An unexplained death: Hannah Greener and chloroform.

HANNAH Greener of Winlaton, near Newcastle in the United Kingdom, died more than 150 yr ago, on January 28, 1848, after receiving a chloroform anesthetic for the removal of a toenail. She was a healthy 15-yr-old girl who had successfully undergone an anesthetic with diethyl ether several months before for the removal of another toenail. Hers was the first death (fig. 1) attributed to the new and wondrous blessing of anesthesia for surgical pain relief. Various authors have ascribed her death to an anesthetic overdose, aspiration of the water and brandy used in attempts to resuscitate her, or some combination of secondary complications that will never be determined. During the past century and a half, understanding of the etiology of perioperative deaths has increased remarkably. What can be learned from another analysis of the facts surrounding the death of Hannah Greener? Is pulmonary aspiration as the proximal cause of her death a realistic possibility? Did she receive an overdose of chloroform as many of the contemporary physicians argued, or using our 21st-century knowledge, is there a better explanation of her untimely death?