The Multipara Homicides Investigation Documents

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Dr. Nicholas Lambert
Head, Forensics
July 14, 1883

I, Nicholas Lambert, a full accredited physician in good standing, do hereby swear and affirm that the following report is based on my expert opinion as a physician and forensic specialist, and is set forth to the best of my ability and experience.

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In May of this year I was approached by Detective-Sergeant Maroney of Police Headquarters and asked to consult in the matter of the suspicious deaths of nine women. 

Accordingly the remains were delivered to my laboratory at Bellevue for post-mortem examination. In four cases I was carrying out a second examination, the first having been performed by other physicians. None of my clinical findings are significantly different from the original reports.

I conducted a full and thorough study of each victim, including analysis of bodily fluids and tissues, in as far as the state of decomposition made testing possible.

Findings

All the victims showed distinct clinical signs of pregnancy at time of death. In one case the pregnancy was in its earliest stages (Campbell), in another (Winthrop) I estimate that the pregnancy was close to or at the end of the second trimester.

An abortion was performed on each of the victims. Traces of fetal tissue were found in eight of the nine victims.

In each victim a trio of deep puncture wounds were found between the uterine horns, penetrating into the lower intestines. Some wounds were more violent or ragged than others, but all were essentially the same in placement in a way that indicates expert knowledge of human anatomy and adequate surgical skills. In one case (Liljeström) subsequent and possibly unintentional damage to the right uterine artery caused death more quickly than in the other eight.

Special note is give to the fact that in none of the nine cases did I find similar damage to the cervix. This indicates that the person performing the operation understood the fine points of female anatomy. Someone unfamiliar with these structures must certainly cause abrasions or cuts when attempting to introduce a surgical instrument into the uterus.

In all cases the puncture wounds in the uterus resulted in lacerations to the ileum, mesentery, visceral and parietal peritoneum, causing fecal matter to be released into the abdominal cavity.

This massive bacterial contamination caused the immediate onset of puerperal endometritis. As a result and as to be expected, the following symptoms were reported for those victims who were seen by physicians before death: severe abdominal pain with guarding, enlarged and tender uterus, high fever, pallor, nausea, vomiting, tachycardia, and copious discharge of purulent matter. In three cases (House, Svetlova, Winthrop) pelvic abscesses presented as palpable masses adjacent to but distinct from the uterus.

Post-mortem examination revealed large amounts of serum, albumin, and fibrino-purulent deposits in the abdomen. Mrs. Liljeström showed just the onset of infection, for reasons explained above.

Also obvious during examination were clear signs of previous pregnancies carried to term for all nine victims.

The pain suffered by eight of the women in their last hours is almost unimaginable.

Medical Science

The three most salient problems that face every surgeon are (1) uncontrollable hemorrhage (2) pain, which limits the patient’s ability to tolerate clinical intervention and (3)inflammation, suppuration and infection following from bacterial contamination of open wounds.

While medical advances of the last fifty years have produced often reliable methods to address each of these areas, deaths still occur during surgery for any number of reasons outside the surgeon’s control. The point to keep in mind while reading this report is a simple one: the responsible party put aside antiseptic methods and in fact proceeded in a way to insure contamination and infection.

Discussion

Leaving aside for the moment the question of legality, abortions performed in an operating theater with the appropriate surgical instruments and strict attention to antiseptic methods by an experienced physician or midwife generally are safe, so long as they are performed before ten weeks gestation and the patient is otherwise in good health.

When the practitioner has no medical training or surgical experience, penetrating wounds of the abdomen through the birth canal, cervix or uterus are not unusual. An accidental puncture that goes deep enough to penetrate and contaminate the peritoneal cavity and intestines is, in my experience, always fatal. In theory, this need not be the case.

In ideal circumstances such a wound would be immediately treated with every aseptic precaution necessary for abdominal surgical incisions. The abdominal cavity would have to be opened, all blood and foreign matter evacuated and the cavity repeatedly rinsed with sterile water to remove infectious matter. Wounds to all nearby organs would have to be treated in the same way: cleaned, repeatedly flushed, sutured. Multiple layers would then be closed with proper drainage.

None of the victims I examined received such medical treatment.

Wounds of this magnitude that are not accidental that can be clearly classified as suicidal or homicidal are extremely rare. Yet that is what I find here in all nine cases.

The evidence indicates that the surgeries were performed by someone with medical knowledge and experience, someone who knew exactly what to do to insure a fatal outcome. In my professional opinion, the same surgeon or doctor or well-trained midwife carried out all nine procedures.

Summary

An unknown party with medical knowledge and experience designed and executed a procedure not to induce abortion (or perhaps, not to bring about abortion in the first line), but to cause systemic sepsis and a slow, extremely painful death. In all these cases, even immediate expert medical surgical intervention would have likely failed to save the mother’s life.

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