Elixir of Sulfanilamide: Deaths in Georgia

Brief newspaper reports of national deaths due to Elixir of Sulfanilamide prompted the FDA's Atlanta Station Chief, John J. McManus, to send veteran inspector Lewis A. Smith to survey Georgia's capital city on October 19 (for background on the FDA's initial investigation in the Southeast, see Deaths in Florida). There Lewis found that several lots of the elixir, 15 pints in total, had been returned intact by 3 Atlanta jobbers that very day to Massengill's company headquarters in Bristol, Tennessee.

But shortly thereafter, Smith also learned of a possible elixir-related death in the state. Word of the fatality and a shipment of the elixir to a doctor in McDonough, a rural town about 30 miles southeast of Atlanta, came to Inspector Smith from the local branch of a Baltimore-based drug company. One of the company's physician customers, Dr. Robert V. Brandon, 26, had left a gallon bottle of Massengill's product with the branch for analysis. The company then turned the elixir bottle over to Smith, who discovered that 2 ounces were missing.

There were other Georgians who also wanted Massengill's product chemically examined. On the morning of October 20, the FDA's Atlanta Station received a disturbing report from the State Drug Inspector. Lawyers from Griffin, about 40 miles south of Atlanta, had contacted state laboratory officials, asking where they "could get some medicine analyzed in connection with a damage suit." The attorneys had the remainder of a prescription for Elixir of Sulfanilamide, two thirds of which had been taken by Leonard Dees, a 22-year-old African American who had died 2 days earlier. The lawyers also possessed "the stomach, liver and kidneys of the victim," which they had left with the state official for "safe keeping and possible analysis." The FDA immediately contacted one of the inquiring lawyers at the State Inspector's office in Atlanta. A half-hour later, the Atlanta Station received an airmail letter from the Eastern District's office in New York, which itemized elixir shipments to the area.

From this communique, McManus learned that more than 21 gallons of Massengill's product had been shipped to 83 drug vendors or physicians among 60 different communities in Georgia—most of which were small towns scattered about the northwest part of the state or along the South Carolina border (for a map of the distribution of elixir in Georgia, go here). Unfortunately McManus received little help from Georgia officials in the urgent effort to confiscate Elixir of Sulfanilamide. The state's Chief Drug Inspector, Jackson Evans Bush, said he could spare only 2 of his men, who only had time to visit about 15 of the 83 druggists. Consequently McManus mustered 2 of the FDA's chemical analysts, in addition to 2 junior inspectors, to cover the rest of the state.

Analyst Arthur M. Henry, a 49-year-old Floridian, was sent to northern Georgia, and Analyst Clarence D. Schiffman, a 33-year-old North Carolinian, was sent to northeast Georgia. These men would complement the investigations of Inspector Smith, a native South Carolinian; Assistant Inspector Wiley H. Simms, a 47-year-old Georgian, who was recalled from downstate; and Allan E. Rayfield, a Junior Sea Food Inspector, who was to proceed to Savannah after covering the Jacksonville area in Florida. The Eastern District's Principal Inspector, "Ollie" Olson, who arrived in Georgia on October 21, would fill in on a much-needed ad-hoc basis. 

In their "race against death," as declared by The Atlanta Constitution on October 24, the FDA men learned that 55 of the 83 shipments had been returned intact to the manufacturer or Massengill's salesmen. But they also learned that at least 2 dozen prescriptions for Elixir of Sulfanilamide had been written in Georgia. In addition, it appeared that several individuals had obtained the elixir over the counter from their local druggists. McManus told the newspaper, "The extreme danger seems to be to those people in rural vicinities who purchased the drug and cannot be located now. We have agents in all parts of the state trying to locate those prescriptions." On October 27, the city paper reported 6 elixir-related deaths in Georgia; however, the FDA's investigation—which was to be stymied by dispensing druggists and prescribing physicians—was far from complete, and more deaths would be discovered in Georgia.

Elixir-related deaths in Georgia (11 confirmed; 2 possible)

Ewell Daughtrey (or Daughtry), 32, a railroad foreman from Dillard, Alabama, died September 26 at the Atlantic Coast Line Railroad Hospital in Waycross, Georgia. Exactly 1 month later, the Atlanta Constitution reported a suspected elixir-related death at Waycross. But the hospital's chief of staff publicly denied the report, because the man—who was, nevertheless, believed to have died of poisoning—had not received sulfanilamide "in any form" while an inpatient. Inspector Rayfield traveled to Waycross on the night of October 25 to investigate.

Obtaining access to the hospital records, Rayfield learned that Daughtrey had been transferred in critical condition from a hospital in Troy, Alabama, to Waycross, some 200 miles east, on September 23rd. The working diagnosis: Bright's disease. When Daughtrey arrived at the medical facility in southwest Georgia at 4:55 am, he was comatose and essentially anuric. The admitting physicians detected uremia (the NPN level was 100 mg/dL) and an elevated creatinine level (at 5 mg/dL). Poisoning with bichloride of mercury, a traditional treatment for syphilis (before the advent of sulfanilamide), was suspected. This presumptive diagnosis was made, despite the fact that there was no recent history of the use of bichloride of mercury. In-house treatment at Waycross consisted of "hot packs in an effort to rid blood of poison thru skin pores." Heroic, but futile, efforts were also made by one physician, who "ran tubes all the way to kidney and with syringes could not obtain any urine." The hospital staff found Daughtrey's case "very odd" and one in which they "gave their interest and professional skill." Nevertheless the patient died 3 days after hospital admission, on September 26th, and an autopsy showed that the kidneys were "perhaps an unusual deep red in color." Working in concert with the FDA's New Orleans Station (which covered Alabama), the FDA was able to piece together the following medical history.

Daughtrey was first treated in late August for "a mild case of gonorrhea" with sulfanilamide tablets by Dr. A. D. Matthews of Ariton, Alabama. He then sought treatment for continued or recurrent infection on September 16 from Dr. J. S. Tillman of Clio, Alabama, who prescribed 2 ounces of Elixir of Sulfanilamide. (Daughtrey was, therefore, one of the first victims of Elixir of Sulfanilamide—along with fellow Alabamans Johnay Holloway and Anderson Crews—to receive a prescription for the product.) Because of Daughtrey's clinical deterioration during the next few days, including the onset of oliguria, Drs. Matthews and Tillman referred their patient to Dr. Robert Beard, a railroad-company physician, who hospitalized Daughtrey on September 22 in Troy, Alabama. Dr. Beard diagnosed "congestion of the kidney" by means of an abdominal radiograph. He also detected white blood cells and renal casts in Daughtrey's urine, 4 ounces of which were obtained by means of catheterization. The urinary findings indicated inflammation and probable kidney disease. Daughtrey was then transferred to Waycross for critical care.

The FDA reported that Drs. Tillman, Matthews, and Beard, Daughtrey's Alabama physicians, "are of the finest type of professional men, and have excellent reputations ethically and scientifically." While Dr. Tilliman believed that Daughtrey's nephritis could have been caused by gonorrhea, he conceded that it was probably aggravated by Elixir of Sulfanilamide. The FDA let the chronology of events speak for itself.

* In the mid-20th century, the use of the NPN level, a measurement of urea and related compounds in the blood and an indicator of renal insufficiency, was supplanted by use of the blood urea nitrogen (BUN) level (see Dunea G, Freedman P. The nonprotein nitrogen level of the blood in renal disease. JAMA. 1968;203:1125-1126).

Jewell Fitts, a 36-year-old post office clerk from Dahlonega, died October 5 at Downey Hospital in Gainesville. Assigned to investigate the territory of northern Georgia, Analyst Henry was, at first, stonewalled by Dahlonega's "extremely irascible" 69-year-old physician, Dr. Samuel A. West, who had received 1 pint of the elixir. Henry's interviews with West on October 22 and 26 produced only sketchy information about prescriptions for the elixir and the doctor's potential victims. Undeterred, the FDA agent continued his investigation by "gossiping with natives," who revealed that Jewell Fitts had, in fact, obtained Elixir of Sulfanilamide from Dr. West. Henry then interviewed the attending physician of the local hospital, Dr. John K. Burns, 42, who described how Fitts had been admitted to the hospital on September 29 for "kidney lock."

Dr. Burns told Henry that, during 6 days of hospitalization, Fitts had passed less than 1 ounce of urine. After learning of the toxicity of Massengill's product (which Dr. West had indeed prescribed to Fitts for gonorrhea), Burns urged the older physician to inform the victim's family. But West "refused to do so, saying it would ruin his practice."

Fitts was buried in Mount Hope Cemetery in Dahlonega.

Betty Louise Satterfield, a 3-year-old girl from Greensboro, died October 7.* FDA inspectors Rayfield and Olson, along with a state inspector, learned that the child had first been seen on October 1 by Dr. Goodwin Gheesling, 48, who diagnosed erysipelas of the right leg. Gheesling initially recommended local therapy, consisting of ichthyol ointment, lanolin, and Vaseline; but he also prescribed systemic therapy in the form of 4 ounces of Elixir of Sulfanilamide, 1 teaspoonful "in a little water" every 3 hours. To address the girl's "chest involvement" and low-grade fever, Gheesling offered phenactin (a now-defunct antipyretic), aspirin, and cocoa-flavored quinine—the latter as treatment for possible malaria.

On October 4, young Betty was brought to Gheesling's office, where "he found the chest involvement seriously complicated." The girl's respiratory rate was "much accelerated," and her temperature exceeded 102 degrees Fahrenheit. Prescriptions dispensed at this time were Calcidine, a branded calcium-iodine preparation for laryngitis; syrup of ipecac; and concillana, a cough syrup.

Gheesling made a house call the following day and found that the erysipelas had improved, but that "all the other conditions" were "aggravated." Prescribed treatments at this time reflected the direness of the girl's condition: atropine sulfate, presumably to stimulate the heart rate; elixir lactated pepsin, presumably for some type of gastrointestinal disturbance; morphine sulfate for pain; and soothing peppermint water.

On October 6, Gheesling found the child cyanotic and in a semicomatose condition. The next day, cyanosis was "completely developed," and the child was "fully" comatose. She died on the afternoon of October 7, reported the FDA; death occurred presumably at her home.

Gheesling listed the official causes of death as pneumonia and septicemia. Although the FDA apparently did not question the contribution of Massengill's elixir to the girl's death, Gheesling was "quite sure that there was no kidney involvement nor suppression of urine."

The girl was buried in Shiloh Cemetery in Penfield.

* There is disagreement between the Georgia death records and the FDA records regarding Satterfield's date of death. State death records indicate that the child died October 6; FDA records provide the date of death as October 7.

Luther N. Gillham (or Gilham), a 29-year-old man from Porterdale, died October 8 at a Covington hospital. During the first visit to Cannon's Drug Store in Porterdale on October 21, FDA Inspector Simms learned that a 4-ounce prescription had been dispensed from a 1-pint bottle of Massengill's antibiotic elixir (the remainder of which had already been returned to company headquarters in Bristol). Simms directed the druggist to contact the prescribing doctor to ensure that the medication was discontinued.

For unclear reasons, the agency's follow-up of this prescription was not performed until November 2, when FDA Inspector Smith visited the drug store. To what must have been his surprise, Smith found no record of the reported elixir prescription at Cannon's; however, he noted that a prescription was missing from the chronologic records for the date of October 1. After "some denials," the druggist finally admitted to Smith that Dr. Jackson C. Loveless, 46, whose office was at the rear of the drug store, had written a 4-ounce elixir prescription for Gillham on October 1.

Dr. Loveless then admitted to Smith that Gillham had visited his office on September 23 with "a very evident pronounced case of gonorrhea." The doctor prescribed a water-based concoction of zinc sulphate, lead acetate, colorless hydrastis (the herb goldenseal), and bismouth subnitrate, which was to be injected (presumably by way of a penis syringe). About a week later, however, on October 1, Gillham again presented to the doctor, who then prescribed Elixir of Sulfanilamide—which had just been received by Cannon's Drug Store from the Massengill Company in Bristol.

Dr. Loveless also admitted that he had taken the record for the elixir prescription from the drug store files. Evidently frightened of being associated with a prescription for Elixir of Sulfanilamide (given the recent national publicity) but apparently even more frightened of a government inspector, Loveless offered to return the prescription record to the drug store. He furthermore admitted that Gillham had died, and that his patient had received subsequent treatment from Dr. W. W. Baxley, also of Porterdale.

With Loveless in tow, Smith proceeded to interview Dr. Baxley, who revealed that he had been first called to Gillham's home on October 4, when he "found the patient suffering considerable pains about the kidneys." He attributed the symptoms to progressive gonorrhea. Unaware that Dr. Loveless had prescribed Elixir of Sulfanilamide, Baxley recommended sulfanilamide tablets as treatment, along with capsules containing caffeine, citrate, acetophenetidin (phenacitin), and acetylsalicylic acid (aspirin). Baxley also administered a "hypodermic of morphine" to "ease the severe pain."

Baxley revisited Gillham on October 5, at which time the patient complained of nausea and vomiting. Gillham also claimed that he had not passed any urine. Baxley then prescribed sodium bromide, elixir phenobarbital, and liquid taka-diastase, a digestion aid. The next day, Baxley found Gillham to be delirious and febrile, and the patient remained anuric; 24 hours later, Gillham was comatose. On the morning of October 7, Baxley admitted Gillham to the Huson (or Hudson) Memorial Hospital in Covington, where the patient received a liter of glucose and a half liter of saline intravenously. Gillham died the following day; the cause was attributed to nephritis.

When Inspector Smith interviewed Baxley, the physician was surprised to learn that his patient had been given Elixir of Sulfanilamide. "It was the first he had heard of it," the FDA agent reported. Baxley suspected that the product killed his patient: "I might say that this man's symptoms were strikingly similar to cases reported who had died taking [Elixir of Sulfanilamide]," he told the agent. After the FDA interview, Baxley proceeded to Gillham's house in an attempt to locate the remaining elixir; but, he learned, all of Gillham's medicine bottles had been "broken and buried."

Herman Bolton, a 34-year-old* taxi driver from Millen, died October 16 in a local hospital. On October 22, FDA Inspectors Rayfield and Olson visited Bell's Drug Store, which had received 1 gallon of the elixir. The store manager, Mr. Seaborn Crawford Bell (son of the owner, Henry Quinn Bell), assured the inspectors that no sales of the product had been made from the store, and that the gallon had been returned intact to the manufacturer on October 18 "via express." Examination of the store's prescription files supported the contention.

However, FDA inspector Ford, stationed in Bristol, found that only 7 pints and 10 ounces had been returned from Bell's Drug Store, leaving 6 ounces unaccounted for. Inspector Rayfield returned to the Millen drug store on October 28, when Mr. Bell again reassured the agent, by way of affidavit no less, that no elixir had been dispensed. Bell did admit, however, that he had sold 36 sulfanilamide tablets to Bolton on or about October 6 and a mixture of tincture of benzoin compound and "Goinchon" on October 14. He also acknowledged filling a prescription for Bolton, written by Dr. Henry G. Lee, for Atabrine—an antimalarial drug.

When interviewed by Rayfield, Dr. Lee reported that he had examined Bolton "a few days" before his death and recorded "complete stoppage of the kidneys, enlarged spleen and liver, the inability to retain food or liquids in the stomatch, and considerable albumin in what little urine the doctor could obtain." The physician also noted severe flank pain and failing eyesight. Lee said that it was difficult to diagnose and treat Bolton, because the patient was "mentally deranged as a result of a head injury received in an automobile accident about a year ago." Without further knowledge, Lee diagnosed "semi-comatose malaria" and sent Bolton to the hospital on October 14.

In hospital, Dr. R. E. Jones diagnosed Bolton with gonorrheal infection, "slight temperature," and acute nephritis with complete anuria. It was noted that Bolton also suffered with vomiting and diarrhea, which suggested to the doctor the possibility of chemical poisoning. Dr. Lee recorded the cause of death as lobar pneumonia; the contributory cause was comatose malaria. At the time of death, neither physician was aware of the elixir-related fatalities throughout the country. However, both believed, in hindsight, that Bolton's death was consistent with elixir poisoning; although they had no knowledge as to whether the patient actually consumed the elixir.

Thus is became the FDA's job to establish that Bolton had obtained Elixir of Sulfanilamide—most probably from Bell's Drug Store—despite repeated denials from the store's manager. On November 3, FDA inspector Rayfield interviewed Bolton's half-brother (probably Ernest McMillan, per census records), who reported that he had cleaned out the decedent's car and found a "half-filled 6 fluidounce bottle containing a clear red liquid with Bell's Drug Store label." There was evidently no number or doctor's name on the bottle, and Bolton's brother reported that he threw the bottle in a rubbish pile next to his store. According to Rayfield's report,

[The half-brother], 3 negro laborers, 2 white boys and myself spent half of the morning and the entire afternoon thoroughly searching this rubbish pile and surrounding area in an attempt to find this bottle. It has not yet been found. All the children in the immediate vicinity have been questioned by [the half-brother] and myself and none have apparently seen it. 

Bolton's mother, Rosa McMillan, confirmed to Rayfield that her son had received 2 different medicines from Bell's Drug Store, one of which was a "red, clear liquid which he took in doses of 2 teaspoonfuls in water every four hours." When Bolton became seriously ill, his mother questioned the "advisability of continuing...the red medicine." An interview with Bolton's coworker and a return to Millen Hospital failed to produce further leads.

Then finally on November 4, Seaborn Bell admitted to Rayfield that the store had indeed dispensed 6 ounces of Elixir of Sulfanilamide to Bolton. The reason for Bell's turnaround remains undisclosed in FDA records; however, it is possible that the manager had difficulty refuting Rayfield's unmistakable descriptions of the elixir from Bolton's half-brother and mother. The FDA discovered that Seaborn Bell and Herman Bolton were "quite good pals" before Bolton's head-injuring car accident and concluded that the elixir was sold over the counter, without a prescription. It seems likely that Bolton presented to his friend in confidence, complaining of gonorrheal symptoms, and that the manager casually supplied the 6 ounces of Elixir of Sulfanilamide in a moment of misguided compassion.

* The chief source for Bolton's age is the 1930 census record for Millen, Jenkins county, Georgia. (Bolton can also be found in census records under the name of Herman McMillan.) The FDA report indicates that Bolton was 25 years of age at the time of his death.

Robert L. Fields, a 68-year-old farmer from Aaron, died October 17. On October 21, Inspector Rayfield visited Metter's Chandler Pharmacy, which had received 1 gallon of elixir, and was informed that a 6-ounce prescription had been dispensed by Dr. Robert L. Kennedy, 39, to a woman from Stillmore. Rayfield was told by the druggist that the remainder of the product had been returned to the manufacturer. Promising to check up on the woman, Dr. Kennedy conveyed that she had consumed almost all of the medication and "suffered no ill effects, excepting some pain in the region of the kidneys when first taking the Elixir." 

Then on November 10, Inspector Ford, at Massengill's headquarterquarters Bristol, reported that no package from Chandler Pharmacy had been received. This news immediately prompted Rayfield to revisit the pharmacy, where he learned that another 8-ounce elixir prescription had been dispensed, also by Dr. Kennedy, to a 45-year-old widow by the name of Lillie Lyons. Further investigation revealed that Fields, who was living with Lyons, had secured the medication for her. In his continued investigation, Rayfield learned from Fields's adult son that both patients suffered with gonorrhea and that both had taken the medicine. The cause of death on Fields's death certificate, which was signed by Dr. H. A. Alderman of Portal, was acute nephritis.

Leonard J. Dees, a 22-year-old "colored" man from Griffin, died October 18 in adjacent Lamar County. The FDA learned of this fatality on the morning of October 20, after lawyers had contacted state laboratory officials, asking where they "could get some medicine analyzed in connection with a damage suit."

In the FDA's immediate follow-up, it was learned that Dees had visited Dr. Arty E. Huckaby, 54, of Griffin on October 11 for treatment of a gonorrheal infection. Dr. Huckaby reported that he had been prescribing sulfanilamide tablets for Dees, "but on this particular day when in Cole's Drug Store he noticed the new shipment of the Elixir and decided to use it instead of the tablets." The official report continued,

Dr. Huckaby did not see Dees again until Oct. 18, when he was called to Dees' home. He found him in a very low state and near collapse. He found that he had not urinated between Oct. 11 and the 18th and had taken about 2/3rds of the original 6 oz. prescription according to directions, namely 2 teaspoonsful in water every 4 to 5 hours. After patients death he was autopsied by Dr. Fry, Griffin, Ga., on Oct. 21st. Autopsy revealed a redened [sic] condition of the kidneys and liver which indicated paralysis of the kidneys.

At the time of death, which was attributed to Bright's disease, neither Dr. Huckaby nor Dr. Fry was aware of the nationwide fatalities due to Elixir of Sulfanilamide. In retrospect, both believed that the product had killed Dees.

The outcome of the damage suit, in which unnamed plaintiffs were presented by attorneys Chester A. Byars and Claude Christopher, is unknown.   

Lillie Lyons, a 45-year-old widow and farm laborer from Aaron, died on October 19 in a Statesboro hospital. Through its continued investigation of the Chandler Pharmacy in Metter, the FDA learned on November 10 that an 8-ounce elixir prescription, written by Dr. Robert L. Kennedy, had been dispensed to Lyons, and that she had shared the medicine with her live-in mate, Robert L. Fields. The widow's hospital physician, Dr. Benjamin "Ben" Arastus Deal, 53, cited the official cause of death as intestinal obstruction.

Robert L. Parks, a 19-year-old man from Dahlonega, died on October 19 at Downey Hospital in Gainesville. From interviews with the "extremely irascible" Dr. Samuel A. West on October 22 and 26, FDA Inspector Henry learned that Parks had received 2 or 4 ounces of elixir from the physician. It was further revealed that, when Parks "began to show bad effects from the medicine," West sent his patient to the Downey Hospital.

In a subsequent interview with the hospital's attending physician, Dr. John K. Burns, Inspector Henry learned that Parks had been admitted (like Dr. West's other elixir-treated patient, Jewell Fitts) with "kidney lock." During his 5 days of hospitalization, Parks had passed only 3 ounces of urine. Burns reported that he was willing to attribute the patient's death to Elixir of Sulfanilamide. 

During Henry's second interview with West, on October 26, it was also revealed that the doctor had given the elixir to yet another man as treatment for gonorrhea. West otherwise gave vague information about the man's identity and whereabouts, stating only that he thought the patient's last name was Cochran and that he worked in "a sawmill back in the mountains several miles to the northwest of Dahlonega." Gossiping with the local residents, Henry discovered that the man's first name was possibly Joe, and that he was in apparent good health.

On November 15, FDA Inspector Meeks reinterviewed Dr. West, who claimed that Cochran had taken 4 ounces of the elixir and "had stated it was the best medicine he had ever taken." Through unexplained efforts, Meeks finally located Cochran, who was working as a stone crusher "10 miles back in the mountains." From Cochran, Meeks learned a contradictory story:

Cochran did not praise the medicine, stating that each dose he had taken almost killed him, causing dizziness, weakness and a terrible headache, but that it had not effected [sic] his kidneys. When he had consumed the 4 ounces he had gone to another physician, and he stated that that was his reason for misleading Dr. West as to the effect of the medicine.  

Seth L. Durden, a 28-year-old single, "colored" farmer from Wadley, died on October 21 in a Millen hospital. When FDA Inspector Rayfield visited the Lewis Drug Co. in Swainsboro on October 21, he learned that over-the-counter purchases of the elixir had been made to 2 unidentified men. The inspector then contacted the county health officer, advising him to "be on the lookout" for any suspect deaths in the area. The death of Seth Durden and the hospitalization of Will Portwood (below) were discovered as a result.

Rayfield learned that, on October 14, Durden had presented to Dr. R. C. Williams of Wadley, with the patient complaining of severe headaches, flank pain, and copious vomiting.* Dr. Williams diagnosed gonorrhea and acute nephritis and administered liquids both orally and subcutaneously "to get the kidneys to function"; however, these efforts failed to produce the desired effect.

On October 20, Williams sent Durden to the hospital in Millen, where the patient was attended by Dr. R. E. Jones. In a note to Williams, Jones relayed his puzzling experience with Durden in colorful and comprehensive fashion:

You really handed me something when you sent me that patient. I went over him very carefully and could find nothing organically wrong with him other than his G. C. infection. As you said, he had almost a complete suppression of urine. I gave him about 4000 cc. of fluids during the time that he was here, but his kidneys never did open up. I catheterized him last night and got about 1-1/2 ounces of bloody purulent urine.

Jones then described his attempts to examine Durden's renal system, by obtaining a "flat plate" or radiographic x-ray image of the abdomen and then by intravenously injecting a radiopaque dye (Hippuran, which is normally passed through the kidneys).

I took a flat plate of his abdomen yesterday afternoon which revealed no stones nor mechanical blocking of the ureters. I gave him an I. V. Hippuran, took a picture twenty minutes later and there was no dye collected in either kidney.

From the course that he ran and the general picture that he presented, he undoubtedly had an acute nephritis with almost complete anuria. Just what the cause of this condition I am not certain. Whether the anuria was due to his urethritis or not I do not know. He had diarrhea with nausea and vomiting, which suggested to me a possible chemical poison, probably bichloride of mercury.

I did everything I could for him but was unable to open up his kidneys. He died this morning at 12:45.

Dr. Jones's official impression: kidney dysfunction due to "puss poison."

While neither Jones nor Williams was aware, at the time of treatment, that Durden had taken Elixir of Sulfanilamide, both agreed later that the product had caused his death.

* Notably the doctor reported that Durden's dog had died after eating the patient's vomitus. 

Will (William Leon) Portwood, a 34-year-old farmer from Swainsboro, died October 26 at Franklin Hospital. The county health officer, Dr. R. L. Smith recognized this case as being due to Elixir of Sulfanilamide after being warned by Inspector Rayfield on October 21 of over-the-counter sales from the Lewis Drug Co.

Portwood was admitted to the local hospital on October 22 with acute nephritis and suspected appendicitis. When questioned by Dr. Smith, the patient admitted that he had purchased 4 ounces of Elixir of Sulfanilamide from the Swainsboro drug store on October 16, and that he had taken the medication for 2 days, until "severe nausea" precluded further consumption of the drug.

Soon after hospital admission, only 1 ounce of urine could be obtained by catheterization. Specific treatment for the poisoning was sought through an extended series of queries: first from Smith to the State Health Officer, then to the FDA's Atlanta and Chicago Stations, and finally, to the American Medical Association. It was ultimately recommended that intravenous glucose and calcium gluconate be tried. Despite this last-ditch therapy, Portwood continued to produce only miniscule amounts of urine; his clinical condition quickly deteriorated.

On October 23, Portwood complained of "failing hearing and eyesight," and 3 days later, "he was totally deaf and blind." In addition, "[p]aralysis developed in the throat, arms and hands before death." Dr. Smith officially ascribed Portwood's demise to Elixir of Sulfanilamide poisoning.

Portwood was buried in the cemetery of the Bethel Primitive Baptist Church in Twin City.

Possible

Arnette (or Anett) Lewis, a 1-year-old "colored" girl from McDonough died October 6 at home. Word of this fatality came to FDA Inspector Smith by way of the local branch of a Baltimore-based drug company. One of the company's customers, Dr. Robert V. Brandon, 26, of McDonough, had left a gallon bottle of Massengill's product with the branch for analysis. The company then turned the bottle over to Smith, who discovered that 2 ounces were missing.

It was learned that the girl had first been brought to Dr. Brandon on October 4 for evaluation of a "bad sore throat" and "swollen neck and lips." Brandon diagnosed a streptococcal infection and prescribed Elixir of Sulfanilamide, which he had received directly from the Massengill Company. The following day, during a house call, Dr. Brandon, along with Dr. W. P. Harris of Hampton, found the "throat situation pretty well cleared up." Then suddenly at 1 AM on October 6, the girl "awoke from a sound sleep, gasped twice and...died."

Although she had consumed one-half of her elixir prescription during the 2 days, she had not shown the tell-tale signs of diethylene-glycol poisoning—namely kidney failure—during her brief illness. Brandon reported to Inspector Smith that the only possible indication of renal dysfunction was the child's swollen face; however, he noted this sign before he prescribed, he said. Dr. Harris believed that the child had suffered with either a "heart condition" or pneumonia.

Nevertheless, because of the girl's death and news of elixir-related fatalities, Brandon wanted Massengill's product chemically analyzed for clarification. But he remained skeptical about the elixir's contribution to his patient's death. The FDA officially concluded, "There is considerable question that this patient died as a result of the administration of elixir sulfanilamide."

In Dr. Brandon's 1993 autobiography, Three Quarters: A Memoir, there is no mention of the Lewis case, his experience with Elixir of Sulfanilamide, or any interactions with the FDA.

Mrs. Mark (Morning Catherine) Reynolds, a 77-year-old woman from Dublin, died on October 12. In its investigation of the E. L. Black Drug Store in Dublin, the FDA learned of 5 elixir prescriptions, 1 of which was associated with a death. On October 7, Dr. Will C. Thompson prescribed the medication, 1 teaspoonful in water every 4 hours, as treatment for Reynolds's pyelitis. Thompson described the woman, whom he saw only once, to be "in an extrememly toxic condition."

It was determined by FDA Inspector Rayfield that Reynolds had not complained of any stomach or back pains during treatment, and that her "kidneys and bowels functioned normally and freely up until [she] died." Five minutes before she died she rose from her bed and urinated. She then returned to bed, stated that the "felt funny," and expired. Further evidence exculpating Elixir of Sulfanilamide is the fact that Reynolds consumed a total of about only 1-1/2 ounces of the product. Her official cause of death, according to the county health officer, was "unknown." The FDA concluded that Elixir Sulfanilamide was "not responsible" for Reynolds's death.