Nurse killed to be centre of attention: Beverly Allitt may have harmed patients to make herself the heroine of each crisis. Reports by Jonathan Foster

THE PICTURE of a perfect nurse, Beverly Allitt, smiles broadly in the photograph taken on Ward 4. She fills the frame and, from her cap to her shoes, every stitch declares she is a nurse, familiar and affectionate.

Nearly two years later, the Beverly Allitt who appeared in the dock at Nottingham Crown Court reflected the terrible inner woman. Anorexia nervosa had reduced her, exaggerated her bone structure, replaced that trustworthy plumpness with a skeletal wildness.

Allitt comes from Corby Glen, a village near Grantham in Lincolnshire, picturesque in sunlight, forbidding in winter. She grew up in a terraced house. A school photograph shows her, pretty and blonde, smiling for the camera, hands behind her back.

She trained to be a nurse at Grantham and Kesteven General Hospital. What had hatched in her mind was clearly well-developed by the time Allitt began there. She was at the hospital 58 days before the police came on 30 April 1991, and the attacks, 26 in all, were by then more frequent and vicious.

Allitt may be suffering from a form of the rare condition of Munchhausen syndrome by proxy, the condition where mothers deliberately harm or injure their own children in a grotesque desire for attention.

Dr Christopher Cordess, a consultant forensic psychiatrist, reports a rise recently in referrals of mothers suffering from MSP in Britain. That may indicate real growth of a syndrome first identified in the late 1970s but is more probably due to increased awareness. American doctors believe greater vigilance has brought about an increase in prosecutions of medical serial murders in the US.

Dr Cordess believes the minds of MSP sufferers are split. However strong the evidence, sufferers refuse to admit their actions, even to themselves. They seem to enjoy the excitement and attention generated through manufactured emergencies and the opportunity for apparent heroism. Dr Cordess said: 'There are usually prior abnormalities in their lives, development and their psychological state.'

Dr Derek Perkins, director of psychological services at Broadmoor, likens Munchhausen's behaviour to an arsonist who starts a fire then hovers round 'helping' or starring as a hero in the panic that follows.

Allitt's attacks were launched out of nowhere. Some of the children were sick, some were well enough to go home. She, almost invariably, raised the alarm. The ward was virtually a field hospital in Allitt's war with herself. Instead of being one of a number of nurses, Allitt would be the centre of attention.

There is little evidence in Corby Glen that Allitt craved attention, but Corby Glen is not the sort of community that could satisfy such an intense craving. Any clues are hidden in her confidential medical records. It is known that, when she was wandering Ward 4 with a mind to kill, she was not seeing the family doctor. Once she had been charged in November 1991, she began the deterioration which was to lead her to anorexia and confinement on remand at Rampton special hospital.

Was Allitt suffering from Munchhausen syndrome by proxy? If so, there were two components: making a patient ill; and distressing the doctor investigating puzzling symptoms. And if Allitt is a classic Munchhausen, her medical notes may reveal that she fabricated illness in herself; she may even attempt to poison herself.

For most of the trial Allitt was absent, ill in hospital. For all of it, the most illuminating glimpse of her was a fine chain she wore around her neck. On the end of it, pulled out to hang over her sweater, was the little bar on which nurses hang their watch. She still affected to be a nurse.

And when she had tiptoed through the ward, ampoules of murderous medication within reach, she craved the kudos awarded the good nurse, and concocted some heart-stopping agony for a tiny body that would give her a quality of mercy.

(Photographs omitted)