title: The case of Dr. Shipman.
abstract: On January 31, 2000, Dr. Harold Shipman was convicted at Preston, England, of murdering 15 of his patients by administering lethal doses of diamorphine (pharmaceutical heroin). Investigations indicate that, during his working life, he killed about 220 to 240 of his patients. The bodies of many victims were cremated. Twelve victims were exhumed, and 9 of these deaths were included in the indictment. Most victims were elderly and had histories of natural disease. Autopsies confirmed known natural disease but showed no evidence of acute lethal events. Analysis of skeletal muscle disclosed significant quantities of morphine, to which the deaths were attributed. Circumstantial evidence was strong, as illustrated by the convictions in 6 deaths without autopsy or toxicology, because the bodies had been cremated. Organic compounds are remarkably stable in buried bodies. Even so, detection and quantitation of morphine in exhumed bodies may become problematic after burial for 4 years or more. Morphine glucuronide is slowly converted back to free morphine in the buried corpse.
authors.affiliation: Department of Forensic Medicine, University of Dundee, Dundee DD1 4HN, Scotland, UK. d.j.pounder@dundee.ac.uk
authors.forename: Derrick J
authors.initials: DJ
authors.lastname: Pounder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000331:legislation & jurisprudence; D002048:Burial; D003644:Death Certificates; D005260:Female; D005554:Forensic Medicine / Q000331:legislation & jurisprudence*; D006197:Hair / Q000737:chemistry; D003932:Heroin / Q000032:analysis / Q000493:pharmacokinetics / Q000506:poisoning*; D006708:Homicide / Q000331:legislation & jurisprudence*; D006801:Humans; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000032:analysis / Q000493:pharmacokinetics / Q000506:poisoning; D018482:Muscle, Skeletal / Q000378:metabolism; D009294:Narcotics / Q000032:analysis / Q000493:pharmacokinetics / Q000506:poisoning*; D010820:Physicians / Q000331:legislation & jurisprudence*; D011180:Postmortem Changes; D006113:United Kingdom
chemical_list: D009294:Narcotics; D003932:Heroin; D009020:Morphine