Massengill's Elixir Sulfanilamide: The Scramble to Confiscate (5)

Tennessee

In Massengill's home state, 17½ gallons were distributed to 35 drug vendors and 10 doctors' offices in 25 communities. One gallon was shipped to the Fox Drug Company in Memphis, and another 4 establishments in Nashville received a cumulative total of 19 pints. The remaining elixir stocks were distributed mostly to roadside towns, along the Appalachian corridor. Curiously no elixir stocks were sent to drug stores or physicians' offices in Bristol, the company's headquarters [1].

In addition to gas-station attendant Charles W. Miller, 25, who died October 20 in Memphis of elixir poisoning, the FDA discovered that at least 3 other Tennessee residents succumbed* [1]:

• Horace Williams (age unknown), of Sevierville, died October 12 after receiving a 3-ounce prescription from his local physician.
• "Colored" butcher William E. Kyte, 38, died October 17 at Knoxville General Hospital after receiving a 4-ounce prescription. Kyte went to a Knoxville drug store on October 7 and asked "for some of that new medicine." The pharmacist advised Kyte to consult a physician, and Kyte obtained the following prescription from Dr. E. L. Lennon, whose office was located above the drug store: "4 Oz. Liquid Sulphanilamide — dose: 1 teaspoonful in a little water every four hours." On October 12, Kyte returned to Lennon's office, complaining of vomiting and stomach pain, whereupon the doctor advised Kyte to discontinue the medicine and wrote a different prescription, which "did not include" Elixir Sulfanilamide. Kyte died 5 days later of "terminal uremia" [2].
• Charles Merideth (age unknown), of Cleveland, died October 24 after receiving a 4-ounce prescription. He had consumed approximately 2 ounces.

Diverting from national coverage, the Bristol, Tennessee, newspapers couched stories of the elixir-related deaths in generalities and implicated sulfanilamide as the cause. On October 19, the Bristol News Bullein declared, "Strong Drug Is Recalled: Sulfanilamide Valuable But Not To Be Used Without Prescription Physician[sic]." Only the first 3 paragraphs of the widely distributed Associated Press story were printed by the paper, thereby deleting Morris Fishbein's warnings about diethylene glycol [3]. Two days later, the Bristol paper printed several abbreviated AP stories, which reported the deaths of Charles Miller in Memphis, the Reverend Byrd in Knoxville, and 2 other Mississippians, under the umbrella headline, "Sulfanilamide Deaths Rising" [4]. Again references to diethylene glycol were omitted, and the over-the-counter sale of elixir was "rapped."

One week after Fishbein publicly identified the toxic ingredient in Massengill's elixir, the Bristol Herald Courier, on October 26, implied that the cause of the deaths remained a mystery. The paper printed the brief article, "Key to Elixir Deaths Sought," on page 3 [5].

While federal and state authorities investigated over a score of deaths of users of a proprietary elixir of sulfanilamide, the American Medical Association, whose "Journal," in an article by Dr. Morris Fishbein, had previously warned doctors to exercise caution in the use of the new commercial drug, is continuing tests to determine the toxicity of the preparation. 

Although an unignorable presence in the city, Massengill's company, as the elixir manufacturer, was not identified by the Bristol press, despite the fact that Dr. Massengill expressed no culpability in the deaths to the AP on October 23 [6]. 

In Tennessee, a total of 20 prescriptions for Massengill's elixir were dispensed,** and 3 purchases were made over the counter (all from the Fox Drug Company in Memphis). As a consequence, 4 Tennesseans died (fatality rate, 17%).

Ohio

Along with Tennessee, the state of Ohio was the purview of the FDA's Cincinnati Station. A total of 17 pints of Elixir Sulfanilamide were distributed to 9 physicians, 4 drug vendors, and 1 hospital in 13 communities. However, only 3 prescriptions were written [1].

In Coldwater, 3 ounces were dispensed for a child with "bad coughing spells." On instruction from the prescribing physician, the patient's mother "destroyed" the remaining elixir, after the patient had consumed about 2 ounces.

In Middleport, 3 ounces were dispensed on prescription to an unnamed patient, who consumed the entire amount without ill effects.

In the farming township of Copley, Dr. Homer G. Long prescribed 2 ounces of elixir for 6-year-old Jo Anne Cramer, who had a "mild case" of scarlet fever. The FDA described the events leading to the prescription [1]:

Dr. Long had successfully treated a boy with the same condition with tablets of sulfanilamide. Massengill's salesman visited Dr. Long on October 7, and Dr. Long told him that he wished he had a liquid preparation of sulfanilamide, as Jo Ann Cramer, his patient, had difficulty swallowing tablets. The salesman gave him a 2 oz. sample, which was administered, 1 oz. on Oct. 9 with instructions to take a teaspoonful every four hours.

Jo Anne Cramer was admitted to the children's hospital in Akron on October 12. She became stuporous and died of "uremic poisoning" 5 days later—2 days before Dr. Long received Massengill's recall telegram [7,8]. The FDA confiscated the remainder of Dr. Long's elixir sample on October 22. Akron's Beacon Journal described the anguish of Jo Anne's mother [8].

Mrs. Cramer, mother of five children, was near collapse when she learned that the medicine which Jo Anne rebelled against was the cause of her death.

"She cried every time she had to take a dose of it," the mother sobbed. "She would say, 'Mamma, I hate that medicine, but if you say I must take it, I will.'

"I try to think that I gave it to her unknowingly, but that doesn't bring her back. She might still be alive if I hadn't made her take it.

"I keep thinking how she used to sit up in her bed with her teddy bear and make it squeak and call to me, Mamma, now it sounds just like it was saying Bob White, doesn't it?'"

In Ohio, 3 elixir prescriptions were dispensed, causing 1 death.

* "Baby" Thompson, of La Follette, died October 9 after receiving a 2-pounce prescription; however, per the FDA, "[A]ll evidence indicates that this patient did not die as a result of Elixir Sulphanildamide."

** One woman received an initial prescription and a refill prescription. She consumed a total of 11 ounces of Massengill's elixir and survived.

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

2. FDA correspondence. Letter from P. B. Dunbar to Lindsay, Young & Atkins. January 7, 1938.

3. Associated Press. Strong drug is recalled: sulfanilamide valuable but not to be used without prescription physician. Bristol News Bulletin. October 19, 1937; p 1 col 8.

4. Associated Press. Sulfanilamide deaths rising: minister died at Knoxville, filling station attendant at Memphis. Bristol News Bulletin. October 21, 1937; p 1 col 6-7; p 2 col 3.

5. Key to elixir deaths sought. Bristol Herald Courier. October 26, 1937; p 3 col 4. 

6. Associated Press. Elixir Sulfanilamide manufacturer disclaims responsibility. St. Louis Post-Dispatch. October 24, 1937; p 9A.

7. Ohio death certificate 65583.

8. FDA newspaper clippings. Roundup of fatal remedy is too late to save child. Beacon Journal. October 26, 1937.

Photograph of East Tennessee roadside foliage, overgrown with kudzu, from Flickr.