Munchausen Syndrome by Proxy
Serial SIDS as Murder:
The Marie Noe Case
On February 25, 1966, a neighbor drove Marie Noe and Catherine, her fourteen-month-old daughter, from their home in the West Kensington section of Philadelphia to St. Joseph’s Hospital where on arrival, the baby was pronounced dead. Marie told the health-care workers at the hospital that she had found Catherine lying unconscious in her playpen. Catherine’s death was not the first such tragedy in the Noe family. Marie’s first baby had been stillborn, another had died six hours after birth, and seven more, including Catherine, had died at home. According to the pathologists who had performed the autopsies on the babies who had died at home, there was no evidence of disease. The pathologists also found no evidence of foul play. The pathologists had labeled the causes of these deaths “undermined.”
Although the doctors had been unable to find the reasons for the babies’ deaths, the children all had histories of medical emergencies in the form of mysterious breathing problems. Catherine, the oldest of the Noe children to die, like the others, had plenty of medical close calls. For example, eight months earlier, Marie had called the family doctor to report that she had saved Catherine’s life by removing a plastic dry cleaning bag that had gotten wrapped around the baby’s head. This, of course, begged the question: how did a cleaning bag get into the baby’s crib? Marie said she didn’t know, maybe it had come from one of her husband’s suits that hung in a nearby closet. The physician in charge of Catherine’s care, uncomfortable with the cleaning bag story, kept the baby hospitalized for five weeks. Catherine, home two months following her five week hospitalization, went limp in Marie’s arms and was rushed back to St. Josephs where she was given oxygen. During that three-week stay in the hospital, Catherine appeared perfectly healthy. Without a compelling medical reason to keep the baby longer, she was released back to the custody of her mother.
On December 23, 1965, two months before her death, Catherine, following a “spell,” was back at St. Josephs. This time the nurses noticed that the baby showed signs of distress whenever approached by a person. Following a period in which she suffered no seizures or respiratory attacks, Catherine was sent home. But after being home two weeks, Catherine had another seizure. Marie, once again, saved the baby by administering oxygen. A month after the seizure, on Valentine’s Day, Marie called the family doctor to report that Catherine had stopped breathing and was turning blue in her crib. Marie informed the doctor that she had, in the nick of time, saved the baby’s life with a shot of oxygen. The doctor prescribed Dilantin, an anti-seizure drug.
Eleven days after the seizure, an ambulance brought Catherine back to the hospital. This time the little girl was dead. Virtually everyone in the hospital familiar with Marie Noe and her history suspected murder. No one had a clue as to why a mother would torture and kill her baby, but no one could otherwise explain Catherine’s death. It was simply a matter of common sense. At the hospital the baby was fine, at home she got sick. And now, as so many had predicted and feared, the baby was dead.
Because the medical examiner had not ruled Catherine the victim of criminal homicide, a case wasn’t opened within the homicide unit of the Philadelphia Police Department. There was, however, within the Philadelphia Office of the Medical Examiner (OME) a strong desire, by two of the medical examiner’s investigators, to look into the Noe family deaths. These experienced death investigators, Joe McGillen and Remington Bristow, decided, on their own, to conduct an unofficial inquiry into the case. These government investigators, in an effort to make the system work, had to work outside the system. This was highly unusual, and far beyond the call of duty. However, if there was a case that cried out for this kind of effort, it was this one. The stakes were high for everyone concerned.
Over the next few months McGillen and Bristow conducted a painstakingly thorough homicide investigation that covered multiple deaths over a period of several years. This investigation, conducted ten years before Dr. Roy Meadow’s Munchausen Syndrome by Proxy discovery became public knowledge, uncovered the story of a ruthless and desperate woman driven by a pathological need for attention. The OME men came to believe that this sociopath, married to alcoholic mill worker, had caused the suffering and death of their children to keep herself the object of sympathy and attention. A background investigation revealed that before Marie Noe had children to exploit in this fashion, before her babies were turning blue, having seizures, choking, suffocating in plastic bags, and going limp in her arms, she had called attention to herself by reporting to the police that she had been raped. Even before giving birth to her children, she continued to file such claims. The OME investigators, before Dr. Meadow added MSBP to the repertoire of homicide motives, didn’t have a fancy term for Marie’s behavior. They simply called it murder.
As a child, Marie had grown up around violence and mental illness. Her father, a drunken janitor, abused her mother who in turn physically abuse Marie and her siblings. When Marie was five, a forty-year-old man went to prison for raping her twelve-year-old sister. Another sibling, when Marie was fourteen, was put into a state mental hospital after being diagnosed as having a “post-traumatic personality disorder.” As a teenager living in Cape May, New Jersey, Marie claimed she had been raped by a man in the Coast Guard. This man was never identified, and the police, after looking into the complaint, suspected she had made up the story. About this time Marie started complaining of terrible headaches followed by periods of hysterical blindness.
In 1949, a few weeks before the birth of her first child, Marie claimed to have been raped by a home intruder. At the time, she and her husband Arthur were living in his father’s house. Marie told the police she was raped on the living room sofa while her father-in-law slept upstairs. Arthur, a machinist, was working the midnight shift at the factory. The police were unable to identify the intruder and had reasons to doubt that the crime had actually occurred.
A few weeks after the alleged home invasion rape, Marie gave birth to Richard who only lived to be four months old. The baby had simply stopped breathing and died in his crib. Twelve days later Marie started complaining of headaches, and said she was blind. Her family doctor, as part of her treatment, injected Marie with sodium amytol, a so-called “truth drug” which apparently got her talking about the death of her baby. She told the doctor that because the child’s death had been “unavoidable,” she did not hold herself responsible. To rid herself of the headaches and blindness, the doctor suggested that Marie get pregnant again.
Throughout the 1950s and early 1960s, Marie Noe continued to have babies, get headaches, go blind, and file reports of being raped. In on such complaint, Marie told the police that a man had broken into her house, tied her up with Arthur’s neckties, sexually assaulted her, and left with her bite-mark on his ear. By now these complaints were so common, and so bizarre, the police didn’t even pretend to investigate them.
The Noe family physician, when interviewed by McGillen and Bristow, said that he had witnessed so many health emergencies, followed by sudden infant deaths, he had come to the conclusion that the Noe babies had not died naturally. Even though none of these deaths were ever designated homicide, and the police were not involved, the doctor said that after a while he had tried to convince Marie not to have any more children. At some point the doctor came to the conclusion that Marie’s need for attention was the reason behind the deaths. Since no one had ever heard of such a thing (Dr. Roy Meadow, the English pediatrician, had yet to introduce the Munchausen Syndrome by Proxy to the world through his famous article in his 1977 Lancet article.) and the family doctor couldn’t prove his suspicion, there was nothing he could do to stop the inevitable deaths of these babies.
On the chance that the Noe family homicides had been motivated by money, the OME investigators looked into the life insurance angle and were a bit surprised to learn that the Noes had taken out policies on all of the babies. Because the life insurance pay-offs barely covered the costs of the funerals, the investigators ruled out insurance as the primary motive. However, without the life insurance, the Noes would not have been able to afford all of these deaths. It was something to think about.
Upon completion of the extended and detailed probe into Marie Noe’s general background, mental state, and pattern of behavior, the OME investigators asked their boss to change the manner of Catherine’s death from undetermined to homicide. McGillen and Bristow argued that if arrested and interrogated, Marie Noe might break down and confess. Even if she didn’t fully confess, the police might rattle her enough to secure incriminating statements, that along with the circumstantial evidence, might support a murder conviction. It was a long shot, but they had everything to gain and nothing to lose.
The medical examiner agreed that Catherine Noe’s death was, under the circumstances, suspicious. But he could not rule homicide solely on the results of an investigation. He could not prove, with medical certainty, that the baby had been killed. The medical examiner was not going to retrofit the science to support the investigation. Reluctantly, the OME men closed their case.
In July 1967, shortly after the OME men closed shop on the Noe investigation, Marie gave birth to Arthur, Jr., her tenth baby, and the second child to be named after her husband. She had “Little Arty” at St. Joseph’s where the baby was kept under observation for two months, a decision that had more to do with preventative murder than preventative medicine. During the baby’s hospitalization, Marie visited him twice. When it became obvious that the infant was in perfect health, the hospital administration had no choice but to discharge him to his parents. Several members of the hospital staff felt that by discharging Little Arty, they were sentencing him to death. From past experience, they knew it wouldn’t be long before they saw him again. And they were right.
A month later, Little Arty was back in the hospital, and the account Marie gave the medical staff was just another version of the same old story: this time “something must have gone down the wrong way” causing the baby to choke and turn blue. Marie had “banged his chest” to get him breathing again, then called the rescue squad. From the emergency room at St. Christopher’s the baby was transferred back to St. Joseph’s were he was kept for nineteen days during which time Marie came to visit him once. Little Arty was home five weeks before his next emergency. This time the story was a little different. Marie had gone into the baby’s room to find one of the family cats lying on his face. The next day, after receiving oxygen, Little Arty was sent home with this rather ominous notation in his medical file: “possible attempted suffocation.”
When they heard that Little Arty had died, Joe McGillen and Remington Bristow knew that the baby, doomed from birth, had been murdered. The OME investigators who had amassed a thick file on Marie Noe and the deaths of her other nine children, went to Marie’s house on the very day of Little Arty’s death. They brought with them a detective from the Philadelphia Police Department. They didn’t wait for the autopsy results because they didn’t need a forensic pathologist to tell them that the baby had been suffocated. Marie must have realized the purpose of their visit when one of the officers read her the Miranda rights, the detective’s preamble to accusatory questioning.
Appearing unfazed by Little Arty’s death, Marie, after being told of her right to remain silent, and her right to an attorney, said, “I have nothing to hide. I will tell you everything I can possibly remember.” And what she remembered was this: At 2:30 that afternoon, as she worked in the kitchen preparing dinner for Arthur, she could hear Little Arty upstairs rattling around in his crib. A few minutes later, when she went into his room to check on him, she found him lying on his back “gasping for breath and turning blue.” She lowered the side of the crib and started mouth-to-mouth resuscitation. When the baby didn’t respond, she called the rescue squad. “I then came downstairs with the baby. I placed him on the kitchen table and started mouth-to-mouth resuscitation again and tried to help it. I called my husband and he started home. The rescue squad arrived but the child was DOA.” The OME investigators noticed that on several occasions Marie would refer to Little Arty as “it.” Based on what they knew of her, and what they suspected, they were not shocked. The officers left the Noe house that day without a confession. Maybe the medical examiner would find, on the little corpse, evidence that the baby had been suffocated. Without that, they had nothing but their strong suspicions.
The medical examiner ruled the death “natural,” which killed any chance of bringing Marie Noe up on charges of murder. The medical examiner’s hard line, his unwillingness to compromise with a manner of death that read like, “undetermined, consistent with suffocation,” infuriated the OME men. How could anyone in their right mind classify Little Arty’s death as natural. (The term SIDS would come into existence a year later.) If Little Arty had died naturally, exactly what disease had killed him? Sure, scientists had to be objective and independent, but this medical examiner was blind. The OME investigators, Joe McGillen and Remington Bristow, decided to re-open their investigation of Marie Noe. This time they would be assisted by a detective with the Philadelphia Police Department.
The investigators continued to interview people who knew Marie and her husband, and the more people they questioned, the weirder the Noes came off. In addition to the false claims of rape, Marie, over the years, had peppered the police with complaints involving the receipt of hundreds of obscene phone calls. Who these callers were, or why they were calling Marie, remained a mystery. Between babies, Marie had killed her pets. Dogs, cats, birds, and even a turtle had died suddenly and mysteriously in her presence. The only member of the Noe household who seemed immune to sudden, violent death was Arthur. Out of leads and desperate for a break in the case, the investigators asked Marie and Arthur to take lie detector tests administered by a polygraph examiner with the Philadelphia Police Department. They agreed and in February 1968 took the tests. Although polygraph results are not admissible in court, they are often used to coax confessions out of examinees who are found to be lying. This was the thinking behind the Noe examinations. While hooked up to the instrument, Arthur, then Marie, denied causing the deaths of any of their children. The polygraph examiner studied their charts and had bad news for the investigators. According to the lie machine, they were both telling the truth.
Virtually everyone in the medical examiner’s office believed that Marie Noe had killed all of her children. The medical staffs at St. Joseph’s and St. Christopher’s believed this as well. The Philadelphia detective, however, based on the polygraph results, thought they were innocent. But it didn’t matter what anyone thought. Without a ruling of homicide from the medical examiner, and with no confession, the case against Marie Noe was dead. Once again Joe McGillen and Remington Bristow had no choice but to shut the book on the case. They had conducted a brilliant criminal investigation, the kind of investigation that was extremely rare in police work. But without the support of forensic science, Sherlock Holmes would have walked away from the Noe case frustrated and defeated.
Following the birth of Little Arty, Marie’s doctor told her that due to medical complications, she would not be able to have any more children. This caused a collective sigh of relief at the hospitals and in the medical examiner’s office. But these signs of relief were replaced with groans when Marie, after Little Arty’s death, said she was considering the possibility of adoption.
The Noe case lay dormant nearly thirty years then came back to life with the1997 publication of a book called, The Death of Innocents by Richard Firstman and Jamie Talon. The book featured the case of Waneta Hoyt, a woman from upstate New York who had been convicted of murdering several of her babies. The authors, in the book, made reference to Marie Noe (under a pseudonym), describing her as the Philadelphia mother who, between 1949 and 1968, lost ten children to sudden infant death. The authors noted that despite the efforts of the OME men, all of the deaths were still classified as naturally caused. The Philadelphia woman, unlike Waneta Hoyt (see her story in Forensics Under Fire) had not been charged with murder.
After reading The Death of Innocents, and learning the identify of Marie Noe from the book’s authors, Stephen Fried, a free-lance journalist from Philadelphia, decided to research the case for an article to be published in Philadelphia Magazine. Unearthing the details of events that went all the way back to 1949 would not be an easy task. This would be particularly true if there was not any significant documentation left. In the Noe case, if the paper trail still existed, it would start at the hospitalsSt. Joseph’s and St. Christopher’srun through the OME and end up at the Philadelphia Police Department. When Fried tried to pick-up the trail at the two hospitals, he was told the records pertaining to the Noe children had been forwarded, years ago, to the medical examiner’s office. At the OME, the journalist learned that the files had been destroyed a long time ago. At the police department all of the old case files, stored in the basement, had been lost to a flood. Paper-wise, there was not trail and that fact would have ended Fried’s inquiry had it not been fro Joe McGillen who had saved his investigative notes, his OME reports, the autopsy files, photographs, hospital records, and a wall-sized chart tracing the Noe Family death tree. It was all there. Joe McGillen had persevered the case. Time had stood still.
Stephen Fried spoke at length with Joe McGillen who was thrilled that the case would get another look. The writer also talked to a pair of forensic pathologists who said the Noe children could have been murdered. Finally, Fried contacted Sergeant Larry Nodiff, the head of the Philadelphia Police homicide unit. The police department, after learning of the Noe case from The Death of Innocents, had opened their own investigation into the deaths. None of Nordiff’s detectives had questioned Marie Noe and the sergeant had no problem with the journalist arranging an interview for his article.
Marie and Arthur Noe, still living in the West Kensington house where their babies had died, were willing to talk to Fried about being the parents of ten dead children, a life story that in the 1960s had made them subjects of a tragic tale published in Life Magazine. During November 1997 Fried paid several visits to the Noe home. Marie, now seventy, big-boned and broad shouldered, did most of the talking while Arthur, seventy-six, florid-faced and frail, chain-smoked. Marie spoke openly and matter-of-factly about the sudden deaths of her children, discussing them from the point-of-view of someone who had been accused of murder. At times she sounded more like a defense attorney than a grieving mother: “They really couldn’t prove I did any harm to the children. Every one of them children didn’t have a bruise, didn’t have anything medically wrong.” Arthur, when asked how he had survived the unimaginable tragedy of losing ten babies, said it “was just one of them stupid things that happens. We just weren’t meant to have children, I guess.”
Stephen Fried came away from the Noe interviews with two principal thoughts: These people were incredibly weird; and Marie Noe had murdered her children. The woman had ice water running through her veins and was married to a man who thought losing ten of his children was a stupid thing like misplacing your wallet or locking your keys in the car. The fact that Marie Noe was not manifestly insane made the spectacle of her all the more frightening. Had she heard voices and drowned her babies in the bathtub, she would been locked up and medicated. But when babies are smothered, one-by-one in cold blood, it’s just “One of them stupid things.”
Stephen Fried’s article, “Cradle to Grave,” appeared in the May 24, 1998 issue of Philadelphia Magazine. The next day, late in the afternoon, Sergeant Larry Nodiff and two of his homicide detectives knocked on Marie Noe’s door and asked her and Arthur to accompany them to the 25th Precinct station for questioning. Marie was not under arrest and didn’t have to go, but like most people confronted by this request, they didn’t say no. All of a sudden, after all of these years, people were interested in the deaths of her children. First the journalist, and now the police. Marie knew exactly what the police wanted to talk to her about, and she knew what they needed. They wanted her to confess to killing her babies. They had to have that confession, otherwise she would have been under arrest. If they hadn’t been able to prove she had murdered her babies in the 1950s and 1960s, how could they prove it now?
Although Marie was not technically in police custody, and not under arrest, the detectives read her the Miranda rights anyway. They told her of her fifth and sixth amendment rights because she was being questioned in a police station and about to be grilled in a murder investigation. Marie said she didn’t need the services of a lawyer because she hadn’t done anything wrong.
Following a grueling interrogation that lasted eleven hours, far too long for constitutional comfort, the detectives had their confession. With nothing to lose, the detectives, without regard to problems of court admissibility, had gone all out for the confession. In this case, an admission of guilt that was possibly flawed constitutionally was better than no confession at all. At three in the morning Marie signed a statement in which she admitted murdering four of her children. She claimed no memory of how the other six babies had died. The detectives were jubilant.
Marie had confessed to killing Richard, her first-born, in 1949 and two years later murdering Elizabeth. She remembered that “Elizabeth was a lot stronger than Richard was, and she was fighting when the pillow was over her head.” Marie also confessed to killing Jacqueline in 1952 and Constance in 1958. As she committed these murders, Marie said she knew that what she was doing was “very wrong.” She didn’t try to mitigate her guilt by claiming she was out of her mind or temporarily insane. She didn’t admit killing them for sympathy and attention, and seemed at a loss to explain it to herself. The best she could offer was, “All I can figure is that I’m ungodly sick.” The detectives didn’t press her for a motive because they didn’t have to establish why she had killed her babies, just that she had intended to kill them and that she knew this was wrong. They would let the psychiatrists and SIDS experts like Dr. Roy Meadow try to figure out why this mother had been so murderous.
It is not every day that a seventy-year-old woman confesses to four murders committed before most of the detectives who interrogated her were born. After they had acquired the confession, the Philadelphia detectives did something that was consistent with the strangeness of the case, they drove the confessed killer home. By not arresting Marie and throwing her into jail the police were giving themselves some time before the media got wind of the story and all hell broke loose. Why not take her home? There weren’t anymore babies to kill and she wasn’t going anywhere.
A week later the story of Marie’s confession leaded out to The Philadelphia Inquirer. The publicity that followed was intense and brought to Marie’s door a defense attorney who bean making a fuss over the eleven-hour interrogation. The poor woman had been grilled without mercy, and worse, without the presence of an attorney. With the cat out of the bag, the police charged Marie with four counts of first-degree murder and hauled her off to jail. A few days later, after making bail, Marie was back home with Arthur.
Following a year’s worth of negotiations between the district attorney’s office and Marie’s attorney, both parties signed a plea agreement. In return for pleading guilty to the murders of eight of her children, the district attorney would recommend that Marie spend four years under house arrest followed by twenty years of probation. She would not have to spend one day behind bars.
The district attorney, in agreeing to this plea agreement, was not acting out of compassion for Marie Noe. The prosecutor must have known that many people would be outraged by such a light sentence. They would wonder how a mother who had killed eight helpless babies in cold blood escape Pennsylvania’s death penalty. The district attorney went along with this one-sided deal because the prosecutor knew that Marie Noe’s confession, the only evidence against her, would probably not hold up in court. Marie’s defense attorney knew this as well and when push came to shove, the district attorney had no choice but to back down. The district attorney had made a practical if not popular decision.
The public had a right to its outrage, but not because the Philadelphia detectives had grilled Marie for eleven hours, or the district attorney had agreed to such a lousy plea bargain deal. The public’s outrage should have been directed at a less visible, more subtle and complex problem: the failure of forensic sciencein this case forensic pathologyto detect homicide in ten infant deaths. The prolonged and potentially coercive interrogation, instead of being rendered obsolete by the application of forensic science, had been, in the Noe case, the detectives’ only chance to get at the truth. The confession had been their only hope and the prosecutor’s unavoidable weakness.