A 44-year-old healthy alcoholic had been taking 0.5 g of disulfiram daily for 8 weeks. On day 1 he drank a “quart” of whisky, was arrested for drunkenness and released. On day 2 he drank a “pint” of whisky prior to his appearance in court where he fainted and was brought to the hospital emergency ward. Half an hour later he complained of crushing retrosternal pain, and 2 hr later cardiac arrest occurred suddenly. An electrocardiogram taken at the time of admission showed changes which were interpreted as acute anteroseptal myocardial infarction. But at autopsy both the coronary arteries and the myocardium appeared normal. The stomach contained 100 ml of fluid which smelled strongly of alcohol; the liver was normal; no signs of uncal or cerebellar herniation were observed; blood obtained 2 hr after death contained 3.6 mg of acetaldehyde and 50 mg of ethanol per 100 ml. The literature on deaths resulting from the disulfiram—alcohol reaction is reviewed, and measures to prevent such deaths are suggested.