LONDON — LONDON - Dr. Harold Shipman was always going to carry the moniker "Dr. Death," was always going to be known as the man who, to this point at least, claimed more victims than any serial killer in British history and perhaps in the history of the world.
Any chance he might have had to do good for the families of those he murdered, though, ended yesterday when he committed suicide in prison, hanging himself by bedsheets and taking to his grave any explanation for what drove a trusted physician to murder more than 200 people - one by one by one - most of them middle-age women and grandmothers.
The exact number probably will never be known, but an investigation completed in 2002 determined that Shipman killed at least 215 people, probably 260 and perhaps more than 300, over nearly a quarter-century, undetected until 1998, when he lapsed into greed and his deeds were exposed. His reasons are as mystifying as the numbers are terrifying.
He did not kill out of mercy; one victim had called him because her rheumatism was acting up, another because she wanted a flu shot, and few of the dead had been considered seriously ill. He apparently did not kill for money; only when he forged the will of his final victim did his murders become exposed, earning him the nickname "Dr. Death" in a story that dominated Britain for months.
The doctor, who was married with four children, was serving 15 life terms without possibility of parole. Britain does not have the death penalty.
Shipman never admitted killing his patients despite mountains of evidence against him. Detectives have said he was wholly without remorse. In 2000, he was convicted of 15 murders, but the investigation exposed hundreds of others. All but 44 victims were middle-aged or elderly women who lived alone in the small, working-class town of Hyde, a suburb of Manchester in Northwest England. The youngest was 49, the oldest 81.
"He betrayed their trust in a way and to an extent that I believe is unparalleled in history," said Dame Janet Smith, the High Court judge who ran the inquiry, when she presented her findings.
Shipman, whose 58th birthday would have been today, did not strike fear the way serial killers so often do. Nobody knew so many people were being killed until after he murdered his last victim. A bespectacled and respected town doctor known to all by his middle name of Fred, he killed during house calls with a deadly injection, most often containing the drug diamorphine, the medical name for heroin. He apparently acquired the drug without suspicion by writing false prescriptions or stealing it from cancer patients.
Often, he would leave his victims sitting in a living room chair for family members to discover. Other times he would report the deaths himself, and always he would persuade relatives that no autopsy was necessary. Many of the bodies were cremated, destroying any evidence against him, part of the reason he was convicted in only 15 of the deaths.
Officials said a guard making hourly rounds found Shipman about 6 a.m. hanging from a noose made from bedsheets and attached to window bars in his cell at Wakefield Prison in West Yorkshire. He was pronounced dead about two hours later.
Prison officials said Shipman was not considered a suicide threat, though he had been under suicide watch at two previous prisons.
"His behavior was not a cause for concern," the statement said.
His wife, Primrose Shipman, said during his trial and the inquiry that followed that she believed in his innocence, and yesterday she would not talk to reporters seeking comment. Short of new evidence coming forth, the families of the doctor's victims will never know why he killed so many people. News of his death brought mixed reactions from victims' families, some saying that they were glad to see him dead, others criticizing the prison for allowing him to kill himself and losing any chance that he would explain his crimes.
"I'm not sorry he has gone," Kathleen Wood, whose 83-year-old mother, Bessie Baddeley, died in 1997, told The Evening Standard. "I just wish he had been forthcoming and admitted he had done those things. It would have put a lot of people's minds at rest."
An inquiry into Shipman's death will be directed by Stephen Shaw, who will be the first person to fill the role of prisons and probations ombudsman. Shipman's attorney, Giovanni di Stefano, told reporters he was at a loss to explain the suicide because the doctor had an appeal pending and there was a chance his convictions would be overturned.
"I am absolutely astounded by this news," the attorney said. "It is extremely strange that a man who should have a slight chance should kill himself."
Shipman was exposed after he forged the will of Kathleen Grundy, the former mayor of Hyde, to make it appear that she'd left her fortune to him. She had been devoted to her grandchildren and her daughter, also named Kathleen, who challenged the will. Medical examiners exhumed the body and found traces of heroin in her remains.
Smith said after her inquiry that Shipman had an addictive personality, first shown in the 1970s when he was a practicing doctor and was convicted of writing himself prescriptions for a heroin-like drug whose side affects included euphoria. He was fined and fired from his practice but opened his own office a few years later.
"It is possible that he was addicted to killing," she said at the time.
Judge Thayne Forbes, who sentenced Shipman, said at the time: "I have little doubt each of your victims smiled and thanked you as she submitted to your fearful administrations."
Whatever Shipman's reasons, Anne Alexander, an attorney for a support group that includes nearly 200 families of the doctor's victims, said yesterday's news was taken by many as the final insult. Most of the women were enjoying their retirements, their years as grandmothers and were taken early only because they never fathomed that their own doctor would kill them.
"That's bad enough," she told the British Broadcasting Corp. "Now we have this terrible shock. I think there are a number of clients who hoped that, at some point, even if it was to be in the years to come, he would talk about why he did what he did. Now they're going to be cheated out of that."