Elixir Sulfanilamide: Deaths in Alabama

Alabama’s history with Massengill’s Elixir Sulfanilamide is distinctive in that the first documented prescriptions for the product, specifically three written on September 16, 1937, were dispensed here. In addition, America’s first known elixir-related death, on September 24, 1937, occurred in Alabama.

During the FDA’s investigation in Alabama, which continued into December, the FDA discovered 11 elixir-related casualties in the state (two of which were only possibly related to Massengill’s product). However, the outcomes of two nameless prescriptions and two over-the-counter purchases were apparently never determined, despite local radio broadcasts that warned of the elixir’s dangers and urged the return of the product.

(For a Google map of elixir shipments in Alabama, click on this link or the map image.)

Elixir-related deaths in Alabama (9 confirmed, 2 possible)

John (Johnay) C. Holloway, 22, a married* “colored” farmhand from Clayton, died on September 24th. Holloway received two elixir prescriptions (for six and four ounces each) from Dr. George Oscar Wallace, a local physician and druggist, who also happened to be the grandfather of George C. Wallace. FDA records indicate that Holloway tolerated his first prescription, dispensed on September 16th, without ill effect, but that he died two days after beginning a second prescription for a “severe case of gonorrhea.” (Symptoms attributed to gonorrhea may well have been the result of Holloway’s first elixir prescription and not the venereal disease.) Holloway’s undoubtedly elixir-related symptoms, as reported to the FDA, were “labored breathing, unconsciousness, deafness,” and kidney failure. Because Holloway’s death was “unusual and unexpected,” Dr. Wallace believed in hindsight that Elixir Sulfanilamide contributed to his patient’s death. Wallace was, as the FDA’s full investigation would later reveal, a physician with an unpleasant distinction: He unwittingly caused the nation’s first known fatality due to Elixir Sulfanilamide. Holloway was also one of the first Americans (along with Anderson Crews [see below] and Ewell Daughtrey [see Deaths in Georgia]) to receive a prescription for Elixir Sulfanilamide.

According to state death records, Holloway, a native Alabaman, was buried September 26th in St. Peter Cemetery (presumably in Barbour County).

* To Lulie Ware; parents were Jake Holloway and Lizzie Mayo. In the 1930 census, 14-year-old “Johnie” is listed in the household of his widowed mother, Lizzie, along with his three sisters and two brothers. They resided at Clayton and Abbeville Road in Cox’s Mill (historical), Barbour County, Alabama–an address that may have been obliterated by consequences of the Walter F. George Dam on the Chattahoochie River.

Syble Gwendolyn Singleton, the ten-month-old daughter of a Georgetown, Georgia, farmer,* died on September 25th at the Salter Hospital in Eufaula (across the Chattahoochee River from Georgetown). The infant, who was desperately ill with streptococcal septicemia, stopped producing urine 24 hours after the first dose of Massengill’s elixir. She died three days after beginning treatment. Her case is notable for the fact that the elixir, prescribed by Dr. Paul Salter on September 22nd, was dispensed from a two-ounce sample bottle peddled by one of Massengill’s detail men (W. C. White of Dothan). According to Singleton family history, Dr. Salter (then unaware of the elixir’s deadliness) was perplexed by the child’s illness, and he and his intern “spent hours reading medical journals in an attempt to find a cure” for the girl.

Syble Gwendolyn was buried on September 26th at Mt. Zion Cemetery in Clay County, Georgia.

* Sam S. Singleton. The baby’s mother was Floy Teel.

Anderson Crews (or Cruce), 63, a married* “colored” or “mulatto” farmer from Headland, died on September 25th. Crews succumbed quickly to the effects of his three-ounce elixir prescription, which was written on September 16th for an infection associated with a “nail in foot.” FDA records indicate that Crews became blind and unconscious within two days of beginning treatment, and that “his kidneys ceased functioning entirely.” Nevertheless he lasted for another nine days before surrendering entirely to the medication’s toxicity. Crews was one of the first Americans (along with John Holloway [see above] and Ewell Daughtrey [see Deaths in Georgia]) to receive a prescription for Elixir Sulfanilamide.

* To Leslie Roberson. His parents were Isiah Crews and Queen Warren. The victim’s Alabama death record does not indicate his place of burial.

(Berry) Edward Walker, a single* 26-year-old man, from Chancellor, died on October 3rd in a Dothan hospital. FDA Inspector M. S. Goodman confirmed this elixir-related death on December 3, 1937, after a protracted investigation by the agency. The investigation was notable for the repeated deception of a regional, dispensing pharmacist (who had received one pint of Massengill’s elixir) and the insight and persistence of a county public health nurse, Lucille Teal. Nurse Teal was initially puzzled by Walker’s death, but she came to recognize that his premortem symptoms were typical of Elixir Sulfanilamide poisoning, thanks to news coverage of the nationwide deaths. The FDA concluded, “Were it not for the action of Miss Teal, who is a fine type of professional woman, this case would probably have never come to light, and the truth would have remained buried.”

Walker died approximately two weeks after beginning treatment with the liquid antibiotic. According to Walker’s Alabama death record, he was interred at the Mount Pleasant Cemetery in Coffee County on October 4th.

* Parents were Charlie Walker and Ada Edwards.

** According to family history submitted at ancestry.com, Edward Walker was “dating Lucille Teal, a nurse at Gibson Hospital, when he died” (reported source: Edward Walker’s sister Nelle).

Ethel (or Ether or Ester) Colston (née Whitehurst), 49, a widowed “colored” laborer from Ariton, died in Dothan on October 4th after drinking about eight tablespoons of elixir. In this case, the FDA probably discovered Colston’s death sometime after January 17, 1938, the date of the agency’s typed compilation of elixir-related deaths. Penciled in the report is a brief note stating that Colston’s death was due to the “complication of possible cerebral hemorrhage”; nevertheless Elixir Sulfanilamide “probably” contributed to her demise, the FDA concluded.

Colston was buried on October 8th in “Elliebella,” Alabama.

Mary Frances “Fannie” Zeanah (née Holman), 68, a widowed housekeeper from Eufaula, died on October 13th at the Salter Hospital. Like the Singleton infant, Zeanah was a patient of Dr. Salter, who prescribed six ounces of the elixir to the woman on October 6th. The elixir, dispensed by a local pharmacy, was compounded with eight grains of phenobarbital, eight grains of codeine sulfate, and three-and-one-half grains of aspirin. Zeanah, who had a number of preexisting medical conditions—including arteriosclerosis and chronic Bright’s disease—consumed an unknown portion of the treatment. On the fifth day after the first dose, she “suffered complete inactivity of the kidneys”; on the seventh day, she died. Despite the fact that Zeanah’s urine showed a profound spilling of albumin (4+ albuminuria) before her elixir treatment, Dr. Salter believed in hindsight that the elixir contributed to her death. No postmortem examination was reported.

Zeanah was buried in Elrod (Tuscaloosa county), Alabama, on October 17th, according to her state death record.

Ed (or Edd) Scott, a five-year-old “colored” boy* from the Demopolis area, died on October 14th. Alabama state inspectors uncovered the details of this death in early December and shared the information with the FDA. How the state came to discover Scott’s case is unclear.

The decedent’s father reported to authorities that, on October 10th, he carried his “sick” son to Dr. Arlington H. Bobo, a white physician in the town of Demopolis. Dr. Bobo prescribed two ounces of Elixir Sulfanilamide for an otherwise undescribed ailment. After taking “all” of the medicine, the boy’s condition grew worse, and Dr. Bobo—visiting the child at midday on October 14th—prescribed two new, unnamed treatments (one was a liquid, and one was a powder). However, by the afternoon, the boy was “in a dying condition,” after having taken only one dose of each of the new drugs. At about 5 pm, he was dead. The child was buried the next day in Bradling Graveyard (or “Merystat” per his death record) near Demopolis. The three bottles of his recently prescribed medications were placed in his casket.

* Parents were Morris and Emily Scott.

Nettie Joe (or Betty Jo) Story, a two-year-old farmer’s daughter* from Guntersville died on October 16th after drinking one-and-one-half ounces of a six-ounce elixir prescription for acute streptococcal pharyngitis (ie, strep throat). The prescription, written by Dr. James M. Crawford, was dispensed by a pharmacy in Arab on October 9th. The physician, according to FDA records, did not see the child again until October 13th, but government reports indicate that the girl “seemed much improved” on October 10th and “was thought to be well” on October 11th. These observations suggest that the elixir’s antibiotic component provided some clinical benefit. On the night of October 12th, however, the girl did not sleep and had difficulty breathing. The following morning, Dr. Crawford “found the baby’s face and hands swollen” and learned that her “[k]idneys had not acted during the night.” The young patient died “in convulsions,” seven days after receiving the elixir prescription. Dr. Crawford believed that his patient’s death was “definitely” due to Massengill’s product.

The girl was buried on October 17th at Hope Well Cemetery in Blount County, Alabama.

* Parents were Dalton Story and Annie Feenister.

Alfred “Alf” McDade (or McDay), 47, a married* “colored” plasterer from Eufaula, died on October 17th. Like the Singleton child and Fannie Zeanah, McDade was a patient of Dr. Paul Salter. Also like Zeanah, McDade had a number of chronic, preexisting illnesses—including hypertension, “mild” endocarditis, and syphilis. McDade consumed two ounces of his elixir prescription, which was compounded with aspirin and phenobarbital in “syrup acacia.”

Although Dr. Salter did not see McDade during the time that he took the treatment, the victim’s family reported that he starting vomiting within 24 hours after the first dose, and that his kidney function ceased “entirely.” The initial, presumptive causes of death were coronary thrombus and cerebral hemorrhage. (McDade experienced “profuse hemorrhage of [the] nose shortly before death.”) Yet Dr. Salter believed, in hindsight, that Massengill’s elixir had killed his patient. McDade underwent autopsy, and his organs were submitted for examination to the state toxicologist, Dr. Hubert W. Nixon, at Auburn. However, the autopsy results were not provided in acquired FDA records.

McDade (or McDay, per his Alabama death record) was buried on October 22nd at Eufaula Cemetery.

* To Withe Mae.

Possible

Rita Glendyne (or Glendine) Mallon, a six-month old daughter of Sylvester and Ruby from Dauphin Island, died on October 10th in the Mobile Infirmary. The child had a several-month history of general failure to thrive, with suspected “cretenism.” Previous, recurrent treatment during life consisted of Abbott’s Cofron Elixir, which was advertised by the company as an “agreeable-tasting tonic of Liver concentrate with Copper and Iron, and designed for the treatment of patients with nutritional and other secondary anaemias, especially children.”

Elixir Sulfanilamide was prescribed by “baby specialist” Dr. Joseph F. Rowe on October 6th for symptoms of fever, inability to digest, and urinary pus. The child, after consuming “three or four doses” of elixir, was admitted to the hospital two days later with cyanosis and respiratory difficulty; renal function was, notably, not affected during the course of hospitalization. Small amounts of intravenous glucose and atropine (the latter to presumably stimulate a failing heart rate) were administered, but the child died two days after admission. Dr. Rowe determined the cause of death to be “[e]dema of lungs due to terminal bronchial pneumonia,” and he did not believe that Elixir Sulfanilamide contributed to his patient’s demise. An autopsy was not performed.

The infant was buried on October 11th at Dauphin Island Community Cemetery (#2).

Martin (D.?) Smith, a 42-year-old man* from the area of Pisgah, died on October 17th. Smith consumed some or all of a three-ounce prescription, which was obtained from a local physician, Dr. W. D. Patton, for an unknown ailment. A brief handwritten note in the FDA’s typed compilation of elixir-related deaths, dated January 17, 1938, concludes, “Can’t prove that Elixir caused death.” Penciled scribbling also indicates that an autopsy was performed, with submission of a pathology report; however, details were not included in the compiled report.

When the FDA initially attempted to confiscate the one pint of Massengill’s elixir received by Dr. Patton, the physician claimed that he had used approximately 11 ounces to treat himself, but that the entire amount was not consumed because of spillage while opening the bottle. The remaining five ounces of elixir were “destroyed under the direct supervision” of the visiting inspector.

Post-hoc reasoning suggests that the agency somehow came to believe later that three of the 11 outstanding ounces of Dr. Patton’s elixir supply were actually dispensed to Smith. Given that the FDA discovered elixir-related deaths in other cases by reviewing state death records, investigators may have learned of Smith’s death, in retrospect, this way.

Smith was buried in Pisgah Cemetery in Jackson County, Alabama.

* On the basis of a WWI military record, this Martin Smith was probably white and married to Agnes (née Wheeler).

Primary sources

FDA historical records (AF1258), Rockville, MD: Invesigation of death of Rita Glendyne Mallon [Inspector Nelson’s report]. October 22, 1937; report from New Orleans Station to Chief, Central District (Elixir Sulphanilamide [Fatalities]). October 25, 1937; letter from M. S. Goodman to Chief, New Orleans Station. December 3, 1937 [Edward Walker]; letter from M. D. Gilmer to Mr. George H. Marsh. December 9, 1937 [Ed Scott].

NARA, College Park, MD: Part I, Elixir Sulfanilamide Investigation. January 17, 1938. Box 935, Central District Sulfanilamide Report [Ethel Colston and Martin Smith].