Two fatalities associated with chloroform inhalation. Variation of toxicological and pathological findings

We report a forced double suicide involving a wife and husband in their late 80s resulting from chloroform inhalation. Macro- and microscopic examinations revealed marked pulmonary edema and extensive contraction band necrosis of the cardiac muscles. Toxicological analysis revealed high levels of chloroform in the blood (41.4 μg/ml in the wife and 29.1 μg/ml in the husband) and in the adipose tissue (128 μg/g in the wife and 131 μg/g in the husband). From these findings, we conclude that the cause of death of both was acute heart failure due to chloroform poisoning. In addition, the pathological examination of the husband revealed submucosal hemorrhage at the root of the tongue and trachea, erosion of the stomach, and upper jejunum, none of which were present in the wife. Furthermore, hyperemia of the mucous membrane of the husband was more marked than that of the wife. Toxicological analysis also revealed that the chloroform levels in the liver and brain of the husband were higher than those of the wife, although the chloroform level in the blood of the husband was lower than that of the wife. We presume that the wife may have inhaled a greater amount of chloroform, and that the wife's circulation may have arrested before irritation of the mucous membranes became apparent. The husband may have inhaled a smaller amount of chloroform in longer duration, leading to irritation of the mucous membranes prior to the fatal heart failure. These findings suggest that toxicological and pathological outcomes of chloroform poisoning may vary between patients, and that they may reflect the dose and duration of chloroform inhalation.