The following item was published in the British Dental Journal on 1 April 1914.

The above heading can scarcely fail to excite the surprise, to say nothing of the criticism, of our readers. What can it mean? will probably be asked.

The explanation is that it is the verdict given by a jury on the case of a woman, aged 51, who died ten days after a hypodermic injection of 10 minims of a certain much advertised local anaesthetic which is said to contain under 1 per cent. of cocaine.

According to the evidence, the woman was perfectly well after the injection and extraction of seven teeth; moreover, she was able to go for a bicycle ride of four miles, after which she became ill and ultimately died on the ninth day after the dental operation with its attendant injection of cocaine.

A local doctor, in evidence, stated that he considered the patient's death to be due to “delayed cocaine poisoning,” in spite of the fact that no post-mortem examination was held to exclude many other possible and probable causes of death.

In view of the fact that no such phenomenon as “delayed cocaine poisoning” has hitherto been recorded, we have thought it well to submit the circumstances to one of the most eminent pharmacologists of the day, and his reply is, “Cocaine does not cause delayed cocaine poisoning of this nature, and the patient certainly died from some entirely different cause.”

A reference to Allbutt's “System of Medicine” gives all the literature on the subject, and no suggestion whatever is given of any such phenomenon as in the case alleged to be the cause of death.

It seems very undesirable, to say the least of it, that such an unknown and unprecedented cause of death should have been accepted by the coroner in the absence of an autopsy, and we certainly feel that the dentist who administered the injection so many days before the death took place has been very unfairly treated.

Meanwhile, for the benefit of our professional brethren, we would state that “delayed” cocaine poisoning as a cause of death remains, at any rate, “unproven,” and in the circumstances recorded may be regarded as something approaching an impossibility.

No analysis appears to have been made of what was left of the liquid used for hypodermic injection, which must leave an additional matter of doubt in the minds of those who study this case.