In the trial of Dr Adams everything happened quite differently.
The prosecution had decided to base its case against Dr Adams upon the indictment concerning Mrs Morrell; presumably because they felt that it was the strongest they had.14
The Crown’s principal witnesses were the nurses who had attended Mrs Morrell during Dr Adams’s treatment of her, and expert medical witnesses to give their opinions about the nature of his treatment. Since the Crown, to prove its case against Dr Adams, had first to prove that murder had in fact been done, the proceedings took on something of the character of an inquest.
The trained nurses were probably the most important figures in the case. These were the various day and night nurses who had been engaged by Dr Adams to attend Mrs Morrell at her house, from the time she left the nursing home in 1948 until her death two years later. The first of the three to give evidence was Nurse Stronach.
She was a small, faded woman with a short upper lip and a determined jaw. The jaw moved slightly but persistently as if she had sore gums or were chewing some kind of cud.
In reply to the Attorney-General’s questions she drew for us a picture of Mrs Morrell’s last days that looked bad for Dr Adams. We heard of his visits at night, of mysterious injections by him of unknown drugs, of poor Mrs Morrell lying doped and helpless, of further injections being pumped into her. Suggestions that Mrs Morrell might have been suffering pain were waved aside by Nurse Stronach. Mrs Morrell’s complaints, she said firmly, were neurotic. She was the ideal prosecution witness.
Then, Geoffrey Lawrence rose to cross-examine.
His manner is quiet and gentle. He asks for the witness’s help like a charity organizer wheedling a small subscription out of a millionaire. He is elaborately courteous. It is no part of his technique to undermine the witness’s personal dignity or self-confidence. What he seems to propose is a friendly collaboration in his great task of getting the truth.
Unfortunately for Nurse Stronach, she chose to reject his proposal.
Lawrence began by reminding her that what she had described so confidently had taken place over six years ago and that she was relying upon her memory. At this not unreasonable suggestion Nurse Stronach took umbrage.
Her attitude was that she knew what she knew, and that nobody was going to trick her into changing her story. When asked about her numerous interviews with the police prior to Dr Adams’s arrest, she became pert. The judge began to eye her coldly.
Lawrence, still very polite, began to question her about the record books kept by the nurses—the regulation nursing diary—and asked if such a diary had been kept for Mrs Morrell. Yes, of course. And it would be accurate? Oh, yes; everything pertaining to her medical history would be entered into it by every nurse concerned. Lawrence looked wistful. If only we had those records now we could see exactly what happened? Nurse Stronach agreed somewhat tolerantly that we could.
Then Lawrence pounced.
It so happened that we did have the books—he waved one aloft—and he would trouble Nurse Stronach to say if this entry, and that entry, and that, and that, and that, were in her handwriting. They were.
The prosecution’s efforts to appear to remain calm under this assault were manful but forlorn. The Attorney-General recovered quickly enough to put up a counter-barrage of technical objections; but did not get very far. Nurse Stronach was too serious a casualty for technical first aid.
As Lawrence proceeded to demolish practically every statement she had previously made by making her read out what she had written at the time, Nurse Stronach got smaller and smaller.
Not that she gave in easily. She adopted an air of being importuned, while feverishly trying to clamber out of the trap by thumbing through the diary ahead of Lawrence’s questions.
But he was not having that.
“Are you listening to me or are you reading that book?” he asked sharply at this point.
“Yes, I am listening,” was the unhappy reply. She was chewing furiously now.
“Don’t try to read them in advance,” Lawrence persisted.
“I am not,” said Nurse Stronach, bridling.
When the Attorney-General re-examined her in an effort to repair the damage, he found a witness almost as hostile to the prosecution as she had been to the defence. Nurse Stronach had had enough of lawyers for the day—all lawyers. The friendly pat on the shoulder she received from Superintendent Hannam when she left the witness box can have been small consolation to her.
The next prosecution witness, Nurse Mason-Ellis, suffered a different misfortune.
On the adjournment that day, the judge solemnly warned all three nurses not to discuss the case between themselves.
But the situation was too much for them. Together, that evening, they went back to Eastbourne by train. The following morning they returned to London, also by train. Their conversations on both journeys were overheard and reported to the defence. The ladies talked their heads off about the case.
Nurse Mason-Ellis, a nice-mannered little woman, was the one who had to admit publicly to the indiscretion. Lawrence made the most of it.
When she had been persuaded to admit that the conversations had indeed taken place, he asked: “Did one or other of you say, ‘don’t say that or you will get me into trouble’? ”
Nurse Mason-Ellis after squirming a bit admitted that one of them had; but not her.
“Which one was it?”
“Must I answer?”
The judge intervened with a sharp, “yes”.
The truth came out. It had been Nurse Randall, the nurse on duty when Mrs Morrell had died, and what she had been talking about was the important matter of how and where the dangerous drugs had been kept in the Morrell house. It also emerged that, on this same subject, one of the answers given by Nurse Stronach had been patently untrue.
Using the prosecution’s own somewhat battered witness and the nursing diaries (the validity of which was not in dispute) Lawrence now proceeded to build up a picture of Mrs Morrell’s last days totally different from that proffered by the Attorney-General in his opening address.
Sick she had certainly been; but she had also been senile and, at times, scarcely sane. She had been liable to sudden paranoid outbursts, during which, half-paralysed though she was, she would attempt to get out of bed, shout, scream and work herself into violent rages, abuse her nurses and accuse them of trying to kill her. In her condition this had been dangerous. She had needed heavy sedation, for only heavy sedation had had any effect. Her behaviour, as recorded in the diaries, even after massive injections of morphine and heroin, showed that clearly. She had died eventually because she was old and sick, and for no other reason.
By the time Lawrence had finished with the nursing diaries, Dr Adams was not the only person on trial there. What, it was being asked, would have happened if the diaries had not been found and produced? Presumably, the court would have accepted as true a lot of evidence it now knew to be false. Had those who had prepared the case for the Crown made any effort to find the diaries? Admittedly, after six years the chances of their still being available would be small; but had any effort at all been made?
Apparently not. After Mrs Morrell’s death, it seems, the diaries had been delivered to the doctor’s house in a bundle, put away with other records in a filing cabinet, and forgotten. It had not been until Superintendent Hannam had questioned him about some drug prescriptions which he had written for Mrs Morrell, that Dr Adams had remembered the diaries. This was when he was preparing to defend himself against the thirteen lesser charges, and some weeks before his arrest for the murder of Mrs Morrell. He and his solicitor had searched for and found the diaries. They had been handed over at once to the defence lawyers, who, of course, would have made them available if the Crown had inquired about them.
The Attorney-General’s contention was that the diaries had been purposely kept by Dr Adams in case of any inquiry into Mrs Morrell’s death; but this line of thought led him along a strang
e path. It ended at the dark suggestion that the doctor (driven, we had to assume, by an unholy passion for Georgian cutlery) had taken “the greatest care possible to secure that any entries put by the nurses in those books were not obviously incriminating to him and not obviously showing the design that he had formed”.
How the doctor was supposed to have managed this, the Attorney-General did not explain. There had been no hint of a suggestion from any of the nurses that the doctor had told them what or what not to write. Indeed, they had all insisted on the accuracy of the entries; and the books were all there; no pages had been removed.
These were not the only nursing diaries to inconvenience the prosecution.
The expert witnesses for the Crown were two Harley Street specialists, Doctors Douthwaite and Ashby.
Dr Douthwaite, senior physician at Guy’s Hospital, described the causes of a stroke such as that suffered by Mrs Morrell in Cheshire in 1948, and the treatment that, in his opinion, should have followed such an incident.
The burden of his evidence was that there was no justification for administering morphine to such a patient unless there was an episode of acute mania. In that event a single injection only might be given. Dr Adams’s programme of morphine and heroin injections had been quite wrong. It had led to Mrs Morrell’s becoming an addict of those drugs, and her tolerance of them had increased to the point where she had been suffering withdrawal symptoms. Finally, in Dr Douthwaite’s opinion, Dr Adams had increased the dosage drastically with the intention of murdering her.
These opinions were given simply, lucidly and temperately; but also very positively. There was no doubt of the impression they made upon the court.
When Lawrence rose to cross-examine, he was, we realised, faced with the task of effacing that impression or, at least, of blurring it pending the introduction of an expert witness for the defence who would flatly contradict Dr Douthwaite’s opinions. It had not been expected that he would have as his unwitting collaborators those who had prepared the case for the Crown. This is how the cross-examination went.
Lawrence: “Are you saying that Dr Adams formed the intention to terminate Mrs Morrell’s life on 8 November and carried that intention into effect over the next five days?”
Dr Douthwaite: “Yes.”
Lawrence: “I think it follows from what you said to my Lord yesterday that that murderous intent, in your view, was present in his mind from and including 8 November onwards to the end?”
Dr Douthwaite: “Yes.”
Lawrence: “A specialist’s profession is a responsible one, but I hardly suppose that you have often expressed a graver or more fateful opinion on a matter than that, have you?”
Dr Douthwaite: “No.”
Lawrence: “Before going into the witness box and expressing that view, have you satisfied yourself that you have every piece of relevant evidence before you on which to judge?”
Dr Douthwaite: “Yes.”
Lawrence repeated this question in several different ways and received affirmative replies before going on: “Did you know that, when Mrs Morrell had the stroke over two years before she died, she was staying with her son in Cheshire?”
Dr Douthwaite: “Yes.”
Lawrence: “Have you made any inquiries, before giving the evidence against Dr Adams that you gave yesterday, into the symptoms of her stroke, the circumstances and the treatment she had in Cheshire before Dr Adams ever took her over in Eastbourne?”
Dr Douthwaite: “I have said in conferences it would be very interesting to know what treatment she had before she came under the care of Dr Adams.”
Lawrence explored this answer a little and then continued: “If it was as relevant and as interesting as that, did you ask for that information to be found, or for attempts to be made to furnish you with it before you came to your final conclusion?”
Dr Douthwaite: “No.”
Lawrence (sharply): “Why not, if it was relevant and material to the medical picture from the point of view of addiction, about which you told us so much yesterday?”
Dr Douthwaite must by now have suspected what was coming, but the hesitation before he replied was only momentary: “In the first place because I was told that the information was not available, and secondly because it would not have materially influenced the answers I have given in respect to the addiction.”
Lawrence’s face was quite expressionless as he produced the nursing record for the case of Mrs Morrell while she had been in the Cheshire cottage hospital. It contained all the information that Dr Douthwaite had been told was not available. The hospital physician had prescribed for her regular injections of morphine. The sedation treatment, which the Crown had postulated as an essential part of Dr Adams’s wicked “design”, had not been initiated by him.
The Attorney-General, while not going so far as to suggest that the cottage hospital in Cheshire had kept its nursing records for six long years solely in order to help Dr Adams defend himself against a charge of murder, dismissed the information in them as “irrelevant” Dr Douthwaite, however, was more interested. While still disapproving of the morphine injections, he conceded that the man on the spot was entitled to exercise his own best judgment. He also said that from six to twelve months would have been a reasonable prognosis in terms of expectation of life for Mrs Morrell after her stroke.
She had lived two years.
From this point on the trial became in effect a debate about the responsibilities of doctors towards their patients and of the ethical dilemmas involved.
Lawrence: “The reasonable object of a general practitioner’s treatment for what he could reasonably expect to be the remaining months of that woman’s life would be to make life as bearable as it could be to her and to those who had to look after her?”
Dr Douthwaite: “The first object would be to try to restore her health if possible.”
Lawrence: “That is at the highest level the object of every doctor in every case, but human life being what it is there are some instances where every sensible doctor knows that, whatever he does, he cannot restore his patient to normal health. No doctor in his senses would think that, short of a miracle, he could restore a woman of seventy-nine or eighty to her pre-stroke health?”
Dr Douthwaite: “Oh, I agree.”
He also agreed that when Dr Adams had been away and his partner had been confronted with a marked degree of cerebral irritation in Mrs Morrell’s case, the partner had been right to increase the morphia administration.
Lawrence: “If a general practitioner decides that he has to make use of some sort of drug, he has to balance up the advantages and disadvantages of his choice?”
Dr Douthwaite: “Certainly.”
Lawrence: “In the case of Mrs Morrell, one of the most prominent circumstances would be his reasonable prognosis at the time of her stroke that her expectation of life was about six to twelve months?”
Dr Douthwaite: “Yes.”
Lawrence: “Therefore, with that short expectation reasonably entertained by the doctor, the disadvantages of addiction following from the selection of these opiates would be far less than if he was selecting them for a person whose prognosis was absolutely indefinite?”
Dr Douthwaite: “Yes.”
In response to a further question on this point he went on: “The problem often confronts us, and my practice in teaching has been that if a patient is obviously dying it is ridiculous to worry about addiction. If the strong probability is that the patient will not live for more than a month or two, and if the drugs are indicated for the condition, you cannot worry about addiction.”
Nevertheless, he persisted in his opinion that, in the last weeks of Mrs Morrell’s life, Dr Adams had set about causing her death and had, in fact, done so. At the same time (it was all most confusing) he agreed that another physician with qualifications comparable to his own might well have a completely contrary opinion.
Dr Ashby put the ethical dilemma another way: “I think that once it can be es
tablished that a patient is dying, considerations of improving their health scarcely apply, and a doctor must give his first thought to the patient’s comfort and well-being. If comfort and well-being are competing against the length of survival, he might properly give them precedence providing death is known for certain.” In his opinion the test was this: if the doctor feels obliged to give priority to treatment of the patient’s discomfort, then he must do so.
Or, in Dr Adams’s words, he must “ease the patient’s passing”.
That concluded the case for the Crown.
Lawrence did not put Dr Adams in the witness box to give evidence on his own behalf. It would have been pointless to submit him to that ordeal. The evidence of what had been done in the case of Mrs Morrell was in the nursing records, and it was the best evidence because it depended on nobody’s memory of things that had happened six years earlier.
He called only two witnesses for the defence. The first was Dr Harman, a consulting physician of St Thomas’ Hospital.
Most laymen fall into two categories where their attitudes towards the medical profession are concerned: those who prefer to believe that most doctors are skilful and wise, and those who profoundly distrust the whole pack of them. For the former group, expert medical evidence is always disconcerting. What is an elderly invalid to think of a flat statement by Consultant X that the drug with which he is being regularly dosed should on no account be prescribed for elderly persons? Should he conclude that his own doctor is trying to murder him? Or should he wait for the reassuring news from Consultant Y that what the doctor ordered is the very thing he needs? The patient has a dilemma, too.
In just under two hours Dr Harman contradicted, politely, good-humouredly, but quite firmly, practically every opinion about narcotic drugs and their use in treatment which had been given by the prosecution witnesses. Cross-examination did not shake him.
The Mammoth Book of Unsolved Crimes Page 30