(dissenting) :
I agree with the conclusions of the majority on all issues except causation. I further agree with the principles enunciated by the majority on that issue. But the conclusion that there is a jury issue as to causation cannot pass muster on the evidence in this record which establishes nothing more than a mere possibility that defendants’ alleged negligence proximately caused Mrs. Wagner’s permanent vision impairment.*
It is fundamental that in a negligence action
“a plaintiff may not recover when he shows nothing more than mere possibility of causal connection between alleged wrongdoing and an injury; something more is required . . . ” Phillips v. Delaware Power & Light Company, Del., 216 A.2d 281 (1966)
A finding of causation may not be based on speculation or conjecture; and where, as here, a layman could not be expected to appreciate or have knowledge of the medical arts, expert medical testimony is required to establish plaintiffs’ case. DiFillipo v. Preston, Del.Supr., 173 A.2d 333 (1961).
“The Courts are agreed that proof of causation must go beyond a showing of a possibility that injuries arose from the defendant’s negligence or lack of skill, since the jury will not be permitted to speculate as to the causes of the injury.” 13 ALR 2d, Proximate cause in malpractice actions, 11, 22.
It is established in Delaware that proximate cause cannot be based on mere speculation :
“Although the drawing of inferences from the proven facts is ordinarily a jury function, those inferences cannot be based on mere speculation; and where there are no facts reasonably pointing to the probability of one possible inference as against another, the matter cannot be submitted to the jury, for in such event the plaintiff does not sustain the burden of proof. Mere possibility of negligence or proximate cause is not enough; there must be probability.” McGuire v. McCollum, 10 Terry 359, 116 A.2d 897, 900 (Del.Super., 1955).
The record supports the possibility that defendants’ alleged negligence could have been a cause, that Dr. Rath’s treatment, or lack of treatment could have been a cause; that the condition could have been caused by an eyelash or other foreign substance, by Mrs. Wagner unconsciously rubbing her *648insensate eye, by throphic changes from the persistent lack of sensation, without anyone’s fault or as a result of medical treatment for a neuralgia condition by other physicians (undisclosed at the time) who gave Mrs. Wagner pain injections, by premature removal of the original tarsorrha-phy, or from an entirely new area of breakdown occurring in the exposed area left by the single stitch tarsorrhaphy, or by other possible causes suggested in the record too numerous to recount. Suffice it to say that defendants are not insurers of the success of their treatment and can only be held liable where a reasonable medical probability demonstrates that their failure to conform to acceptable standards of care resulted in the injury complained of — here, permanent vision impairment. Because of the numerous possible causes of the injury and the utter lack of any evidence of the probable cause, the inference of negligence and a jury issue is unwarranted in this case. Before the doctrine can be applied, responsible causes other than the defendants’ negligence, including conduct of the plaintiff and third parties, must be sufficiently eliminated by the evidence. Restatement Torts 2d § 328D (1) (b).
The majority’s reliance on bits of evidence taken out of context, which largely are unrelated to the history or facts of this case, or otherwise neutralized in the full text of the evidence from which the inferences were drawn, is misplaced and within the realm of speculation.
In my opinion the judgment of the Superior Court should have been affirmed.
It must be noted that summary judgment was granted below “insofar as plaintiff is claiming damages for permanent injury to her eye.” Thus, on this appeal, we are not concerned with whether or not any of the alleged negligent acts resulted in the initial condition, except insofar as such condition may be related to the subsequent permanent corneal scarring first observed by Dr. Rath some 10 months after Mrs. Wagner was released from the hospital and placed in Dr. Rath’s care.