High Court of Ireland Decisions

1. The Plaintiff in this case, who is 42 years of age, is a married lady and resides at Upper Cloghroe, Blarney in the County Cork which, apparently, is a rural part of the county. Her husband, who is 43 years of age, is self-employed and carries on a fruit and vegetable business which, apparently, involves extensive travelling throughout West Cork. The Plaintiff and her husband were married in the year 1980 and, at that time, she was employed by the Revenue Commissioners as a clerical assistant. However, she retired from that position in the year 1982 on the birth of her eldest son but she told me, and I accept, that it was always her intention to resume some form of employment when her youngest son became school-going. The Plaintiff and her family moved to Blarney some time in the late 1980s and, shortly afterwards she joined the local branch of the I.C.A. with which she became involved in a variety of activities. In particular, she organised coffee mornings for the purpose of raising funds for the Association and she participated in a number of plays which they staged. She also told me, and I accept that, up to a relatively short time before the events which gave rise to this claim, she had been a very active person and enjoyed gardening, swimming and going on long walks. She also assisted her husband with making deliveries and with the paper work associated with his business. She comes before the Court seeking damages by way of compensation for injuries allegedly suffered by her as a result of a fall in the Defendant's grocery shop at Coburg Street in the City of Cork on the 9th March, 1993 which she attributes to the dangerous condition of the floor at the entrance to the said shop.

2. In support of her claim, the Plaintiff gave evidence before me and, at this juncture, I think it appropriate to note that I did not consider her to be either an accurate, or a reliable historian of the circumstances or events which she purported to describe in the course of her evidence. My reservations in this regard arise; not because I doubted the honesty of the Plaintiff, for I believe that she is, basically, a trustworthy person, who did not try to prevaricate and told the truth as she believed it to be. However, in light of the medical evidence given before me, I am persuaded that her ongoing medical problems, to which I will be referring in greater detail in the course of this judgment, has effected her memory to the extent that she cannot now be considered to be a reliable historian of past events. Accordingly, in arriving at some of the conclusions to which I have come with regard to this case, I have been influenced; more by the evidence of other witnesses with regard to contemporaneous descriptions of her accident given by the Plaintiff and contemporaneous complaints made by her with regard to her medical problems than I have been by the evidence which Mrs Curran, herself, gave in the witness box. That is not to say that I have rejected her evidence in its entirety. On the contrary, I think that so far as generalities are concerned, she was probably a reliable witness; for example, I have no doubt but that she experienced the fall which she described in the Defendant's shop on the stated date and I accept her evidence that, as a result of that fall, she suffered some injuries. However, as I have indicated, I am not happy that, when it came to specifics, the Plaintiff's evidence could be relied on.

3. Now, as I have indicated, I am satisfied that the Plaintiff did experience a fall in the Defendant's shop on the 9th March, 1993. Why she visited the shop and what purchases she made while she was there is, I think, irrelevant but I am satisfied, that on the occasion she was accompanied by her youngest, Shane, who was then 3½ years of age and that she made some purchases while she was in the shop. I think that it is also probable that, at the time that she suffered her fall she was holding the child with one hand and carrying her purchases with the other. At the hearing, photographs of the entrance to the Defendant's shop and of its interior were produced in evidence. However, although invited to do so, the Plaintiff was unable to indicate on those photographs the precise point at which she had fallen. However, she was adamant that she had fallen somewhere close to the entrance, at a point at which there was a dip in the ground and the ground was wet. She also gave evidence that there was no mat on the ground at the point at which she fell although there was a mat further in in the shop and that, after she had fallen, she was lying on the ground with her legs on the footpath outside the entrance to the shop. Apart from the fact that the defence did not seriously challenge the Plaintiff's assertion that she had fallen at a point near the entrance to the shop at which the ground was wet and not covered by a mat and where there was a dip in the ground, the account of her fall which the Plaintiff gave in evidence closely resembled that which she had given to her Solicitor when he interviewed her on the 3rd November, 1993. Moreover, Mr Tony O'Keeffe, an engineer, who examined the Defendant's shop on the Plaintiff's behalf and who produced the photographs to which I have already referred, confirmed that, at the entrance to the shop, there is a steeply sloped section which, in my view, is clearly the area which the Plaintiff described as being a dip in the ground. Accordingly, I have no doubt but that that is where the Plaintiff fell and I think that the probabilities are that, at the material time, the ground was wet and there was no mat on it. Furthermore, Mr O'Keeffe pointed to the fact, as was evident from his photographs, that, originally, that area of the entrance to the shop had been serrated in order to give a better grip for people entering and leaving the shop. However, over the years, pedestrian traffic in and out of the shop had smoothed the serrations leaving a highly polished surface which can, in Mr O'Keeffe's view, be particularly dangerous when wet. Indeed, as I interpreted the evidence of the Defendant's wife, Mary Finn, she agreed with that view. Accordingly, I have no doubt but that, that section of the entrance to the Defendant's shop was a trap for the unwary unless covered by a mat or, as Mr O'Keeffe agreed "an accident waiting to happen". As I have already indicated, I am satisfied that it was not covered by a mat at the material time and I think that that omission amounted to negligence on the part of the Defendant for which he is liable in damages to the Plaintiff. In this connection, it was suggested on behalf of the defence that, because the Defendant's shop had been there for a very long time, because Coburg Street is located in an extremely hilly section of the city of Cork and because there was no history of previous falls at the entrance to the Defendant's, shop despite evidence that it was frequented by a vast number of people, the Defendant should not be blamed for what happened to the Plaintiff. Alternatively, it was submitted by the defence that, having entered the Defendant's shop a short time earlier, the Plaintiff was on notice of the conditions which obtained at the entrance and, therefore, had she been keeping any kind of a proper look-out for her own safety when she was leaving, she would not have fallen. Accordingly, it was submitted that the Plaintiff was the author of her own misfortune or, at the very least, was guilty of contributory negligence. I reject all of those submissions. In my view, this accident would have been avoided by the simple precaution of placing a mat at the entrance to the Defendant's shop. I think that the potential danger from not doing so should have been obvious to the Defendant as, indeed, it appears to have been to his wife. I do not consider that the absence of previous falls on his premises or the fact that the shop is located in a hilly section of Cork excused the Defendant from taking precautions to avoid this obvious danger and neither do I think that the mere fact that the Plaintiff had entered the Defendant's shop a short time before she fell was sufficient to put her on notice of the potential danger at the entrance to the extent that a failure to keep a proper look-out contributed to her fall on the way out.

4. The Plaintiff gave evidence, in the course of which she described the mechanics of her fall as follows: "The floor was wet and my two legs were taken from me. I just fell down and my bottom hit the ground and I banged the back of my head." "It was a very bad fall." Given that she gave what was, essentially, the same account of the incident to her General Practitioner, Dr John O'Riordan, when she saw him on the following day, I think that it is probable that it is what actually happened to her. She said that, immediately after the fall, she was shocked, felt dreadful and experienced pain at the back of her head. Shortly afterwards, she became aware of pain at the top of her spine which radiated down her right arm and pain between her right shoulder and the top of her head and between both shoulders. She said that she became stiff all over and, in particular, her right arm was stiff. On the day of her accident, she attended Dr Bernie O'Riordan, a General Practitioner, who practises locally with her husband, Dr John O'Riordan. Dr Bernie O'Riordan was not called to give evidence so I do not know what complaints the Plaintiff made to her. However, on the day following her accident, the Plaintiff was attended on by Dr John O'Riordan and she gave evidence that, at that stage, she was feeling sick and sore all over and, in particular, had pain in her back and head. She said that Dr O'Riordan had advised her to put a heated towel around her neck. She said that, subsequently, she had attended Dr O'Riordan on a number of occasions but it was not clear to me what, if any, other treatment Dr O'Riordan prescribed for her. Whatever it was, the Plaintiff said that, all the time, she was getting progressively worse, that the pain in her back and her head was dreadful and she had pain up to the very top of her back between her shoulders. She also complained of all round stiffness and, in particular, stiffness of her right arm down to her right hand. She says that, because she was not getting any better, she consulted a Dr Barry, who is a General Practitioner, for a second opinion and that he sent her for an X-ray but, apparently, did not prescribe any treatment for her. She said that she was then referred to a Mr Anthony McGuinness F.R.C.S.I., who is an orthopaedic surgeon, who examined her and referred her to Dr Noel Callaghan, who is a neurologist. She said that all that time she was very sick and sore. She said that Dr Callaghan arranged for her to have a M.R.I. scan which was carried out on the 28th May, 1993, following which she was told that she had demyelination in the head and that a thoracic disc was out. She was then referred to Mr J C Marks, who is a neuro surgeon. In or about the same time, she was admitted to Cork University Hospital for a week under the care of a Dr Kellegher. She said that she continued to feel unwell, although she was able to drive and walk and that she was dragging her right leg. In this connection, it is, perhaps, relevant to note that, under cross examination, the Plaintiff admitted that contemporary medical records made following her fall were inconsistent with some of the evidence which she gave with regard to the problems which she experienced after her fall. However, by Christmas 1993, the Plaintiff said that she found that she could not move and was confined to bed. At about that time she was seen again by Mr Marks, who advised surgery for her thoracic spine and, on the 25th January, 1994, she was admitted to hospital where she underwent an operation at the hands of Mr Marks for the removal of a thoracic disc. She said that she got no relief from that operation. She subsequently, had another M.R.I. scan, following which she was told that she was suffering from multiple sclerosis and she spent the next 10 months in hospital during which she said that she was very sick. In this connection, it is common case that the Plaintiff is, indeed, suffering from multiple sclerosis and that the condition has got progressively worse over the years to the extent that she is now grossly disabled and can only mobilise with the assistance of a wheelchair. Moreover, she requires attendant care virtually around the clock and needs assistance to carry out the most basic functions including going to the toilet, eating and dressing. In addition, she appears to be in constant pain. In this connection, not only is it common case that the Plaintiff is suffering from multiple sclerosis but it is also common case that that condition developed a year or more prior to the incident which gave rise to this claim, although it was not diagnosed at that time, and the central issue at the trial of this action was whether or not the condition was aggravated by the fall which the Plaintiff experienced on the 9th March, 1993 and the medical treatment, including the surgery which she underwent on the 25th January, 1994, to which she had to submit following that fall; it being the Plaintiff's case that the condition of multiple sclerosis from which she was suffering during the year or so prior to her fall was a benign form of the disease which caused few problems and, in particular, did not interfere with the Plaintiff's normal enjoyment of life and, in the long term would have continued to be so, had it not been for the fact of that fall and the treatment to which the Plaintiff had to submit following it, whereas the defence argued that there was no evidence upon which the Court could conclude, as a matter of probability, that, whatever injury the Plaintiff suffered on the 9th March, 1993, it aggravated the condition of multiple sclerosis from which she was then suffering and neither did any of the treatment to which she subsequently had to submit, aggravate that condition. On the contrary, the defence argued that the condition of multiple sclerosis from which the Plaintiff was admittedly suffering at the time of her fall would, irrespective of that fall, and any medical treatment which she had following it, have progressed to the state in which this unfortunate lady now finds herself.

5. At this stage I think it appropriate to review the evidence of Dr John O'Riordan with regard to his involvement with the Plaintiff following her fall. In this regard, Dr O'Riordan said he first attended the Plaintiff on the day following her fall i.e. the 10th March, 1993 and that she had been seen on the previous day by his wife, Dr Bernie O'Riordan. He said that on that occasion, the Plaintiff was complaining of low back pain, soreness in her right elbow with mild headache and that, on clinical examination the only objective finding was some bruising of her right elbow and muscle spasm in her back. He said that he advised the Plaintiff to rest and to continue with the medication which, apparently, his wife had prescribed on the previous day. Dr O'Riordan said he next saw the Plaintiff on the 16th March, 1993, approximately a week after her accident, and that, at that stage, she was complaining of severe headache and of weakness, numbness and hot sensations in her lower limbs. She also complained that the pain in her back had got worse and that she was experiencing trouble getting in and out of cars and chairs. As there was considerable controversy about the nature and extent of the injuries which the Plaintiff had suffered as a result of her fall, it is, I think, appropriate to record that Dr O'Riordan had no note that the Plaintiff ever complained to him about problems with her neck or problems in the area of her thoracic spine from which a disc was subsequently removed. However, he said that, as the Plaintiff appeared to be making no improvement under his care, he referred her to Mr Anthony McGuinness F.R.C.S.I., the orthopaedic surgeon, who, in turn, referred her to Dr Noel Callaghan, the neurologist, who arranged for the M.R.I. scan to which I have already referred. As I interpret Dr O'Riordan's evidence, he did not see the Plaintiff from the time that he referred her to Mr McGuinness until he saw her in September, 1993, at which stage he had been advised that she was suffering from multiple sclerosis. Dr O'Riordan then went on to confirm that, since that time, the condition of multiple sclerosis from which the Plaintiff is suffering had got progressively worse to the extent that she now requires the care and assistance to which I have already referred.

6. At this juncture I must record my astonishment at the fact that Dr John O'Riordan was the only doctor, who had attended the Plaintiff during the year prior to her accident and since then, to be called to give evidence on her behalf. Although it was clear from the evidence that, during that period, she had also attended and had been treated by a Dr Bernie O'Riordan, by a Dr Barry, another G.P., by Mr Anthony McGuinness F.R.C.S.I., an orthopaedic surgeon, by Dr Noel Callaghan, the neurologist, by Mr J C Marks F.R.C.S.I., the neuro-surgeon, by a Dr Kellegher, by a Dr Fogarty, by a Dr Sweeney, another neurologist who replaced Dr Callaghan, and there was even a suggestion that she was seen by another G.P., a Dr Denis Cotter, no one of those doctors was called to give evidence on her behalf. Given that there was considerable controversy with regard to the extent to which the Plaintiff manifested symptoms of multiple sclerosis prior to her accident, with regard to the nature and extent of the injuries which she had suffered as a result of her fall and, especially, with regard to the cause of the progression of her multiple sclerosis following her fall, I find it incredible that 90% of the doctors, who treated her at the material times, were not witnesses in this case. I would have thought that many of the doctors, whose evidence I did not hear, would have been of considerable assistance to establish the condition of the Plaintiff's health prior to her fall, the nature and extent of the injuries which she suffered as a result of that fall and the extent (if any) which that fall and the treatment to which the Plaintiff had to submit following it aggravated her multiple sclerosis and I can only say that it seems to me that the omission to call those doctors to give evidence is tantamount to inviting me to try this case "in blinkers". Indeed, throughout the hearing, several witnesses, including witnesses for the Plaintiff, commented that they would have liked the views of Dr Callaghan or Mr Marks with regard to various matters. In fact, in reply to one question put to him in cross examination Professor Leslie Findley said, in effect, 'I cannot answer that question because I don't know what was in Dr Callaghan's mind and Mr Marks' mind.' Admittedly, I did have access to hospital notes with regard to the Plaintiff's admission to hospital on the 13th April, 1992, the 12th June, 1993, the 23rd January, 1994, the 27th October, 1994, the 27th February, 1995 and the 21st March, 1995 and to notes with regard to her condition while she was an in-patient in hospital. I also had access to reports submitted by Mr J C Marks F.R.C.S.I. and to a variety of letters which Dr Callaghan wrote to Dr John O'Riordan with regard to the Plaintiff's ongoing problems. However, these notes, reports and letters, while helpful, did not answer many of the controversial questions which arose in the course of the hearing which, in my view, might well have been answered had some of the doctors, other than Dr John O'Riordan, who treated the Plaintiff since April, 1992 been called to give evidence on her behalf. In this regard, the defence has submitted that the only reasonable inference that can be drawn from the failure to call these several doctors to give evidence is that they would not support many of the controversial arguments which were advanced on behalf of the Plaintiff and, in particular, the premise that the injuries suffered by her as a result of her fall and/or the treatment to which she had to submit following it exacerbated the condition of multiple sclerosis from which she was then suffering. Given that the proceedings in this case were instituted on the 8th February, 1995, at a time when the Plaintiff was aware that she was then suffering from multiple sclerosis and had been aware of that fact for a year or more and, at a time, when, presumably, her legal advisors were also aware of that fact and had access to medical reports on her which, again, presumably identified the condition from which she was suffering, and, yet, those proceedings were instituted in the Circuit Court, I am drawn to the conclusion that, at that stage, no-one was connecting the Plaintiff's condition of multiple sclerosis with her fall in March 1993 and that it is reasonable to infer that the failure to call the several doctors to whom I have referred to give evidence on the Plaintiff's behalf was due to the fact that those doctors are not prepared to associate the progression of the Plaintiff's multiple sclerosis with any injury which she suffered as a result of her fall or to the treatment to which she had to submit following it. In this regard, it is, I think, relevant to record that, as it was indicated to me during the course of the hearing that Dr Noel Callaghan was unfit to attend Court, although it was conceded on behalf of the Plaintiff that he had not been invited to attend, on an application in that behalf by the defence, I directed that Dr Callaghan's evidence be taken on commission. However, although I was advised that the commission sat on the appointed day, with Dr Callaghan in attendance and available to give evidence, the defence declined to call him as a witness and so, also, did the Plaintiff's advisors, although it was indicated to them that the defence would have no objection to Dr Callaghan giving evidence on that occasion. I do not know what inferences I should draw from the fact that neither party was prepared to call Dr Callaghan to give evidence on that occasion. However, I have little doubt but that, if he was prepared to support the thesis that the injuries suffered by the Plaintiff as a result of her fall and her subsequent medical treatment had exacerbated the condition of multiple sclerosis from which she was then suffering, he would have been called as a witness for the Plaintiff.

7. I now turn to the evidence which I had with regard to the Plaintiff's health prior to her fall in March 1993. While, in her direct evidence, the Plaintiff gave me to understand that she had no significant medical problems prior to the spring of 1992, she conceded under cross-examination that, after the birth of her third child, which would have been about seven years previously, she experienced slight pain in her back which occurred on and off over a few years. In this connection, in a letter to Dr Cotter dated the 10th April, 1992, Dr Noel Callaghan indicated that the Plaintiff had told him that it was after the birth of her second child that she had experienced low back pain, with pain radiating into her right lower leg but that the problem resolved; a statement which was repeated in the notes of the Plaintiff's admission to Cork Regional Hospital on the 13th April, 1992. It would also appear that, when she was admitted to the Cork Regional Hospital on the 12th June, 1993, she was complaining of low back pain and pain radiating into her right lower limb which she is alleged to have said started three years previously. However, that is as it may be. The Plaintiff said that, in spring 1992, she experienced stiffness in her legs, a slight sensation in her legs like pins and needles and that she had a weak back. She consulted Dr O'Riordan, who referred her to Dr Noel Callaghan and she was admitted to hospital for a week where she was subjected to a number of tests after which she was told there was no problem. She was subsequently diagnosed as having an ovarian cyst, which was an incidental finding and it was removed surgically by a Dr Fenton. She said that while she was in hospital, weights were put on her legs which made her legs stiffer and that, after her discharge from hospital, she consulted an osteopath following which she had some physiotherapy and the stiffness in her legs went away. She said that, after that, which I interpreted to be some time in the summer of 1992, she was back to normal and from thence until her accident in March of 1993 was able to do everything that she had been doing previously. Dr John O'Riordan gave a somewhat different story. He said that he had been consulted by the Plaintiff in the month of November 1991 with complaints of joint pains and that he prescribed anti-inflammatory treatment. He said that she came back to him in March 1992 complaining of back pain, of heat and pins and needles in her back and of unpleasant sensations and coldness in her thighs and legs. She also complained that her arms were weak and that her left leg was weak. Dr O'Riordan said that he gave her a full examination at that time and that she had a full range of movements and a neurological examination was absolutely normal. He said that he tried to reassure her and told her that her symptoms would settle down but that she did not seem to accept that and, unbeknown to him, she consulted a Dr Denis Cotter, or, perhaps, it was her husband who contacted Dr Cotter but, in any event, it seems that Dr Cotter had an inside track to Dr Noel Callaghan because he was able to arrange for Dr Callaghan to see the Plaintiff early in April 1992 following which Dr Callaghan wrote to Dr Cotter on the 10th April, 1992 and copied that letter to Dr O'Riordan which, apparently, took Dr O'Riordan by surprise because, until he had received that letter, he was not aware that the Plaintiff had been referred to Dr Callaghan at that time. In this regard, it was suggested to the Plaintiff that the fact that Dr Cotter had been contacted to arrange for a speedy appointment with Dr Callaghan indicated that her symptoms at that time were considerably worse than she had indicated in the course of her evidence; a suggestion which she rejected. However, I am inclined to think that there was a substance to that suggestion. In any event, Dr Callaghan reported on the 10th April, 1992 that the Plaintiff was complaining of unpleasant sensation in her back, unpleasant sensations in the thighs on both sides in the inner border of the thighs and the outer border of the thighs. He said that she also complained of a cold sensation in her lower limbs distal to the knee joints on both sides and a sensation of weakness in her left lower limb and that she stated that her left arm felt weak on occasions. However, Dr Callaghan said that he examined her and he could find nothing wrong. In particular, he ruled out any form of nerve root irritation and, did not think that her symptoms were indicative of a disc problem. In that letter of the 10th April, it is obvious that Dr Callaghan considered the question as to whether or not Mrs Curran might then have developed multiple sclerosis but seems to have rejected the idea and surmised that she was suffering from muscular symptoms aggravated by anxiety. Dr Callaghan also indicated that he had arranged for a CT scan of the Plaintiff's lumbar spine, for blood tests and for nerve conduction studies and that he had also suggested to the Plaintiff that she might have a lumbar puncture but that she was unwilling to undergo that procedure. Dr Callaghan wrote again to Dr Cotter on the 22nd April, 1992; a letter which was also copied to Dr O'Riordan, in which he indicated that the CT scan of the Plaintiff's brain was normal, that a CT scan of the lumbar spine did not reveal any form of disc protrusion although minor degenerative changes were manifest, and X-rays of the lumbar spine were also normal, as were the results of blood tests. He also indicated that a neurological examination of the Plaintiff was within normal limits. His conclusion was that she was a difficult case to evaluate and that her symptoms had a functional element to them. The hospital notes from the Cork Regional Hospital on the Plaintiff's admission on the 13th April, 1992 indicated that, at that time, she was complaining of parasthaesia and a "hot feeling" of her lower back radiating down both lower limbs to her toes and that these symptoms had been present for the previous six weeks. They also indicate that she was complaining of a cold sensation from her knees down, that she dragged her left leg when walking, and that she had weakness and stiffness of both lower legs. She was also complaining of numbness and parasthaesia of her upper legs and of headache, convulsions, problems with her eyesight and hearing, tinnitus and vertigo which suggests to me, that at that time, from a symptomatic point of view, the Plaintiff was in a very poor condition. It was unfortunate that Dr Callaghan was not available to give evidence with regard to the implications of these multitudinous complaints. For his part, Dr O'Riordan gave evidence that he did not attend the Plaintiff professionally from the month of April, 1992 until after her accident in March 1993 and neither did she attend his wife during that period. However, he said that he would have met the Plaintiff socially on many occasions throughout the latter part of 1992 and that, on those occasions, she appeared to him to be in very good health which seems to corroborate her own evidence that she was back to normal and doing everything that she wanted to do for many months prior to her accident. However, with all due respect to Dr O'Riordan's powers of observation, I am not convinced that that was so. It seems to me that the combination of the concession which the Plaintiff made on her admission to Cork Regional Hospital on the 13th June, 1993, as recorded in the hospital note relating to that admission, that she had low back and pain radiating into her right lower leg which had started three years previously, her concession on her admission to hospital on the 23rd January, 1994 that she had been unwell for the previous two years and the statement which she is alleged to have made to Ms Jean Murphy, the assistant in the Defendant's shop to whom she reported her fall that "I have had physiotherapy with my back and I hope this does not erupt it or do harm to it", suggests that all was not well with the Plaintiff during the months immediately prior to her accident. In this connection, by the way, I have no difficulty in accepting that the Plaintiff made the statement which Ms Murphy ascribed to her because I can think of no good reason why Ms Murphy would have invented that piece of evidence. However, that is by the by. As I have indicated, I am not persuaded that the Plaintiff was in rude health between the events which occurred in the spring of 1992 and her accident in March of 1993. It may well be that, during that period, she was able to look after her family and to attend to most of her household chores and it may well be that she did not consult a doctor during that period although she was very vague as to when she ceased physiotherapy in the year 1992. However, the concessions to which I have referred all suggest to me that, at the very least, the Plaintiff was having problems with her back up to the time of her accident and that these problems were uppermost in her mind immediately after her fall and provoked the statement which she made to Ms Murphy.

8. As I have already indicated, the central issue in this case was whether or not the condition of multiple sclerosis from which the Plaintiff was, admittedly, suffering at the time of her fall on the 9th March, 1993 was aggravated by injuries suffered as a result of that fall and by the medical treatment; in particular, the surgery which she underwent on the 25th January, 1994, to which she had to submit following that fall. For the Plaintiff, it was submitted that the condition of multiple sclerosis from which she was then suffering was a benign form of the disease which, in the long term, would have continued to be so, had it not been for the fact of the injuries suffered by her as a result of that fall and the treatment to which she subsequently had to submit, whereas it was submitted on behalf of the defence that there was no evidence upon which the Court could conclude, as a matter of probability, that, whatever injury the Plaintiff suffered at that time and whatever medical treatment she had to submit to subsequently, it aggravated the condition of multiple sclerosis from which she was then suffering. On the contrary, it was submitted on behalf of the defence that the injuries suffered by the Plaintiff as a result of her fall and the treatment to which she subsequently had to submit had nothing whatsoever to do with the progression of the condition of multiple sclerosis from which she was then suffering which, in any event, would have progressed to its present state. In this connection, I was satisfied by the medical evidence given before me that, despite extensive research over the years by a variety of distinguished scientists and clinicians in the field of neurology, it has never been established how the condition of multiple sclerosis is caused. Apparently, it is generally accepted that there are genetic, environmental and ethnic factors but, apart from that, the precise cause, or causes, for the onset of the disease is not known. On the other hand, the signs and symptoms of the disease appear to be easily recognisable and facilitate a ready diagnosis. Moreover, it appears to be accepted that a person suffering from multiple sclerosis can, symptomatically, experience periodic remissions and relapses with regard to their general health and mobility. Unfortunately, it appears to be entirely unpredictable at the outset of the disease as to whether or not an individual victim will experience remissions or relapses although Professor Findley said that he had an arbitrary rule of 3; one third of the victims became disabled and dependant, one third were disabled but able to do things and the remaining third functioned reasonably well. Professor Findley thought that the Plaintiff slotted into the latter category. It has also been established that the disease can be asymptomatic, in that, post-mortem examinations have shown the existence of lesions or plaques, consistent with multiple sclerosis, in persons who have lived their lives without ever displaying any of the symptoms of the disease. In this regard, I was also satisfied by the medical evidence which I heard that symptomatic multiple sclerosis can exist in a benign, or malignant, form, in that some persons, who are diagnosed as suffering from the condition, only manifest minor symptoms associated with it and live relatively untroubled lives whereas, in others, the disease progresses to a stage where the victim is totally incapacitated and dependant on others for their every need. In this case, as I have indicated, the suggestion on behalf of the Plaintiff is that it was the benign form of the disease from which she was suffering before her fall in March of 1993 and that, but for that fall, it would have remained so for the rest of her days. In this connection, it is also relevant to note that I had evidence that, when the onset of multiple sclerosis occurs in the fourth decade of the victim's life, or at a younger age, and the manifesting symptoms are sensory only, the likelihood is that the condition will continue to be a benign one so that, as this Plaintiff was only 36 years of age when she was diagnosed as suffering from the disease and, initially, the symptoms of which she complained were sensory only, the prognosis that the disease would not progress was very good. However, while it appears to have been accepted that the younger the victim is when the disease is diagnosed and the presenting symptoms are sensory only, the less likely it is that the disease will progress, there was controversy about the cut-off age and it seemed to me that, at 36 years of age, the Plaintiff was borderline in this respect so that I was not persuaded that she fell into the category of persons in respect of whom it was more likely that the disease would not progress.

9. The possible role of trauma in causing or exacerbating multiple sclerosis and, in particular, the role of trauma to the spinal cord in that regard was the subject of considerable controversy in the course of the trial of this action. In this connection, I heard evidence from eight specialists in the field of neurology; four consultant neurologists, two consultant neuro-surgeons and two consultant neuro-radiologists, each of whom presented with very impressive qualifications and considerable experience in their respective fields of expertise. In addition, I was referred to a multiplicity of studies, results of investigations and other literature in which the question of a causative relationship between trauma and the onset, or exacerbation of multiple sclerosis was discussed and analysed. Insofar as the literature to which I was referred is concerned, while I have read and considered each and every document to which reference was made in the course of the evidence, I do not consider it necessary for the purpose of this judgment to review it all in detail. I think it sufficient to note that, on a careful consideration of this literature, it seems to me that, firstly, the preponderance of medical opinion is that trauma, of whatever kind, is extremely unlikely to be a cause of the onset of multiple sclerosis; a view which, as I interpreted their evidence, seemed to be shared by the several specialists, who gave evidence before me, but that secondly, the jury were still out on the question as to whether or not trauma and, in particular, trauma to the spinal cord, could exacerbate, or progress, the disease and, in this respect, there was a marked divergence of opinion between the views expressed by the several specialist witnesses, who gave evidence on behalf of the Plaintiff, and those, who gave evidence on behalf of the defence. On the one hand, Professor Peter Behan and Professor Leslie J Findley, both consultant neurologists, who gave evidence on behalf of the Plaintiff, were adamant that trauma and, in particular, trauma to the spinal cord, such as the Plaintiff suffered as a result of her fall and the trauma associated with the surgical procedure which she underwent at the hand of Mr Marks in January of 1994 could and did exacerbate and progress the condition of multiple sclerosis from which she was suffering at the time of her fall and they maintained that the preponderance of the literature to which I have referred supported that view. Mr Thomas Russell, a consultant neuro-surgeon, who also gave evidence on behalf of the Plaintiff, while protesting that he had no particular interest in multiple sclerosis, gave evidence that it was a commonly held view, to which he subscribed, that thoracic disc surgery does exacerbate multiple sclerosis although he conceded that he had no personal experience of a patient of his with thoracic disc problems developing the disease and Mr Matthias C Hickey, a consultant neuro-radiologist, who also gave evidence on behalf of the Plaintiff, said that, on reviewing M.R.I. scans of the Plaintiff's spinal cord, he found multiple plaques in the characteristic distribution of multiple sclerosis and evidence of a thoracic disc injury which, in his view, was likely to be due to recent trauma and, having heard and been impressed by the evidence given by Professor Behan, he would subscribe to the view that the condition of multiple sclerosis which he found had been exacerbated by that trauma. For the defence, Dr Sean Murphy another consultant neurologist, was equally certain that trauma does not exacerbate, or progress, the disease of multiple sclerosis and, in particular, that the injuries suffered by the Plaintiff as a result of her fall and the treatment to which she subsequently had to submit had nothing whatsoever to do with the progression of the multiple sclerosis from which she was then suffering. In his view, the progression of the disease which the Plaintiff has experienced is no more than he would have expected whether or not she had suffered that fall. He agreed that the literature referred to; in particular, by Professor Behan, asserted an association between trauma and the exacerbation of multiple sclerosis but he maintained that an analysis of the findings of the contributors to that literature clearly established that the association was never proven. Moreover, he pointed out that the most recent studies on the question of the association between trauma and multiple sclerosis; those of Sibley et al, which was published in 1991 with a follow-up by Professor Sibley on a date upon which I am not certain and Siva et al, which was published in 1993, both of which purport to establish that there is no such association, post date all of the literature referred to by Professor Behan and, therefore must be considered to be more persuasive. Furthermore, Dr Murphy said that, as the Sibley study was a prospective one, its conclusions were more reliable than any of the other studies, which were all retrospective. At this juncture I might diverge to comment that, while the reliability of the conclusions arrived at by Sibley and Siva was challenged for reasons for which I will go into in greater detail later on in this judgment, it appeared to be the opinion of all the medical witnesses, who addressed the subject, that a prospective study is more reliable than a retrospective one. However, that is as it may be. Evidence on behalf of the Defendant was also given by Dr Hugh Harrington, another consultant neurologist who, incidentally had previously worked with both Professor Behan and Professor Findley. Essentially, Dr Harrington supported the views expressed by Dr Murphy; avowing the opinion that there was no evidence that trauma could cause or exacerbate multiple sclerosis and that his view in that regard was supported by modern literature. Dr Harrington also said that, in his experience, the progression of the Plaintiff's multiple sclerosis was not unusual and that he did not consider that that progression was in any way exacerbated by injury suffered by her as a result of her fall. Another witness for the Plaintiff was Mr G F Buckley, a consultant neuro-surgeon, who said that, in his vast experience, he had never come across a case in which there was a connection between trauma to the spinal cord and exacerbation of multiple sclerosis and, in the instant case, he was quite satisfied that the surgery which the Plaintiff underwent in January of 1994 did not exacerbate her multiple sclerosis because the deterioration in her condition following that operation involved a weakness of all four limbs whereas, if the surgery had been responsible for the deterioration, only the lower limbs would have been affected. Dr Dermot Ryder, another consultant neuro-radiologist and a colleague of Dr Matthias Hickey, who also gave evidence on behalf of the Defendant, expressed the view, which he conceded was influenced by modern literature, that the damage to the Plaintiff's thoracic spine, which he agreed was evident on the M.R.I. scans of her spine, did not exacerbate the condition of multiple sclerosis from which she was suffering.

10. As I have indicated, my interpretation of the literature to which I was referred with regard to the possible association between trauma and the exacerbation of multiple sclerosis and, in particular, the association between trauma to the spinal cord and such an exacerbation is that the jury is still out on the question. In other words, I accept that there are persuasive arguments for and against the proposition but I am not convinced that the question has been resolved on the balance of probabilities, one way or the other. However, whatever may be my views on the conclusions reached by the several contributors to the literature to which I was referred with regard to the general proposition that trauma can exacerbate multiple sclerosis, I cannot ignore the fact that, in this case, I had unequivocal evidence from eminently qualified and hugely experienced specialists in the field of neurology, that, on the balance of probability, the condition of multiple sclerosis from which the Plaintiff was admittedly suffering at the time of her fall on the 9th March, 1993 was exacerbated by injury suffered as a result of that fall and the treatment to which she subsequently had to submit to the extent that an otherwise benign condition was rendered malignant. In this regard, it seems to me that, while it may not be established as a general proposition that trauma can exacerbate multiple sclerosis, it is likely that, in an isolated case, the association can be proved and I think that there is support for that proposition in the literature. Accordingly, and whatever the views of other scientists may be, I think that I must consider whether or not the evidence which I heard in this case persuades me on the balance of probability that, so far as this Plaintiff is concerned, the injury which she suffered as a result of her fall in March, 1993 and the medical treatment to which she was subjected following that fall did, in fact, exacerbate the condition of multiple sclerosis from which she was then suffering whereby she is now in the pitiful condition in which she now finds herself.

11. Arising from the foregoing, I must first of all consider what injuries did the Plaintiff suffer as a result of her fall. In this regard, I have no doubt but that she was very shocked and shaken and suffered trauma to her head with associated pain and that, as a result, she subsequently experienced headaches. On the evidence of Dr John O'Riordan, I am satisfied that she suffered bruising of her right elbow and an injury to her back which gave rise to muscle spasm. In this regard, I think that the likelihood is that she aggravated the degenerative changes which were manifest on the CT scan of her lumbar spine which had been carried out in April of 1992. In the circumstance that Dr O'Riordan had no note that the Plaintiff ever complained to him of problems with her neck following her fall, I am not persuaded that the Plaintiff suffered a whiplash injury or, indeed, any injury to her neck as a result of that fall and I might add that I have arrived at that conclusion notwithstanding that, when the Plaintiff saw Dr Callaghan some eight weeks after her fall she appears to have told him that she had experienced pain in her neck following the fall because, in the first place, that complaint was far removed from the fall and, in any event, when Dr Callaghan examined her on that occasion, he found no restriction and no pain on neck movement. In this regard also, I have taken account of what I consider to be the speculative evidence of Professor Behan, Professor Findley and, indeed Dr Harrington and the implications of the evidence which was given by Dr Hickey; all of which suggest that, as a result of her fall, the Plaintiff suffered an injury to her cervical spine but have rejected that conclusion because of the absence of complaints by the Plaintiff with regard to her neck in the weeks following her fall. On the other hand, while there was controversy as to whether or not the herniated thoracic disc which was manifest on the M.R.I. scan of the Plaintiff's spine which was carried out on the 28th May, 1993 was attributable to injuries suffered by her as a result of her fall, I am persuaded by the evidence of Mr Russell and, to a lesser extent, by that of Professor Findley and Mr Hickey that the fall did, indeed, precipitate that disc lesion. I have arrived at that conclusion because most of the specialists who addressed the subject and that included Dr Murphy and Mr Harrington, agreed that that lesion was attributable to trauma and the only evidence which I had with regard to trauma suffered by the Plaintiff was her fall in March 1993. Moreover, I was impressed by the evidence of Mr Russell and Dr Hickey that the absence of osteophytes in the vicinity of the herniated disc which was manifest on the M.R.I. scan; an absence which was not challenged by the defence, suggested that the lesion was of recent origin by which I understand to be that it would have occurred within three or four months or, at the outside within six months of the date of M.R.I. scan.

12. In the light of the foregoing, it is my judgment that, as a result of her fall in March, 1993, the Plaintiff suffered shock and a general shaking up which probably gave rise to widespread pain and stiffness in its immediate aftermath, a relatively minor head injury, some bruising of her right elbow and an injury to her back which, in all likelihood, aggravated pre-existing degenerative changes in her lumbar spine and very probably gave rise to herniation of a thoracic disc. In the light of those findings, I must now consider the evidence which I heard with regard to the suggested exacerbation, or progression, of the Plaintiff's multiple sclerosis arising from those injuries. In this connection, as I interpret the evidence of the proponents of the proposition that the injuries suffered by the Plaintiff as a result of her fall exacerbated or progressed the condition of multiple sclerosis from which she was then suffering, of the injuries which I have found could be attributed to that fall, the only one that could have had that effect was the injury which she suffered to her thoracic spine. Now I appreciate that it was Professor Behan's view that the disease was also progressed by an injury which he perceived that the Plaintiff had suffered to her cervical spine but, as I have already indicated, I do not think that she suffered any injury to her neck as a result of her fall and, accordingly, Professor Behan's views with regard to the implications of the appearance of the Plaintiff's cervical spine after her fall does not seem to me to be relevant to the issue which I have to decide save insofar as any changes in the appearance of the cervical spine after the fall could suggest the progression of multiple sclerosis without the involvement of trauma. As I understand the proposition that the injury which the Plaintiff suffered to her thoracic spine exacerbated or progressed the condition of multiple sclerosis from which she was then suffering, it is based on the supposition that that injury caused a breakdown of what is known as the blood brain barrier which, in turn, lead to demyelination which, apparently, is of the essence of the disease of multiple sclerosis. In this regard, as I understand the position, multiple sclerosis is a demyelinating disease whereby, as a result of the loss of myelin, which is an insulating material in which the axons of both sensory and motor neurones are ensheathed, lesions or plaques, which are the manifestation of the disease, occur. I also understand that the central nervous system in the human make-up includes a large supply of blood vessels, the cells of which are tightly joined together to create a barrier which keeps many substances in the general circulation of the blood from getting into the brain and spinal cord and this barrier is known as the blood brain barrier. Moreover, it appears to be common case that a breakdown of the blood brain barrier can cause demyelination leading to multiple sclerosis and the suggestion in this case is that the injury which the Plaintiff sustained to her thoracic spine caused a breakdown of the blood brain barrier which, in turn, added to the demyelination which had precipitated the onset of the multiple sclerosis from which the Plaintiff was then suffering and, therefore, progressed the disease. Furthermore, it was suggested that the thoracic disc surgery which the Plaintiff underwent in January of 1994 gave rise to an additional breakdown of the blood brain barrier thereby causing more demyelination and further progressing the disease. The evidence relied on in support of these propositions was, firstly, that the M.R.I. scan of the Plaintiff's spinal cord taken on the 28th May, 1993 manifested multiple plaques in the characteristic distribution of multiple sclerosis on the thoracic spine and, secondly, that, symptomatically, the Plaintiff's condition deteriorated dramatically following her fall in March of 1993 and that there was a further, even more dramatic deterioration, following the surgery in January of 1994. Now, insofar as an examination of the M.R.I. scan is concerned, I am quite satisfied by the evidence which I heard that it did, indeed, reveal the existence of plaques on the thoracic spine which are indicative of multiple sclerosis. If it did, however, I am equally satisfied that similar plaques could be demonstrated on the cervical spine. Moreover, as I understood the evidence of Mr Mathias Hickey, the neuro-radiologist, it is not possible to say how long it takes a plaque to become apparent on a M.R.I. scan and the appearance of a plaque is merely a manifestation of the existence of multiple sclerosis but, apart from being evidence of demyelination, it does not suggest why that demyelination occurred. I also heard evidence that the M.R.I. scan demonstrated a significant disc protrusion at the level T6/7 which compressed the spinal cord thereby interfering with the blood supply and causing a disruption of the blood brain barrier. There was dispute as to whether or not such compression had, in fact, occurred or that, if it had, that the blood brain barrier had been breached as a result of it and, in this regard, I think that it was a great pity that Mr Marks was not called to give evidence because, being the person who had operated on the Plaintiff's thoracic spine, it seems to me that he was in the best possible position to give evidence which might have resolved that dispute. For myself, I cannot find any good reason why I should prefer the views of the Plaintiff's specialists to those of the Defendant. Accordingly, it seems to me that, what is shown on the M.R.I. scan is, at best, equivocal. It demonstrates the existence of plaques which are characteristic of multiple sclerosis but, for all I know, an M.R.I. scan of the Plaintiff's spinal cord taken before her fall could have demonstrated similar plaques. It also demonstrates plaques on both the cervical spine and the thoracic spine so that it cannot be said that one area was more affected than the other and, as the cause of demyelination which precipitates a plaque is not known, it cannot be said that a plaque is due to an exacerbation of an existing multiple sclerosis or a natural progression of the disease. In all these circumstances, I am not persuaded that the appearances on the M.R.I. scan of the Plaintiff's spine on the 28th May, 1993, of itself, establish that the condition of multiple sclerosis from which the Plaintiff was suffering at the time of her fall was exacerbated of progressed by the injury to her thoracic spine which she suffered as a result of that fall.

13. The second leg of the argument in support of the proposition that the condition of multiple sclerosis from which she was then suffering was exacerbated and progressed by the Plaintiff's fall and by the medical treatment to which she had to submit following that fall was based on a perceived dramatic deterioration in her condition in the immediate aftermath of her fall and a further dramatic deterioration following the surgery which she underwent in January, 1994. In this regard, it was the evidence of Professor Behan and Professor Findley that the condition of multiple sclerosis, which they accepted that the Plaintiff had developed in early 1992 was, in their view, a benign form of the disease because, firstly, the presenting symptoms at that time were sensory only and, secondly, the Plaintiff became asymptomatic with regard to those symptoms within a relatively short time and, thereafter, remained asymptomatic with regard to those symptoms until the date of her fall, during which period she was able to engage in all her normal activities. In those circumstances, Professor Behan and Professor Findley argued that the recurrence of those symptoms, following the fall, and their rapid progression thereafter was consistent only with an aggravation of the pre-existing condition of multiple sclerosis, as a result of which a benign disease became malignant. Insofar as Professor Behan was concerned, as a result of her fall, the Plaintiff suffered a herniated thoracic disc which inevitably caused neurological changes and a hyper-extension injury to her neck; both of which, in his view, contributed to the extensive demyelination in the thoracic area and in the cervical area which was manifest on the M.R.I. scan carried out on the 29th May 1993. Moreover, in support of his argument, Professor Behan said that he had personally collected case histories in respect of 64 or 65 patients, who had suffered damage to either their cervical cords or their thoracic cords and, within a month of suffering such injuries, had developed multiple sclerosis and that he had been advised of many similar cases by a Professor Poser of Harvard. For his part, Professor Findley agreed in substance with the views expressed by Professor Behan and added that his view as to the benign nature of the multiple sclerosis from which the Plaintiff was suffering prior to her fall was influenced by the fact that, at that stage, she manifested no hard signs of the disease whereas, following her fall, her symptoms were more intrusive. Professor Findley agreed under cross-examination that the symptoms of which the Plaintiff complained in 1992 were similar to those of which she complained following her fall in 1993 but he said that after her fall, there were changes in her physical manifestation. In this regard, as I interpreted the evidence, it seems to have been accepted by all of the medical witnesses, who addressed the subject, that the symptoms of which the Plaintiff complained in 1992, which are the symptoms on which the diagnosis that she had developed multiple sclerosis at that time is made, were only of a sensory nature and, to that extent, the disease was then benign. If it was, however, as I have already indicated, the hospital notes on the Plaintiff's admission to Cork Regional Hospital on the 13th April, 1992 indicate, that, symptomatically, she was then a very sick woman and I think that it is not without significance that, in the course of his evidence, Professor Behan said that he was satisfied that the Plaintiff had developed multiple sclerosis in April, 1992 and, given the symptoms of which she was then complaining, he was surprised that Dr Callaghan had not diagnosed it at that time. As a layman, I would have thought that the symptoms of which the Plaintiff was then complaining were indicative of anything but a benign disease and, as I have said, I regret that Dr Callaghan was not available to express his views on the implications of the Plaintiff's symptomatic complaints at that time. However, whatever view I might have, I must accept the medical opinion that the symptoms of which the Plaintiff was complaining in 1992 were sensory only. If they were, as Professor Findley agreed in cross-examination, they were very similar to the symptoms of which the Plaintiff was complaining in April and May of 1993 and again it is not, I think, without some significance that, at that time, while the Plaintiff said in evidence that she was feeling unwell, she also conceded that she was able to walk, drive her car and generally get about although she complained that she was inclined to drag her right leg (curiously enough, the previous year she had complained that she was dragging her left leg). Accordingly, I am not convinced that the deterioration in the Plaintiff's condition following her fall was quite as dramatic as Professor Behan and Professor Findley would seem to suggest and, in this regard, I note that Dr Murphy, in the course of his evidence, indicated that, as he interpreted the Plaintiff's medical notes, she did not develop motor symptoms until some eight weeks after her fall, which seems to endorse my lack of conviction in that respect. As I interpreted the evidence, while the condition of multiple sclerosis from which the Plaintiff was then suffering certainly progressed after her fall, it did not do so, as it were "overnight". In the immediate aftermath of the fall, the symptoms of which she complained were consistent with the type of fall which she described and were of a kind which one might expect of anyone who had had such an experience. As time passed, however, her symptoms took on a similar character to those of which she had been complaining the previous year and, clearly, were related to the condition of multiple sclerosis from which she was suffering. However, this seems to me to have been a gradual progression rather than a dramatic one and quite in keeping with the type of relapse which a victim of multiple sclerosis can experience after a period of remission. Professor Behan and Professor Findley argue that it is too much of a coincidence that such a relapse would occur within a short time of the Plaintiff's fall; be that days or weeks, without there being a causative connection whereas Dr Murphy, in particular, says that, if the progression of her multiple sclerosis had been occasioned by the Plaintiff's fall, the onset of symptoms would have been much more immediate than it was and that, in his view, it was purely coincidental that the Plaintiff suffered a relapse of her multiple sclerosis at the time that she did. In this regard, as I interpreted Dr Murphy's evidence, while he did not concede that the multiple sclerosis which the Plaintiff had developed before her fall was a benign form of the disease, he was adamant that, even if it was, there were no positive indications and, in particular, the Plaintiff's age did not suggest that it was more likely than not that it would have remained benign and that, in his view, the progression of the disease following the Plaintiff's fall was no more than any victim of the Plaintiff's age might expect. Dr Harrington was equally positive that the progression of the Plaintiff's multiple sclerosis was not unusual and, in his view, unrelated to any injury suffered by her as a result of her fall and, indeed, Professor Behan conceded under cross-examination that multiple sclerosis can develop quickly or slowly, that minor symptoms can persist for some time; perhaps even years, and then develop to major symptoms which quickly progress although he was emphatic that that was not the situation so far as the Plaintiff was concerned. So far as the suggested progression of the Plaintiff's multiple sclerosis by the surgery which she underwent in January 1994 is concerned, leaving aside the conflicting evidence in that regard which I heard from the several specialists who gave evidence before me, it seems to me that, on her own evidence and ever before she underwent that surgery, the Plaintiff was confined to bed and could not move, which was much the same position in which she found herself following that surgery so that I am not persuaded that there was any dramatic deterioration in her condition following that surgery.

14. Given their respective qualifications and experience when compared with my lack of expertise in the field of medicine, I am not qualified to say whether or not Professors Behan and Findley on the one hand, or Drs Murphy and Harrington on the other are right or wrong with regard to the views which they have expressed. However, I must either declare a preference for one or other view or an inability to choose between them. In this connection, in arriving at a conclusion, I have had regard for the following matters, namely; (a) with the exception of Dr John O'Riordan, no treating doctor has given evidence on behalf of this Plaintiff from which I infer that none of them would support the thesis that the condition of multiple sclerosis from which the Plaintiff was suffering at the time of her fall was aggravated by injury sustained as a result of that fall, or by the treatment to which she had to submit following it, (b) no specialist, practising in this jurisdiction, was called to give evidence on behalf of the Plaintiff, from which I infer that there is substance to Dr Murphy's assertion that there are a few, if any, doctors in this country, who specialise in the field of neurology, who subscribe to the opinion that multiple sclerosis can be aggravated by trauma (c) I am persuaded by the evidence which I heard and, in particular, the evidence of Professor Behan, himself, that his testimony did not have the objectivity which one is entitled to expect from a specialist giving evidence with regard to a subject in respect of which he purports to be an expert. In this regard, while, in the light of the evidence of Dr Michael Crowley that the studies of Sibley et al and Siva et al were incomplete and statistically flawed, Professor Behan was quite entitled to be critical of those studies, in the circumstance that they were published in a journal entitled "Neurology", in respect of which I had evidence, which I accept, is regarded in neurological circles as the best clinical journal printed, in that, any study in it has to survive the most detailed peer investigation before it is published, Professor Behan was not entitled, as he did, to describe them as "stupid", "rubbish" and "appalling". Moreover, while, in the course of several reports which he furnished in connection with this case, Professor Behan referred to a multiplicity of studies in support of the views which he expressed, he ignored and made no reference to the studies of Sibley et al and Siva et al, which, in fact, was the most recent published literature with regard to the matters in respect of which he was giving evidence. Furthermore, while Professor Behan was quite entitled to take issue with and to disagree with the views expressed by colleagues, who gave evidence in this case, he was not entitled to rubbish the evidence of Dr Hugh Harrington, a fellow neurologist, by saying, as he did, that what Dr Harrington knew about the association between trauma and multiple sclerosis could be written on the back of an envelope. In my view, in the course of his evidence, Professor Behan displayed an arrogance and selectivity which was not consistent with the objectivity which might have been expected of him and, indeed lent credence to suggestions on behalf of the defence that he was on a crusade. I might add, in this regard, that neither was I impressed by his concession that he had been caught out giving wrong evidence in a case in which he had been involved in England and I note that, in the course of her judgment given in that case, the trial judge commented on his lack of objectivity and (d) while I did not doubt the objectivity of either Professor Findley or Mr Russell, I note that both of them had had previous associations with Professor Behan and that it was Professor Behan who suggested to the Plaintiff's Solicitor that they might be witnesses at the hearing; presumably, because Professor Behan was aware that they shared his views with regard to the relationship between trauma and multiple sclerosis. Accordingly, insofar as the crucial issue in this case was concerned, the Plaintiff's medical witnesses presented to me as a team rather than as a group of independent specialists.

15. For all the foregoing reasons, although I very much regret that I have had to come to this conclusion, I am not persuaded on the balance of probability that the condition of multiple sclerosis from which this Plaintiff was suffering at the time of her fall in March of 1993 was aggravated or progressed by the injuries which she suffered as a result of that fall or, indeed, by the treatment to which she had to submit as a result of those injuries.

16. I now come to the question of damages and, in this regard, I find myself greatly inhibited by the fact that, throughout the trial of this action, the case on behalf of the Plaintiff proceeded on the basis that she is entitled to be compensated for all that has happened to her since her fall in March of 1993 and for all that is going to happen to her in the future on account of the condition of multiple sclerosis from she is suffering. However, that case was based on the assumption that the condition of multiple sclerosis from which the Plaintiff was suffering at the time of her fall was aggravated or progressed by injury sustained as a result of that fall whereas, as I have indicated, I have regretfully come to the conclusion that that is not so. Accordingly, the Plaintiff is not, in my view, entitled to compensation for the effect which the condition of multiple sclerosis from she is suffering has had and will, in the future, have with regard to her personal comfort, her capacity to look after herself and her family, her capacity for employment or the recoupment of the cost of past and future care or future loss of income. She is only entitled to be compensated for the effect on her of the injuries which I have found were attributable to her fall and the sequelae of those injuries. However, as I have already pointed out, the case which was presented on her behalf did not attempt to identify what compensation might be appropriate in the event that the Court concluded that the condition of multiple sclerosis from which she is suffering is not related to any injury suffered by her as a result of her fall. Hence my difficulty in assessing appropriate damages. However, while the case with regard to damages presented on behalf of the Plaintiff did not contemplate the conclusion at which I have arrived, it was submitted on behalf of the defence that, in the event that I concluded that the injuries suffered by the Plaintiff as a result of the incident which gave rise to this claim did not aggravate or progress the condition of multiple sclerosis from which she was then suffering, the Plaintiff's entitlement to compensation was limited to such general damages as would be appropriate to award in respect of such injuries. Given that no special damage, which was solely related to the injuries suffered by the Plaintiff as a result of her fall, was proved, I think that that is the correct approach. Moreover, as it is clear that the Plaintiff's current problems are largely, if not totally, attributable to the condition of multiple sclerosis from which she is suffering rather than to the sequelae of the injuries which she suffered as a result of her fall, I do not think it appropriate to differentiate between the past and the future in assessing a sum for general damages. In my view, in the circumstances of this case, it is appropriate to award one lump sum. In this regard, I have already detailed the injuries which I believe that the Plaintiff suffered as a result of her fall and I do not think it necessary that I should review them again. Suffice it to say that it is clear that the incident was a very shocking and distressing experience for the Plaintiff and resulted in a considerable amount of pain and discomfort; particularly with regard to her head and her back. Moreover, the injury which she suffered to her thoracic spine necessitated surgery which, on top of the problems which she was experiencing on account of the condition of multiple sclerosis from which she was suffering, must have been an additional source of pain, discomfort and worry for her. In this connection, because of the fact that, at the time of her fall, the Plaintiff was already suffering from multiple sclerosis, she was an extremely poor candidate for any injury and, therefore, I have no doubt but that the effect on her of the injuries which she suffered and the surgery to which she had to submit as a result of those injuries was considerably worse than it might have been for someone who was not suffering from multiple sclerosis and I think that I am entitled to take that fact into account when assessing what is an appropriate amount of compensation for her. In those circumstances I will award a sum of £100,000 for general damages which, when compared to the level of damages ordinarily awarded in respect of the type of injuries which this lady suffered as a result of her fall, might appear to be excessive but, in all the circumstances of this case, is, in my view, an appropriate sum to award although I appreciate that it will be of little or no help to the Plaintiff to alleviate the problems which she is currently experiencing and will, in the future, experience on account of the condition of multiple sclerosis from which she is suffering. However, as I am not persuaded that the Defendant is in any way responsible for that condition, I regret that I am not entitled to award her damages in respect thereof.