"The fatal chloroform case at Newcastle"

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To the Editor of the Lancet

Sir,--The recent fatal case of inhalation of chloroform appears to confirm in a melancholy manner the remarks contained in my paper in the Lancet of the 12th instant, respecting the danger arising from the cumulative property of the agent when administered on a handkerchief. The alarming symptoms came on after the cloth with chloroform was removed from the patient's face. Some of Dr. Simpson's observations on this case confirm the view I have taken. He says--"I have seen in a few cases such a blanched state of the lips and features come on, under the use of very powerful and deep doses of chloroform, stimulating syncope, and with the respiration temporarily suspended." It may be presumed, that the cases Dr. Simpson has seen were under his immediate superintendence; and this makes the danger still more evident; for if any one could prevent his patient from getting into a state which cannot be looked on therwise than as one of imminent peril, it would be the authority who introduced the agent, and recommended this method of its administration.

On January 10th, two days after I read the remarks at the Westminster Medical Society, respecting the effects of chloroform increasing after the inhalation was left off, M. Sédillot related, in the Academy of Sciences of Paris, that he had observed the pallor, smallness of pulse, feebleness of respiration, and coldness, to augment in an alarming manner after the employment of the chloroform had been discontinued. His observations were reported in the Gazette Médicale of January 15th.

I agree with Dr. Simpson, that it was not advisable to give brandy, or even water--the more so, as I do not think with him that there was syncope; but that these liquids caused suffocation, filling up the pharynx, and being partially drawn into the larynx, seems improbable. This question, however, can be only determined by those who observed the symptoms at the time of death, and the nature of the froth found in the bronchi afterwards, as there is nothing in the reported evidence of the appearances on dissection which might not be caused by the kind of asphyxia liable to be induced when the effects of chloroform are carried too far; and these appearances are quite incompatible with Dr. Simpson's supposition that there was syncope. Preventing the recovery from syncope would not cause the state of the heart and lungs, which is characteristic of the opposite kind of death--that by asphyxia. In a certain number of those who are drowned, the heart and lungs are not congested, but the contrary, and it is believed by medical jurists, that those persons have fainted on falling into the water.--I remain, Sir, your obedient servant,

John Snow.

Frith-street, Soho.