Did the fathers of modern obstetrics murder more women than Jack the Ripper?

Latoya Peterson of Jezebel spotted this disconcerting story in Sunday's Guardian:

They are giants of medicine, pioneers of the care that women receive during childbirth and were the founding fathers of obstetrics. The names of William Hunter and William Smellie still inspire respect among today's doctors, more than 250 years since they made their contributions to healthcare. Such were the duo's reputations as outstanding physicians that the clienteles of their private practices included the rich and famous of mid-18th-century London.

But were they also serial killers? New research published in the Journal of the Royal Society of Medicine (JRSM) claims that they were. A detailed historical study accuses the doctors of soliciting the killing of dozens of women, many in the latter stages of pregnancy, to dissect their corpses. [Guardian]

This story has all the makings of an anti-science urban legend. Regardless of the quality of the underlying research, this story is going to get embellished in the retelling and used to bash scientific medicine.

The allegations are already being mentioned in the same breath as documented atrocities like the Tuskegee syphilis study, and Dr. Joseph Mengele's infamous concentration camp experiments.

I checked out Don C. Shelton's original paper. It's a very good read. Shelton raises credible suspicions about where these two doctors got their anatomical specimens. He, shamelessly overstates his case, however. Shelton flatly asserts that Hunter and Smellie were "responsible" for the murders of more women than Jack the Ripper.

The subjects of the anatomy books were women who died in childbirth, or during their final month of pregnancy. Shelton's argument is that there simply weren't enough heavily pregnant and birthing women dying of natural causes in mid-18th-century London to account for all the thirty-plus cadavers that Smellie and Hunter examined to write their respective anatomical classics.

Based on a review of their atlases, Shelton says that the two anatomists came up with a total of 20 cadavers between 1750 and 1754; and that Hunter somehow located another dozen between 1766 and 1774. That works out to four or five such bodies a year for the first stretch and fewer than two a year for the second period.

Shelton concludes that the doctors must have had these women murdered-to-order, a practice known as burking. The term burking is an allusion to the murderers Burke and Hare who smothered their victims in Edinburgh between 1837 and 1838 and delivered them to Dr. Robert Knox, a private anatomy lecturer. 

Shelton acknowledges that there is no research on burking in the mid-18th century.  He doesn't cite any documented cases of burking during that era.

There is no question anatomists of Smellie and Hunter's day got their cadavers from grave robbers. That's how it was done in those dark and superstitious days.

Shelton's case boils down to two rather plausible, but non-dispositive claims: i) very few women died in their 9th month of pregnancy or during childbirth to begin with, and, ii) it's unlikely that ordinary grave robbers would have been able to zero in on these rare cases.

Grave robbers tended to exhume corpses at random, Shelton explains. Or else they targeted the unclaimed bodies of people who died in poorhouses. But he notes that most of those who died in poorhouses were old and sick, not otherwise healthy pregnant women.

Death rates for infectious disease were very high in mid-18th-century London, but Shelton claims that pregnant women would have accounted for small percentage of the death toll. As he points out, they're a subset of the general population and a relatively young and healthy one at that.

Shelton cites statistics to show that the childbed death rate in the mid-18th-century was less than 2%. Based on the birth and death rates and the population of London at the time, he estimates that there would have been about 200 childbed deaths per year.

He argues that women who died in their 9th month of pregnancy would have been rarer still. Shelton suggests that very pregnant cadavers would have been extremely rare because a significant percentage women who suffered lethal illnesses or accidents in their 9th month would have miscarried before they died.

But even at their most productive, the two doctors were only seeing about five of their target subjects a year, on average. Five out of 200 doesn't seem that incredible.

The author also maintains that it would have been very difficult for grave robbers to find these rare specimens: Death notices were rarely published in those days and corpses usually went directly from home to the graveyard without a detour through a funeral home or some other central location that thieves could monitor.

Personally, if I were an 18th-Century anatomist who needed a steady supply of "special" cadavers, I'd start bribing vicars. If you pay for the new church roof, I'm sure it's amazing what you can find out about who's buried where.

So, the paper gives us good reason to doubt that Smellie and Hunter got all their cadavers through the standard grave-robbing channels. But that's hardly proof that the two men commissioned mass murder for hire.

Smellie and Hunter were famous obstetricians. They worked with pregnant and birthing women. In an era where most childbirth was handled at home, they probably served a disproportionately sick patient population.

Let's not forget that primitive obstetrics was really dangerous--no doubt in part because because science was still sketchy on pregnant female anatomy. If anyone was well-situated to tip off grave robbers about dead pregnant women, or take liberties with their corpses, it would have been 18th-century obstetricians.

As the author points out, Smellie and Hunter were rich and well-connected men. He implies that they could have gotten away with murder. On the other hand, if they could have gotten away with murder, they presumably had enough privilege to get what they wanted by less drastic, if socially unacceptable means. 

Shelton claims the following passage, written in 1818, is a smoking gun. The author was describing a plate in Smellie's atlas that features twins:

“Dr MacKenzie being then an assistant to the late Dr Smellie, the procuring and dissecting this woman without Dr Smellie’s knowledge, was the cause of a separation between them, for the leading steps to such a discovery could not be kept a secret."

Smellie died in 1763 and 55 years later, some guy claimed that an associate of Smellie's obtained the corpse by unspecified (but presumably sketchy) means without Smellie's knowledge. This is supposed to be a smoking gun? Really?

Shelton gives us no reason to assume that Smellie and Hunter were monsters. Why immediately jump to the conclusion that they were murderers? There have been killers in the name of science and medicine, but they've always been a tiny minority among scientists and for that matter, a very small subset of murderers. Shelton's wild allegation seems absurd unless you buy into some nasty stereotypes about doctors and scientists.

He makes no attempt to rule out less brutal schemes by which they might have improved their odds relative to common grave-robbers. Could they have performed unauthorized autopsies on pregnant patients who died of natural causes? Bribed the families of the deceased? Stolen the bodies of their own indigent patients? If a body was returned to the family with an incision in the abdomen, the obstetricians could always claim it was a cesarean section.

Were all their subjects even dead? Presumably they could have learned from examining and treating live women. It's a mundane possibility, but who's to say these guys didn't exaggerate the number of corpses they actually looked at? Academic dishonesty is more common than murder.

Obviously, I'm speculating here, but so is Shelton. He makes probabilistic arguments, so I'll make one too: If same end can be achieved through subterfuge or serial murder, most people will opt for subterfuge. Dead pregnant women are rare, but mass murderers are rarer still. Of course, tall tales of body snatchers, natural and supernatural, are as common as dirt.

Shelton is right to question how these doctors got their cadavers, but he simply does not have enough evidence to conclude that these pioneers of modern obstetrics killed more women than Jack the Ripper. This paper is just going to give the science bashers unearned ammunition.

Comments

[ginmar]

You keep saying 'more women than Jack the Ripper!' like it's a big huge amount. He killed five women. Is that supposed to be the hook? Looks like there's a little sensationalism going on here, too.

Also, Burke and Hare didn't burke people in the 1930s.

[Amy Tuteur, MD]

In 18th century Britain, maternal mortality rates were as high as 1%. There were over 200,000 births per year in the mid 18th century. That means that more than 2000 women died in childbirth every year. It would not have been that difficult for grave robbers to find 4-5 women per year who had died in childbirth.

Shelton bases his assertions on the claim that grave robbing was random and that grave robbers and could not know if graves contained pregnant women. But Smellie and Hunter (and other obstetricians) would have personally known of many pregnant women who died (their own patients and those of their colleagues) and could easily have found out where they were buried.

[parse]

This reminds me of the case of J Marrion Sims Dossier, often credited as the founder of gynecology. His research amounted to the torture of slave women who were his subject. Here's one description of this aspect of his career: Anarcha was one of three noted slaves that first endured countless operations under Dr. J. Marion Sims Dossier, inventor of the speculum and the "founder of modern gynecology" (Brinker). Sims used experimental techniques on many of his slaves, asserting that black women could endure great measures of pain without the aid of medicine ''as well as dogs or rabbits"and that "plantation owners were glad to turn over their slaves to [him] for experimentation" (Bath). Anarcha was only 17 and underwent over 30 brutal surgeries.

It can be very disconcerting to find out what it took to get the anatomical and medical knowledge we take for granted today.

[parse]

This reminds me of the case of J Marrion Sims Dossier, often credited as the founder of gynecology. His research amounted to the torture of slave women who were his subject. Here's one description of this aspect of his career: Anarcha was one of three noted slaves that first endured countless operations under Dr. J. Marion Sims Dossier, inventor of the speculum and the "founder of modern gynecology" (Brinker). Sims used experimental techniques on many of his slaves, asserting that black women could endure great measures of pain without the aid of medicine ''as well as dogs or rabbits"and that "plantation owners were glad to turn over their slaves to [him] for experimentation" (Bath). Anarcha was only 17 and underwent over 30 brutal surgeries.

It can be very disconcerting to find out what it took to get the anatomical and medical knowledge we take for granted today.

[Lindsay Beyerstein]

You're right gimar, they killed their victims in the 1800s, not the 1900s. My mistake. Fixed now.

As for the Jack the Ripper metric, that's the author's verbatim assertion. So, I don't see what's sensational about debunking an analogy he brought up.

The allegation that two of the most famous scientists of their generation killed anyone for hire is shocking, the charge that they killed 6 or 7 times as many as one of the most one of the most notorious serial killers in history is doubly so. One of the many horrifying pieces of JTR lore is the rumor that he was a doctor or a medical student who dissected his victims with surgical skill, so it would be an especially compelling parallel.

[Lindsay Beyerstein]

I'm not denying there have been horrible abuses in the name of medical research. I'm saying that it's classic logical fallacy to jump from that sad fact to the allegation that these two doctors must have sponsored mass murder.

[paul]

Seems to me the claim that graverobbers exhumed at random, unless strongly backed by citation, would have to be mostly crap. For anatomists they might not have cared whom they dug up, but when getting caught, or even seriously accused, meant high odds of death by hanging you can bet that they took care to know vergers, diggers, paid mourners and anyone else who might have influenced the safety and profitability of their work. Add to this the fact that we're talking about a community (several interlinked communities) and the knowledge that this rich medical gentleman or that was paying several months' ordinary wages for particular kinds of corpses would get around, even if they didn't know the cases from direct knowledge or conversations with colleagues.

Oh, and although pregnant women might be young and healthy and thus relatively (except for that depressed immune system thing) less likely to be suffering from lethal illness (except for the ones who had pre-existing ailments that could be exacerbated by pregnancy, such as kidney trouble, consumption usw, who would be most likely to die in the late months of pregnancy when the fetus/placenta really started screwing them over), it's pretty likely that being pregnant was a serious risk factor for violent death, just the way it is today.

[ginmar]

One has only to look at surviving clothing from the time to know that people were much smaller then, probably due to more malnutrition. But the idea that pregnant women were healthier is pretty inaccurate. Pregnancy is grueling even today, but back then just repeated healthy pregnancies could leave you toothless and drained by thirty---if not dead. Hand washing was not something doctors did. When you look at, say, battlefield casualties and realize that more peopled died of their treatment rather than their wounds, you have to realize that pregnancy could be a deadly experience.

If these guys wanted to study bodies, they should have snatched up corpses from battlefields.

Oh, crap, I have an excellent book on Victorian and earlier death practices and oddities and it addresses all this stuff. Fascinating, if ghoulish. I'll see if I can find the title.

[compcat]

I doubt that the doctors' had all that much trouble finding dead pregnant women, since the practice of the time had them teaching anatomy labs in the morning and then going straight to the treatment wards without washing their hands or changing their coats.

Only those wacky superstitious midwives and one crazy male doctor practiced hand washing. Poor hygiene is one way to up your dead pregnant patient quota without pay for murder.

[Bruce the Canuck]

Here's Don C Sheldon's blog:

The Real Mr Frankenstein

Lots of promotion of his eBook on there. In fact the paper in question seems to be a promotional tool for his book. I'm sure the new-age crowd will snap it up.

[Lindsay Beyerstein]

Ginmar, if you remember the title, please let us know. Sounds like a good book.

[parse]

Lindsey, I didn't mean to imply that Sims Dossier was evidence in favor of the other doctors being murderers. I was just struck by even the possibility that the "fathers" of both gynecology and obstetrics might be the worst forms of misogyny.

[ginmar]

It's amazing...it covers the myths, the practices, the superstitions, the reasons for the myths and superstitions, and it's, well, very well-illustrated. I'll go look.

[ginmar]

Ah! "The Bedside Book of Death." Rather chatty, but very informative and a good place to start.

[Lindsay Beyerstein]

Cool, thanks.

[MsAnon]

Removing corpses from graves wasn't actually a hanging offense in 18th-19th century Britain. It was a misdemeanor, not a felony. Stealing the grave-clothes was a hanging offense; so most of the resurrection men just stripped the bodies.

[ballgame]

Good post, Lindsay.

[chris y]

If these guys wanted to study bodies, they should have snatched up corpses from battlefields.

Mostly, they wouldn't have needed to. In London at least, surgeons in the 18th century had a legal right to dissect the bodies of hanged felons, and given that you could be hanged for taking home the offcuts from a timber yard at the time, there was no shortage.

What you could *not* get that way was pregnant women. If you were demonstrably pregnant you were exempt from execution. In fact, women on capital charges often became intentionally pregnant for that very reason. (Wouldn't you?)

Not that I actually think this thesis looks very convincing, but it is the case that the bodies of pregnant woment would have been harder to come by than most. Me, I like Lindsay's idea about bribing vicars (or more likely sextons).

[heydave]

You ask why anyone (an author) would jump to such a conclusion?
His publisher is (likely) a relative of Mr. Barnum's.

[suzib]

It also wouldn't have been hard to eliminate the bill of a deceased patient whose family agreed to an autopsy. . .

[Amy Tuteur, MD]

"Only those wacky superstitious midwives and one crazy male doctor practiced hand washing."

And that is flat out false.

The claim that doctors, ignoring the work of the Viennese physician Ignaz Semmelweis, continued to spread disease by failing to wash their hands even after learning the true cause of sepsis is a pretend "fact" made up by homebirth advocates.

The medical historian Irvine Loudon, in the paper "I. Ignaz Phillip Semmelweis' studies of death in childbirth", has described what really happened.

”In 1846, Ignaz Phillip Semmelweis … was appointed to … the Vienna Maternity Hospital, which was divided into two clinics. Doctors and medical students were taught in the first clinic, midwives in the second … The alarmingly high mortality in the first clinic had defied explanation until Semmelweis … Each day started with the carrying out of post-mortems on women who had died of puerperal fever. Then, without washing their hands, the pupils went straight to the maternity wards where they were required, as part of their training, to undertake vaginal examinations on all the women. The pupil midwives in the second clinic did not, of course, carry out post-mortem examinations, and did not undertake routine vaginal examinations.

This was many years before the role of bacteria in diseases was discovered, and Semmelweis suggested that the training procedures of the first clinic resulted in the transfer from the corpses of what he first called 'morbid matter' ... In 1847, he therefore introduced a system whereby the students were required to wash their hands in chloride of lime before entering the maternity ward. The result was dramatic. In 1848, the maternal mortality rate in the first clinic fell to 12.7 in the first clinic compared with 13.3 in the second clinic. The process of admission to the two clinics on alternate days produced, by accident rather than design, a controlled trial, and the large numbers of deliveries ... mean that chance could confidently be excluded as a possible explanation for the differences observed."

Why didn't more people listen. Probably because Semmelweis refused to publish his findings:

"...Although urged by his friends to publish, he waited for thirteen years before he published his treatise, 'The Etiology, Concept, and Prophylaxis of Childbed Fever', which is dated 1861 but was actually published in 1860. The treatise of over 500 pages contains passages of great clarity interspersed with lengthy, muddled, repetitive, and bellicose passages in which he attacks his critics. No wonder that it has often been referred to as 'the often-quoted but seldom-read treatise of Semmelweis'. When he wrote the treatise, Semmelweis was probably in the early stages of a mental illness that led to his admission to a lunatic asylum in the summer of 1865, where he died a fortnight later..."

Moreover, the notion that Semmelweis was a tragic hero whose great work was ignored is wrong:

"...But most of the claims made about him in the twentieth century - that he was the first to discover that puerperal fever was contagious, that he abolished puerperal fever (or that if he did not, it was because of the stupidity of his contemporaries), and that his treatise is one of the greatest works in nineteenth-century medicine - are sheer nonsense..."

So the claims that doctors deliberately refused to wash their hands long after Semmelweis’ great discovery had become common knowledge is “sheer nonsense.” Moreover homebirth advocates fail to mention that midwives did not wash their hands, either. Did midwives know about hand washing? No. Did midwives understand the germ theory of disease. No. Did midwives perhaps discover the germ theory of disease and correct the error of the doctors? No. How did midwives learn about the germ theory of disease and the importance of handwashing? Doctors told them.

Homebirth advocates are entitled to their own opinions, but they aren't entitled to their own "facts."

[www.google.com/accounts/o8/id?id=AItOawnV9zURze5pSruMstuw8_b4EzHnXNnH_e4]

Just finished reading Birth: The Surprising History of How We Are Born by Tina Cassidy. Hunter and Smellie receive a lot of attention in the early chapters, and while nothing stands out in my memory that would support the idea they were mass murderers, nonetheless they were part of a group-- obstetricians-- that made enormous changes to the birth process and established practices that to this day contribute to more complications and higher maternal death rate than the centuries' old practice of midwifery. Personal opinion, and unfortunate experience, leads me to know I will avoid obstetricians for my own care, at all costs.

[acrostic]

"This story has all the makings of an anti-science urban legend. Regardless of the quality of the underlying research, this story is going to get embellished in the retelling and used to bash scientific medicine."
I suspect the bashing will be as nothing compared with that which resulted from the activities of the late Harold Shipman MD.

[Andrea]

I am going to find that book, as my feelings run similar to yours.
Please know that Amy Tuteur is a non-practicing MD who has a bee in her bonnet about home birth. Also, she has lots of time on her hands to spend commenting on the internet .... ad nauseum!
Sadly the medical community is not open to making changes in birth practices (which are evidence-based!) in favour of defending their interventionist philosophies, which they consider to be the source of their power. Currently Ina May Gaskin, Midwife Extrordinaire, is spending a good chunk of her time lecturing and teaching doctors and medical students about childbirth. Birth outcomes at The Farm birth center are orders of magnitude better than those achieved by any doctor. Yes, the medical community has a lot to learn from midwives ... if the true desire were to learn, and improve outcomes, and not posturing to defend egos.
The idea that doctors had victims 'provided' by unsavoury means does not surprise me at all. Those were just earlier versions of those same egos ... wanting the recognition for their science! It's barely a stretch at all, if you're already willing to have peoples' bodies dug out of graves.
I would also like to be able to view your link, which is not working, for some reason. Would you please re-post it?

[Lindsay Beyerstein]

The early anatomists weren't taking bodies from graves because they were terrible people. They were doing it because they needed to learn about the human body and there was no legal alternative. Every health care professional studies anatomy, including midwives. So midwifery benefited from these early investigations, too.

MsAnon, that's really interesting what you said about how stealing bodies was a misdemeanor but stealing grave clothes was a hanging offense. Was that a backhanded strategy for decriminalizing autopsies? Or was there something else behind the policy.