Britain's "Dr Death" Harold Shipman joined the ranks of the world's worst serial killers on Friday when an official inquiry ruled he had murdered at least 215 patients with heroin injections.
The inquiry said Shipman killed quietly, coldly and systematically over 23 years, ending the life of patient after patient in a betrayal of trust "unparalleled in history."
"No-one reading this report can fail to be shocked by the enormity of the crimes committed by Shipman," said Dame Janet Smith, who investigated the killings.
Smith said she had "real cause" to suspect the soft-spoken family doctor might have killed another 45 patients while working in northern England and found it "deeply disturbing" that he escaped detection for so many years.
Described as caring but arrogant, prosecutors say Shipman's drive to kill was fuelled by a desire for a God-like power over life. Others speculated Shipman, 56, was influenced by watching his mother die from cancer while he was a teenager.
The findings confirm him as one of recent history's most prolific serial killers, on a par with Colombian Pedro Lopez -- dubbed the "Monster of the Andes" -- who was convicted of 57 murders in 1980 but is suspected of killing 300 young girls.
Shipman's killing spree ran from 1975 to 1998: 171 victims were women and 44 were men. They ranged from a 93-year-old woman to a 41-year-old man.
Smith ruled out financial gain or sexual depravity as motives, saying the bearded doctor was highly dominant and addictive, but his true psyche remains a mystery.
Families wonder how Shipman killed so prolifically and for so long without drawing suspicion, a fact the British Medical Association blamed on "a tragic systems failure".
"We can reassure the public that something of this magnitude will not happen again," said its chairman Ian Bogle, insisting new checks were now in place.
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