Insulin as a murder weapon

Thirty-five years after the first human received an injection containing insulin came the first documented case of this miracle drug as a murder weapon.¹ However, the villainous role insulin played in this case was almost overlooked. When Elizabeth Barlow was found submerged in her bath by her husband Kenneth Barlow on a May 1957 evening in Yorkshire, UK, it presented as a possible accidental drowning. 

Kenneth recounted that his ill, eight weeks pregnant wife had sought the comfort of a bath but slipped into death instead. A 1958 report of Elizabeth’s death published in the British Medical Journal (BMJ) by V J Birkinshaw and colleagues describes her position in the bath as ‘one associated with natural sleep’ and that ‘[t]here were no obvious signs of violence’.² A postmortem exam confirmed drowning, but questions remained. Birkinshaw and colleagues articulated the remaining conundrums expertly: ‘it seemed difficult to explain why a healthy young woman should have drowned in her bath without any apparent signs of reaction to inhaled water; she lay as though asleep with no evidence of splashing or violence’. Why didn’t the human physiological responses that fight drowning kick-in and manifest in physical findings of distress?

The conclusion was she was not merely asleep, but unconscious. Kenneth stated Elizabeth had been sweating profusely and vomiting prior to her bath, with ‘the gross dilation of pupils’ noted postmortem. These signs suggested Elizabeth was hypoglycemic, with a dangerously low blood sugar level possibly rendering her insensate. But no additional evidence was found to support this condition. Analysing specimens collected postmortem for ‘several hundred poisons and drugs’ found ‘nothing abnormal’, seeming ruling out a toxicological explanation to Elizabeth’s unconsciousness. Then, five days after Elizabeth’s death, the cause of her unconsciousness came to light. Literally.