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.
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