THOMAS PULLAR, MB, Ch. B., DPH

JUNE 20, 1959 OBITUARY MEDICAL JOURNAL1595
department as it is to-day he did tremendous lists, often
involving most laborious surgery, in catching up with
arrears as well as keeping abreast. During the war he very
much wished to join the Royal Navy, but Suffolk would
not spare him and so he worked harder than ever, hastening
his sad departure. In his work he was a perfectionist and
expected others to be the same, even beyond their ability.
Yet few of us who worked for him remembered for long
his moments of irascibility, for he never spared himself;
and when, after a long operation involving several radiographs,
he said, " I'll accept that," we were sure that a good
job had been done and that we had in some measure
contributed. Only the day before he died he was tackling a
long list, including a particularly difficult Bankart's operation
in a temperature of 80-90' F., and in the evening he
returned to do an emergency.
There can be few people in the Ipswich area who have
not encountered " B. J." and still fewer who did not know of
him. His interests were so wide and varied that he was an
excellent conversationalist, and his anecdotes, often in
dialect, were always entertaining. At social functions, which
he highly enjoyed, he was always the centre of a group, but
he could listen as well as talk. He well knew his own
diagnosis and prognosis and used sometimes to refer to
them, but he just kept on and finished, I believe, as he
would have wished.
Medico-Legal
PRECEDENT AND THE DUTY OF CARE IN
NEGLIGENCE
[FROM ouR LEGAL CORRESPONDENT]
In a recent industrial case, the House of Lords reaffirmed
a well-settled principle that tends to be forgotten (Qualcast
(Wolverhampton) Ltd. v. Haynes-The Times, March 26).
The case concerned a moulder who was burnt by molten
metal splashing on to his foot. He knew that his employers
kept a stock of protective spats, but 'he had not been
advised or ordered to wear them, as he was an experienced
workman.
In a county court action by the moulder against his
employers, the judge gave it as his opinion that in all the
circumstances of the case there had been no negligence on the
part of the employers. However, since there was a reported
decision on similar facts in another case holding employers
liable, the judge held that he was bound by precedent to
give a decision contrary to his own view of the facts.
On appeal, the House of Lords gave judgment in favour
of the employers. They held that in negligence cases it is
a question of law whether a duty of care is owed by persons
in one class to persons in another. Thus when a court has
held that an employer owes a duty of care to his employeeor
a doctor to his patient-that creates a precedent on a
point of law binding on all courts except those senior to the
court making the decision. But the question whether that
duty has been broken is a question of fact which should be
left for the jury if there is one-or if the case is tried by
judge alone, it should be decided by the judge in the way
in which a jury would decide it: that is, the question whether
the duty of care (once it is found to exist) has been broken
is to be decided without regard for precedents. Whether an
act constitutes negligence must be decided in relation to all
the surrounding facts. No situation is precisely the same as
another; previous cases may therefore be cited as a guide
only and not as a rule.
For doctors there is this lesson: besides reaffirming the
pertinence of differing circumstances in negligence cases, this
decision makes it plain that advances in medicine may well
convert yesterday's accepted practice into to-day's
professional negligence-and vice versa.
Medical Notes in Parliament
When the Commons reassembled after the Whitsun recess
on June 2 they returned to the question of radiation risks,
with Mr. ANEURIN BEVAN (Ebbw Vale, Lab.) asking the
Prime Minister for the latest evidence on whether there is
a threshold value below which there is no risk of genetic
damage, leukaemia, or bone cancer. The PRIME MINSTER
said it was impossible to say with certainty.
In the House of Lords on June 4 the Mental Health Bill
was given its second reading.
Treatment of Migraine
Three M.P.s spoke about the need for investigation into
the causes of migraine, and the work being done at the
Putney Clinic, on June 4. Mrs. EVELiNE HILL (Manchester,
Wythenshawe, Con.) said it was estimated that between
150,000 and 200,000 people had to take from one to three
days in bed each week because of this disease. Many people
had eventually found their way to the Putney Clinic and
received considerable benefit. But the service was limited
by the time the specialist could spend there, because his
services were given free. What they were asking was that
the whole question should be investigated, so that the
treatment could be made available to all sufferers.
Mr. D. HOUGHTON (Sowerby, Lab.) asked for a report on
investigations which the Minister of Health had said as far
back as 1954 he would be interested to make. If they could
be given no news, he implored the Parliamentary Secretary
to impress on the Minister that this was a matter on which
the House wanted him, the Medical Research Council, and
the clinics to carry out with will and determination every
possible research and investigation. Mr. READER HARRIS
(Heston and Isleworth, Con.) said the Eileen Lecky Migraine
Clinic at Putney did not make exaggerated claims, but could
prove that in about 25% of cases there had been a complete
cure, and in about 70% of the rest there was sufficient
improvement to warrant continuing the treatment. In about
5% of cases the clinic had to admit that it could do nothing.
Mr. RICHARD THOMPSON, Parliamentary Secretary,
Ministry of Health, said that one of the difficulties was
that migraine was a transient illness in which no
pathological lesion had been demonstrated. It was known
to be associated in some cases with a temporary change
in the cerebral blood vessels, but the cause of the change
was still obscure. It was probable that migraine was a set
of symptoms occurring as a result of quite different causes.
Special attention had been given by research workers in
London and provincial hospitals to studying the causes of
headache. This work had included investigation into the
anatomy and physiology of blood vessels in the brain, the
sensory nerve pathways from the head, alterations in the
circulation of cerebrospinal fluid, and related ophthalmological
disturbances. The clinical aspects had also been
extensively investigated in many neurological departments.
A number of different drugs had been tested, but none had
been found significantly better than the present accepted
remedies. Similar results had been obtained by workers in
America. Research had so far been unrewarding, but to
continue study on the lines described appeared to offer the
best prospect of success. The specialist associated with the
Putney Clinic had published a book on his findings, and the
medical profession was in a position to evaluate the claims,
and, if thought fit, to adopt any promising method of
treatment advocated in them. The specialist's reports, he
added in answer to Dr. J. DICKSON MABON (Greenock, Lab.),
showed that he had had a number of successes, but the
reports were not based on controlled clinical trials and
therefore it had been impossible to make a wholly objective
assessment of their value.
They had considered, in relation to everything else that
investigation elsewhe.re had thrown up, the claims made by
this doctor for his own experience. On the basis of that
their medical advisers were not satisfied that there was here