Forensics

by Val McDermid

  The Victorians were fascinated by the figure of the female poisoner, oozing loveliness and sweetness, offering her husband a second spoonful of sugar for his tea and then making it a lethal one. Readers found a mixture of fascination, fear and excitement in this literally femme fatale image. In fact, more than 90 per cent of convicted spouse murderers in nineteenth-century Britain were men. But men were far more likely to stab or strangle their wives; twice as many wives as husbands stood trial for the more indirect murder method of poisoning.

  It wasn’t always a straightforward case. Arsenic abounded in everyday life. Arsenical paint found its way on to children’s toys, nursery book covers, green wallpaper and curtains; cosmeticians incorporated it into beauty products; it was an ingredient in virility pills, pimple creams and cheap beer. As a result, in cases of unexpected death, toxicologists had to be sensitive to the amount of arsenic in a corpse, so as to avoid wrongly charging someone with murder.

  Down the years manufacturers have used a variety of other poisonous elements in their products, sometimes in ignorance of their ill effects, sometimes hoping to keep everyone else in ignorance. In the early twentieth century the work of two New York doctors would have lasting implications for negligent corporations as well as for would-be killers.

  In 1918 Charles Norris set up the first organised medical examiner system in the world when he became New York City’s first Chief Medical Examiner, responsible for investigating the bodies of people who had died unnaturally or suspiciously. Previously, forensic pathology had been the preserve of ‘elected coroners’, who were generally unqualified barbers or undertakers or worse. Forensic historian Jurgen Thornwald counted ‘eight undertakers, seven professional politicians, six real-estate agents, two barbers, one butcher, one milkman [and] two saloon proprietors’ serving as elected coroners in New York between 1898 and 1915. The system was incompetent and corrupt. But now the Chief Medical Examiner and his staff would have to be doctors of medicine as well as ‘skilled pathologists and microscopists’.

  Norris appointed Alexander Gettler as Pathological Chemist, and asked him to set up the first forensic toxicology lab in the US. Gettler set about inventing a host of techniques for uncovering toxins. At a time when poisonings from bootlegged alcohol were reaching epidemic levels, Gettler developed many new ways to identify the active ingredients. Each time he dealt with a case involving an unknown toxin he took a piece of liver from the local butcher’s shop, injected it with the toxin and experimented until he could recover and identify it.

  He studied more than 6,000 brains to come up with ‘the first scientific scale of intoxication’. After Gettler, pathologists started testing brain tissue for the presence of alcohol in all violent or unexplained deaths. He also devised tests for chloroform, carbon monoxide, cyanide, blood and semen, among other substances. So when science itself was put in the dock, Norris and Gettler were the obvious experts to put it under scrutiny.

  The story begins in Paris in 1898, with Marie Curie’s discovery of a trio of radioactive elements, thorium, polonium and radium, and the subsequent exploitation of their properties. By 1904 doctors had started using radium salts to shrink cancerous tumours, which they called ‘radium therapy’. It was seen as the new miracle substance – radium water, radium soda, radium facial creams, radium face powder, radium soaps were all the rage. Advertising hoardings were full of the glowing element, rejuvenator of body and soul.

  Nothing seemed beyond radium’s benevolent rays. The US Radium Corporation even applied radium paint to watch faces to make them emit a pale greenish glow. By the end of the First World War, glow-in-the-dark watches had found their way on to the wrists of fashionistas across the United States, and the Radium Corporation was doing a roaring trade.

  The dial painters at the Corporation’s factory in Orange, New Jersey, painted around 250 watch faces a day. Their managers instructed them to be as neat as possible when applying the expensive paint to the watches; they were taught to make the brush tips come to a sharp point with their lips. These were young women, and when they had a break they used to paint their fingernails and streak their hair with the radium paint; one of them even gave herself a spooky smile by covering her teeth.

  A contemporary advert for a radium-based facial cream, ‘made to the formula of Dr Alfred Curie’

  But by 1924 the Orange dial painters had started to fall ill. Their jawbones were rotting. They lost the ability to walk as their hips dislocated and their ankles cracked. They were constantly tired from low levels of red blood cells. Nine died. Worried about the business repercussions, US Radium hired a group of scientists from Harvard University to investigate. They concluded that the deaths were ‘connected’ to the factory work. The nervous management were so scared about the profit implications that they prevented the report from being published. But another group of scientists also carried out tests on the workers.

  Forensic pathologist Harrison Martland read their report and was determined to investigate further. Martland was a passionate campaigner for workplace safety, publishing research demonstrating that nitroglycerine was poisoning workers in explosive factories, and that beryllium, used in the fledgling electronics industry, could cause fatal lung diseases. Regulation on both those chemicals soon followed his work.

  Nine of the ‘Radium Girls’, whose jobs painting watch faces with glow-in-the-dark paint gave them fatal radiation poisoning

  Martland studied the bodies of living and recently dead Orange workers, and published his findings in 1925. The element radium is structurally related to calcium, he explained. When it is ingested, the body treats it like calcium: some is metabolised, some is transmitted to the nerves and muscles, most is deposited in the bones. But unlike calcium, which strengthens bones, radium bombards them with radiation, destroying the blood-building marrow at their core and creating tiny holes, which get larger with time.

  That year a small group of former employees took the brave step of suing US Radium. It took the ‘Radium Girls’ – as the press quickly dubbed them – three years of legal wrangling just to get a trial date.

  Meanwhile, Martland had asked Charles Norris at the New York Medical Examiner’s Office to gather evidence for the trial. Together they planned to exhume the body of former dial painter, Amelia Maggia, who had died at the age of twenty-five. In her last year of work she had lost weight and suffered joint pains. The following year her jaw had started splintering, and nearly all of it had had to be removed. She had died in September 1923, of ‘ulcerative stomachitis’, in the words of the coroner.

  Norris asked Alexander Gettler to analyse Amelia’s bones, including the skull, feet and right tibia. Gettler’s team boiled them for three hours in a solution of washing soda. Then they sawed the larger ones into two-inch pieces. Gettler brought the bones into a darkroom which contained X-ray films. He sealed the bones tight up next to the X-ray films and did the same for some control bones from another corpse. When Gettler came back to see the results ten days later, the X-ray films around Amelia Maggia’s bones had a dazzle of pale spots on them, and the control films had nothing. He published the results of his experiment.

  As the lawsuit dragged on, the condition of the Radium Girls deteriorated. Two of the five girls were Quinta and Albina Maggia, sisters of Amelia. Both of Quinta’s hips had fractured and Albina could not leave her bed; by now, one of her legs was four inches shorter than the other. Another woman, Katherine Schaub, was hoping to use the money to buy roses for her funeral.

  The defence lawyers for US Radium tried to stall things further, arguing that the women couldn’t sue because they weren’t working at the factory any more. But the prosecution drew on the research of Martland and Gettler to argue that, while traditional toxins like arsenic and mercury poison you for a period of time, radium stays with you for ever. When the Radium Girls breathed out, all five of them exhaled radon gas.

  The courts dismissed US Radium’s motion and insisted the trial go ahead. This prompted them to settle
, giving each of the women $10,000 cash, annual pensions and free health care. It was a cheap settlement; at least two of them were dead within the year.

  The sad story of the Radium Girls is told by Deborah Blum in her book The Poisoner’s Handbook (2010). The length of time it took for the employers to be punished and the victims to be given some kind of justice speaks to the modern problem of industrial worker poisonings. James C. Whorton, author of The Arsenic Century (2010), has written: ‘As with arsenical candles and papers and fabrics, items become established in commerce before their dangers are recognized, ensuring that any attempt to curtail their use will be resisted by manufacturers … and fought or ignored by politicians ideologically opposed to government interference …’

  Gettler’s forensic toxicology laboratory became a model for others. The combined endeavours of scientists narrowed down the list of untraceable toxins until virtually none remained. But although the use of poison as a murder weapon has tailed off, and working conditions for industrial workers have improved in developed countries, the number of people injured or killed from ‘drugs of abuse’ – heroin, cocaine, crystal meth – remains large. This is the area in which forensic toxicologists have become most heavily involved lately.

  Robert Forrest is Honorary Professor of Forensic Chemistry at the University of Sheffield, and Britain’s leading authority on forensic toxicology. His route into forensics started when he set up a clinical toxicology service in Sheffield, enlisting a range of high-tech instruments in the service of state-of-the-art analysis. Among their other work, Robert and his team started analysing post-mortem samples following a spate of deaths from the heroin substitute methadone.

  Then the local coroner contacted Robert to ask if he would help with forensic investigations. ‘And that of course would bring a bit of money in, so I started doing that and it grew from there,’ he says. The work was new and difficult and Robert’s expertise grew. Because most toxins don’t make a visible difference to bodily tissues, even under the microscope, Robert needed to chemically test samples of blood, urine, organs, hair and, more recently, toenails supplied by the pathologist.

  Sometimes methadone poisoning is chronic rather than acute, and Robert can reveal that from the victim’s hair. Hair grows at about a centimetre a month, so Robert chops a hair sample into centimetre segments and analyses each one to provide a timeline of drug ingestion. The technique is useful in drug screening and also in what is known as drug-facilitated assault. ‘The sort of case where it’s useful is when there is a prostitute who has got a kid who she needs to keep quiet while she is entertaining clients and she feeds the kid a smidge of methadone and then one day she feeds him too much. Her defence is that somebody else must have fed it to him, but then you find in the hair lots and lots of methadone ingested over a period of several months, which makes that defence not terribly good.’

  However, this is not a foolproof method. For example, light hair binds drugs less well than dark hair because it contains less melanin. And cosmetic treatments such as dyeing and straightening tend to strip out drug traces. Nevertheless hair remains a useful indicator of drug content, not least because it remains stable after death.

  Something that became clear to Robert over time was that drug concentrations change significantly after death in most other parts of the body. ‘Interpreting the results is not at all straightforward,’ he admits. The scientific consensus used to be that ‘living blood’ gives the same toxicological results as post-mortem blood. ‘Nowadays we know that’s not true. You have to look at it with a great deal of caution. It’s very, very difficult.’

  How much toxin and where it can be found in the body depends on how it was taken. If it was inhaled, it will be predominately in the lungs. If injected intramuscularly, it will be mainly in the muscles around the injection site; injected intravenously, it will all be in the blood and there will be very little or nothing in the stomach and liver. If it was swallowed, then it will be mainly in the stomach, intestines and liver. Robert explains: ‘The standard samples which are taken at post-mortem are blood. It is unfortunately the case, and I notice this quite often, that in the south of Britain pathologists seem not to regularly take stomach content, and stomach content can be incredibly useful.’ It seems that in toxicology, as in so many aspects of British life, there remains a north–south divide.

  Toxicology is sometimes about more than identifying alien substances in the body. It can even help reconstruct the circumstances around suspicious deaths. The moral stakes are high when somebody may have been unlawfully killed by any employee of a public institution; higher still when their job is to care for the sick and fragile.

  Sister Jessie McTavish, a 33-year-old nurse, worked on a geriatric ward at Ruchill Hospital in Glasgow. On 12 May 1973 she watched an episode of the American TV series A Man Called Ironside, in which the relatives of elderly patients paid a nurse to murder them by lethal injection. The next day she discussed the programme with some of her colleagues, one of whom mentioned that insulin poisoning doesn’t leave a trace. Three weeks after the episode, patients in Jessie’s ward starting dying unexpectedly; five passed away in June alone.

  On 1 July, a sixth patient, 80-year-old Elizabeth Lyon died unexpectedly. Alarm bells began to ring with the doctor who certified her death. He spoke to patients on Jessie’s ward, one of whom was terrified of her. Jessie had given her an injection which had made her ‘feel awful’; when asked, the nurse said that the syringe contained sterilised water, a placebo. Other members of staff revealed that Jessie was in the habit of giving patients injections without recording them in the patients’ notes. Witnesses had heard her tell a visitor she was known at the mortuary as ‘Sister Burke and Hare’ because of all the recent deaths on her ward.

  McTavish was suspended, and charged with injecting drugs not medically prescribed into three further patients, one of whom had died. At the time the technology for measuring insulin in the body was not well developed. Nevertheless the toxicologist established that tissue from both of Elizabeth Lyon’s arms showed needle marks and contained excessive insulin.

  McTavish went on trial in June 1974, and was convicted of the murder of Elizabeth Lyon and of assaulting three other patients with illegal injections. A selection of nurses and doctors gave evidence against her. One nurse recorded finding three empty insulin phials in a ward side room, even though none of the patients had been prescribed insulin at that time. Another nurse testified to Jessie saying ‘they could dig up the bodies if they liked and they would not find any trace of insulin’. She was sentenced to life imprisonment.

  Five months later McTavish appealed her conviction. Her lawyer argued that the original judge, Lord Robinson, had misdirected the jury by not telling it that Jessie had in fact denied responding to her murder charge in the way the police inspector who made the charge said she had. That inspector had not taped Jessie’s response, but he had told the trial that she said, ‘I gave half a cc of insulin soluble to Mrs Lyon only because she wanted to be put out of pain and misery, and had trouble with her bowels.’ Jessie denied saying this, claiming instead that she only mentioned injections of sterilised water. She said the inspector had told her that if she admitted to injecting insulin she would only get ‘a £5 fine in the Sheriff’s court’. The appeal judges agreed that Lord Robinson had misdirected the jury and quashed McTavish’s verdict and sentence.

  McTavish’s name was removed from the Register of Nurses in Scotland. A short time later she married, and in 1984 she was restored to the Professional Register of the UK Central Council for Nursing, Midwifery and Health Visiting, under her married name.

  Jessie McTavish’s conviction was quashed. There was never any question of that happening in the case of a notorious medical practitioner who made a habit of injecting his patients with morphine and who wrote his own death certificates.

  Harold Frederick Shipman (always known as ‘Fred’) was born in 1946 on a council estate in Nottingham. A bright boy, he did so well at
his 11-plus exams that he was awarded a scholarship to the best local boys’ grammar school, High Pavement. His mother always felt that she was a cut above her neighbours, and brought Fred up to feel superior, which contributed to his isolation from his peers. He was devoted to his mother, and was devastated when lung cancer slowly and painfully wrenched her from him. The doctor came in the afternoons to inject morphine to alleviate her pain, and Fred was usually there, watching his mother sink into a peaceful state. She died in 1963, when Fred was seventeen.

  In his first year at Leeds University medical school, in 1965, he met Primrose Oxtoby, a 16-year-old window dresser, whom he married three months before their daughter was due. While still a student, a new husband and a first-time father, Shipman became addicted to pethidine, a painkiller used mainly in childbirth. As part of their training, the medical students were encouraged to experiment with different drugs in groups of four, two taking the drug and the other two monitoring its effects – and this is probably how he became hooked.

  Shipman forged prescriptions for pethidine for years, until eventually his veins collapsed. After psychiatric treatment for his addiction, he gave it up in 1975. Outwardly he seemed a normal middle-class family man, with four children and a devoted wife. His patients thought him a good doctor and, whilst a few colleagues found him arrogant and aloof, he was generally liked in the communities in which he worked, first in Todmorden, Yorkshire from 1974, and later, from 1977, in Hyde, Lancashire.

  But the truth about Shipman was that he was the diametric opposite of a good family doctor. For twenty-five years, he murdered patients at a rate of about one a month. Typically, he would visit elderly women living alone in their homes, inject them with a lethal dose of morphine, leave them sitting in a chair or on a sofa, fully clothed, and turn the fire on high. The next day, he would return, pronounce them dead and give an estimate of death considerably later than his previous visit. He managed to do this because the heat of the room kept the bodies warm, distorting body-cooling evidence of time of death. He would declare the patient dead of heart failure or old age, no post-mortem necessary because he’d recently been in attendance on them.