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

By Lindsay Beyerstein

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. So, it seems important to refocus the debate on the facts as quickly as possible. 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 interesting questions about exactly 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 Smellie and Hunter's 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 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 and 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) relatively 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 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 in the city. (Childbed death includes fatalities during labor and during the first few days postpartum.)

Shelton argues that women who died in their 9th month of pregnancy would have been rarer still. He speculates 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.

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

[Slartibartfast]

Fascinating article, Lindsay. The problem with probabilistic arguments is when one makes the error of assigning certainty to the highest probability case, without the requisite supporting evidence.

Which would be caused for raised eyebrows, even if the historian in question were extremely well-known, -published and -respected.

[John Thullen]

Stringent tort reform is the solution to this problem. If the good doctors had not been pursued by the demons in the tort lobby, they would not have been under such heavy stress and would not have harmed their patients.

Neither should healthcare insurance reform permit faceless bureaucrats (they have been dissected, too) to interfere with the delicate relationship between these doctors and their dissected corpses.

Further, were these dissections free of charge to the corpses?

That's socialism for dead people and we can't have that in a free society. It leads to free-loading corpses and overcrowded cemeteries.

Make the corpses pay the real cost of dissection and they will be incentivized to forgo unnecessary procedures.

In a pinch, they can go to the emergency room for their dissections. The morgue takes all comers, too.

People should die alone and penniless at no expense to me.

If the corpses don't likeit,they can gun down the sillouette of a Republican politican at a target range.

[Carleton Wu]

Personally, if I were an 18th-century anatomist who needed a steady supply of "special" cadavers, I'd start bribing vicars.

Better yet, midwives.

[elm]

Better yet, midwives.

Better yet, murderers. HOAS, I think that brings us full circle.

[CarolDuhart(Aquariusmoon)]

Why not pimps? A pregnant hooker probably wasn't going to be buried in the graveyard anyway, so if one died with nobody to claim her, it would be easy to get corpses that way.

[RAM]

Sextons were the guys who actually oversaw cemetery operations. They weren't religious people; they were workers who could read, write, and follow a map so people could be buried in the right place and they maintained the records of burials. Those would be the guys to bribe, along with midwives.

I simply don't buy that there was a lack of women who died in childbirth or at any stage of pregnancy during the 1760s in England, especially London. Go through any newspaper in the U.S. in the 19th Century and you'll find countless women dying in childbirth. In my own family as late as the 1920s, one of my great uncle's wives died from a botched abortion which he forced her to have, and one of my great aunts died during childbirth. And that's just one family nearly two centuries after the period in question.

[efgoldman]

Stringent tort reform is the solution to this problem.
Damn. I knew that was Thullen without even looking.
Not that you're getting predictable, John, but your style is familiar and welcome.
Winning the thread, as usual.

[Jon H]

As Carleton noted, midwives would be a good source of info.

Honestly, if they just set up an information network consisting of a few more doctors, some midwives, and maybe some contacts among charity workers, they'd probably have little trouble getting access to newly-dead pregnant women.

[Bernard Yomtov]

Why not pimps? A pregnant hooker probably wasn't going to be buried in the graveyard anyway, so if one died with nobody to claim her, it would be easy to get corpses that way.

Stringent tart reform would get in the way of this.

[R. Johnston]

Fascinating research. It proves, beyond a shadow of a doubt, that the Journal of the Royal Society of Medicine is the intellectual inferior of the special edition of Mad Libs: Author a Sarah Palin Speech. No one heretofore suspected this now undeniable fact.

Whoever approved this for publication should be tarred and feathered, tarred again and feathered again, forced to listen to an autotuned version of the greatest hits of Vogon poetry as recited by Fran Drescher, and forced to intern as a consultant for Ben Stein's next "documentary."

[Ginger Yellow]

"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 in the city."

So, this makes 32 cadavers over the course of a decade unlikely how?

[Sebastian]

"So, this makes 32 cadavers over the course of a decade unlikely how?"

The author thinks it makes it unlikely because most grave robbers exhumed corpses at random. But that is buying into the fallacy that these doctors were using 100% typical grave robbers. It seems very possible that they used a network of (as suggested above) midwives, or pimps, or perhaps had connections at the graveyard.

[Fair Economist]

Weren't these guys treating pregnant women during a time when deaths during pregnancy were rather common (as pointed out above?) I'd think they'd have gotten several from their own practices. Add in a few from referrals, a few from grave-robbing, and a few bought from destitute family and I see no problem in getting 32 out of 2000 or so women.

[Ginger Yellow]

"The author thinks it makes it unlikely because most grave robbers exhumed corpses at random."

But why the assumption that they were all from random grave robbing? I mean, as you and Lindsay point out, there are dozens of plausible ways they could have found out about the deaths - including the rather obvious fact that they treated a lot of pregnant women themselves, some of whom will have died. They presumably knew plenty of other obstetricians and midwives. It just seems remarkably thin grounds for such a bold claim. How did this get past peer review?

[Audie]

The mortality rate in London in the mid 18th century was less than 2% for women in childbirth or in the ninth month of pregnancy? Completely implausible. It was probably higher than that in London (or New York) in 1900 or 1920.

Death rates in London in the mid 18th century were a lot higher than birth rates, as far as we can tell from the very incomplete data available. The population of the city grew because of migration from outside, not because more people were born than died in the city. Infant mortality was horrendous, and it stands to reason that mortality of women in childbirth, especially poor women, was a lot higher than 2%.

What records there were, much less records which have survived, tend to refer to wealthy and the nearly wealthly. The poor--- probably 70% or more of the population--- didn't usually have their births or deaths recorded in parish registers and weren't usually buried in churchyards. Even if that 2% rate holds for the wealthy (which I very much doubt), hundreds of thousands of people lived and died in London in those twelve years without leaving any record at all.

There is every reason to assume that it would be quite possible to find enough of the 'right' kind of cadavers without resorting to murder in a filthy, disease ridden, gin soaked, poverty-stricken city, with rampant malnutrition and dreadful sanitation.

[Mike Schilling]

Dammit, I know there's a joke here about death panels.

[Ginger Yellow]

I could tell you what the joke is, but I'd have to kill you.

[Slartibartfast]

Stringent tart reform would get in the way of this.

Thread-winner, right there. Thullen's probably beating his head against something even harder than his head, in frustration that he didn't write that first.

The mortality rate in London in the mid 18th century was less than 2% for women in childbirth or in the ninth month of pregnancy? Completely implausible.

Particularly in the age of smallpox. But probably a smallpox cadaver wouldn't be a choice for dissectors. But still, the fatality rate of smallpox alone in London was probably on that level.

No, I'd guess that, as suggested upthread, these cadavers were requests; whether they were located by sextons or gravediggers or some other source (or some combination of sources, even) will probably never be known.

[MFB]

Incidentally, I understand a great deal of obstetric surgery was apparently experimentally carried out in the late 19th and early 20th century. Perhaps this is not so incidental, as historians now look back on this and suggest that this wouldn't have been possible had the women in question had the right to refuse the surgery, which was often disastrous or fatal.

Possibly the original author of this offending article is trying to get some attention by outdoing those historians?

[NEVABeck]

According to my analysis, thousands of people on our planet get the loans at good creditors. Thence, there's a good possibility to find a college loan in every country.