"Dr. Aschendorf's case of alleged death by chloroform—a rare, extant letter written by Snow"

(12 February 1851)

Peter Hodds acquired the following handwritten letter by John Snow to William Bedford Kesteven, and graciously agreed to have it included in the John Snow Archive and Research Companion. Hodds also provided images scans and a preliminary transcription which I (Peter V-J) lightly edited and annotated with his permission.

W. B. Kesteven was a surgeon-apothecary (M.R.C.S.E. 1838; L.S.A. 1837), with premises at 1 Manor Road, Upper Holloway, London. The British Medical Directory (1853) stated that he was formerly the Senior Surgeon at the Holloway and North Islington Dispensary and "author of . . . numerous papers in the Med. Gaz. from 1845 to 1851," the journal containing an article about which Snow comments in the letter.

Aschendorf was court physician and district medical officer for Bentheim (now within Lower Saxony), Kingdom of Hanover in the German Confederation. His article, "Ein Todesfall durch Chloroform," was published in J. L. Casper's Wochenschrift für die gesammte Heilkunde (7 September 1850), 572-74. The London Medical Gazette (LMG) published a short summation that year: "Death from chloroform. Dr. Aschendorf states a child, one year old, had been operated upon for a nævus under the influence of chloroform, with apparent success, when, on the child being removed from the table, its head fell back, and it instantly died in a state of convulsion. The quantity used had been six drops in the first instance, and a second application of three drops in some tow placed in a cup" (29 November 1850), 950.

According to Hodds, the short notation at the top of side one was written by Alfred Swaine Taylor, toxocologist and chemist.

54 Frith St, Soho

12 February 1851

My Dear Sir,

As you have stated that loss of blood has been suggested as the cause of death in Dr Aschendorf's case [see note 1] and thus directed the attention of the reader to that view of it [see note 2], I will not trouble the Editor of the Med. Gaz. [London Medical Gazette with any remarks of mine on the subject.

It is the chronology of the

case that proves that the death was not caused by the chloroform. The child lived 8 minutes after the last three drops of chloroform were put on the tow ["The fibre of flax, hemp, or jute prepared for spinning"--O.E.D.]. These three drops must have been inhaled immediately or not at all for they could not remain in the tow without evaporating, and 8 minutes is long enough for the effects of chloroform on a child to go off entirely two or three times over. The child was probably in a state of collapse from loss of blood for some

time before death, but the surgeon being entirely absorbed in the operation did not notice its condition. At all events they say not a word about it. The blood is supped [soaked] up by sponges during an operation and the quantity which cannot be ascertained is very often greatly underestimated by the surgeon. I have heard the remark that not more than 2 or 3 ounces of blood was lost when the quantity was not less than as many pounds

when in fact the mere coagula of that blood which escaped the sponges would if collected have gone far to filling a pint basin. I don't say that this excessive underestimation is common with good surgeons, but yet it exists.

No operating surgeon who reads Dr Aschendorf's case will think his estimate of the blood lost as at all approaching to the real quantity.

It is quite true that chloroform is capable of causing death "mit blitzahnlichen Schlage" but then it must be on the

instant it is given and not 8 minutes afterwards. Whilst from loss of blood a patient may expire at a subsequent period and especially "on raising" him [having patient sit up or stand after coming out of an anesthetic state].

I would have made these remarks to you when you kindly sent the journal for my inspection, but I was afraid I did not understand that part rightly which refers to the 8 minutes.

I shall probably at a future

time have to make some remarks on alleged deaths from chloroform and will then allude to the case.

Dr Bagot's case which follows the above in the Med. Gaz. is one of aggravated hysteria. I have seen a similar one in which however the chloroform had not been given by myself.

I remain,

Yours very truly

John Snow

W. P. Kesteven

___________

1. LMG published a translation/detailed summation of Aschendorf's article in its section on "Selections from Journals," to "enable our readers to judge how far death was attributable to the poisonous influence of chloroform" (7 February 1851), 261–62.

2. "We regret that want of space compels us to postpone various communications which are in type, including those of . . . Mr. Kesteven" (21 February 1851), 352; the journal never published Kesteven's letter, however. Kesteven apparently offered an alternative to the editors' comment, "We can arrive at no other conclusion than that of Dr. Aschendorf, that the chloroform, like a lightning-stroke (mit Blitzähnlichen Schlage), paralyzed the heart's action, and thus destroyed life" (262).