Massengill's Elixir Sulfanilamide: The Scramble to Confiscate (3)

North Carolina

More than 13 gallons of Massengill's Elixir Sulfanilamide, divided mostly in pint bottles, were distributed to 21 drug stores and 3 doctors in 14 different communities. FDA inspectors found that most recipients had returned their stocks to Massengill headquarters in response to the company's telegram requests, before any prescriptions were dispensed [1].

However, in the coastal plain city of Rocky Mount, 6 elixir prescriptions, including those for 3 children, were given out. One prescription was, in fact, dispensed by a physician for his 11-year-old daughter. One mother gave "a dose or two" of the elixir, which was intended for her 4-year-old son, to her 18-month-old child. All prescriptions were taken, most in their entirety (2-4 ounces), without obvious ill effect except for the infrequent report of headache and nausea [1,2].

Additional prescriptions for Massengill's elixir were written by Rocky Mount's Dr. E. [Earnest] M. Perry. FDA inspectors who were assigned to investigate the status of Dr. Perry's treated patients were stonewalled [1].

Dr. Perry claimed he did not know [the patients'] names or make any inquiries as to their identity. He stated he treats many patients for venereal diseases, that they pay cash, and that he keeps no record as to their names or addresses. Because of this unsatisfactory answer a telegram was sent [to] Dr. Perry by the [Atlanta FDA] Station urging him to locate his patients. A similar telegram was sent to the State Health Officer who later contacted [FDA] Inspector Grey, without results. Followup investigation was made by [FDA] Inspector Simms and Grey on November 7 in which all possible sources of information were thoroughly canvassed. Simms reports that, while Perry is a member of the A.M.A., his practice has all the appearance of quackery and he did not appear to be unduly concerned about his patients or worried about any possible publicity which might result if they died. He reiterated previous reports that he keeps no records of these patients and, even though the State law requires reports of venereal cases, he has made only one such case report since September 1st to the State Board of Health, and then only by number, which is permitted. Conferences with the State Board of Health officials were not productive.

Owing to persistent pressure from the state and the FDA, Dr. Perry finally admitted to giving out 4 elixir prescriptions, totalling 18 ounces, beginning in late September. The FDA inspector ultimately determined that 3 prescriptions were consumed without consequence. However, one patient, a 28-year-old school teacher, could not be traced. After canvassing the area that surrounded the woman's alleged home town, 60 miles from Rocky Mount, the inspector was left to conclude that the "school teacher" probably gave a fictitious name at the time of treatment. The mystery patient's status was never determined [1,2].

In nearby Red Oak, the patience of FDA inspectors was tested again, this time by the doddering Dr. J. [John] H. Martin, who had dispensed 8 ounces of the elixir to 24-year-old farmer Charles Richardson of Nashville, North Carolina. After taking 4 ounces, Richardson developed "acute urinary suppression" 2 days before his death, on October 17. Notably the farmer was diagnosed with "acute appendicitis," the symptoms of which were probably confused with elixir-induced abdominal or flank pain [1,3]. Dr. Martin had also dispensed 4 ounces of Massengill's elixir to 59-year-old logger John Thomas Tanner, who began experiencing symptoms of "acute glomerular nephritis" on October 18 [4]. Tanner died 13 days later at Parkview Hospital in Rocky Mount. FDA and state inspectors discovered that at least one other 4-ounce prescription had been dispensed by Dr. Martin. This time, investigation was thwarted not so much by willful resistance, but by apparent mental incapacity:

Repeated visits by [FDA] Inspector Grey to Dr. Martin failed to result in any information as to the patients who had taken the prescription dispensed, until one of the patients, J. T. Tanner, was taken to Parkview Hospital, Rocky Mount, in a dying condition. Even the State Board of Health officials had no satisfactory results from interviewing Martin. Further followup was made on November 7 by [FDA Inspectors] Simms and Grey who report that Martin is over 80 years old, very feeble, and in poor mental condition. His practice consists chiefly of venereal patients and there appears to be no hope of his recalling any of the patients, since he did not keep records of their names or addresses. He is also the local Registrant of births and deaths, and said there had been no recent deaths in his section, but many of his patients came from some distance, and check at the State Board of Health later in the month will be necessary.

A follow-up report indicated "no further progress" on Dr. Martin's patients and little hope of any fruitful developments, given the doctor's "advanced age and condition." Inspectors went so far as to interview the doctor's wife and son, hoping to gather any useful bit of information [1,2].*

Other elixir prescriptions in the state included one in the village of Chadbourn, in Waccamaw Souian territory. A 2-ounce elixir prescription was written for a Betty Hughes. The FDA learned she became nauseated after taking one-half ounce; the remainder of the prescription was duly confiscated [1]. In the Indian Woods township of Bertie County, approximately 1½ ounces of a 4-ounce prescription were consumed by a Linden Gillam. After "some difficulty," the patient was located by the FDA, and the rest of the elixir was seized [1]. On October 7, one-half ounce of elixir was also prescribed by Dr. J. P. Corbett of coastal Swansboro for a 2-month-old baby with ear abscesses and possible meningitis. The baby died of septicemia at Morehead City Hospital on October 8. It was determined later that none of the elixir had been given to the child [1,5,6].

In the state of North Carolina, at least 16 prescriptions were written for Massengill's elixir, and 2 related deaths were confirmed (fatality rate, 12.5%).**

South Carolina

Two doctors, 9 pharmacies, and 1 hospital training school received a cumulative volume of 11 gallons of Massengill's Elixir Sulfanilamide. Seven recipients were located in Charleston, and the remainder were in 5 small towns situated within the state's southern coastal plain. One physician, Alexander S. Blanchard of Williston, received 5 gallons of elixir, and another doctor, Johnston Peeples of Estill, received 1 gallon. Four prescriptions written by Dr. Blanchard, which were either wholly or partially consumed, caused no deaths. However, 7 prescriptions written by Dr. Peeples caused 4 deaths [1].

The deceased patients of Dr. Peeples:

• 16-year-old Susie Mae DeLoach: A 2-3-ounce prescription was dispensed in mid-September for a streptococcal leg infection. Deloach died October 7 in Brunson of "kidney suppression" [7].
• 34-year-old "laborer" Harry Terry died October 14 in Estill of "acute uremia" and "acute nephritis" after consuming 3 ounces of a 4-ounce elixir prescription [8].
• 35-year-old John McDaniel (or J. J. McDanie), of Luray, also died October 14, after taking about 3 ounces of a 4-ounce prescription [9]. 
• Willie Badger (age unknown) died October 18, after consuming about 1½ ounces of elixir. The bottle containing the remainder of Badger's 4-ounce prescription was recovered by FDA inspector M. O. Rentz in the weeds behind Badger's home in Scotia, on October 28 [10].

During his investigation to retrieve every last ounce of elixir in the state, Rentz found Dr. Peeples to be not entirely forthcoming [11].

[A] South Carolina doctor...told the inspector he had dispensed 1 pint 15 fluid ounces to three white patients and two Negroes whose names he did not reveal. He insisted that none of these patients had died. Information acquired by the inspector from other sources showed that the doctor had administered the elixir to seven patients, that three survived, that a white man, a white girl, and two Negro men had died. One of the fatal prescriptions was traced through neighborhood gossip describing the symptoms of the fatal illness of a Negro employee of a lumber mill [John McDaniel]. The inspector recognized the symptoms as characteristic of "elixir" poisoning, and through the mill superintendent found the victim's sister. She remembered that the doctor had given her brother some red medicine about October 2 or 3. She said that, in accordance with their custom, all medicines, glasses, spoons, etc., had been placed on the grave, which was about 1½ miles back in the fields. Accompanied by the Negroes, the inspector walked to the wooded knoll with its single mound of fresh earth on which lay several bottles, dishes, and spoons. One 4-ounce bottle contained about 1 ounce of the "elixir." It bore the weatherbeaten but legible prescription label of the doctor.

In Charleston, 7 prescriptions dispensed by McFalls Pharmacy led to 5 deaths [1,12]:

• 2-year-old Oscar Chisolm was admitted in a "stuporous state" to Charleston's Roper Hospital on September 30. A 2-ounce prescription for Massengill's elixir had been dispensed to the child 6 days earlier for a "sore throat." His blood urea nitrogen (BUN) was 105 mg/dL (normal, 8-23), and his creatinine level was 6 mg/dL (normal, 0.6-1.2). He died 13 hours after admission of "uremia from acute nephritis" [12,13].
• 3-year-old Ella Blanche Washington also died September 30 at Roper Hospital of "uremia" and "acute nephritis." She had received a 3-ounce prescription for the elixir [12,14].
• 37-year-old Pearl Locklair, wife and mother, was admitted to Roper Hospital on September 29 for a "retropharyngeal abscess or tumor." She had been given a 6-ounce prescription for the elixir 5 days earlier. During her hospitalization, she developed anuria and lapsed into a coma. On the day of her death, October 4, her BUN was 135 mg/dL, and her creatinine level was 19.2 mg/dL [12,15].
• On October 11, 10-year-old James Stewart was also admitted to Roper Hospital. He arrived in a "comatose state" and died 21 hours later of "uremia from acute nephritis." He had been ill for 11 days and had been given a 4-ounce prescription for Elixir Sulfanilamide on October 2. On the day of his death, October 12, his BUN was 165 mg/dL, and his creatinine level was 12.4 mg/dL [12,16].
• 39-year-old Ward St. John O'Brien, a cook, "developed dizziness, nausea, epigastric pain and vomiting" on about October 8. Two days later, he was anuric. On the day of his death, October 13, his BUN was 127 mg, and his creatinine level was 13.8 mg/dL. He died at Charleston's Hospital & Training School. It was determined postmortem, that O'Brien had consumed 4 ounces of elixir between October 6 and 8 [12,17]. 

After autopsies were performed on Chisolm, Locklair, and Stewart, "it became apparent to the staff members [of Roper Hospital] that something unusual had been encountered" [12]. While postmortem examinations were expedited, the local health authorities were warned of these possible cases of poisoning; although, it was apparently not known at the time that Chisolm, Locklair, and Stewart had all received prescriptions for Massengill's elixir. Roper physicians then learned that O'Brien, who died elsewhere, had been taking sulfanilamide, and an investigation to determine whether their deceased patients had received the same drug was initiated. Just at that moment, the news story broke of elixir-related deaths in Tulsa, and the common link among the cases was established.

In South Carolina, 19 elixir prescriptions resulted in 9 deaths (fatality rate, 47%). 

* It may have been the mileage, not the years--or Dr. Martin was trying to pull a fast one. The 1920 and 1930 censuses indicate that Dr. Martin was about 69 years of age in 1937.

** It should be noted that 3-year-old Billy Lindsay, of Nashville, died at Parkview Hospital in Rocky Mount on October 12, after consuming one ounce of Massengill's product. However, for some unwritten reason the FDA doubted that death, in this case, was due solely to the elixir. Lindsay's North Carolina death certificate lists the cause of death as "acute nephritis" with the contributory condition of "acute streptococcic tonsillitis." It was not reported who prescribed the elixir for Lindsay.

1. FDA correspondence. Report from J. O. Clarke to P. B. Dunbar. November 17, 1937.

2. FDA correspondence. Letter from J. J. McManus to Chief, Eastern District. November 16, 1937.

3. North Carolina death certificate 41392.

4. North Carolina death certificate 40310.

5. FDA correspondence. Letter from J. J. McManus to Chief, Eastern District. November 19, 1937.

6. North Carolina death certificate 32043.

7. South Carolina death certificate 15420.

8. South Carolina death certificate 19132.

9. South Carolina death certificate 19130.

10. FDA correspondence. W. G. Campbell to George Warren. December 4, 1937.

11. Wallace HA. Report of the Secretary of Agriculture on the deaths due to Elixir-Sulfanilamide-Massengill. November 16, 1937.

12. Lynch KM. Diethylene glycol poisoning in the human. S Med J. 1938;31:134-137.

13. South Carolina death certificate 13400.

14. South Carolina death certificate 13401.

15. South Carolina death certificate 14748.

16. South Carolina death certificate 14750.

17. South Carolina death certificate 14749.