Massengill’s Elixir Sulfanilamide: East St. Louis and Mt. Olive Deaths

For previous installments of the Elixir Sulfanilamide disaster, see the following posts (in order):

• The Beginning—Tulsa
• The Beginning—Tulsa (2)
• Inspiration, Formula, and Distribution
• Early Investigation and Recall

In addition to the now 10 known deaths* in Tulsa, Oklahoma, caused by the consumption of Massengill’s Elixir Sulfanilamide, the AMA’s Morris Fishbein confirmed 4 similar deaths in East St. Louis, Illinois, to news sources on October 19. And a fifth person was dying. A young St. Louis pathologist, Omer E. Hagebusch, had performed autopsies on the local victims and wrote of their deaths to Fishbein, with the idea that publication in the AMA’s flagship journal was the most expeditious way to inform physicians of the new product’s risk [1].

Four days earlier, 24-year-old J. D. (Jee) Kimbrough died at St. Mary’s Hospital in East St. Louis, after taking a total of about 4 tablespoons of the elixir for a “sore throat” over the course of 5 days. Symptoms of poisoning, the hallmark of which was reduced urine production, began on the fifth day of treatment, and Kimbrough was hospitalized 2 days later, October 13. He died another 2 days after admission, with a diagnosis of “encephalitis” (a label possibly applied in the absence of recognizing uremic encephalopathy induced by the elixir’s diethylene glycol). Four-year-old Morris Slaughter, son of Edwin and Helen, died at the same hospital the following day, October 16, after receiving a similar amount of Massengill’s product for “inguinal adenitis,” a gland infection. Symptoms of poisoning began 3 days after the first dose of medication [2,3,4].

On October 18, a child and an adult died across the Mississippi River, at St. Mary’s Infirmary in St. Louis, after consuming (again) a few ounces of the elixir. Like Kimbrough and Slaughter, both had received prescriptions from the same physician. Five-year-old George Nixon, son of Joseph and Mary, hung on for 10 days after symptoms of elixir poisoning began. He was given the drug for a streptococcal sore throat. A railroad switchman, Joseph L. Henry, 60, died 6 days after stopping his prescription for prostatitis [2]. (The dying fifth person was most likely widower Alexander A. Brooks, 70, who took the medication for 4 days before symptoms of poisoning began. He lasted for another 9 days at St. Mary’s Infirmary before succumbing.)**

The prescribing doctor, identified repeatedly in contemporary news sources as a “Negro” physician, Dr. Henry H. Weathers maintained an active practice in East St. Louis (either at 1341 Piggott Ave. or 1421 Kansas St.), where he served a population that was largely, if not exclusively, African American. Weathers was a graduate of Meharry Medical College in Nashville, Tennessee—the first medical school for African Americans in the US South—and had served on staff at the St. Louis Negro City Hospital, an open example of racially segregated healthcare in the United States at the time [3]. Weathers reported to the St. Louis Post-Dispatch that he began prescribing Massengill’s elixir, distributed by the company’s Missouri branch, on October 11. He also revealed that 3 other patients, to whom he had given prescriptions, were in serious condition [3].*** According to Hagebusch’s case report, Weathers had prescribed the drug to about 30 people [1]. If true, the fatality rate associated with Massengill’s product (so far) was approximately 20%—a rate consistent with animal studies performed at the University of Chicago.

The day that Nixon and Henry died, the chief of the FDA’s St. Louis station, A. E. Lowe, reported initial findings of his local investigation, which was based on circulating rumors of the deaths. Astonishingly a representative of the city’s medical association and the bureau of vital statistics knew of no deaths related to Massengill’s elixir, despite the fact that Morris Fishbein had phoned the St. Louis Board of Health earlier in the day to inquire about the local rumors. Two agents of the Board specifically advised Lowe that “a careful review” of records dating back of October 1 revealed “nothing that could possibly be of value” [6].

Lowe’s check of local drug distributors and chain stores showed that only one wholesaler had purchased Massengill’s Elixir Sulfanilamide. On September 24, the Meyers Brothers Drug Company received 6 pint bottles of the product. However, when the company received Massengill’s recall wire on October 15, it had only 1 bottle to return. The other 5 had been distributed to local drug stores, and Meyers Brothers advised the FDA that a search of the firm’s records, to identify the stores that had received the elixir, would be a “tremendous job.” It would be easier to locate the bottles by surveying the area’s drug stores, the company advised. So while Massengill’s reps were directed to search for the at-large product on foot, 2 FDA agents began sifting through the company’s 20,000 sales slips [6].

These efforts would lead to the recovery of 2 bottles of the product in East St. Louis, Illinois—an important development, given that it established interstate commerce of Massengill’s elixir from its Missouri branch. In addition, recovery efforts revealed that 1-pint elixir bottles, sold directly by Massengill’s sales reps, were in circulation [4,6]. One local Massengill rep, after recovering a few bottles of elixir that he sold directly himself, advised FDA agents that the deaths, if due to the company’s product, resulted from “oxidation” of the substance on contact with air. In an illogical attempt to bolster his argument, he added that adverse effects had only resulted when the drug was administered from 1-gallon containers and that “no illness has yet been traced to the pint bottles” [4].

Whether Massengill’s rep came up with this explanation on his own or received it from company headquarters is unclear. Regardless, the argument was both scientific nonsense and false. In a statement to the Post-Dispatch, Dr. Weathers attempted to clarify where fault lay [7]:

There has been an impression created that the error causing the East St. Louis deaths was made locally, either on my part or by the four East. St. Louis drug stores filling the prescription, so I wish to point out that the prescription was a legitimate one and that the error, if any, was made by the Kansas City pharmaceutical company which prepared the elixir. Sulfanilamide has been used extensively and successfully by physicians in other sections of the country.

Nationwide misinformation and misunderstanding about Massengill’s elixir and the cause of the related deaths in Tulsa and the St. Louis area remained among physicians, despite published explanations from Weathers and, most important, Fishbein. For instance, Ohio’s health director, perhaps attempting to explain the apparent absence of deaths in his state, implied to the local press that only certain lots of the product were inadvertently contaminated [8].

However, given that diethylene glycol was an intended and major ingredient in Massengill’s product, a local inquiry into recent, unexplained deaths in the St. Louis area was proceeding. Examined cases included 23-year-old manicurist Hazel Fea, who died of a “mystifying” case of acute nephritis on October 10 at Barnes Hospital. Investigation would reveal that, about 5 days earlier, Fea had consumed a total of 2 ounces of Massengill’s elixir, which was prescribed for an “abdominal ailment.” Fea had received the prescription directly from her physician, a Dr. Philip M. Dale of Granite City, Illinois, who had dispensed it from one of Massengill’s 1-pint bottles [7]. Dr. Dale had also given the elixir to 3 other patients, including his wife, with “no ill effects” [9].

News of more deaths, including those in Massengill’s home state, would undermine the explanations of those who tried to divert blame or allay public fear. On October 20, Charles W. Miller, a married 25-year-old gas station attendant from Memphis, Tennessee, died at Methodist Hospital after taking about 4 ounces of the elixir. The local paper described how Miller had obtained the product without a doctor’s prescription [7,10,11].

Mr. Miller, friends of his family said, took the elixir to cure a venereal disease which he believed he had contracted. He sent a negro to the drug store with a note telling the druggist of his suspected ailment. The drug clerk prescribed the elixir of sulfanilamide. 

The following day (the same day that Alexander Brooks, of East St. Louis, died), a Baptist minister, 65-year-old James Edward Byrd died in a Knoxville, Tennessee, hospital after taking “13 doses” of the elixir. The reverend, a resident of a tiny town in southern Mississippi, Mt. Olive, had been traveling on clerical business when he became ill. He had received his prescription from his longtime friend and hometown physician, Dr. Archibald “Archie” Calhoun [12].

Calhoun, a seasoned doctor and highly respected Mt. Olive native, ran a busy, racially integrated practice out of a 2-room office above his brother’s drug store. He began prescribing Massengill’s liquid medication in mid-September, after receiving a sales call from a company rep; one of Calhoun’s first patients was a visiting cousin, who took 4 ounces, without ill effect. Calhoun proceeded to prescribe Elixir Sulfanilamide for a dozen individuals, including his office nurse, Evelyn Sharbough. However, one of his patients died (probably Eddie Sullivan), and he couldn’t figure out why.

When Calhoun received the company’s October 19 telegram warning of the elixir’s potential to kill, he “rode all night visiting every patient that I could remember prescribing to” [12,13]. But for half of them, it was too late. In addition to Reverend Byrd, the elixir’s local victims were Eddie Sullivan, of nearby Magee, who died October 17; Otis Coulter, 36, who died October 19; Mrs. J. Edmond (Vala) Penn, who died in the early morning hours of October 20; and “two negroes,” the Associated Press reported. The last 2 victims were Gussie Mae (or Jessie May) Grubbs and Leffie (or Linnie) Easterling, both Mt. Olive residents who most likely died on October 20 after consuming 3-4 ounces each.

In a public letter, Dr. Calhoun expressed his anguish at the fatalities and his role in them [14]:

Nobody but Almighty God and I can know what I have been through in these past few days. I have been familiar with death in the years since I received my M.D. from Tulane University School of Medicine with the rest of my class of 1911. Covington County has been my home. I have practiced here for years. Any doctor who has practiced more than a quarter of a century has seen his share of death.

But to realize that six human beings, all of them my patients, one of them my best friend, are dead because they took medicine that I prescribed for them innocently, and to realize that that medicine which I have used for years in such cases suddenly had become a deadly poison in its newest and most modern form, as recommended by a great and reputable pharmaceutical firm in Tennessee; well, that realization has given me such days and nights of mental and spiritual agony as I did not believe a human being could undergo and survive. I have spent hours on my knees, once I had done all any physician could do for his patients. I have known hours when death for me would be a welcome relief from this agony.

Thank God, the six remaining patients to whom I gave that medicine show no signs of dying as a result. It seems like a miracle to me. I have spent hours driving to see every one of them, white and Negro. I have checked and rechecked their condition several times a day. Why they are not dead like the first six who died, I do not understand. For some obscure physical reason, their bodies were able, apparently, to throw off the poisonous effects of the medicine.

It is miraculous to me. I do not understand it. But I am grateful to Almighty God. Those six deaths weigh heavily enough on my mind and heart. Six more! I shudder when I think of it as a possibility. To me those six yet living who took that elixir have been like six human beings standing under sentence of death ever since I got the warning from the pharmaceutical house that made and sold it, that it was poisonous in that form. I have lost track of how many miles I have driven, trying to counteract the results of the fatal mistake of the men who prepared that medicine.

I want to make it clear to the lay world that there is nothing poisonous or unfamiliar in sulfanilamide as a medicine in itself. It is invaluable in cases involving the urinary tract. I have used it for years. Hitherto it has come in two forms, a powder taken in capsules, and in tablets. I could not ever tell without checking my records how many hundreds of times I have prescribed it. But in capsule and tablet form it is very distasteful to many patients.

Within the past few weeks a representative of this big Tennessee pharmaceutical firm came to me with a liquid preparation of this drug, called Elixir Sulfanilamide, that was easier for patients to take than sulfanilamide in capsule or tablet form. He induced me to get it and administer it to my patients. The high standing of the firm he represented was all the recommendation their products needed. So I got some.

I am informed now that diethylene glycol, a solvent in the elixir, is responsible for its poisonous effect, its toxicity.

I had prescribed this elixir to 12 patients and they had taken it when I received a telegram from the pharmaceutical firm informing me that they had discovered its effect was deadly.

Imagine my feelings. My heart sank. I stood reading that telegram with cold sweat streaming down my forehead. Then I started out to warn all those 12 patients who had taken this elixir on my prescription, and to do all in my power to save their lives.

The Rev. J. E. Byrd, secretary of the Mississippi state Baptist Sunday school board, was one of them. He was my closest personal friend, as well as my patient. And he died at Knoxville, Tenn., where he was rushed in a vain effort to save his life. Then Mrs. J. E. Penn, Ed Sullivan and Otis Coulter died in the hospital at Magee, Miss., where they were taken. Then the two negresses, Jessie May Grubbs and Leffie Easterling died.

They died in agony. The effect of this poisonous elixir was violent nausea, and acute abdominal cramps, and complete cessation of the function of the kidneys.

Six dead because of medicine I had prescribed for them innocently! Six dead, who would have been living if I had prescribed for them the old, familiar sulfanilamide in its tablet or capsule form! One of them my closest friend on this earth, the Rev. Byrd.

But it was worse than that. There were six more human beings who had taken that elixir on my prescription, who were living yet, and who to me were living under sentence of death as surely as if jury and judge had convicted and sentenced them, and the gallows and the noose awaited. They had trusted me. I was their physician. They took the medicine I prescribed in complete confidence.

As I said at the beginning, nobody but Almighty God and I know what I have been through. Whenever I hear the words “living in hell” on this earth again, I know now what they mean. I have lived in a hell of fear for those human lives ever since I read that telegram from the pharmaceutical house.

But it seems as if a miracle had been vouchsafed those remaining six.

I checked again on every one of those remaining six cases today. In lay language, they seem “out of the woods.” I believe that they are going to live, now, though I do not know why. Any doctor after a quarter of a century of practice can tell you of human beings who have refused obstinately to die; who have lived when as far as their physician could tell, they were condemned to death by causes beyond their physician’s control. That is the case with these six who live yet. They seem on the road to recovery. They have been spared the death of agony that was the portion of the other six. I thank God on my knees for that.

But it seems to me that somebody should be responsible for the preparation of that elixir that brought an agonizing death to six innocent patients.

The total number of known deaths caused by the consumption of Massengill’s Elixir Sulfanilamide was now 23: 10 in Tulsa; 6 in the St. Louis area; 1 in Tennessee; and 6 from Mt. Olive, Mississippi.

 

* Millard Wesley Wakeford, 5; Joan Marler, 6; Michael S. Sheehan, 6; John “Jack” King (a child, age currently unknown); Mary Earline Waters/Watters, 10 months; Robert “Bobby” Sumner (a child, age currently unknown); Kathleen Hobson, 8; Glen F. Entler, 19; Charlene Mardell Canady, 4; and Earl L. Beard, 25.

** A retrospective comparison of autopsy findings from the East St. Louis victims with those from experimental animals given diethylene glycol at the University of Chicago, would reveal striking similarities [2]. On October 20, an autopsy on 2 guinea pigs in Tulsa, which died after being dosed with Elixir Sulfanilamide, also showed renal findings that were similar to those of the city’s human victims [5].

*** One of these patients was likely housewife Gertrude Lee Black, 38, who died at Homer G. Phillips Hospital in St. Louis, Missouri, on October 24, 1937.

1. Hagebusch GE. Necropsies of four patients following administration of Elixir of Sulfanilamide-Massengill. J Am Med Assoc. 1937;109:1537-1539.

2. Geiling EMK, Cannon PR. Pathologic effects of Elixir of Sulfanilamide (diethylene glycol) poisoning: a clinical and experimental correlation–final report. J Am Med Assoc. 1937;111:919-926. According the case description for Alexander Brooks, he broke the first bottle of Massengill’s elixir after consuming about 3 ounces. He then obtained a second bottle without consulting his physician (presumably Weathers). He took 1/2 ounce “from the second bottle at which time physician called.”

3. Four deaths here among 13 laid to use of new drug. St. Louis Post-Dispatch. October 19, 1937; p 3A.

4. FDA correspondence. S. W. Ahlmann to Central District Chief. October 18, 1937.

5. Associated Press. Pigs used in new drug quiz: doctors perform autopsy, find clues in strange death investigation. Ada News Weekly. October 21, 1937; p 6 col 6.

6. FDA correspondence. A. E. Lowe to Central District Chief. October 18, 1937. See also FDA report Part I. Elixir Sulfanilamide Investigation. The FDA determined that Meyers Brothers sent 4 pints to East St. Louis (3 pharmacies) and 1 pint to a pharmacy in Lovejoy, IL.

7. Associated Press. New drug fatal to pastor and gas station operator. Kingsport Times. October 21, 1937.

8. Alleged fatal drug is widely in use here. The Lima News. October 21, 1937; p 4, col 5.

9. Death in elixir case to be probed: Granite City woman may have succumbed to poison drug dose. Globe-Democrat. October 21, 1937. [FDA files]

10. FDA correspondence. J. O. Clarke to P. B. Dunbar. November 17, 1937.

11. Poison ‘elixir’ kills Memphian who had druggist prescribe; medical society gives warning. The Commerical Appeal. October 21, 1937; p 1.

12. Associated Press. Sulfanilamide elixir kills 6 in Mississippi. St. Louis Post-Dispatch. October 22, 1937; p 3A.

13. Toler K. Dr. A. S. Calhoun commended by Mt. Olive for candidness about lethal drug cases. News Commercial. October 29, 1937; p 1,2.

14. Calhoun AS. Doctor’s story of deaths. New Orleans States. October 22, 1937. Dr. Calhoun’s surviving patients were listed as Mrs. Frank Hamilton, 29; Velma Lucas, 21; Mrs. H. D. [or N. E.?] Booth, 60; Mrs. Baxter Pittman, 38; Lula Herring, 30; and Evelyn Sharbough. See Breazeale J. Elixir victim is laid to rest. New Orleans Item-Tribune. October 24, 1937.