Massengill's Elixir Sulfanilamide: More Deaths in the Deep South

By Saturday, October 23, an understanding of the distribution of deaths due to Massengill's Elixir Sulfanilamide was emerging. The AMA's Morris Fishbein now confirmed the toll at 36.* Five citizens of another Mississippi community, about 10 miles from Mt. Olive, were dead [1,2,3]:

• Claiborne L. Anderson, 37, from Laurel died October 4 of "nephritis." He had consumed 2¾ ounces of the elixir.
• Albert Cole, 19, from Laurel died October 5 of "acute nephritis." The amount he consumed was unknown.
• Robert A. Boutwell, 27, from nearby Ellisville died October 10 of "nephritis." The amount he consumed was unknown.
• James Monroe Vick, 53, from Ellisville died October 20 of "carcinoma of gallbladder and stomach." The amount he consumed was unknown.
• Emmett (or possibly Era) Pickens, age unknown, of Laurel died October 24 of "complications." One ounce of elixir had been consumed.

Other elixir-related deaths in Mississippi were reported in Magee (Hettie Young, 18, died October 5) and Philadelphia (Lorene Lewis, age unknown, died October 20). A town along the southern border of Georgia and Alabama, Eufaula, counted 3 deaths: a baby (possibly Syble G. Singleton), who died in September (date unknown); Fannie Zeanah (age unknown), who died October 13; and Alfred McDade (age unknown), who died October 17. In nearby Headland, Alabama, Anderson Crews (or Cruce), 63, died September 25. And Texas confirmed 1 death: Levi (or Levy) Kelly, 19, died October 12 in Marlin [2,3]. An elixir-related death was also suspected in California.

Laurel physician Joe Green had prescribed Massengill's Elixir Sulfanilamide for the 5 patients who died in his hometown or in nearby Ellisville, Mississippi. In a lengthy statement to the local newspaper, he reserved final judgment on the cause of the deaths—possibly due, in part, to the influence of his local Massengill rep [2]:

It is more than possible that elixir of sulfanilamide played a part in the death of five patients...This drug was prescribed by me for some fourteen or fifteen people, all of whom were sick and some desperately sick. Five of the patients who took the elixir have died and it is more than possible that the drug played a part in their demise...Only a small amount of the elixir was taken and the people that died, with possibly one exception, had diseases that could prove fatal.

The other people who took it suffered no ill effects. One small baby about two years old had a rather large amount. Yet she suffered no ill effects and her family was highly pleased with the results obtained...Some five or six people were given the elixir 12 to 30 days ago and none suffered ill effects and are all right at the present time.

In a show of quaint transparency, Dr. Green added,

We want it strictly understood, and have so informed the families where there is a possibility that injury has been done, that my files are absolutely at their disposal. All records are just as they were written and are open to public officials as well as to the families.

Dr. Green, who had received samples of the elixir from his Massengill sales rep during a regular visit, was later informed that the elixir had been recalled. According to Green, the rep claimed that "up to the present time best chemists of the American Medical Association and the company were making a close and thorough investigation, but so far had not been able to determine what poison, if any, caused death of the alleged victims." The company also expected to visit every family "which felt that the drug had injured their relatives." For what it was worth, the local Massengill rep absolved doctors and druggists of any "ill effects" from the elixir [2].

Massengill's rep also had news of a telegram from the AMA, which reported "no chemical antidote for sulfanilamide poisoning [emphasis added]" [2].

In point of fact, the Massengill company had sent the following telegram to the AMA on October 20, asking for an antidote to its product [4]:

PLEASE WIRE COLLECT BY WESTERN UNION SUGGESTION FOR ANTIDOTE AND TREATMENT FOLLOWING ELIXIR SULFANILAMIDE

And the AMA responded in terse fashion [4]:

ANTIDOTE FOR ELIXIR SULFANILAMIDE-MASSENGILL NOT KNOWN TREATMENT PRESUMABLY SYMPTOMATIC

In an attempt to exonerate his company, Dr. Massengill issued his first public statement on October 23, regarding the "unfortunate elixir sulfanilamide affair" [5]. Massengill's apparent strategy was to implicate the toxicity of sulfanilamide, while avoiding the subject of diethylene glycol altogether.

My chemists and I deeply regret the fatal results, but there was no error in the manufacture of the product. We have been supplying legitimate professional demand and not once could have foreseen the unlooked for results. I do not feel that there was any responsibility on our part. The chemical sulfanilamide had been approved for use and had been use in large quantities in other forms, and now its many bad effects are developing.

Perhaps most of the unfair statements have been given out from two sources that are willing to capitalize on this tragic occurrence to further their certain ends.

Dr. Massengill declined to name the "two sources" to the Associated Press.

* One death reported by news sources in Hutchinson, Kansas, has not been found in government records or reports in from the AMA.

1. Associated Press. Sulfanilamide elixir deaths increase to 36. St. Louis Post-Dispatch. October 23, 1937; p 3A.

2. Elixir of Sulfanilamide may have played part in deaths of five, states local doctor. The Laurel Leader-Call. October 25, 1937; p 1, col 1, 2.

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

4. Survey of deaths. J Am Med Assoc. 1937;109:1539. By telegraph, the AMA had solicited treatment recommendations for diethylene glycol poisoning from those few individuals (E. K. Marshall, Jr., W. F. von Oettingen, and P. J. Hanzlik) who had studied the toxic effects of the substance. They could only recommend trials of intravenous concentrated dextrose solutions.

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