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Acknowledgements

Many people have made this collection possible and the editors would like to
express their sincerest gratitude. We would like to thank all the contributors
for sharing their time and knowledgeable insights, and for their commitment
to this very important project. We thank Federica Giordano for her research
assistance and reliable support throughout the project and Marthe Goudsmit for
her assistance with indexing. Special thanks are due to the British Academy and
the Oxford University Faculty of Law’s Research Support Fund for funding our
seminar. The generous funding enabled fruitful and exciting exchange of ideas
at a seminar and this undoubtedly makes this book a better collection. Thanks
to Exeter College for hosting our seminar and to all the administrative staff in
the Faculty of Law who provided invaluable assistance throughout the project.
Finally, we are so grateful to all at Routledge who were instrumental in bringing
this collection to print.
Contributors

Karen Brennan is a Senior Lecturer in Law at the University of Essex.

Rachelle Chadwick is a Senior Lecturer in Sociology at the University of
Pretoria.
Sara Cohen Shabot is an Senior Lecture at the Women’s and Gender Studies
Graduate Program at the University of Haifa.
Soo Downe is a Professor at the School of Community Health and Midwifery,
University of Central Lancashire.
Lisa Forsberg is a British Academy Postdoctoral Fellow in Law and Philosophy
at the University of Oxford.
Susan Garthus-Niegel is a Psychologist and a Research Professor at the Norwe-
gian Institute of Public Health, and Head of the ‘Epidemiology and Women’s
Health’ research unit at the Dresden University of Technology.
Samantha Halliday is an Associate Professor of Law at Durham University.
Jonathan Herring is a Professor of Law at the University of Oxford and the DM
Wolfe-Clarendon Fellow at Exeter College.
Antje Horsch is a clinical psychologist and an Assistant Professor at the Insti-
tute of Higher Education and Research in Healthcare, University of Laus-
anne, and at the Woman-­Mother-Child Department, Lausanne University
Hospital.
Emily Jackson is a Professor of Law at the London School of Economics and
Political Science.
Elizabeth Kukura is a Visiting Assistant Professor of Law at Drexel University.
Camilla Pickles is a British Academy Postdoctoral Research Fellow in Law
at the University of Oxford and a Fellow at the South African Institute for
­Advanced Constitutional, Public, Human Rights and International Law at
the University of Johannesburg.
x Contributors
Elizabeth Prochaska is a Barrister, Legal Director at the Equality and Human
Rights Commission, and founder of Birthrights.
Jessica Rucell is a Postdoctoral Research Fellow in Sociology at the University
of Cape Town.
Nancy Stone is a Postdoctoral Researcher in maternal healthcare in Germany.
Introduction
Camilla Pickles and Jonathan Herring

This book explores the themes of vulnerability, violence, and control around
childbirth. This might seem incongruous to some readers. Even if one does not
accept the glorified accounts of childbirth as involving joy and wonder, but rather
agony and distress, the terms ‘violence’ and ‘control’ might seem an exaggera-
tion. Yet, in 2014 the World Health Organization (WHO) released a statement
recognising that there is a growing body of research that ‘paints a disturbing
picture’ of women’s childbirth experiences:1

Many women across the globe experience disrespectful, abusive or neglect-

ful treatment during childbirth in facilities. … While disrespectful and
abusive treatment of women may occur throughout pregnancy, childbirth
and the postpartum period, women are particularly vulnerable during child-
birth. Such practices may have direct adverse consequences for both the
mother and infant.2

Research reveals that women face discrimination within facilities, and they are
sometimes sexually, physically, verbally, and/or emotionally abused by health-
care professionals.3 Communication between women and healthcare profession-
als is sometimes inadequate and medical professionals give insufficient attention
to women’s concerns. This can lead to professionals failing to provide supportive
care in general, objectifying women, and treating them as passive participants
in their births.4 There is evidence that health professionals fail to meet profes-
sional standards by neglecting to obtain women’s informed consent and by per-
forming procedures without due regard for women’s right to privacy.5 At times

1 World Health Organization, ‘The Prevention and Elimination of Disrespect and Abuse During
­Facility-based Childbirth’ (2014) <https://apps.who.int/iris/bitstream/­handle/10665/134588/
WHO_RHR_14.23_eng.pdf?sequence=1> accessed 11 February 2019.
2 Ibid.
3 Meghan A Bohren and others, ‘The Mistreatment of Women during Childbirth in Health Facil-
ities Globally: A Mixed-Methods Systematic Review’ (2015) 12(6) PLOS Med e1001847.
4 Ibid.
5 Ibid.
2 Camilla Pickles and Jonathan Herring
healthcare professionals perform painful procedures without appropriate care
and compassion, and women are denied access to pain relief medication. Some
women have reported being neglected or completely abandoned during child-
birth.6 Further, facility and system deficiencies create birthing environments
that compromise respectful and dignified care. Toxic facility cultures, caused by
staff shortage, constraints on necessary supplies, problematic facility policies, are
not women-centred and objectify women.7 Women and their babies may survive
childbirth but reports reveal that women’s experience of facility-based care has
left them traumatised and these circumstances may have dire consequences for
mental well-being and the ability to bond with their babies.
In many ways these findings are surprising. Around the world there is greater
awareness of and acceptance of women’s rights.8 There is a growing awareness of
the problem of violence against women and a determination to address it. The
quality of training for medical professionals is improving, including more im-
portance being given to ethics. It is not hard to find fine-sounding professional
and government documents setting out support for respecting women’s choices
in relation to childbirth.9 Yet, despite all of this, it is clear that on the ground all
too often women are abused during their labour.
Of course, these issues are not new. Abuse during facility-based childbirth has
been occurring for decades, arguably for as long as childbirth became a medical
event.10 However, Hodges explains:

[W]e are in about the same position we were in the 1950s and 1960s regarding
domestic abuse and violence against women. Abuse and violence were hap-
pening, but we did not have a name for it. If your husband or boyfriend was
verbally or physically abusive, well, that was just the way he was. It probably
was your fault, and in any case, there was not much you could do about it.11

The WHO’s statement (quoted above) makes it very clear that relevant stake-
holders must do more to establish mechanisms to prevent and eliminate abuse
during childbirth.

6 Ibid.
7 Ibid.
8 United Nations High Commissioner for Human Rights, ‘Women’s Human Rights and Gender
Equality’ (United Nations, 2019) <www.ohchr.org/en/issues/women/wrgs/pages/wrgsindex.
aspx> accessed 11 February 2019.
9 Department of Health, ‘Maternity Matters: Choice, Access and Continuity of Care in a Safe
Service’ (Department of Health 2007); The Royal College of Obstetricians and Gynaecologists,
‘Providing Quality Care for Women: Obstetrics and Gynaecology Workforce’ (The Royal Col-
lege of Obstetricians and Gynaecologists 2016).
10 For instance, see Henci Goer, ‘Cruelty in Maternity Wards: Fifty Years Later’ (2010) 19 J Perinat
Educ 33; Marsden Wagner, ‘Confessions of a Dissident’ in Robbie E Davis-Floyd and Carolyn
F Sargent (eds), Childbirth and Authoritative Knowledge (University of California Press 1997)
366.
11 Susan Hodges, ‘Abuse in Hospital-Based Birth Settings?’ (2009) 18 J Perinat Educ 8.
 Introduction 3
The theme of abuse and violence during childbirth has connected research-
ers, activists, organisations, and other stakeholders across the globe from di-
verse disciplines. However, most of the literature available on the subject of
abuse and violence during childbirth originates from disciplines other than
law. In fact, debates in law are glaringly absent,12 short of a small selection
of contributions considering international human rights law and the differ-
ent positions in South Africa, the United States, and Kenya.13 We hope that
this book can provide a starting point for legal debates over responses to this
issue. This collection arose out of the need to initiate further legal debates
on abuse during childbirth through the lens of violence, vulnerability, and
control. Since this edited collection is one of the first contributions to take on
this role, we considered it important to adopt an interdisciplinary approach
by including contributions from other disciplines that are intended to provide
much-needed context. These contextualising chapters unpack and explore the
different dimensions and complexities of vulnerability, violence, and control
during childbirth.
We certainly have come a long way in developing and understanding
­facility-based abuse and violence. We have a better grasp of how it manifests
and why. We highlight here three aspects in particular. First, it is now recog-
nised that abuse and violence during childbirth occur at an individual and a
structural level.14 That is, we are not dealing with only a few bad apples but a
system that is structured in a way that oppresses women because it enables abuse
and violence. The individual and structural systems are interrelated. Because the
structures permit and authorise abusive practices against women, these are prac-
tised by medical professionals; and this practice is seen to normalise and justify

12 This is the case for English speaking countries. Several Latin American countries have enacted
laws that recognise obstetric violence as a form of violence against women. Some recognise it
a crime while others create a form of statutory right of action. See Grupo de Información en
Reproducción Elegida, ‘Obstetric Violence: A Human Rights Approach’ (2015) <https://gire.
org.mx/en/wp-content/uploads/sites/2/2015/11/ObstetricViolenceReport.pdf> accessed 11
February 2018.
13 Beatrice Odallo, Evelyne Opondo and Martin Onyango, ‘Litigating to Ensure Access to Quality
Maternal Health Care for Women and Girls in Kenya’ (2018) 26(53) Reprod Health Matters
123; Elizabeth Kukura, ‘Obstetric Violence’ (2018) 106 Georget Law J 721; Maria T R Borger,
‘A Violent Birth: Reframing Coerced Procedures during Childbirth as Obstetric Violence’
(2018) 67 Duke Law J 827; Farah Diaz-Tello, ‘Invisible Wounds: Obstetric Violence in the
United States’ (2016) 24(47) Reprod Health Matters 56; Rajat Khosla and others, ‘International
Human Rights and the Mistreatment of Women during Childbirth’ (2016) 18 Health Hum
Rights 131; Camilla Pickles, ‘Eliminating Abusive “Care”: A Criminal Law Response to Obstet-
ric Violence in South Africa’ (2015) 54(1) SACQ 5. Carlos Vacaflor provides a detailed account
of the Argentinian position in Carlos Herrera Vacaflor, ‘Obstetric Violence: A New Framework
for Identifying Challenges to Maternal Healthcare in Argentina’ (2016) 24(47) Reprod Health
Matters 65.
14 For instance, see Miltenburg Solnes and others, ‘Disrespect and Abuse in Maternity Care: Indi-
vidual Consequences of Structural Violence’ (2018) 26(53) Reprod Health Matters 88; Michelle
Sadler and others, ‘Moving beyond Disrespect and Abuse: Addressing the Structural Dimensions
of Obstetric Violence’ (2016) 24(47) Reprod Health Matters 47.
4 Camilla Pickles and Jonathan Herring
the structures in place. For example, the structures may perpetuate a view that
women are not competent to make decisions during labour and so professionals
do not seek to involve women in making decisions, a practice which silences
women or against which women rebel, which reinforces the view that women
are not competent.
Second, violence and abuse during childbirth is a gendered phenomenon
shaped by hierarchical relationships of power and broader social inequalities.15
Women’s treatment during childbirth reflects their position in society because a
health system ‘wears the inequalities of the society in which it functions’.16
Third, abuse during childbirth reflects a particular model of doctor-female
patients’ relations. It is not just in childbirth, but in a range of medical and
quasi-medical interventions that we see medical power exercised over women’s
bodies.
So, the issue of abuse during childbirth should be recognised as reflecting
and being reinforced by wider social and institutional forces. It means also that
we need to adopt a multipronged approach to tackling this issue. Adequate re-
sources are essential but so too is the need to reshape embedded norms through
improved training of professionals and effective accountability.17 However, the
broader issue requires responses at a wider social level. We must be committed to
developing and providing women-centred, evidence-based care.18
As the chapters in this book demonstrate, the conceptualisations of violence,
vulnerability, and control are contested. Indeed, not all contributors are equally
comfortable with the use of these three words in this context. However, we
deliberately did not confine contributors to a particular conception of the con-
cepts of violence, vulnerability, or control, for two reasons. First, this is an
interdisciplinary collection and conceptualisations of these terms will naturally
vary according to discipline. Second, we consider ‘conceptual freedom’ neces-
sary in this context because we are venturing into unchartered terrain. Most of
the themes considered in this collection have not been aired before a court and
this freedom brings with it innovative arguments and contributions, and we
leave it to each contributor to define for themselves these terms according to the

15 Lydia Zacher Dixon, ‘Obstetrics in a Time of Violence: Mexican Midwives Critique Routine
Hospital Practices’ (2015) 29 Med Anthropol Q 437, 440–41.
16 Joanna N Erdmann, ‘Bioethics, Human Rights, and Childbirth’ (2015) 17 Health Hum Rights
43, 48. Also see Stephanie Rose Montesanti and Wilfred E Thurston, ‘Mapping the Role of
Structural and Interpersonal Violence in the Lives of Women: Implications for Public Health
Interventions and Policy’ (2015) 15 BMC Womens Health 100, 103.
17 Diana Bowser and Kathleen Hill, ‘Exploring Evidence for Disrespect and Abuse in ­Facility-Based
Birth: Report of a Landscape Analysis’ (USAID-TR Action Project and Harvard School of
Public Health, 20 September 2010) <www.ghdonline.org/uploads/Respectful_Care_at_
Birth_9-20-101_Final1.pdf> accessed 18 October 2018.
18 Suellen Miller and others, ‘Beyond too Little, too Late and too Much, too Soon: A Pathway
towards Evidence-Based, Respectful Maternity Care Worldwide’ (2016) 388.10056 The Lancet
2176.
 Introduction 5
direction of their contribution. What we will do here is very briefly explore the
three words used and highlight some of the tensions around them, particularly
as applied to childbirth.

Violence
Violence is typically understood to involve an intentional act of excessive physi-
cal force used to cause suffering or injury.19 However, this conceptualisation is
increasingly recognised as being far too narrow for three main reasons.20 First,
there is widespread appreciation of the importance of mental and emotional
well-being. In some cases, the emotional or psychological impact of being hit
will be far more significant than the physical pain. Traditionally, the criminal
law supports a conception of violence that focuses on attacks to the body (in the
English context an assault occasioning actual bodily harm, inflicting grievous
bodily harm, etc.). However, we are more recently seeing offences of stalking,
coercive control, online abuse and harassment, recognising the importance of
relational or psychological harms.21 Second, and linked to the first point, there is
a challenge to the division between mind and body. The argument that the body
and mind can be separated (known as Cartesian Dualism in the philosophical
literature) now has few supporters. Biology is clear that such a separation cannot
be maintained. This indicates that restricting violence to attacks on the body and
not including attacks on the emotional well-being can no longer be supported.
Third, there is growing acknowledgement that violence need not be intentional,
as traditionally understood. Harassment, for example, may be understood by the
perpetrator as an expression of love. Indeed, it is common for men to fail to ap-
preciate (or claim to fail to appreciate) that their wrongful and harmful conduct
against women is such.
In the case of ‘obstetric violence’ we see the above listed themes reflected in
the volume. Obstetric violence is usually defined as the appropriation of women’s
bodies and reproductive processes by health personnel which brings with it a loss
of autonomy and the ability to decide freely about their bodies and sexuality, and
which has a negative impact on the quality of women’s lives.22 This term is used
to describe the wide range of abuses during childbirth, including unintentional
and neglectful care and structural inadequacies. Clearly these kinds of harms do

19 Vittorio Bufacchi, ‘Two Concepts of Violence’ (2005) 3 Polit Stud Rev 197.
20 For instance, see Vittorio Bufacchi, Violence and Social Justice (Palgrave Macmillan 2007); Wil-
lem de Haan, ‘Violence as an Essentially Contested Concept’ in Sophie Body-Gendrot and Pieter
Spierenburg (eds), Violence in Europe: Historical and Contemporary Perspectives (Springer 2007).
Johan Galtung, ‘Violence, Peace, and Peace Research’ (1969) 6 J Peace Res 167.
21 For a more detailed discussion of this see Jonathan Herring, Law and the Relational Self (CUP
2019) ch 6.
22 Rogelio Pérez D’Gregorio, ‘Obstetric Violence: A New Legal Term Introduced in Venezuela’
(2010) 111 Int J Gynaecol Obstet 201.
6 Camilla Pickles and Jonathan Herring
not fit within the traditional image of a typical act of violence being one person
hitting another. Yet they can be understood as violence in the sense outlined
above as an attack on the psychological and emotional integrity of the person.
In this volume several chapters explore how different harms inflicted in child-
birth can be understood as violence. In fact, the contributions in this collec-
tion go beyond the usual definition of obstetric violence and venture into more
challenging areas of ‘violence’. For instance, Chadwick offers an intersectional
analysis of marginalised South African girls’ experiences of ‘silencing’ during
childbirth and she explores how modes of silencing amount to obstetric violence.
Similarly, Cohen Shabot extends the scope of obstetric violence to instances of
‘gaslighting’, women during labour, and thereafter by loving family and friends.
She draws from her personal experience of care during her miscarriage to theo-
rise the experience of gaslighting as a form of obstetric violence. Pickles consid-
ers whether obstetric violence can occur in the case of an omission, and Herring
innovatively teases out the unique harms associated with obstetric violence
through an analogy with domestic violence.
Rucell’s and Downe and Stone’s contributions remind us to broaden our focus
to include considerations of care providers and the oppressive contexts in which
some healthcare professionals are expected to work. Rucell, for example, shifts
our focus to the structural dimensions of obstetric violence and pinpoints im-
portant institutional failings, particularly in the context of accountability mech-
anisms that foster violence more generally and that maintain an environment
that allows violence to persist.
These chapters are all a ‘first’ within the obstetric violence literature land-
scape; they directly challenge conventional conceptualisations of violence and
work to problematise the conventional conception of violence. Nevertheless,
it must be admitted that the traditional understanding of violence still holds
sway, particularly, among the public. The WHO’s researchers are expressly set
on avoiding the use of ‘violence’23 in the context of childbirth and that is why
it is possible to identify concerns about the terminology of violence in some
chapters. For instance, Downe and Stone raise important issues with the current
use of ‘obstetric violence’. They explain that some midwives consider themselves
excluded from the ‘obstetric’ scope and they are concerned by the fact that it is
shaped by essentialist claims that this type of violence against women is rooted
in male power, rendering birthing women and midwives subservient and subject
to abuse by male obstetricians.
Despite there being a measure of pushback or resistance to expanding how
we are to understand violence during childbirth, Horsch and Garthus-Niegel’s
exploration of post-traumatic stress disorder following childbirth highlights the
severity of the consequences of inappropriate ‘care’ during childbirth. This con-
tribution makes it clear that the traditional understanding of violence needs

23 Bohren and others (n 3) 210; J P Vogel and others, ‘Promoting Respect and Preventing Mistreat-
ment during Childbirth’ (2016) 123 BJOG 671.
 Introduction 7
to be under constant consideration and it may also support understanding of
violence in the broad ways presented in this collection.

Vulnerability
At one level it is an obvious point that a woman in childbirth is in a vulnerable
state. Her movements may be limited; she may be attached to medical technol-
ogy; she may be in considerable pain; and she may face some medical risks that
are associated with childbirth. All of these put her in a position that she is at risk
of harm and with limited authority to protect herself. However, a vulnerability
analysis of the issue is more complex than this.
There is a powerful strand of feminist critiques of the use of vulnerability in
political and popular discourse.24 This strand claims that groups of people are
labelled as vulnerable and this is used to subject them to paternalistic interven-
tions designed to protect them from hurting themselves, being taken advantage
of, or to restore them to a non-vulnerable state. This is clearly a concern in
this context. Halliday tackles this very issue in her contribution on court-or-
dered obstetric interventions on women living with serious mental illness. She
reveals how the clinical construct of ‘insight’ is used to assess capacity of women
living with serious mental illnesses, particularly when they refuse medical ad-
vice during obstetric care. Their capacity to make decisions about their births
is undermined if women are perceived to ‘lack insight’ and choice in maternity
care becomes illusionary for them. The more the powerlessness of the woman is
emphasised, the greater the risk that she is in ‘need of protection’ and interfer-
ences in her autonomy can be justified. This in part may explain the ‘silencing of
women’ and ‘epistemic violence’ which is discussed in Chapter 2 by Chadwick.
It is also reflected in the infantilisation explored by Cohen Shabot in Chapter 1.
The concept of vulnerability is drawn on by another strand of feminist critique,
which is universal vulnerability. This approach is most prominently ­favoured by
Fineman.25 She claims that everyone is in their nature vulnerable:

The vulnerability approach recognizes that individuals are anchored at each

end of their lives by dependency and the absence of capacity. Of course,
between these ends, loss of capacity and dependence may also occur, tempo-
rarily for many and permanently for some as a result of disability or illness.
Constant and variable throughout life, individual vulnerability encompasses
not only damage that has been done in the past and speculative harms of
the distant future, but also the possibility of immediate harm. We are beings
who live with the ever-present possibility that our needs and circumstances
will change. On an individual level, the concept of vulnerability (unlike

24 Vanessa Munro and Jane Scoular, ‘Abusing Vulnerability? Contemporary Law and Policy
­R esponses to Sex Work in the UK’ (2012) 20 Fem Leg Stud 189.
25 Martha Albertson Fineman, ‘The Vulnerable Subject: Anchoring Equality in the Human
­C ondition’ (2008) 20 Yale J Law Fem 177.
8 Camilla Pickles and Jonathan Herring
that of liberal autonomy) captures this present potential for each of us to
become dependent based upon our persistent susceptibility to misfortune
and catastrophe.26

This approach recognises the universal nature of everyone’s vulnerability. It is

therefore sceptical of attempts to identify those who are particularly vulnerable
and in need of protection and elevation from vulnerability.
This universal vulnerability approach might seem to be rather unhelpful to
the issue of childbirth as it appears to argue against giving special protections
to women in labour. Even though we are in our nature all vulnerable, society
distributes resources to give different degrees of resilience to different groups.
It is true that at different times and in different circumstances we may be more
overtly in use of societal resources but that should not disguise the fact that we
are in need of communal and relational support for all our lives. We may be dif-
ferently positioned within a web of economic and social relationships, and this
will impact on our experience of vulnerability and the resources at our disposal.27
The significance of this observation is that there is nothing about being in
labour which in and of itself renders a woman more vulnerable than everyone
else; rather it is the social power structures that render a woman in labour open
to abuse. The chapters in this contribution certainly support this understanding.
There are two reasons why this way of explaining the vulnerability is helpful.
First, it makes it clear that the source of the particular vulnerability is not the
woman, but the structure of medical and societal force acting on her during
childbirth. Part of this theme is explored in Downe and Stone’s chapter. They
reveal that institutional management of maternity care prevents midwives from
‘being with women’ and instead results in the ‘othering’ of women and render-
ing them enemies of the system, thus creating fertile ground for abuse during
childbirth. Second, it means that the legal protections should not be designed to
remove the vulnerability by rendering the woman fully autonomous and putting
her in sole charge of the situation as that would be impossible and undesirable.
The message of universal vulnerability is that we need to cooperate together
in respectful ways to find solutions to the challenges we face as we lack the re-
sources alone to respond to them.28

Control
The concept of control is a complex one in relation to the birth process. For
one thing it is in the nature of birth that the body cannot be controlled and
contained. The process is about moving through bodies. It is a process that
challenges the image of the body as a contained, static entity. The simple call for
a woman to be in control of her childbirth is unrealistic in that sense.

26 Ibid.
27 Jonathan Herring, Vulnerability, Childhood and the Law (Springer 2018) 34.
28 Jonathan Herring, Vulnerable Adults and the Law (OUP 2016).
 Introduction 9
However, the experience of birth, as outlined above, is all too often an experi-
ence of other people taking control of a woman’s body. That she becomes a baby
producing machine for medical professionals to manipulate, tear, cut, and force
at their bidding. Of course, this is typically done ‘in order to produce a healthy
baby’ and is justified on the basis that this is what the woman would want.
Halliday notes in this collection that ‘women are supposed to remain in con-
trol, but what is actually meant is compliant’. Herring considers the concept of
coercive control and uses it to explore the nature of obstetric violence as misuse
of a trustful relationship to abuse the woman. Forsberg’s chapter highlights how
denying women access to information because it is too complex, too distressing,
or cannot be processed undermines women’s autonomy.
As these points indicate, the issue of power and who controls the process
is complex. Too often the medical professionals take control of the woman’s
body during childbirth. However, women, through birthing, are in a position
of power whether ‘others’ accept this or not. They bring life into the world and
that is an incredibly powerful physiological and psychological process. Yet this is
not power as it is commonly understood in patriarchy. First, because this power
challenges patriarchal depictions of femininity.29 Second, because it is not power
in the sense of exercising control or domination over someone, as the concept
is commonly understood in patriarchy. It is a generative power creating new
life and new relationships. Similarly, in relation to control, birth is at one level
a brute uncontrollable process. Yet it is one that only the woman concerned
should be making decisions over. Again, not in the patriarchal sense of control
as exercising domination over or subduing something, but in the sense of having
the moral and legal authority to make decisions about the physiological process.

Legal responses to obstetric violence

One of the aims of this collection is to explore legal tools that could be used
to provide an effective response to obstetric violence. One option is the use of
human rights. Khosla and others argue that childbirth has not been adequately
addressed or analysed under international human rights law.30 This, they argue,
is an essential first step because ‘[h]uman rights standards are an important ac-
countability tool for recognizing and protecting the human rights of women
during childbirth in facilities, and for supporting health system reform to pre-
vent mistreatment in the future’.31 Prochaska offers a practitioner’s perceptive on
this issue in the collection. She traces important international case law relevant
to childbirth and reflects on their significance in the context of violence, vulner-
ability, and control during childbirth. She explains that human rights law offers
women in the United Kingdom an opportunity to challenge hospital decisions

29 Sara Cohen Shabot explores this issue in ‘Making Loud Bodies “Feminine”: A Feminist-­
Phenomenological Analysis of Obstetric Violence’ (2016) 39 Human Studies 231.
30 Khosla and others (n 13).
31 Ibid 138.
10 Camilla Pickles and Jonathan Herring
through litigation but she urges that the full might of human rights law lies in
its potential to shape hospital culture. This is best achieved through the injection
of human rights values within the maternity care context.
A second option is tort law. Borger and Diaz Tello consider this in the US con-
text.32 They emphasise that individual tort litigation is ineffective in the context
of abuse, violence, or coercion. Dias Tello reveals that this avenue remains out
of reach for many women and tort law tends to frame the issue as an individual
problem rather than a structural one and it therefore hides the gendered dimen-
sions of this phenomenon.33 Kukura has earlier argued that

obstetric violence will continue as long as doctors perceive that they risk
liability by not intervening and thus force treatment on unwilling women
out of fear of malpractice exposure. Courts must recognize and enforce
informed treatment refusals as a necessary part of robust and meaningful
informed consent.34

She emphasises that professional standard setting is an important avenue that

needs further attention.35 In this collection, Forsberg moves beyond these de-
bates. She explores violations of women’s autonomy during childbirth in relation
to being deprived of information about treatment options and their risks. She
demonstrates that depriving women of information or of the opportunity to
decide amounts to a harm in and of itself, and negligence laws are ill-equipped
to offer redress in this context.
A third option is the use of fiduciary law. In her contribution to this collection,
Kukura explores the use of this doctrine in the context of US jurisprudence.
Its attraction lies in the highlighting of the importance of trust in the medical
professional-patient relationship and the strict liability approach. However, the
chapter shows that the American courts have been reluctant to develop the con-
cept of fiduciary obligations within a medical context. Despite this, her chapter
offers a glimmer of hope to those seeking to employ the law in innovative ways.
A fourth option is the use of targeted legal interventions. Borger makes the
case that obstetric violence laws are the most effective way to address current
shortcomings; she recommends importing to the United States the obstetric
violence law framework adopted in Latin America and thereby develop a crim-
inal and civil law regime.36 Pickles emphasises this point in her chapter on
­evidence-based guidelines and obstetric violence by omission. She argues that,
in fact, governments are obligated by international human rights laws to enact
legislation to tackle this very particular manifestation of gender-based violence.

32 Borger (n 13); Diaz-Tello (n 13).

33 Diaz-Tello (n 13).
34 Kukura (n 13) 800.
35 Ibid.
36 Borger (n 13).
 Introduction 11
A fifth option is the use of criminal law.37 Brennan’s chapter explores this
in detail. She advocates for a specific offence of obstetric violence to ensure
the wrong done to the victim is fully captured. She highlights how traditional
criminal offences do not capture the severity of the issue. Nevertheless, as she
acknowledges, there are limits to the role of the criminal law. It will be rare
where sufficient mens rea can be proved and a jury may well be reluctant to
convict medical professionals if they were seen as ‘doing their best in a difficult
situation’.

Concluding reflections
Abuse, violence, and control during childbirth and women’s vulnerability dur-
ing childbirth remain ill-defined and under-theorised from a legal perspective
but this collection offers a promising start. It is necessary to see ourselves at the
start because there are many themes not covered in this collection.
In the main, the more legally focused chapters in this collection have fo-
cused on the visible forms of violence and abuse during childbirth, rendering
structural violence free from legal analysis. This is a particularly pressing issue
because individual manifestations of violence are a consequence of structural
inequalities.38 It is not entirely clear what role the courts can play in the broader
context of structural violence. The Kenyan experience in relation to strategic lit-
igation brings home this point. The Centre for Reproductive Rights represented
­Majani; she was abused and neglected during childbirth in a Kenyan facility
and the High Court of Bungoma ruled in her favour.39 Nevertheless, Odallo,
Opondo, and Onyango highlight several failures. They argue that the court
failed to make an order that would facilitate much needed structural changes
such as mandating human rights training for nurses, mandating the government
to actively share information about complaints procedures for aggrieved patients,
and failing to mandate the government to develop and implement policy guide-
lines on healthcare.40 While this judgment reflects a promising development
it also lays bare the reality that courts can play only a limited role in the fight
against abuse and violence during childbirth. This limitation deserves deeper
analysis and interrogation.
Further, we left open the question of whether medical negligence itself can
constitute a manifestation of obstetric violence. Research reveals that obstetric
violence is used to describe instances of medical negligence41 and medical neg-
ligence is recognised as a manifestation of obstetric violence in some Mexican

37 Pickles (n 13).
38 Johan Galtung, ‘Cultural Violence’ (1990) 27 J Peace Res 291.
39 Odallo, Opondo, and Onyango (n 13).
40 Ibid 127.
41 For instance, see Simone Grilo Diniz and others, ‘Abuse and Disrespect in Childbirth Care as a
Public Health Issue in Brazil: Origins, Definitions, Impacts on Maternal Health, and Proposals
for its Prevention’ (2015) 25 J Hum Growth Dev 377.
12 Camilla Pickles and Jonathan Herring
states’ laws.42 However, it is not clear whether contemporary theories of violence
are broad enough to include negligent conduct and what the law should do if
negligence comes to be accepted as a form of violence.
This book seeks to start a discussion on where the violence in obstetric vio-
lence starts and where it ends. It has opened up debates about the nature and
definition of obstetric violence. Until we are able to capture its multifaceted na-
ture we will not be able to identify its core wrong(s) or produce an effective legal
response to the issues raised. Our hope is that this volume and work flowing
from it will generate a more effective legal response to violence in childbirth and
more respectful treatment of women in labour.

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42 See Grupo de Información en Reproducción Elegida (n 12).

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1 ‘Amigas, sisters: we’re being
gaslighted’
Obstetric violence and epistemic
injustice
Sara Cohen Shabot

Introduction
In ‘Making Loud Bodies “Feminine”’, I focused on how women live with and
experience obstetric violence and why it is frequently described not only in terms
of violence in general but specifically in terms of gender violence: as violence
directed at women because they are women.1 For this purpose, I used feminist
phenomenology to explain and account for the feelings that many victims of this
violence experience and report, including those of embodied oppression, of the
diminishment of self, and of physical and emotional infantilisation.
In this chapter, I examine such feelings of diminishment of self and infan-
tilisation through the epistemic aspects of the phenomenon of obstetric vio-
lence, mainly by observing it from the perspective of recent theories on epistemic
injustice and specifically through the concept of ‘gaslighting’. I argue that a
central part of obstetric violence involves labouring women being disbelieved,
distrusted, and (unjustifiably) questioned about their violent labouring experi-
ences and, more pressingly, even being made to doubt their own experiences of
violence and to feel deprived of epistemic authority altogether. I show that the
distrust shown towards labouring women operates both during the experience
of labour and afterwards, when they attempt to tell others about their (violent)
labouring experiences and to obtain epistemic recognition from them. I empha-
sise that this experience of deep distrust needs to be understood not simply as a
response to the phenomenon of obstetric violence but must be recognised as a
core part of the phenomenon itself.
The idea of ‘gaslighting’ has recently been used to account for specific cases
of epistemic injustice, where the victim is intentionally or unintentionally made
to doubt and distrust her own experience and testimony, since her interlocutor
(often her supposedly ally) heavily questions their truth. Thus, in this chapter,
I argue that to be a victim of obstetric violence means (also) to be continuously
gaslighted: first by the medical staff involved and then by those who listen to the
victim’s story.

1 Sara Cohen Shabot, ‘Making Loud Bodies “Feminine”: A Feminist-Phenomenological Analysis

of Obstetric Violence’ (2016) 39 Human Studies 231, emphasis added.
Another random document with
no related content on Scribd:
 A moment later she came in carrying a small Pomeranian. She
was paler than I had ever seen her, and there was unmistakable
fright in her eyes. When she greeted us it was without her habitual
gaiety.
“This thing is getting rather ghastly, isn’t it?” she remarked when
she had taken a seat.
“It is indeed dreadful,” returned Markham soberly. “You have our
very deepest sympathy. . . .”
“Oh, thanks awf’ly.” She accepted the cigarette Vance offered her.
“But I’m beginning to wonder how long I’ll be here to receive
condolences.” She spoke with forced lightness, but a strained quality
in her voice told of her suppressed emotion.
Markham regarded her sympathetically.
“I do not think it would be a bad idea if you went away for a while
—to some friend’s house, let us say—preferably out of the city.”
“Oh, no.” She tossed her head with defiance. “I sha’n’t run away.
If there’s any one really bent on killing me, he’ll manage it somehow,
wherever I am. Anyway, I’d have to come back sooner or later. I
couldn’t board with out-of-town friends indefinitely—could I?” She
looked at Markham with a kind of anxious despair. “You haven’t any
idea, I suppose, who it is that’s obsessed with the idea of
exterminating us Greenes?”
Markham was reluctant to admit to her the utter hopelessness of
the official outlook; and she turned appealingly to Vance.
“You needn’t treat me like a child,” she said spiritedly. “You, at
least, Mr. Vance, can tell me if there is any one under suspicion.”
“No, dash it all, Miss Greene!—there isn’t,” he answered
promptly. “It’s an amazin’ confession to have to make; but it’s true.
That’s why, I think, Mr. Markham suggested that you go away for a
while.”
“It’s very thoughtful of him and all that,” she returned. “But I think
I’ll stay and see it through.”
“You’re a very brave girl,” said Markham, with troubled
admiration. “And I assure you everything humanly possible will be
done to safeguard you.”
“Well, so much for that.” She tossed her cigarette into a receiver,
and began abstractedly to pet the dog in her lap. “And now, I
suppose, you want to know if I heard the shot. Well, I didn’t. So you
may continue the inquisition from that point.”
“You were in your room, though, at the time of your brother’s
death?”
“I was in my room all morning,” she said. “My first appearance
beyond the threshold was when Sproot brought the sad tidings of
Rex’s passing. But Doctor Von shooed me back again; and there I’ve
remained until now. Model behavior, don’t you think, for a member of
this new and wicked generation?”
“What time did Doctor Von Blon come to your room?” asked
Vance.
Sibella gave him a faint whimsical smile.
“I’m so glad it was you who asked that question. I’m sure Mr.
Markham would have used a disapproving tone—though it’s quite au
fait to receive one’s doctor in one’s boudoir.—Let me see. I’m sure
you asked Doctor Von the same question, so I must be careful. . . . A
little before eleven, I should say.”
“The doc’s exact words,” chimed in Heath suspiciously.
Sibella turned a look of amused surprise upon him.
“Isn’t that wonderful! But then, I’ve always been told that honesty
is the best policy.”
“And did Doctor Von Blon remain in your room until called by
Sproot?” pursued Vance.
“Oh, yes. He was smoking his pipe. Mother detests pipes, and he
often sneaks into my room to enjoy a quiet smoke.”
“And what were you doing during the doctor’s visit?”
“I was bathing this ferocious animal.” She held up the
Pomeranian for Vance’s inspection. “Doesn’t he look nice?”
“In the bathroom?”
“Naturally. I’d hardly bathe him in the poudrière.”
“And was the bathroom door closed?”
“As to that I couldn’t say. But it’s quite likely. Doctor Von is like a
member of the family, and I’m terribly rude to him sometimes.”
Vance got up.
“Thank you very much, Miss Greene. We’re sorry we had to
trouble you. Do you mind remaining in your room for a while?”
 “Mind? On the contrary. It’s about the only place I feel safe.” She
walked to the archway. “If you do find out anything you’ll let me know
—won’t you? There’s no use pretending any longer. I’m dreadfully
scared.” Then, as if ashamed of her admission, she went quickly
down the hall.
Just then Sproot admitted the two finger-print experts—Dubois
and Bellamy—and the official photographer. Heath joined them in the
hall and took them up-stairs, returning immediately.
“And now what, sir?”
Markham seemed lost in gloomy speculation, and it was Vance
who answered the Sergeant’s query.
“I rather think,” he said, “that another verbal bout with the pious
Hemming and the taciturn Frau Mannheim might dispose of a loose
end or two.”
Hemming was sent for. She came in laboring under intense
excitement. Her eyes fairly glittered with the triumph of the
prophetess whose auguries have come to pass. But she had no
information whatever to impart. She had spent most of the forenoon
in the laundry, and had been unaware of the tragedy until Sproot had
mentioned it to her shortly before our arrival. She was voluble,
however, on the subject of divine punishment, and it was with
difficulty that Vance stemmed her oracular stream of words.
Nor could the cook throw any light on Rex’s murder. She had
been in the kitchen, she said, the entire morning except for the hour
she had gone marketing. She had not heard the shot and, like
Hemming, knew of the tragedy only through Sproot. A marked
change, however, had come over the woman. When she had
entered the drawing-room fright and resentment animated her
usually stolid features, and as she sat before us her fingers worked
nervously in her lap.
Vance watched her critically during the interview. At the end he
asked suddenly:
“Miss Ada has been with you in the kitchen this past half-hour?”
At the mention of Ada’s name her fear was perceptibly
intensified. She drew a deep breath.
“Yes, little Ada has been with me. And thank the good God she
was away this morning when Mr. Rex was killed, or it might have
been her and not Mr. Rex. They tried once to shoot her, and maybe
they’ll try again. She oughtn’t to be allowed to stay in this house.”
“I think it only fair to tell you, Frau Mannheim,” said Vance, “that
some one will be watching closely over Miss Ada from now on.”
The woman looked at him gratefully.
“Why should any one want to harm little Ada?” she asked, in an
anguished tone. “I also shall watch over her.”
When she had left us Vance said:
“Something tells me, Markham, that Ada could have no better
protector in this house than that motherly German.—And yet,” he
added, “there’ll be no end of this grim carnage until we have the
murderer safely gyved.” His face darkened: his mouth was as cruel
as Pietro de’ Medici’s. “This hellish business isn’t ended. The final
picture is only just emerging. And it’s damnable—worse than any of
the horrors of Rops or Doré.”
Markham nodded with dismal depression.
“Yes, there appears to be an inevitability about these tragedies
that’s beyond mere human power to combat.” He got up wearily and
addressed himself to Heath. “There’s nothing more I can do here at
present, Sergeant. Carry on, and phone me at the office before five.”
We were about to take our departure when Captain Jerym
arrived. He was a quiet, heavy-set man, with a gray, scraggly
moustache and small, deep-set eyes. One might easily have
mistaken him for a shrewd, efficient merchant. After a brief hand-
shaking ceremony Heath piloted him up-stairs.
Vance had already donned his ulster, but now he removed it.
“I think I’ll tarry a bit and hear what the Captain has to say
regarding those footprints. Y’ know, Markham, I’ve been evolving a
rather fantastic theory about ’em; and I want to test it.”
Markham looked at him a moment with questioning curiosity.
Then he glanced at his watch.
“I’ll wait with you,” he said.
Ten minutes later Doctor Doremus came down, and paused long
enough on his way out to tell us that Rex had been shot with a .32
revolver held at a distance of about a foot from the forehead, the
bullet having entered directly from the front and embedded itself, in
all probability, in the midbrain.
 A quarter of an hour after Doremus had gone Heath re-entered
the drawing-room. He expressed uneasy surprise at seeing us still
there.
“Mr. Vance wanted to hear Jerym’s report,” Markham explained.
“The Captain’ll be through any minute now.” The Sergeant sank
into a chair. “He’s checking Snitkin’s measurements. He couldn’t
make much of the tracks on the carpet, though.”
“And finger-prints?” asked Markham.
“Nothing yet.”
“And there won’t be,” added Vance. “There wouldn’t be footprints
if they weren’t deliberately intended for us.”
Heath shot him a sharp look, but before he could speak Captain
Jerym and Snitkin came down-stairs.
“What’s the verdict, Cap?” asked the Sergeant.
“Those footprints on the balcony steps,” said Jerym, “were made
with galoshes of the same size and markings as the pattern turned
over to me by Snitkin a fortnight or so ago. As for the prints in the
room, I’m not so sure. They appear to be the same, however; and
the dirt on them is sooty, like the dirt on the snow outside the French
doors. I’ve several photographs of them; and I’ll know definitely when
I get my enlargements under the microscope.”
Vance rose and sauntered to the archway.
“May I have your permission to go up-stairs a moment,
Sergeant?”
Heath looked mystified. His instinct was to ask a reason for this
unexpected request, but all he said was: “Sure. Go ahead.”
Something in Vance’s manner—an air of satisfaction combined
with a suppressed eagerness—told me that he had verified his
theory.
He was gone less than five minutes. When he returned he carried
a pair of galoshes similar to those that had been found in Chester’s
closet. He handed them to Captain Jerym.
“You’ll probably find that these made the tracks.”
Both Jerym and Snitkin examined them carefully, comparing the
measurements and fitting the rough patterns to the soles. Finally, the
Captain took one of them to the window, and affixing a jeweller’s
glass to his eye, studied the riser of the heel.
 “I think you’re right,” he agreed. “There’s a worn place here which
corresponds to an indentation on the cast I made.”
Heath had sprung to his feet and stood eyeing Vance.
“Where did you find ’em?” he demanded.
“Tucked away in the rear of the little linen-closet at the head of
the stairs.”
The Sergeant’s excitement got the better of him. He swung about
to Markham, fairly spluttering with consternation.
“Those two guys from the Bureau that went over this house
looking for the gun told me there wasn’t a pair of galoshes in the
place; and I specially told ’em to keep their eyes pealed for galoshes.
And now Mr. Vance finds ’em in the linen-closet off the main hall up-
stairs!”
“But, Sergeant,” said Vance mildly, “the galoshes weren’t there
when your sleuths were looking for the revolver. On both former
occasions the johnny who wore ’em had plenty of time to put ’em
away safely. But to-day, d’ ye see, he had no chance to sequester
them; so he left ’em in the linen-closet for the time being.”
“Oh, that’s it, is it?” Heath growled vaguely. “Well, what’s the rest
of the story, Mr. Vance?”
“That’s all there is to date. If I knew the rest I’d know who fired
the shots. But I might remind you that neither of your sergents-de-
ville saw any suspicious person leave here.”
“Good God, Vance!” Markham was on his feet. “That means that
the murderer is in the house this minute.”
“At any rate,” returned Vance lazily, “I think we are justified in
assuming that the murderer was here when we arrived.”
“But nobody’s left the place but Von Blon,” blurted Heath.
Vance nodded. “Oh, it’s wholly possible the murderer is still in the
house, Sergeant.”
 CHAPTER XVI.
The Lost Poisons
(Tuesday, November 30; 2 p. m.)

Markham and Vance and I had a late lunch at the Stuyvesant

Club. During the meal the subject of the murder was avoided as if by
tacit agreement; but when we sat smoking over our coffee Markham
settled back in his chair and surveyed Vance sternly.
“Now,” he said, “I want to hear how you came to find those
galoshes in the linen-closet. And, damn it! I don’t want any garrulous
evasions or quotations out of Bartlett.”
“I’m quite willing to unburden my soul,” smiled Vance. “It was all
so dashed simple. I never put any stock in the burglar theory, and so
was able to approach the problem with a virgin mind, as it were.”
He lit a fresh cigarette and poured himself another cup of coffee.
“Perpend, Markham. On the night that Julia and Ada were shot a
double set of footprints was found. It had stopped snowing at about
eleven o’clock, and the tracks had been made between that hour
and midnight, when the Sergeant arrived on the scene. On the night
of Chester’s murder there was another set of footprints similar to the
others; and they too had been made shortly after the weather had
cleared. Here, then, were tracks in the snow, approaching and
retreating from the front door, preceding each crime; and both sets
had been made after the snow had stopped falling when they would
be distinctly visible and determinable. This was not a particularly
striking coincidence, but it was sufficiently arresting to create a slight
strain on my cortex cerebri. And the strain increased perceptibly this
morning when Snitkin reported his discovery of fresh footprints on
the balcony steps; for once again the same meteorological
conditions had accompanied our culprit’s passion for leaving spoors.
I was therefore driven to the irresistible inference, as you learned
Solons put it, that the murderer, so careful and calculating about
everything else, had deliberately made all these footprints for our
special edification. In each instance, d’ ye see, he had chosen the
only hour of the day when his tracks would not be obliterated by
falling snow or confused with other tracks. . . . Are you there?”
“Go ahead,” said Markham. “I’m listening.”
“To proceed, then. Another coincidence attached to these three
sets of footprints. It was impossible, because of the dry, flaky nature
of the snow, to determine whether the first set had originated in the
house and returned there, or had first approached the house from
the street and then retreated. Again, on the night of Chester’s
demise, when the snow was damp and susceptible to clear
impressions, the same doubt arose. The tracks to and from the
house were on opposite sides of the front walk: not a single footstep
overlapped! Accidental? Perhaps. But not wholly reasonable. A
person walking to and from a door along a comparatively narrow
pathway would almost certainly have doubled on some of his tracks.
And even if he had failed to superimpose any of his footprints, the
parallel spoors would have been close together. But these two lines
of prints were far apart: each clung to the extreme edge of the walk,
as if the person who made them was positively afraid of overlapping.
Now, consider the footprints made this morning. There was a single
line of them entering the house, but none coming out. We concluded
that the murderer had made his escape via the front door and down
the neatly swept walk; but this, after all, was only an assumption.”
Vance sipped his coffee and inhaled a moment on his cigarette.
“The point I’m trying to bring out is this: there is no proof
whatever that all these footprints were not made by some one in the
house who first went out and then returned for the express purpose
of leading the police to believe that an outsider was guilty. And, on
the other hand, there is evidence that the footprints actually did
originate in the house; because if an outsider had made them he
would have been at no pains to confuse the issue of their origin,
since, in any event, they could not have been traced back farther
than the street. Therefore, as a tentative starting-point, I assumed
that the tracks had, in reality, been made by some one in the house.
—I can’t say, of course, whether or not my layman’s logic adds lustre
to the gladsome light of jurisprudence——”
“Your reasoning is consistent as far as it goes,” cut in Markham
tartly. “But it is hardly complete enough to have led you directly to the
linen-closet this morning.”
“True. But there were various contribut’ry factors. For instance,
the galoshes which Snitkin found in Chester’s clothes-closet were
the exact size of the prints. At first I toyed with the idea that they
were the actual instruments of our unknown’s vestigial deception.
But when, after they had been taken to Headquarters, another set of
similar tracks appeared—to wit, the ones found this morning—I
amended my theory slightly, and concluded that Chester had owned
two pairs of galoshes—one that had perhaps been discarded but not
thrown away. That was why I wanted to wait for Captain Jerym’s
report: I was anxious to learn if the new tracks were exactly like the
old ones.”
“But even so,” interrupted Markham, “your theory that the
footprints emanated from the house strikes me as being erected on
pretty weak scaffolding. Were there any other indicants?”
“I was coming to them,” replied Vance reproachfully. “But you will
rush me so. Pretend that I’m a lawyer, and my summation will sound
positively breathless.”
“I’m more likely to pretend that I’m a presiding judge, and give
you sus. per coll.”
“Ah, well.” Vance sighed and continued. “Let us consider the
hypothetical intruder’s means of escape after the shooting of Julia
and Ada. Sproot came into the upper hall immediately after the shot
had been fired in Ada’s room; yet he heard nothing—neither
footsteps in the hall nor the front door closing. And, Markham old
thing, a person in galoshes going down marble steps in the dark is
no midsummer zephyr for silence. In the circumstances Sproot
would have been certain to hear him making his escape. Therefore,
the explanation that suggested itself to me was that he did not make
his escape.”
“And the footprints outside?”
“Were made beforehand by some one walking to the front gate
and back.—And that brings me to the night of Chester’s murder. You
remember Rex’s tale of hearing a dragging noise in the hall and a
door closing about fifteen minutes before the shot was fired, and
Ada’s corroboration of the door-shutting part of the story? The noise,
please note, was heard after it had stopped snowing—in fact, after
the moon had come out. Could the noise not easily have been a
person walking in galoshes, or even taking them off, after having
returned from making those separated tracks to and from the gate?
And might not that closing door have been the door of the linen-
closet where the galoshes were being temporarily cached?”
Markham nodded. “Yes, the sounds Rex and Ada heard might be
explained that way.”
“And this morning’s business was even plainer. There were
footprints on the balcony steps, made between nine o’clock and
noon. But neither of the guards saw any one enter the grounds.
Moreover, Sproot waited a few moments in the dining-room after the
shot had been fired in Rex’s room; and if any one had come down
the stairs and gone out the front door Sproot would certainly have
heard him. It’s true that the murderer might have descended the front
stairs as Sproot went up the servants’ stairs. But is that likely? Would
he have waited in the upper hall after killing Rex, knowing that some
one was likely to step out and discover him? I think not. And anyway,
the guards saw no one leave the estate. Ergo, I concluded that no
one came down the front stairs after Rex’s death. I assumed again
that the footprints had been made at some earlier hour. This time,
however, the murderer did not go to the gate and return, for a guard
was there who would have seen him; and, furthermore, the front
steps and the walk had been swept. So our track-maker, after having
donned the galoshes, stepped out of the front door, walked round the
corner of the house, mounted the balcony steps, and re-entered the
upper hall by way of Ada’s room.”
“I see.” Markham leaned over and knocked the ashes from his
cigar. “Therefore, you inferred that the galoshes were still in the
house.”
“Exactly. But I’ll admit I didn’t think of the linen-closet at once.
First I tried Chester’s room. Then I took a look round Julia’s
chamber; and I was about to go up to the servants’ quarters when I
recalled Rex’s story of the closing door. I ran my eye over all the
second-story doors, and straightway tried the linen-closet—which
was, after all, the most likely place for a transient occultation. And lo!
there were the galoshes tucked under an old drugget. The murderer
had probably hidden them there both times before, pending an
opportunity of secreting them more thoroughly.”
“But where could they have been concealed so that our
searchers didn’t run across them?”
“As to that, now, I couldn’t say. They may have been taken out of
the house altogether.”
There was a silence for several minutes. Then Markham spoke.
“The finding of the galoshes pretty well proves your theory,
Vance. But do you realize what confronts us now? If your reasoning
is correct, the guilty person is some one with whom we’ve been
talking this morning. It’s an appalling thought. I’ve gone over in my
mind every member of that household; and I simply can’t regard any
one of them as a potential mass-murderer.”
“Sheer moral prejudice, old dear.” Vance’s voice assumed a note
of raillery. “I’m a bit cynical myself, and the only person at the
Greene mansion I’d eliminate as a possibility would be Frau
Mannheim. She’s not sufficiently imaginative to have planned this
accumulative massacre. But as regards the others, I could picture
any one of ’em as being at the bottom of this diabolical slaughter. It’s
a mistaken idea, don’t y’ know, to imagine that a murderer looks like
a murderer. No murderer ever does. The only people who really look
like murderers are quite harmless. Do you recall the mild and
handsome features of the Reverend Richeson of Cambridge? Yet he
gave his inamorata cyanide of potassium. The fact that Major
Armstrong was a meek and gentlemanly looking chap did not deter
him from feeding arsenic to his wife. Professor Webster of Harvard
was not a criminal type; but the dismembered spirit of Doctor
Parkman doubtless regards him as a brutal slayer. Doctor Lamson,
with his philanthropic eyes and his benevolent beard, was highly
regarded as a humanitarian; but he administered aconitine rather
cold-bloodedly to his crippled brother-in-law. Then there was Doctor
Neil Cream, who might easily have been mistaken for the deacon of
a fashionable church; and the soft-spoken and amiable Doctor
Waite. . . . And the women! Edith Thompson admitted putting
powdered glass in her husband’s gruel, though she looked like a
pious Sunday-school teacher. Madeleine Smith certainly had a most
respectable countenance. And Constance Kent was rather a beauty
—a nice girl with an engaging air; yet she cut her little brother’s
throat in a thoroughly brutal manner. Gabrielle Bompard and Marie
Boyer were anything but typical of the donna delinquente; but the
one strangled her lover with the cord of her dressing-gown, and the
other killed her mother with a cheese-knife. And what of Madame
Fenayrou——?”
“Enough!” protested Markham. “Your lecture on criminal
physiognomy can go over a while. Just now I’m trying to adjust my
mind to the staggering inferences to be drawn from your finding of
those galoshes.” A sense of horror seemed to weigh him down.
“Good God, Vance! There must be some way out of this nightmare
you’ve propounded. What member of that household could possibly
have walked in on Rex Greene and shot him down in broad
daylight?”
“ ’Pon my soul, I don’t know.” Vance himself was deeply affected
by the sinister aspects of the case. “But some one in that house did it
—some one the others don’t suspect.”
“That look on Julia’s face, and Chester’s amazed expression—
that’s what you mean, isn’t it? They didn’t suspect either. And they
were horrified at the revelation—when it was too late. Yes, all those
things fit in with your theory.”
“But there’s one thing that doesn’t fit, old man.” Vance gazed at
the table perplexedly. “Rex died peacefully, apparently unaware of
his murderer. Why wasn’t there also a look of horror on his face? His
eyes couldn’t have been shut when the revolver was levelled at him,
for he was standing, facing the intruder. It’s inexplicable—mad!”
He beat a nervous tattoo on the table, his brows contracted.
“And there’s another thing, Markham, that’s incomprehensible
about Rex’s death. His door into the hall was open; but nobody up-
stairs heard the shot—nobody up-stairs. And yet Sproot—who was
down-stairs, in the butler’s pantry behind the dining-room—heard it
distinctly.”
“It probably just happened that way,” Markham argued, almost
automatically. “Sound acts fantastically sometimes.”
 Vance shook his head.
“Nothing has ‘just happened’ in this case. There’s a terrible logic
about everything—a carefully planned reason behind each detail.
Nothing has been left to chance. Still, this very systematization of the
crime will eventually prove the murderer’s downfall. When we can
find a key to any one of the anterooms, we’ll know our way into the
main chamber of horrors.”
At that moment Markham was summoned to the telephone.
When he returned his expression was puzzled and uneasy.
“It was Swacker. Von Blon is at my office now—he has something
to tell me.”
“Ah! Very interestin’,” commented Vance.
We drove to the District Attorney’s office, and Von Blon was
shown in at once.
“I may be stirring up a mare’s nest,” he began apologetically, after
he had seated himself on the edge of a chair. “But I felt I ought to
inform you of a curious thing that happened to me this morning. At
first I thought I would tell the police, but it occurred to me they might
misunderstand; and I decided to place the matter before you to act
upon as you saw fit.”
Plainly he was uncertain as to how the subject should be
broached, and Markham waited patiently with an air of polite
indulgence.
“I phoned the Greene house as soon as I made the—ah—
discovery,” Von Blon went on hesitantly. “But I was informed you had
left for the office; so, as soon as I had lunched, I came directly here.”
“Very good of you, doctor,” murmured Markham.
Again Von Blon hesitated, and his manner became exaggeratedly
ingratiating.
“The fact is, Mr. Markham, I am in the habit of carrying a rather
full supply of emergency drugs in my medicine-case. . . .”
“Emergency drugs?”
“Strychnine, morphine, caffeine, and a variety of hypnotics and
stimulants. I find it often convenient——”
“And it was in connection with these drugs you wished to see
me?”
 “Indirectly—yes.” Von Blon paused momentarily to arrange his
words. “To-day it happened that I had in my case a fresh tube of
soluble quarter-grain morphine tablets, and a Parke-Davis carton of
four tubes of strychnine—thirtieths. . . .”
“And what about this supply of drugs, doctor?”
“The fact is, the morphine and the strychnine have disappeared.”
Markham bent forward, his eyes curiously animated.
“They were in my case this morning when I left my office,” Von
Blon explained; “and I made only two brief calls before I went to the
Greenes’. I missed the tubes when I returned to my office.”
Markham studied the doctor a moment.
“And you think it improbable that the drugs were taken from your
case during either of your other calls?”
“That’s just it. At neither place was the case out of my sight for a
moment.”
“And at the Greenes’?” Markham’s agitation was growing rapidly.
“I went directly to Mrs. Greene’s room, taking the case with me. I
remained there for perhaps half an hour. When I came out——”
“You did not leave the room during that half-hour?”
“No. . . .”
“Pardon me, doctor,” came Vance’s indolent voice; “but the nurse
mentioned that you called to her to bring Mrs. Greene’s bouillon.
From where did you call?”
Von Blon nodded. “Ah, yes. I did speak to Miss Craven. I stepped
to the door and called up the servants’ stairs.”
“Quite so. And then?”
“I waited with Mrs. Greene until the nurse came. Then I went
across the hall to Sibella’s room.”
“And your case?” interjected Markham.
“I set it down in the hall, against the rear railing of the main
stairway.”
“And you remained in Miss Sibella’s room until Sproot called
you?”
“That is right.”
“Then the case was unguarded in the rear of the upper hall from
about eleven until you left the house?”
 “Yes. After I had taken leave of you gentlemen in the drawing-
room I went up-stairs and got it.”
“And also made your adieus to Miss Sibella,” added Vance.
Von Blon raised his eyebrows with an air of gentle surprise.
“Naturally.”
“What amount of these drugs disappeared?” asked Markham.
“The four tubes of strychnine contained in all approximately three
grains—three and one-third, to be exact. And there are twenty-five
tablets of morphine in a Parke-Davis tube, making six and one-
quarter grains.”
“Are those fatal doses, doctor?”
“That’s a difficult question to answer, sir.” Von Blon adopted a
professorial manner. “One may have a tolerance for morphine and
be capable of assimilating astonishingly large doses. But, ceteris
paribus, six grains would certainly prove fatal. Regarding strychnine,
toxicology gives us a very wide range as to lethal dosage, depending
on the condition and age of the patient. The average fatal dose for
an adult is, I should say, two grains, though death has resulted from
administrations of one grain, or even less. And, on the other hand,
recovery has taken place after as much as ten grains have been
swallowed. Generally speaking, however, three and one-third grains
would be sufficient to produce fatal results.”
When Von Blon had gone Markham gazed at Vance anxiously.
“What do you make of it?” he asked.
“I don’t like it—I don’t at all like it.” Vance shook his head
despairingly. “It’s dashed queer—the whole thing. And the doctor is
worried, too. There’s a panic raging beneath his elegant façade. He’s
in a blue funk—and it’s not because of the loss of his pills. He fears
something, Markham. There was a strained, hunted look in his
eyes.”
“Doesn’t it strike you as strange that he should be carrying such
quantities of drugs about with him?”
“Not necessarily. Some doctors do it. The Continental M.D.s
especially are addicted to the practice. And don’t forget Von Blon is
German-trained. . . .” Vance glanced up suddenly. “By the by, what
about those two wills?”
 There was a look of astonished interrogation in Markham’s
incisive stare, but he said merely:
“I’ll have them later this afternoon. Buckway has been laid up with
a cold, but he promised to send me copies to-day.”
Vance got to his feet.
“I’m no Chaldean,” he drawled; “but I have an idea those two wills
may help us to understand the disappearance of the doctor’s
pellets.” He drew on his coat and took up his hat and stick. “And now
I’m going to banish this beastly affair from my thoughts.—Come,
Van. There’s some good chamber-music at Æolian Hall this
afternoon, and if we hurry we’ll be in time for the Mozart ‘C-major.’ ”
 CHAPTER XVII.
Two Wills
(Tuesday, November 30; 8 p. m.)

Eight o’clock that night found Inspector Moran, Sergeant Heath,

Markham, Vance, and me seated about a small conference-table in
one of the Stuyvesant Club’s private rooms. The evening papers had
created a furore in the city with their melodramatic accounts of Rex
Greene’s murder; and these early stories were, as we all knew, but
the mild forerunners of what the morning journals would publish. The
situation itself, without the inevitable impending strictures of the
press, was sufficient to harry and depress those in charge of the
official investigation; and, as I looked round the little circle of worried
faces that night, I realized the tremendous importance that attached
to the outcome of our conference.
Markham was the first to speak.
“I have brought copies of the wills; but before we discuss them I’d
like to know if there have been any new developments.”
“Developments!” Heath snorted contemptuously. “We’ve been
going round in a circle all afternoon, and the faster we went the
quicker we got to where we started. Mr. Markham, not one damn
thing turned up to give us a line of inquiry. If it wasn’t for the fact that
no gun was found in the room, I’d turn in a report of suicide and then
resign from the force.”
“Fie on you, Sergeant!” Vance made a half-hearted attempt at
levity. “It’s a bit too early to give way to such gloomy pessimism.—I
take it that Captain Dubois found no finger-prints.”
“Oh, he found finger-prints, all right—Ada’s, and Rex’s, and
Sproot’s, and a couple of the doctor’s. But that don’t get us
anywheres.”
 “Where were the prints?”
“Everywhere—on the door-knobs, the centre-table, the window-
panes; some were even found on the woodwork above the mantel.”
“That last fact may prove interestin’ some day, though it doesn’t
seem to mean much just now.—Anything more about the footprints?”
“Nope. I got Jerym’s report late this afternoon; but it don’t say
anything new. The galoshes you found made the tracks.”
“That reminds me, Sergeant. What did you do with the
galoshes?”
Heath gave him a sly, exultant grin.
“Just exactly what you’d have done with ’em, Mr. Vance. Only—I
thought of it first.”
Vance smiled back.
“Salve! Yes, the idea entirely slipped my mind this morning. In
fact, it only just occurred to me.”
“May I know what was done with the galoshes?” interjected
Markham impatiently.
“Why, the Sergeant returned them surreptitiously to the linen-
closet, and placed them under the drugget whence they came.”
“Right!” Heath nodded with satisfaction. “And I’ve got our new
nurse keeping an eye on ’em. The minute they disappear she’s to
phone the Bureau.”
“You had no trouble installing your woman?” asked Markham.
“A cinch. Everything went like clockwork. At a quarter to six the
doc shows up; then at six comes the woman from the Central Office.
After the doc has put her wise to her new duties, she gets into her
uniform and goes in to Mrs. Greene. The old lady tells the doc she
didn’t like this Miss Craven anyway, and hopes the new nurse will
show her more consideration. Things couldn’t have gone smoother. I
hung around until I got a chance to tip our woman off about the
galoshes; then I came away.”
“Which of our women did you give the case to, Sergeant?” Moran
asked.
“O’Brien—the one who handled the Sitwell affair. Nothing in that
house will get by O’Brien; and she’s as strong as a man.”
“There’s another thing you’d better speak to her about as soon as
possible.” And Markham related in detail the facts of Von Blon’s visit
to the office after lunch. “If those drugs were stolen in the Greene
mansion, your woman may be able to find some trace of them.”
Markham’s account of the missing poisons had produced a
profound effect on both Heath and the Inspector.
“Good heavens!” exclaimed the latter. “Is this affair going to
develop into a poisoning case? It would be the finishing touch.” His
apprehension went much deeper than his tone implied.
Heath sat staring at the polished table-top with futile
consternation.
“Morphine and strychnine! There’s no use looking for the stuff.
There’s a hundred places in the house where it could be hid; and we
might search a month and not find it. Anyway, I’ll go out there to-
night and tell O’Brien to watch for it. If she’s on the lookout she
maybe can spot any attempt to use it.”
“What astounds me,” remarked the Inspector, “is the security felt
by the thief. Within an hour of the time Rex Greene is shot the
poison disappears from the upper hall. Good Gad! That’s cold-
bloodedness for you! And nerve, too!”
“There’s plenty of cold-bloodedness and nerve in this case,”
answered Vance. “A relentless determination is back of these
murders—and calculation no end. I wouldn’t be surprised if the
doctor’s satchel had been searched a score of times before.
Perhaps there’s been a patient accumulation of the drugs. This
morning’s theft may have been the final raid. I see in this whole affair
a carefully worked-out plot that’s been in preparation perhaps for
years. We’re dealing with the persistency of an idée fixe, and with
the demoniacal logic of insanity. And—what is even more hideous—
we’re confronted with the perverted imagination of a fantastically
romantic mind. We’re pitted against a fiery, egocentric, hallucinated
optimism. And this type of optimism has tremendous stamina and
power. The history of nations has been convulsed by it. Mohammed,
Bruno, and Jeanne d’Arc—as well as Torquemada, Agrippina, and
Robespierre—all had it. It operates in different degrees, and to
different ends; but the spirit of individual revolution is at the bottom of
it.”
“Hell, Mr. Vance!” Heath was uneasy. “You’re trying to make this
case something that ain’t—well, natural.”
 “Can you make it anything else, Sergeant? Already there have
been three murders and an attempted murder. And now comes the
theft of the poisons from Von Blon.”
Inspector Moran drew himself up and rested his elbows on the
table.
“Well, what’s to be done? That, I believe, is the business of to-
night’s conclave.” He forced himself to speak with matter-of-factness.
“We can’t break up the establishment; and we can’t assign a
separate bodyguard for each remaining member of the household.”
“No; and we can’t give ’em the works at the police station, either,”
grumbled Heath.
“It wouldn’t help you if you could, Sergeant,” said Vance. “There’s
no third degree known that could unseal the lips of the person who is
executing this particular opus. There’s too much fanaticism and
martyrdom in it.”
“Suppose we hear those wills, Mr. Markham,” suggested Moran.
“We may then be able to figure out a motive.—You’ll admit, won’t
you, Mr. Vance, that there’s a pretty strong motive back of these
killings?”
“There can be no doubt as to that. But I don’t believe it’s money.
Money may enter into it—and probably does—but only as a
contribut’ry factor. I’d say the motive was more fundamental—that it
had its matrix in some powerful but suppressed human passion.
However, the financial conditions may lead us to those depths.”
Markham had taken from his pocket several legal-sized sheets of
closely typed paper, and smoothed them on the table before him.
“There’s no necessity to read these verbatim,” he said. “I’ve gone
over them thoroughly and can tell you briefly what they contain.” He
took up the top sheet and held it nearer to the light. “Tobias Greene’s
last will, drawn up less than a year before his death, makes the
entire family, as you know, the residuary devisees, with the
stipulation that they live on the estate and maintain it intact for
twenty-five years. At the end of that time the property may be sold or
otherwise disposed of. I might mention that the domiciliary stipulation
was particularly strict: the legatees must live in the Greene mansion
in esse—no technicality will suffice. They are permitted to travel and