpelledandcompelled
toholdthat,despitethegreatcareandabilitymanifestedbythelearned
judge,therewaslackingtheevidenceneededtoupholdhisbasicfinding
thatMr.Jordan"pulledtoohardandtoolong,sothatthefoetusbecame
"stuck".Ithereforeconcurinholdingthattheappealshouldbedismissed.

13

LordFraserofTullybelton
MyLords,
Thisisanactionofdamagesforprofessionalnegligenceagainsta
seniorregistraratBirminghamMaternityHospital.Afteralongtrial,the
learnedjudgeheldnegligenceestablishedagainsttheregistrar,butthe
CourtofAppealbymajority(LordDenningM.R.andLawtonL.J.,with
DonaldsonL.J.dissenting)reversedhisdecision.Theydidsonotbecause
theyconsideredthatthelearnedtrialjudgehadmisstatedtherelevant
law.Clearlyhedidnothesaid,rightlyinmyopinion,thatnegligence
forthepurposesofthiscasemeant"afailure...toexercisethestandard

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"ofskillexpectedfromtheordinarycompetentspecialisthavingregard
"totheexperienceandexpertisethatspecialistholdshimselfoutas
"possessing."Headdedtheprovisothattheskillandexpertisetobe
consideredwerethoseapplyingin1969to1970.Althoughthatstatement
wasnotcriticisedintheCourtofAppeal,LordDenningM.R.didcriticise
alatersentenceinthejudgmentbecause,inhisview,itsuggestedthatthe
lawmadenoallowanceforerrorsofjudgmentbyaprofessionalman.
Referringtomedicalmen,LordDenningsaid:
"Iftheyaretobefoundliable[sc.fornegligence]wheneverthey
"donoteffectacureorwheneveranythinguntowardhappensit
"woulddoagreatdisservicetotheprofessionitself."
Thatisundoubtedlycorrect,buthewentontosaythis:
"Wemustsay,andsayfirmly,that,inaprofessionalmanan
"errorofjudgmentisnotnegligent."
Havingregardtothecontext,IthinkthatthelearnedMasteroftheRolls
musthavemeanttosaythatanerrorofjudgment"isnotnecessarily
"negligent".Butinmyrespectfulopinion,thestatementasitstandsis
notanaccuratestatementofthelaw.Merelytodescribesomethingasan
errorofjudgmenttellsusnothingaboutwhetheritisnegligentornot.The
truepositionisthatanerrorofjudgmentmay,ormaynot,benegligent
itdependsonthenatureoftheerror.Ifitisonethatwouldnothavebeen
madebyareasonablycompetentprofessionalmanprofessingtohavethe
standardandtypeofskillthatthedefendantheldhimselfoutashaving,
andactingwithordinarycare,thenitisnegligent.If,ontheotherhand,
itisanerrorthatsuchaman,actingwithordinarycare,mighthavemade,
thenitisnotnegligent.
ThemainreasonwhytheCourtofAppealreversedthejudge'sdecision
wasthattheydifferedfromhimonthefacts.Thequestionthereforeis
whethertheCourtofAppealwasentitledtoreversethejudge'sdecision
onapurequestionoffact.Theviewofthejudgewhosawandheardthe
witnessesastotheweighttobegiventotheirevidenceisalwaysentitled
togreatrespect.Wewereremindedparticularlyofdictatothateffectin
TheHontestroom(1927)A.C.37andPowellv.StreathamManorNursing
Home[1935]A.C.243,andthereisotherhighauthoritytothesameeffect.
Butinthiscase,unlikecasessuchasPowellandTheHontestroom,no
directissueofcredibilityarises.Itisnotsuggestedthatanywitness,or
bodyofwitnesses,wasgivingdishonestevidence.Theonlywitnesswhose
reliabilityisseriouslyinquestionisMrs.Whitehouse,themotherofthe
plaintiff,andIshallrefertothecriticalpartofherevidenceinamoment.
Apartfromherevidence,theimportantfactsarealmostentirelyinferences
fromtheprimaryfacts,andindeterminingwhatinferencesshould
properlybedrawn,anappellatecourtisjustaswellplacedasthetrial
judge.Accordinglythisisacasewherethejudge'sdecisiononfactis
moreopentobereassessedbyanappellatecourtthanitoftenis.
Thelearnedjudgeexpressedhisconclusionastotheprimaryfactswhich
hadbeenestablishedwithadmirableclarityandconciseness,asfollows:
"OnthebalanceofprobabilitiesIhavecometotheconclusion,
"firstlythatthedamagetothebrainofStuart[theinfantplaintiff]was
"nottheresultofinherentmaldevelopment,andsecondlythatasphyxia

14

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"oranoxiacausedthebraindamage,andthirdlythattheasphyxia
"itselfwascausedbysomeeventbetween23.45and00.25hours,that
"isbetweenthecommencementofthetrialofforcepsandthe
"deliveryofthechildbyCaesareansection."

Thatpassageinthejudgmentisimmediatelyfollowedbyarepetitionofthe
caution,tobefoundelsewhereinthejudgment,thatsuchdamagemaybe
causedbytheviolenteventofbirthitselfand"mayoccurwithout
"professionalfaultonthepartofthosehavingthecareandmanagement
"ofthepatient".Sothelearnedjudgewasevidentlyonhisguardagainst
treatingthisasacaseofresipsaloquitur.

Hethenturnedtoconsiderwhatevidencetherewasonthevitalquestion
ofwhether"unprofessionalforce",bywhichheevidentlymeantexcessive
force,hadbeenappliedbyMr.Jordanwhenusingforceps.Herelied
firstlyontheevidenceofMrs.Whitehouseherself,andsecondlyonwhathe
regardedas"perhapsthestrongestpieceofevidencethatsomething
"untowardwasdone"namelythereportbyProfessorMcLarenwhowasthe
HeadoftheDepartmentinwhichMr.Jordanworked,andwhohimselfwas
adistinguishedobstetrician.ProfessorMcLarenwasillatthetimeand
wasnotpresentatthebirth.Thirdly,thelearnedjudgereliedonthe
evidenceofMr.Jordan,thefirstdefendant.Imustconsiderthesepiecesof
evidence.

TheevidenceofMrs.WhitehousewasthatwhenMr.Jordanpulledon
theforcepsshehad"feltsomethinglikeadeadenedelectricshockthat
"liftedmyhipsoffthetable".Allthemedicalevidencewasthat
Mrs.Whitehousewasnot,andcouldnothavebeen,liftedupoffthetable
bythepullingontheforcepsbecausethetractionwouldhavebeenina
downwarddirection.ThejudgethereforerejectedMrs.Whitehouse's
accountofwhathadoccurredasbeingmistaken.Hehadalreadyrejected
herevidenceonseveralpointsrelatingtohertreatmentintheearlierstages
ofpregnancy.Sofarasthismatterisconcerned,itisnotsurprisingthat
shewasmistakenconsideringherconditionatthetimetowhichshewas
referring.Shehadbeenwithoutsleep,accordingtoherownaccount,for
40hoursbythistime.Shehadnothadanyfoodbecauseshehadbeen
vomiting,andassheputitherself"Iwasattheendofthelinereally".
Aboveallthelowerpartofherbodywasunderepiduralanaestheticwhich
meantthatitwaslargelywithoutsensation.Butthejudge,havingrejected
Mrs.Whitehouse'saccount,wentontoacceptaninterpretationofit
suggestedbySirJohnStallworthyoneofthemedicalexpertswhogave
evidenceonbehalfoftheplaintiff.Hesaidthatheinterpreted
Mrs.Whitehouse'sevidenceasmeaningthatshehadbeenpulleddownoff
thebedandthenliftedbackontoitbythemedicalstaff.Thatinterpretation
wasneverputtoMr.Jordanortotheothermedicalwitnesswhohadbeen
presentatthetime(Dr.Skinner)althoughDr.Skinnerwasaskedabout
Mrs.Whitehouse'soriginalaccountofbeingliftedupoffthebedand
deniedthatanysuchthinghadoccurred.Itwouldbenaturalfor
Dr.SkinnertofeelprofessionalandpersonalloyaltytowardsMr.Jordan,
whowashissuperiorandalsohisfriend,andwhohadtakenchargeofthe
deliverybecauseDr.Skinnerfeltthatitwasbeyondhiscompetence.I
wouldthereforehavebeenpreparedtodiscounthisevidencetosomeextent
ifithadstoodalone,butthelearnedjudgedoesnotindicateanydoubtabout
itsreliability,andsofarasitgoesitisentirelyconsistentwiththeevidence
ofthemedicalexpertsastotheimpossibilityofMrs.Whitehouse'saccount.
Thelearnedjudge'sconclusionaboutMrs.Whitehouse'sevidenceonthis
matterwasexpressedthus:
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"ThoughMrs.Whitehouse'sdescriptionofwhatoccurredtoher
"whentheforcepswereappliedmaynotbeexactinitsclinicaldetail,
"Ibelieveher,insofarasherdescriptioncanbetakentobe
"understood,asapullingofhertowardthebottomofthedelivery
"bedinamannerandwithsuchforceastobeinconsistentwithatrial
"offorcepsproperlycarriedout."

15

Inmyopinionthatconclusioncontainstwoseriousflaws,eitherofwhich
wouldbeenoughtomakeitunacceptable.FirstlyIdonotconsiderthat
itispermissibletoacceptMrs.Whitehouse'sevidence"insofaras"her
descriptioncanbetakentomeansomethingdifferentfromwhatshesaid,
andsomethingwhichwasnottestedbyacrossexaminationofthe
witnesses,includingthedefendantandDr.Skinner,whocouldhave
confirmedordeniedit.IagreewithLawtonL.J.whosaidthis:
"InLordSumner'swordsintheTheHontestroomthetrialjudgein
"thiscase'palpablymisusedhisadvantage'inhavingseenandheard
"themother.Theseadvantagescouldnotbeused,asthetrialjudge
"usedthem,toturnanaccountofwhathadhappenedwhichphysically
"couldnothavetakenplace,intoonewhichcould."
Secondly,eveniftheinterpretationofMrs.Whitehouse'sevidencewere
correct,itwouldnotbyitselfindicatethatthedegreeofforceusedwas
excessiveandinconsistentwithatrialofforcepsdeliveryproperly
carriedout.
IcomenowtoProfessorMcLaren'sreport.Thiswaswritteninanswer
toarequestfromthehospitaladministratorforinformation.Itwas
basedpartlyontheclinicalnotesandpartlyonoraldiscussionwithMr.
Jordan,anditwasshowntoMr.Jordanbeforebeingsent(byMr.Jordan)
totheadministrator.Itcan,therefore,beregardedashavingbeen
acceptedbyMr.Jordanandashavingpossibleevidentialvalueagainst
him.Therewasonewordinthereportuponwhichthelearnedjudge
particularlyreliedfordrawinganinferenceunfavourabletoMr.Jordan.
Thatwastheword"disimpacted".Itwasused,asthejudgepointedout,
nolessthanthreetimesinthereport.Probablythemostsignificantuse
wasinthefollowingsentencewhichisquotedinthejudgment:
"Descent,however,didnotfollowtractionandintheinterestof
"thechildtheheadwasdisimpactedpriortospeedydeliveryby
"Caesareansection."

Theimportanceattachedtothewordbythejudgearoseinthisway.He
said"Forsomethingtobedisimpacteditmustfirsthavebeenimpacted"
andherelieduponadefinitionoftheword"impacted"inrelationtoa
foetusgiveninSteadman'sMedicalDictionaryasfollows:
"Denotingafoetusthat,becauseofitslargesizeornarrowingof
"thepelviccanal,hasbecomewedgedandincapableofspontaneous
"advanceorrecession."

Thatdefinitionwasacceptedbyseveralofthemedicalexperts,though
notbyallofthem,andthelearnedjudgeconsideredthat,iftheheadwas
impacted,thatindicatedthatithadbecometightlystuckorwedged
betweenpartsofthebonystructureofthepelvisandthatithadbeen
pulledbyforcepstoolongortoohard.Idonotthinkthatthelatterpart
ofhisconclusionwasjustified.ProfessorMcLareninhisevidence
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apologisedforusingtheword.Hesaidthatitwasnotagoodwordbut
itwasonethathewasaccustomedtouse,thoughhedidnotintenditto
suggestthattherehadbeensuchwedgingthatoneneededalotofforce
topushtheheadupagainbeforeembarkingupontheCaesareansection.
ItseemsthatProfessorMcLaren'sapologeticevidencemadeanunfavour
ableimpressionuponthejudgeandhisfindingonthematterwasexpressed
thus:
"ItiswithregretthatIfinditdifficulttoacceptProfessorMcLaren's
"explanationofhisuseoftheword'impacted'".

Ihavetriedtomakeproperallowancefortheimportancetobeattached
tothejudge'sviewonthismatterbutIhavereachedtheopinionthatthe
CourtofAppealwasentitledtodifferfromitforthesereasons.Firstly,
theconclusionoftheProfessor'sreportwastotheeffectthatMrs.
Whitehousehadreceivedexcellentcarewhileinthehospital,andin

16

particularhesaidthattherewasnoevidencethatshehadanythingbut
"firstclassobstetriccare".Thatconclusionwouldhavebeenimpossible
iftheobstetricianconcerned,Mr.Jordan,hademployedforcepswith
excessiveforce,anditisthereforeveryunlikelythattheProfessorused
theword"disimpacted"inasenseintendedtoimplythatsuchforcehad
beenused.ItisalsounlikelythatMr.Jordanwouldhavepassedthe
report,containingthatword,withoutobjectionifhehadunderstoodthe
wordinthatsense.Secondly,themedicalevidenceasawholeshowed
thatthewordisusedwithvariousshadesofmeaning,andthatitdoesnot
necessarilymeanthatthefoetusissofirmlywedgedorstuckastorequire
muchforcetodislodgeit.Themedicalevidenceshowedalsothatthe
exactdegreeofforcewhichcouldproperlybeusedwasamatterforexpert
judgmentbyaskilledobstetricianandmightvaryconsiderablyaccording
tocircumstances.Thirdly,(andinmyopinionofconsiderableimportance)
whenthetwoexpertwitnesseswhogaveevidencefortheplaintiffwere
preparingtheirjointreport(orratherapprovingthejointreportwhichwas,
rathersurprisingly,"settled"forthembycounsel),theydidnotemphasise
ProfessorMcLaren'sreferenceto"disimpaction"ifitwasreallysofatal
tothedefendant'scaseasthelearnedjudgeseemstohavethought,one
wouldhaveexpectedthemtofastenonitatonce.Itseemstome,therefore,
thatheattachedtoomuchimportancetoit.

Apartfromtheuseofthatoneword,thelearnedjudgeevidentlyregarded
ProfessorMcLaren'sreportasawholeasindicatingthatthedefendant
hadpulledtoohardandtoolong.Thatmayhavebeenpartlybecause
hetreatedtheexpression"descentdidnotfollowtraction"asmeaning
thatthefoetusdidnotdescendatallasaresultoftraction.Thatmeaning
wasurgeduponusinargument,butIdonotacceptitbecauseifnodescent
tookplace,i.e.ifthefoetusdidnotmovedownwardsatallasaresultof
traction,theimpaction(whatevermaybetheexactmeaningoftheword)
couldnothavebeencausedbythetraction.Ireadtheexpressionas
meaning,whatMr.Jordansaiditmeant,thatdescentdidnotcontinueto
theextentofdelivery.Soread,thestatementiscorrectbutthrowsno
lightonthequestionweareconsidering.Ithinkmuchoftheimportance
attachedbythelearnedjudgetothereportwasduetothestatementit
containedthat"afterareasonableattemptatdeliverybyforcepsa
"Caesareansectionwascarriedout."(Myemphasis.)Thesignificance
ofthewordsemphasisedisthatadistinctionwasdrawnbythemedical
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witnessesbetweenatrialofforcepsdelivery(generallyabbreviatedtoa
trialofforceps)andanattemptedforcepsdelivery.Theformershouldbe
verytentativeandgentle.Thelatter,inwhichstrongertractionis

permissible,shouldneverbeembarkeduponunlessthephysician'sclinical
judgmentpermitshimtoconcludeunequivocallythathecandeliverthe
patientsafelypervaginam.Mr.Jordaninhisevidencewasinsistentthat
henevergotbeyondthetrialstageandthatthefactofhishavingused
fiveorsixpullsdidnotindicatethecontrary.Hedidnotprofessto
remembereverydetailofwhathehaddone,andhisevidencewasbased
ontheclinicalnotesandonhisusualpractice,buthewasquiteclear
aboutwhathemusthavedone.Hesaidthat,takingsixpullsasthetotal,
hemusthavemadesomeprogressuntilthefifthpull.Thefifthpullmade
noprogressandthesixthpullwouldhaveconfirmedthatnofurther
progresswaspossibleconsistentwithsafety.Thelearnedjudgedidnot
intermsrejectthatevidencenordidheexpressanyreservationaboutMr.
Jordan'sevidenceasawhole.Whathesaid,inthedecisiveparagraphof
hisopinion,wasthis:
"InallthesecircumstancesIamdoubtfulwhetherMr.Jordan
"wasinfactundertakingatrialofforcepsasopposedtoanattempt
"atvaginaldeliverywhichfailed,andinthecourseofwhichthe
"babywaswedged,stuckorjammed,andwhichonanyone'sview
"ofthematterwouldbeunjustified.However,inanyeventifitwere
"atrialofforcepsthenhepulledtoohardandtoolongsothatthefoetus
"becamewedgedorstuck.Ingettingitwedgedorstuck,orunwedged
"orunstuck,Mr.Jordancausedasphyxiawhichinitsturncaused

17

"thecerebralpalsy.InthisrespectMr.Jordanfellbelowthevery
"highstandardofprofessionalcompetencethatthelawrequiresof
"him."
Itseemstomewithrespectthatthelearnedjudgewasseekingtodraw
toosharpalinebetweenatrialofforcepsdeliveryandanattempted
forcepsdelivery.Theformer,ifitmakesprogress,willmergeintothe
latter,andmaybecarriedontoacompletedelivery.WhetherMr.Jordan
evermovedfromthetrialstagetotheattempteddeliverystageisreallya
questionofwordstheimportantissueiswhethertherewasevidencethat,
inthelearnedjudge'swords,"hepulledtoohardandtoolongsothatthe
"foetusbecamewedgedorstuck."Hehimselfdeniedthatiteverbecame
wedgedorstuck,andIhavealreadyexplainedwhyIdonotthinkthat
ProfessorMcLaren'suseoftheword"impacted"meansstuck.The
evidencewhichseemstometocomenearesttoconvictinghimofnegligence
inthisrespectishisown.Heexplained,whatafterallisobvious,that
thepurposeofpullingwithforcepsistoovercomeresistancetothedescent
ofthefoetusdownthenatalcanalandthatafterthefifthpullhewould
havehadtomakeadecisionwhethertocontinue,andwhethera"littleextra
"pressureortraction[would]deliverthisheadpastthatbonyobstruction
ornot".ItwasarguedthatthatpassageinMr.Jordan'sevidence,and
someotherpassagestothelikeeffect,showedthathewaswillingtopull
toohard.Butthetrialjudgedoesnotseemtohavethoughtso,andnor
doI.Themerefactthathepulledfiveorsixtimesisnoindicationof
howhardhepulled.Afterhehadfinishedthetrialofforcepshepushed
thefoetalheadupwardstofacilitateremovalofthefoetusbyCaesarean
section,butthatagaindoesnotindicatethatithadbecomewedgeditisa
normalpreliminarytoCaesareansection,asDameJosephineBarnes
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explained.Inthesecircumstancestherewasinmyopinionnosufficient
evidencetojustifyafindingthathehadbeennegligent.

Iwouldthereforedismisstheappeal.
Irespectfullyagreewiththeobservationsofmynobleandlearned
friendLordWilberforceinthefinalparagraphofhisspeechabouthis
concernastothemannerinwhichpartoftheexpertevidenceforthe
plaintiffwasorganised.

LordRussellofKillowen
MyLords,
Iwishattheoutsettoemphasiseonematter.Somepassagesinthe
CourtofAppealmightsuggestthatifadoctormakesanerrorofjudgment
hecannotbefoundguiltyofnegligence.Thismustbewrong.Anerror
ofjudgmentisnotperseincompatiblewithnegligence,asDonaldsonL.J.
pointedout.Iwouldacceptthephrase"amereerrorofjudgment"ifthe
impactoftheword"mere"istoindicatethatnotallerrorsofjudgment
showalapsefromthestandardofskillandcarerequiredtobeexercised
toavoidachargeofnegligence.
Thedetailsofthiscaseandthereasonsfordismissingthisappealhave
beensofullycanvassedbymynobleandlearnedfriendsthatthereis
butlittlethatIcanadd,withouttediousrepetition,insayingthatIagree
tothatdismissal.
Ashasbeenpointedout,andasSirJohnStallworthyaccepted,therewas
noindicationfromthefoetalheartbeatsthatduringthetrialofforceps
deliverythefoetuswasinanywaydistressed.Theywerenormal.
Thelearnedjudge,inapassagequotedbyyourLordships,whichcame
immediatelybeforehisconclusionofnegligencebyMr.Jordan,inthathe
pulledtoolongandtoohard,inferredfromevidencegivenbythemother
thatshewasphysicallypulleddownthebed.ThisIthinkwasquite

18

withoutjustificationonthebasisofherevidencewhichdidnotpointto
thatatall.Itwasnotpermissibletoerectatheoryofwhatshemighthave
saidbutdidnotsay,andbaseaconclusionofnegligenceatleastinpartupon
thattheory.Itmaybethatthejudgeborrowedthetheoryfrommedical
evidencegivenonbehalfofthePlaintiff:butthemedicalexpertswere
nomoreentitledthanthejudgetoreadthemother'srejectedevidenceas
intendedtomeansomethingtotallydifferent.Ashasbeenpointedoutit
wasneversuggestedtoMr.Jordanthathisactivitiespulledthemother
towardshim.AstothereportwrittenbyProfessorMcLaren(andshownto
Mr.Jordan)twopointsweresoughttobemade.Thefirstwasitsstatement
thatdescentdidnotfollowtraction:Iseenothinginthis:itmeansnot
thatnoprogressatallresultedfromthetrialofforcepsdelivery
butthattherewasnodeliverybyforceps.Thesecondwasthe
referencetodisimpaction.Muchevidencewasgivenastothemeaningof
disimpactionandimpaction,andwhatwasinvolvedin"stuck"and
"wedged".Allthesewordsarewordsofdegree."Impacted"maysimply
meanthatthefoetusisunabletomoveeitherwayspontaneously,andsome
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assistanceisrequired.Themerefactthatsomeassistancewasrequiredto
"disimpact"cannotshownegligence:ifitdid,thejointmedicalreport
wouldnotmerelyhavementioneddisimpactionbutwouldsurelyhavesaid
thatitprovednegligence.
MyLords,Ialsowoulddismissthisappeal.

LordBridgeofHarwich
MyLords,
Attwentyfiveminutespastmidnighton7thJanuary1970theappellant
wasbornattheBirminghamMaternityHospital.Themotherhadbeenin
laboursincetheearlyhoursofthe6th.Thepossibilityofadifficultbirth
hadbeenanticipatedbythemedicalauthoritiesatthehospitalresponsible
forhercase.By11.30p.m.onthe6th,themotherwasfullydilated.From
thatpointonwardsthefirstrespondent,nowaconsultantobstetrician,then
aseniorregistrarinProfessorMcLaren'sunitatthehospital,wasin
chargeoftheoperationofdeliveringthechild.Heconcludedfromhis
examinationofthemotherthatanormaldeliverywasoutofthequestion.
At11.45p.m.heproceededtoundertakea"trialofforceps".Inthelight
ofthistrialhedecidedthatdeliverypervaginamwouldbetootraumaticfor
themotherandthechild.Accordinglyheproceededtoeffectdeliveryby
Caesareansection.Thechildwasfoundtohavesustainedseverebrain
damage.
BushJ.,thetrialjudge,madeafinding,whichisnotchallenged,thatthe
braindamagetotheappellantwascausedbyanoxiaoccurringatsometime
betweenthebeginningofthetrialofforcepsandthedeliveryofthechild.
Thismightseemtothelaymantosuggestsomeimproperuseoftheforceps,
butanysuchsuggestionisemphaticallyrefutedbytheevidence.Itis
commongroundthatachildmay,inthecourseofanapparentlynormal,
birth,sufferanoxiaforwhichnospecificcausecanbeassignedandcertainly
thatthemerefactofanoxiaoccurringwhenitdidinthecourseofthe
appellant'sbirthaffordsnoevidencewhatsoeveroffaultonthepartofthe
firstrespondent.
Thejudge'sfindingofnegligenceagainstthefirstrespondent(onwhich
thevicariousliabilityofthesecondrespondentinturndepends)isbasedon
afindingthatinusingtheforceps"hepulledtoohardandtoolongsothat
thefoetusbecamewedgedorstuck"andthat"ingettingitwedgedor
stuck,orunwedgedorunstuck"thefirstrespondentcausedtheanoxia
whichoccasionedthebraindamage.Inthelightofthedirectionthejudge
hadgivenhimselfearlyinhisjudgmentindefiningthecriteriontobeapplied
todecidewhetherthefirstrespondentwasnegligent(adirectionwhichIdo

19

notcriticise)thisfindingmustbeunderstoodasimplyingthatthefirst
respondentappliedtractiontothefoetuswiththeforcepswhichbothin
strengthanddurationexceededwhatanycompetentobstetricianofthestatus
ofseniorregistrarwouldhaveregardedasthepermissiblelimitsincarrying
outtheprocedureofatrialofforceps.Thejudge'sdecisioninfavourof
theappellantshavingbeenreversedbyamajorityintheCourtofAppeal,
thesolequestion,asitseemstome,whichyourLordships'Househasto
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decideiswhetherthejudge'sfindingthatthefirstrespondentapplied

excessivetractiontothefoetusinthesenseindicatedabovecanbesupported
ontheevidence.

MyLords,Irecognisethatthisisaquestionofpurefactandthatinthe
realmoffact,astheauthoritiesrepeatedlyemphasise,theadvantageswhich
thejudgederivesfromseeingandhearingthewitnessesmustalwaysbe
respectedbyanappellatecourt.Atthesametimetheimportanceofthe
partplayedbythoseadvantagesinassistingthejudgetoanyparticular
conclusionoffactvariesthroughawidespectrumfrom,atoneend,a
straightconflictofprimaryfactbetweenwitnesses,wherecredibilityis
crucialandtheappellatecourtcanhardlyeverinterfere,to,attheother
end,aninferencefromundisputedprimaryfacts,wheretheappellatecourt
isinjustasgoodapositionasthetrialjudgetomakethedecision.It
hasbeenstronglyurged,onbehalfoftheappellant,thatinthiscasethe
judge'sassessmentofthereliabilityofthewitnesses,particularlyofthe
firstrespondenthimselfandofhissuperiorattheBirminghamMaternity
Hospital,ProfessorMcLaren,wasofsuchcriticalimportancetohisdecision
astorenderitunassailableandthisviewprevailedwithDonaldsonL.J.,who
dissentedintheCourtofAppeal,eventhoughheintermsrejectedoneof
thejudge'ssubordinatefindingsonwhichhisultimateconclusiondepended.
AtfirstblushIwasmuchattractedtothisviewofthecasebutaclose
scrutinyofthejudge'sanalysisoftheevidenceandoftheparticularfeatures
oftheevidenceonwhichhereliedinsupportofhisfindingofnegligence
persuadesmethatthatfindingwasnotjustified.Iwillconsiderinturnthe
fourmainaspectsoftheevidenceonwhichthejudgebasedhisconclusion.
1.TheMother'sEvidence.Themothergaveevidenceemphatically
thatwhentheforcepswereappliedshewasliftedupfromthebed.Every
oneacceptedthatthiswasimpossible.Anypullingontheforcepsis
downward.Theappellant'sexpertwitnessescanvassedthepossibilitythat
themothermighthavebeenpulledofftheendofthebedandliftedback
ontoit.ThiswasdeniedbyDr.Skinner,awitnesswhowaspresentatthe
birth,andthesuggestionwasneverevenputtothefirstrespondentin
crossexamination.Themother'sevidenceateveryotherpointwhereit
wasincontroversyhadbeenrejectedbythejudge.Atthetimeofthe
trialofforcepsshehadbeeninlabourformanyhoursandwasunderan
epiduralanaesthetic.Yetthejudgesaidofher:
"ThoughMrs.Whitehouse'sdescriptionofwhatoccurredtoher
"whentheforcepswereappliedmaynotbeexactinitsclinical
"detail,Ibelieveher,insofarasherdescriptioncanbetakentobe
"understoodasapullingofhertowardthebottomofthedelivery
"bedinamannerandwithsuchforceastobeinconsistentwithatrial
"offorcepsproperlycarriedout."
Counselfortheappellanthasnotsoughttosupportthispartofthejudge's
judgmentanditwasrejectedbyallthreemembersoftheCourtofAppeal.
Iagreewiththem.Themother'sevidencecouldnotbeunderstoodinthe
sensesuggestedandwasmanifestlyincapableofaffordinganyreliable
indicationofthedegreeofforceappliedwiththeforcepsbythefirst
respondent.
2.ProfessorMcLaren'sReport.Followingcomplaintsbytheappellant's
parentstotheHospitalAdministrator,ProfessorMcLaren,asheadofthe
unitresponsible,preparedareportonthecircumstancesoftheappellant's
birth.Thiswasbasedinpartonthehospitalrecords,inpartondiscussion

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withthefirstrespondent.Initsexpresstermsthereportwaswholly

20

favourabletothefirstrespondent.InhissummaryProfessorMcLaren
said:
"Finallyanexpertobstetricianinmyteamundertooktheaccepted
"obstericaltechniqueoftentativetrialofforceps.Afterareasonable
"attemptatdeliverybyforcepsaCaesareansectionwascarriedout.
"Thebaby,alas,wasseriouslyaffectedbythiswellconductedtrialof
"labourandforceps."
Inexpressinghisopinionheadded:
"MyownviewisthatbothMr.andMrs.Whitehousearenaturally
"verydistressedalthoughthereisnoevidencethatshehadanything
"butfirstclassobstetriccare.Wecanappreciatetheletterfrom
"Mr.Whitehouseof22.1.70butweacceptnocriticismorimplication
"thatintermsofbeinghumane,orintechnicalskills,weneglected
"Mrs.Whitehouse."
Despitethesepassagesthejudgedescribedthereportas"perhapsthe
"strongestpieceofevidencethatsomethinguntowardwasdone".He
basedthisviewontheusemorethanonceinthereportoftheword
"disimpaction"todescribetheactionofthefirstrespondent,having
decidedtoabandonthetrialofforcepsandproceedtoCaesareansection,
inpushingtheheadofthefoetusupwardswiththeforcepstofacilitate
deliverybyCaesareansection.
Itwascommongroundthatatrialofforcepsisatentativeprocedureto
discoverwhetherthebaby'sheadcanpasssafelythroughthemother's
pelvis.Theobstetricianmustproceedgentlyandnotattemptactualdelivery
unlessanduntilheissatisfiedthatthereisnosuchbonydisproportion
betweenheadandpelvisastopresentariskofinjurytothebaby.Of
course,ifnosignificantobstructionisencountered,thetrialofforcepswill
mergeintoanactualforcepsdelivery.
Againstthisbackgroundagreatdealofevidencewasgivenbythe
expertwitnessesonbothsidesastothesignificance,inrelationtothe
conductofatrialofforceps,ofthefactofthefoetusbecoming"stuck"or
"wedged"inthecourseofit.Adefinitionof"impacted"fromSteadman's
MedicalDictionaryas"denotingafoetusthatbecauseofitslargesizeor
"narrowingofthepelviccanalhasbecomewedgedandincapableof
"spontaneousadvanceorrecession"wascanvassedwiththewitnesses.
Nowitwillbeapparentthatinanycontextthewords"stuck"or
"wedged"areimprecise.Anobjectmaybelightlyortightlystuckor
wedged.Thedegreeofforcerequiredtofreeitmaybegreatorsmall.
Icanfindnothingintheexpertevidencetosuggestthatinanobstetric
contextthewordsasappliedtoafoetusdescribedas"stuck"or"wedged"
inthepelviccanaldonotsufferfromthesameimprecision.If"impacted"
issynonymouswith"wedged"thesameconsiderationmustapply.
Thejudge,however,hasdrawntheinferencefromProfessorMcLaren's
useoftheword"disimpaction"thatthefoetushadbecomesofirmly
wedgedastoindicatethatadegreeofforcemusthavebeenusedbythefirst
respondentinproducingthatresultwhichwasclearlyexcessiveinatrialof
forceps.HerejectedProfessorMcLaren'sexplanationthathemeantno

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moreby"disimpaction"thanwhatcouldbeachievedbygentlypushing
theheadofthefoetusupoutofthepelviccavitywithonefinger.

IfProfessorMcLarenusedtheword"disimpaction"intendingittobear
themeaningthejudgeattributedtoit,theimplicationsaretwofold.First,
ProfessorMcLarenmusthaveappreciatedfromwhatthefirstrespondent
toldhimthatthetrialofforcepshadbeenmisconductedandhadended
indisasteritwouldfollowfromthisthattheexculpatorypassagesinthe
reportwereadishonestattempttowhitewashasubordinate.Butsecondly,
italsorevealsProfessorMcLarenasnotonlyaknavebutafoolwho
attemptsawhitewashinonepartofhisreportbutgivesthegameawayin
anotherpart.

21

Ifinditimpossibletosupposethatthejudgeappreciatedthese
farreachingimplicationsofthesignificancehewasattachingtoasingle
wordintheProfessor'sreportorthat,ifhehaddoneso,hewouldhave
beenpreparedtostigmatisethewitnessinsuchamanner.

3.TheFoetalHeartRate.Therespondentsreliedatthetrial,insupport
oftheircasethatthetrialofforcepswasnotthecauseoftheappellant's
anoxia,onreadingsofthefoetalheartrateduringthetrialofforceps
beingwithinnormallimits.At11.35p.m.theratewas140.At11.45
p.m.,whenthetrialofforcepsbegan,itwas130.Itwasthesamefive
minuteslater.At12.10a.m.whenthetrialofforcepsconcludeditwas
120.Afterthedeliveryofthebabyat12.25a.m.theratehadfallento
100orbelow.Afterreferringtothisevidencethejudgecommented:
"Thoughallthesereadingssavetheoneat100orbelowarewithin
"normallimits,thereishereasteadydropindicatingtomymind
"thatsomethingwaswrong".
Itakethiscommenttoindicatethatthejudgenotonlyrejectedtheevidence
thatthereadingsduringthetrialofforcepswereinconsistentwithanoxia
beingcausedatthatstagebutalsoregardedthefallfrom140beforethe
trialbeganto120whenitconcludedasaffordingsomesupportforthe
contraryview.Thatview,however,wasnotexpressedbyanyofthe
expertwitnessesandindeediscontrarytoalltheexpertevidenceonthe
subject.

4.TheNumberofPulls.Thefirstrespondenthadrecordedinhis
operationnotes:"Afterpullingwithfiveorsixcontractionsitwasobvious
"thatvaginaldeliverywouldbetootraumatic".Heacceptedinevidence
thathehadprobablyexertedsixpullscoincidentwiththemother'suterine
contractions.Theeffectofhisevidencewasthat,sofarashecould
rememberorreconstructtheoccasion,thefirstpullwasextremelytentative
andproducednomovement.Thereafter,thenextthreepullsachieved
someprogress,thelasttwonone.Havingencountereddifficultyonthe
fifthpull,hepulledoncemoretoseewhetheralittleextratractionwould
overcometheresistancehewasfeeling,butitdidnot.SirJohnPeel,an
expertwitnesscalledfortheappellant,hadbasedhiscriticismofthefirst
respondentinpartontherecordednoteoffiveorsixpullsbuthadsaid
thatitwas"difficulttobedogmatic"aboutthis.
Thejudgereferstothisissueinthefollowingpassage:
"SirJohnPeel,whileconcedingthatthenumberofpullsmay
"dependontheprogressbeingmade,hassaidthathecannotunder
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6/16/2017 WhitehousevJordan[1980]UKHL12(17December1980)

"standwhyitshouldhaveneededfiveorsixpullstotestwhether
"deliverypervaginamwaspossible.Mr.Jordan'sanswertothisis,
"asIhaverelatedabove,thatuntilsaythefifthpullhewasmaking
"progress.If,asIhavefound,theheadwasengageditwouldnot

"haveallthatfartogobeforethewidestpartoftheheadwasatthe
"ischialspines,andIshareSirJohnPeel'sdoubt."

Thejudgeaddedareferencetotwocrypticanswersgiveninreexamination
bythefirstrespondent,butIrefrainfromquotingthesebecauseIconfess
thatIdonotfollowwhatsignificancethejudgeattachedtothem.
Thisisperhapsthemostdifficultpartofthecase,butIamsatisfied
thatthecriticismofthefirstrespondentforexertingsixpulls,qualifiedas
itwas,couldnotbyitselfsustainafindingofnegligenceagainsthim.
Asregardstheevidenceofthefirstrespondent,thejudgerecordsthat,
accordingtohim,therewasnothingunusualthatoccurredfromthe
commencementofthetrialofforcepstothedeliveryofthechild.I
appreciate,ofcourse,thatthejudge'sfindinginvolves,bynecessary
implication,arejectionofthisevidence.Itistritetoobserve,however,
thatrejectionofadefendant'sdenialprovidesnomaterialtoestablishthe
positivecasesoughttobemadeagainsthim.Ontheotherhand,ifthe

22

judgehadconstruedanythinginthefirstrespondent'sevidenceasamounting
toanadmissionoffaultonhisownpart(whichthecrypticanswersreferred
toabovecertainlydidnotprovide),hewouldsurelyhavemadethis
abundantlyclearandputitintheforefrontofhisreasonsformakinga
findingofnegligenceagainsthim.
IntheresultIcanfindnosufficientfoundationforthisfindingandwould
accordinglydismisstheappeal.

312955Dd801361920012/80

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