Death of Edith Alice Morrell
Edith Alice Morrell was a resident of Eastbourne, East Sussex, England, and patient of Dr John Bodkin Adams. Although Adams was acquitted in 1957 of her murder, the question of Adams' role in Morrell's death excited considerable interest at the time and continues to do so. This is partly because of negative pre-trial publicity which remains in the public record, partly because of the several dramatic incidents in the trial and partly as Adams declined to give evidence in his own defence. The trial featured in headlines around the world and was described at the time as "one of the greatest murder trials of all time" and "murder trial of the century". It was also described by the trial judge as unique because "the act of murder" had "to be proved by expert evidence." The trial also established the legal doctrine of double effect, where a doctor giving treatment with the aim of relieving pain may, as an unintentional result, shorten life.
Background
Origin of the enquiry
Edith Alice Morrell was a wealthy widow who suffered a brain thrombosis on 24 June 1948 while visiting her son in Cheshire. She was partially paralysed and was admitted to a hospital in Neston, Cheshire the following day. After returning to Eastbourne, she was under the care of Dr John Bodkin Adams for two years and four months from July 1948 until her death on 13 November 1950: as she had been attended by a doctor throughout her last illness and as the death was apparently not sudden, violent or unnatural, there was no requirement for an inquest and none was held. Adams, as her medical attendant, certified the cause of death as a "stroke" following a coma that had lasted two hours. Cullen records that, on the day of Mrs Morrell's death, Adams arranged for her cremation and that her ashes were scattered over the English Channel. However, Mrs Morrell had made various wills, and it was her son, Claude, as her sole executor who was obliged to carry out her wishes for her funeral arrangements, not Adams. Adams did complete the medical certificate required for the cremation form, answering "no" to the form's printed question "Have you, so far as you aware, any pecuniary interest in the death of the deceased?", which avoided the necessity of a post-mortem. As Adams was not a beneficiary of Mrs Morrell's final will, as amended by a codicil of 13 September 1950, this answer was in fact correct, although he may have believed he was a beneficiary, as he later told the police.The Eastbourne police had received an anonymous call, later discovered to be from the music hall performer Leslie Henson who had been working in Dublin at the time, about the unexpected death of his friend Gertrude Hullett on 23 July 1956, while being treated by Adams. Mrs Hullet had been depressed since the death of her husband four months earlier and had been prescribed sodium barbitone and also sodium phenobarbitone to help her to sleep. In the months immediately after her husband's death in March 1956, Mrs Hullett had told Adams of her wish to commit suicide. Her daughter, a close friend and her two servants later told the police that they believed that she had taken her own life, and the friend added that he had found the letters in which she had contemplated suicide in April 1956, calling her death a "planned suicide".
No information about Mrs Hullett's possible suicidal intentions had reached Adams' colleague, Dr Harris, who was called after Mrs Hullett was found comatose. He diagnosed a cerebral haemorrhage as most likely cause of her death on hearing that she had complained of a headache and giddiness the previous evening. As the death was unexpected, an inquest was held into Mrs Hullett's death, which ended on 21 August. The inquest concluded that Mrs Hullett had committed suicide, but the coroner questioned Adams' treatment and said in his summing up that it was "extraordinary that the doctor, knowing the past history of the patient" did not "at once suspect barbiturate poisoning".
Police involvement
Two features of Adams' way of practicing medicine had attracted attention among doctors, nurses and others in Eastbourne: his lavish use of the opiate drugs, heroin and morphia, and his asking wealthy patients for legacies. It was rumoured that the two were not unconnected, and that someone whose duty it was to keep his patients alive should not have a pecuniary interest in their deaths. The circumstances surrounding Mrs Hullett's death, in particular his apparent attempt to disguise that its cause was barbiturate poisoning and his wish to clear a substantial cheque she had given him shortly before her death as rapidly as possible together with these rumours, prompted the Eastbourne police to involve the Metropolitan Police in the investigation.Instead of having to find a suspect for a known crime, the senior Metropolitan Police officer, Detective Superintendent Herbert Hannam, had a known suspect in Adams but wished to link him to more serious crimes than forging prescriptions, making false statements and mishandling drugs. Devlin suggests that Hannam became fixated on the idea that Adams had murdered many elderly patients for legacies, regarding his receiving a legacy as grounds for suspicion, although Adams was generally only a minor beneficiary in his patient's wills. Hannam's team investigated the wills of 132 of Adams' former patients dating between 1946 and 1956 where he had benefited from a legacy, and prepared a short list with around a dozen names for submission to the prosecuting authorities. The list included Mrs Morrell, Mrs Hullett and two other cases in which evidence had been taken on oath, these being among the cases where Hannam considered he had collected enough evidence for a prosecution. Devlin considered that Mrs Morrell's case, which was chosen by the Attorney-General for prosecution, looked the strongest of Hannam's preferred cases, despite it being six years old, although he noted that some others believed that the Hullet case was stronger.
The evidence
Context
is a criminal offence under the common law of England and Wales, defined as "the unlawful killing of a reasonable person in being under the King or Queen's peace with malice aforethought express or implied", and matters outside this definition are not murder. Devlin told the jury that, even if they decided that Mrs Morrell did not die a natural death but was killed, there had also to be the intention of killing. He pointed out in his account of the Morrell trial that prosecution could only draw inferences about the intention of an accused person, whereas the defence had the advantage that only the accused could say what had really been in his mind.The prosecution case, based on the police investigation and outlined in the opening speech of the Attorney-General Sir Reginald Manningham-Buller, was that Adams either administered or instructed others to administer drugs that killed Mrs Morrell with the intention of killing her, and that these drugs were unnecessary as she was not suffering pain and had been semi-comatose for some time before her death. The prosecution added that the likely motive for the killing was he had decided that it was time for Mrs Morrell to die, as he feared her altering her will to his disadvantage. In strict law, the prosecution did not need to show a motive but, if none were advanced, the offence had to be proved by demonstrating beyond doubt how the killing was carried out. Throughout the trial, the prosecution maintained that the motive was a mercenary one, and it did not rely on the possible alternative of euthanasia.
Not only did the alleged manner in which Mrs Morrell met her death have to be proved by expert evidence, the police evidence offered at the trial depended for its accuracy on two statements made by Adams while not under caution in apparently friendly conversation with Hannam. Adams' first statement, that he had administered almost all the dangerous opiate drugs he prescribed for Mrs Morrell himself and that virtually none were left unused at her death, was critical to the prosecution's case on method, but was later contradicted by other evidence. Devlin considers that this admission was made in response to Hannam searching the doctor's house and surgery on 24 November 1956 and at the same time presenting Adams with a list of drugs prescribed for Mrs Morrell between 8 and 12 November 1950, the latter being the day before she died. Had Adams not said that all the drugs had been used, he could have been accused of illicitly hoarding them. Adams' second statement that he had inherited certain items under Mrs Morrell's will, the basis for the case on motive, was also incorrect.
Medical evidence
After Mrs Morrell had suffered a stroke and was partly paralysed, she was admitted to a cottage hospital in Neston, Cheshire on 25 June 1948. Cullen, whose account is based on the Scotland Yard case files, stated that Adams was already her doctor, that he arrived in Cheshire on 26 June, and on the following day prescribed morphia for the pain. Adams, she claimed, also made special arrangements to take Mrs Morrell back to Eastbourne and gradually increased the dose of morphia and added heroin until she was addicted. However, it was established during the trial that the morphia injections Mrs Morrell received for the nine days she spent in hospital to ease pain and symptoms of "cerebral irritation" and to help her sleep were prescribed by a Doctor Turner of that hospital, not by Adams. On her return to Eastbourne, Mrs Morrell was first cared for at the Esperance Nursing Home before returning home. The Attorney-General's opening speech also stated that Mrs Morrell was transferred to Eastbourne on 5 July 1948, only then becoming one of Adams' patients, and that he first prescribed morphine on 9 July 1948, adding heroin on 21 July. Rather than a gradually increasing dose, between July 1949 and the end of October 1950, the regular dose given was a quarter grain of morphia and one-third grain of heroin.Four of the nurses that had attended Mrs Morrell had given statements to the police in August and November 1956. Two of these, nurses Stronach and Randall, had suggested to the police that Adams had increased the frequency of injections and the amount of each injection throughout the period they had nursed Mrs Morrell, and that many of the injections Adams gave were of drugs that he took from his bag, which he prepared himself rather than asking the nurses to prepare them, and that they were unaware of their contents. These two nurses repeated these allegations when questioned near the start of the trial by Manningham-Buller, but they were forced to admit under cross examination that it was they and the other two nurses that usually made up the injections to be administered both by them and by Adams, that they had recorded that relatively few injections were brought in already made up by Adams, and also that they had recorded their nature on at least some occasions. Another nurse recalled that these were said to be vitamin injections, and it was also clear that the amounts of opiates injected were constant until September 1950, when another doctor first increased the dosage.
Although Dr Douthwaite, a medical expert witness for the prosecution, claimed that addiction from such doses must have been inevitable, there was no evidence that Mrs Morrell had developed a craving for or addiction to the drugs prescribed. Dr Douthwaite had been a member of the prosecution team since December 1957 when, together with the pathologist Dr Francis Camps, he had assured the Attorney General, Melford Stevenson and the Director of Public Prosecutions that the amounts of opiates prescribed for Mrs Morrell would have been fatal beyond doubt had they been injected, and he also gave evidence to this effect in the Committal hearing. Devlin commented that, having assured the prosecution of the soundness of his opinion, Douthwaite was determined to stand by it in the trial of Dr Adams.
At the time Mrs Morrell left hospital after her stroke, her prognosis was for a life expectation of six months, but she survived for 28 months and, under cross-examination, Dr Douthwaite accepted that it would have been impossible to restore a woman of around 80 years old to her pre-stroke condition, and that the best that could be done was to make her comfortable and help her to sleep. She remained in tolerable health until August 1950 when she began to decline. Dr Douthwaite also accepted that, by the start of November 1950, Mrs Morrell was dying and, had he seen her in October that year, he would only have expected her to survive for a few weeks.
The dosage of opiates was increased from the end of August 1950, but this was initially the action of Adams' partner, Dr Harris. On 9 October 1950 when, after receiving an injection, Mrs Morrell became drowsy and semi-comatose, the nurse that gave it considered that this and other symptoms might have indicated a stroke, and Adams diagnosed it as such. When she revived, she had difficulty speaking and was confused. Although Dr Douthwaite interpreted these symptoms as arising from excessive drug use, both he and Dr Ashby, the other medical expert for the prosecution, agreed that the symptoms were also compatible with this diagnosis of a further stroke. Dr Harman, the defence's medical expert witness, regarded it as a slight stroke as might be expected from her age, having previously had a major stroke and her arteriosclerosis. Cullen quotes a pathologist who reviewed the Morrells case in the 2000s as concluding that the incident of 9 October was not a stroke, partly on the basis of the lack of slurred speech, although the court heard that Mrs Morrell had difficulty speaking after the episode.
The prosecution's opening statement claimed that, at some time not more than two weeks before her death, the amount of opiates given to Mrs Morrell dramatically increased with the intent of ending her life. The Attorney General concentrated on the period from 8 and 12 November 1950 in which he said that Adams had issued prescriptions for 40½ grains of morphia and 39 grains of heroin, 79½ grains of opiates in total. One grain under the apothecaries' system of weights is approximately 64.8 milligrams
Manningham-Buller initially argued that all 79½ grains of these drugs were injected into Mrs Morrell, an amount which was sufficient to kill her despite any tolerance she may have developed, and which could only have been intended to kill. Adams was accused of murdering Mrs Morell by one of two methods, singly or in combination. The first was that, as a result of the amounts of opiates given since January 1950, she was already dying by November that year. The second, the immediate cause of death, was said to be two large injections of an unknown, but presumed lethal, substance prepared by Adams and injected on his instructions into a supposedly unconscious Mrs Morrell on the night of 12 to 13 November 1950, the second an hour before her death. However, on the second day of the trial, the defence produced nurses' notebooks, which showed that smaller quantities of drugs were given to the patient than the prosecution, basing its calculations on Adams' prescriptions, had thought. These recorded that 10½ grains of morphia and 16 grains of heroin were injected in the period, although the prosecution claimed this was an incomplete record. The notebooks also stated that Mrs Morrell was conscious until shortly before her death, and the two injections made the night of 12 to 13 November 1950 were recorded as being of paraldehyde, described as a safe soporific.
The leading Defence counsel Sir Frederick Geoffrey Lawrence, QC asked for a list of all prescriptions for the whole period in which Adams had cared for Mrs Morrell, not just of the dangerous drugs for ten and a half months in 1950 presented by the prosecution. The earlier list showed Adams had prescribed a total of 1,629½ grains of barbiturates; 1,928 grains of Sedormid; 16411⁄12 grains of morphia and 139½ grains of heroin. Lawrence was able to use the complete list, together with the results of his cross examination of the nurses and the prosecution expert witnesses and examination-in-chief of the defence medical expert to describe the decline of an old lady during which Adams had made her comfortable to the best of his ability although using substantial amounts of opiate drugs, until her decline accelerated towards a natural death from old age, possibly related to a second stroke. Lawrence also secured an admission from Dr Douthwaite that, in his examination-in-chief, his evidence on symptoms related to possible withdrawal symptoms was in response to instances selected by the Attorney-General that might not have been representative.
In response to the defence's production of the nurses' notebooks, Dr Douthwaite, who had initially suggested 8 November 1950 as the day on which an intent to kill could be first deduced, changed this to 1 November. This was because Adams had completely withdrawn morphia injections on 1 November, later reintroducing the drug on the evening of 5 November, which Dr Douthwaite interpreted as a plan to reduce Mrs Morrell's tolerance to morphia, before it was brought back in increasing doses. His new theory was that, rather than a single injection being lethal, all injections of morphia after its reintroduction on 5 November were potentially lethal, and could only have been intended to be lethal, through a process of accumulation. This was because a moribund patient such as Mrs Morrell could not excrete the build-up of opiates. Dr Douthwaite also claimed that the second, larger, paraldehyde injection on 13 November brought about Mrs Morrell's death more quickly than the opiates alone would have done. Dr Douthwaite had previously accepted the defence argument that the withdrawal of morphia was Adams experimenting with variations in drugging, and in cross-examination, Lawrence suggested that his new idea was not based on generally accepted ideas. When questioned by Devlin, Dr Douthwaite accepted that it would be essential to his accumulation theory that Adams knew that opiates would accumulate, but that a doctor with Adams' anaesthetist's qualifications should have known this. Dr Douthwaite also admitted in cross-examination that his evidence at the committal hearing was given without knowledge of her treatment in Neston, was based on the medication Mrs Morrell had received from January 1950 only, and on the incorrect assumption that she had been in a coma for the last three or four days of her life.
Dr Douthwaite's new theory was not accepted by his colleague, Dr Ashby, who did not consider then the withdrawal of morphia sinister and also accepted Mrs Morrell may have been in pain or considerable discomfort through arthritis exacerbated by being bedridden, rather than pain-free, as Manningham-Buller had claimed. Dr Ashby also said under cross-examination that he was not prepared to say whether Adams' instructions to the nurses were of a murderous nature. Dr Harman, for the defence, also disagreed with Dr Douthwaite's theories on accumulation, the withdrawal and reintroduction of morphia and the effects of paraldehyde. The Attorney-General continued to focus on 8 November 1950 as the critical date and on Adams' unguarded admissions that he had used almost all the drugs he had prescribed as showing the nurses' records were incomplete. Devlin commented that, by this point, a conviction seemed to him unlikely because the medical evidence had been inconclusive and the motive, the acceleration of a paltry legacy, ludicrous. A guilty verdict would have indicated that the jury had been unable to resist the prejudicial pre-trial publicity.