Nine cases in this archive were prolonged by a doctor writing something down. Not a corrupt doctor, in most of them. A competent one, examining a body, finding what the medical knowledge of the period told him to expect, and certifying a natural death.
Olaf Däter is the modern case and the plainest. He had worked as a geriatric nurse in Bremerhaven, and the women he killed were women he had nursed. Between the fifth and the fourteenth of June 2001 he killed five of them, suffocating each from behind with his full bodyweight. The doctors who examined the first four did not notice the severe internal injuries and certified the deaths as natural. Five women died in ten days because of that. It ended when a sixth woman survived and gave police his name.
The nineteenth-century cases follow one pattern, and it is not really about incompetence.
George Chapman poisoned three women he lived with in London with antimony between 1897 and 1902. Each declined over weeks with vomiting and wasting, which doctors recorded as consumption or gastric illness. Those were the correct diagnoses for those symptoms in the 1890s. Antimony poisoning presents exactly as chronic gastric disease, and a doctor who wrote consumption was doing his job with the tools he had.
Bertha Gifford nursed her neighbors in rural Missouri between about 1909 and 1928. A considerable number of them died with violent stomach pain and vomiting, which country doctors recorded as gastritis or as bad food. She was charged with three of the deaths and found not guilty by reason of insanity. Lydia Sherman's six children died one after another over a single year, of what doctors recorded as remittent fever and bronchitis. Mary Ann Cotton's household deaths were certified as gastric fever, over years, in three counties.
The number of arsenic and antimony cases here is not a coincidence. Both produce a slow decline indistinguishable from the ordinary killers of the period, and both were legally available in the household.
George Joseph Smith worked the certification rather than relying on it. Before each of his three wives drowned, he had taken her to a doctor days earlier about a minor complaint, establishing a medical history. Each death was then recorded at the inquest as an accident or a fit. He was not hoping a doctor would guess wrong. He was manufacturing the record the doctor would rely on.
Dorothea Waddingham had a conviction for theft and no nursing qualification of any kind when the County Nursing Association placed Louisa Baguley, eighty-nine, and her daughter Ada, fifty, in her Nottingham house in January 1935. Louisa died in May and Ada in September, and the doctor certified cerebral hemorrhage. What broke it was not a doctor's second look but a letter, purportedly from Ada, asking that she be cremated and her relatives not informed.
Belle Gunness's first husband died in 1900 on the single day two of his life insurance policies overlapped. The coroner recorded an accident. She was never tried for anything, and the body found in the 1908 fire that ended the case has never been positively identified.
The worst case is Jeanne Weber's, because there the certification was not a mistake made in passing. Four children died in her care in Paris in March and April 1905. The trial turned on the evidence of Léon Thoinot, one of the most eminent forensic physicians in France, who examined the bodies and testified that the children had died of natural causes and the marks were not signs of strangulation. She was acquitted. In April 1907 a nine-year-old boy died while she was working for a family in the Indre under an assumed name. Thoinot was consulted again and the case collapsed again. She was finally stopped in 1908 and declared insane.
Thoinot never withdrew. That is why Weber's victim count in this roster runs from one to ten and the range reflects a real dispute rather than poor record-keeping: most of those deaths were formally found to be natural, by the most qualified man available, and no court has ever unfound them.
Read the nine together and the pattern is not that doctors were careless. It is that a death certificate is a judgment made in a few minutes, on the medical knowledge of its decade, usually without any reason for suspicion, and that a certain kind of killer works precisely in the gap between what a body shows and what a doctor is looking for.
Which is also why almost every case here was broken by something other than medicine: a surviving victim, a forged letter, an insurance clerk, a relative who would not accept it.