[Correspondence] Thirlwall, Bier's spots, and the Letby murders

The Thirlwall Inquiry1 was set up to examine events at the Countess of Chester Hospital (Chester, UK) and their implications following convictions for murder and attempted murder of babies by nurse Lucy Letby. The inquiry's terms of reference are mainly about the needs of bereaved parents and hospital safety;1 both are important, but are secondary to the prevention of the murders that led to such needs. When babies continue to die unexpectedly and clinical and postmortem explanations are uncerta