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Elixir Sulfanilamide: Deaths in Illinois and Missouri

The FDA’s confiscation of Elixir Sulfanilamide in Illinois and Missouri was coordinated out of the agency’s St. Louis office, where Station Chief Austin E. Lowe directed the investigation of shipments to these two states, as well as those to Arkansas and Memphis, Tennessee. Legitimate rumors of elixir-related deaths in the St. Louis metropolitan area, which included East St. Louis in Illinois, began circulating as early as October 16th.

In the end, it was determined that more than seven gallons (7.375), mostly in pint bottles, had been shipped directly from Massengill’s Kansas City, Missouri, hub to 16 doctors’ offices, 14 drug stores, and one hospital in Illinois. In addition, a total of 3-3/4 gallons had been sent directly from the company’s Missouri branch to five physicians, 10 retail pharmacies, and one drug wholesaler within the state. Almost all of the shipments to Illinois and within Missouri, save for six pints, were concentrated in and around the St. Louis/East St. Louis metropolitan area, a fact that should have made their confiscation relatively easy (for a Google map of the distribution of elixir shipments to Illinois and Missouri, go here). But 16 Illinois pharmacies, some of which were not direct recipients of Massengill’s product, had received, supplied, or otherwise exchanged variable amounts of the elixir, presumably because of local demands for prescriptions. To complicate matters, several Illinois pharmacies had received pints of elixir from drug vendors in Missouri. Specifically a large wholesaler in St. Louis, Meyer Brothers, had shipped five pints of elixir to four Illinois establishments, but the identities of these recipients could not be established until FDA inspectors and company clerks sifted through 20,000 sales records at the wholesaler.

Among the 71 elixir prescriptions ultimately identified by the FDA in Illinois and Missouri, nine deaths were discovered. All but one of these prescriptions were dispensed in Illinois, and most of these prescriptions (~70%) were provided by two East St. Louis pharmacies (the Walter J. Daut Pharmacy and the Lincoln Pharmacy).

Elixir-related deaths in Illinois or Missouri (8 confirmed, 1 possible):

Hazel Mildred Fea, a 23-year-old manicurist from Potosi, Missouri, died on October 10th at Barnes Hospital in St. Louis. The FDA learned of this case sometime before October 19th, during its investigation of the whereabouts of one pint of Massengill’s elixir, which had been shipped directly to Dr. Paul M. Dale of Granite City, Illinois.*

The FDA discovered that Dr. Dale had prescribed four ounces of the elixir, mixed with sodium bicarbonate,** on October 4th to the woman for unclear reasons; however, it is noted in FDA records that the victim had recently undergone an “illegal operation”to wit, a surgical abortion. (Whether Dr. Dale performed this surgery is not explicitly stated in government accounts.) When interviewed by the St. Louis Post-Dispatch, on October 21st, Dr. Dale stated that he had prescribed the treatment to Fea for an “abdominal ailment.”

Government records further indicate that Fea was admitted to Barnes Hospital on October 6th, after consuming a cumulative total of about two ounces of Dr. Dale’s treatment. Her unexpected death, which prompted an official inquest,*** was initially attributed to “acute hemorrhagic nephritis,” and the St. Louis coroner, Dr. Louis Padberg, suspected mercury bichloride poisoning as the cause. But after learning that Fea had consumed Elixir Sulfanilamide, Padberg changed his verdict and amended Fea’s death certificate accordingly.

Fea was survived by her parents, John and Ada, and a younger sister. She was buried in the New Masonic Cemetery in Potosi.

* Records conflict on the victim’s residence at the time of her death. The FDA clearly concluded that her home was in Granite City, Illinois, where she was treated; however, other primary sources and secondary accounts indicate, or at least strongly suggest, that Hazel Fea lived in Missouri. Unconfirmed genealogic records suggest that the victim had relatives in Granite City, and it is possible that she sought care there (ie, for an “illegal operation”), away from her immediate family in Potosi.

** Ten grains per two teaspoonfuls of elixir. Why sodium bicarbonate was compounded with the elixir is unclear. Two other patients of Dr. Dale also consumed this Elixir Sulfanilamide concoction at his direction without consequence.

*** See for instance, the Globe-Democrat, October 21, 1937 (FDA newspaper files).

J. D. Kimbrough (or Jee D. Kimbrew), a 26-year-old married black laborer* from East St. Louis, Illinois, died on October 15th at the city’s St. Mary’s Hospital. Kimbrough was one of four “negro” victims examined postmortem by Omer E. Hagebusch, 32, a St. Louis pathologist, who forwarded his necropsy report on October 19th to the editors of JAMA.** Kimbrough’s elixir-related death was publicly reported on the same date by the St. Louis Post-Dispatch (“Four deaths here among 13 laid to use of new drug”).

The FDA learned that Kimbrough had received his elixir prescription on October 7th from East St. Louis physician Henri H. Weathers, a popular black surgeon with a large practice among the city’s African-American population. The indication for treatment was “sore throat,” and the prescribed therapy called for four ounces of Elixir Sulfanilamide to be compounded with eight grains of codeine sulphate, 30 grains of potassium iodide, and 30 grains of phenolphthalein. (The latter substance was a coal-tar product, often prescribed in the early 20th century as a laxative.) The compounded treatment was dispensed by the Walter J. Daut Pharmacy of East St. Louis. Directions were to take one teaspoonful “in a little water” every four hours.

Kimbrough consumed about four tablespoons of the elixir concoction over the course of five days, at which time his urine production ceased. He was hospitalized two days later, on October 13th. The initial cause of death was attributed to “encephalitis”a diagnosis possibly applied in the absence of recognizing uremic encephalopathy due to diethylene-glycol-induced kidney failure.

Autopsy findings, which were similar among Dr. Hagebusch’s four examined cases, included “pulmonary edema, marked nephritis with hemorrhage into the cortex of the kidney, marked hemorrhage into the pericardium, mucosa of the stomach and duodenum and into the serous surfaces of lung and liver.” The liver was also noted to be “pale, edematous and enlarged.”

A Mississippi native, Kimbrough was buried on October 16th in Centreville Station, Illinois, a southeastern suburb of East St. Louis. FDA records indicate that the remainder of the elixir prescription, 2-1/2 ounces, was “held in evidence” by Altoona Graham (whose relationship to Kimbrough is not indicated).

* Kimbrough/Kimbrew’s parents were Will Kimbrew and Bertha Montgomery. His wife was Mattie Kimbrew, according to his Illinois death record.

** Hagebusch’s brief report was published in a JAMA issue dated November 6, 1937, along with a series of articles on the elixir-related death tally in the United States, available pathologic findings, and animal experiments at the University of Chicago with diethylene glycol and Massengill’s product.

Edwin Maurice Slaughter, the four-year-old son of Edwin H. and Helen, from East St. Louis, Illinois, died on October 16th at the city’s St. Mary’s Hospital (the day after J. D. Kimbrough died at the same facility). The child’s autopsy findings were among those provided by area pathologist Omer E. Hagebush on October 19th to the editors of JAMA. The boy’s elixir-related death was publicly reported on the same date by the St. Louis Post-Dispatch (“Four deaths here among 13 laid to use of new drug”).

Elixir Sulfanilamide was, likewise, prescribed by Dr. Henri H. Weathers of East St. Louis in this case. The doctor’s directions were to compound one ounce of the liquid antibiotic with codeine sulfate (one grain), phenolphthalein (five grains), ferrous iodide syrup (one ounce), and “simple” syrup (quantity sufficient to make four ounces). One teaspoonful of the mixture was to be administered to the boy, every four hours, as treatment for gonococcal urethritis and inguinal adenitis (or inflammation of the lymph nodes in the groin).* The compounded formula was dispensed on October 4th by the Lincoln Pharmacy of East St. Louis.

Unspecified symptoms of diethylene-glycol poisoning began three days after the first dose of treatment. It is unclear when the child was admitted to the hospital. Government reports otherwise indicate that he consumed probably “all but two doses” of his treatment. The balance of the medication was held by Dr. Weathers.

After an inquiry into the death and an autopsy, the boy was buried October 20th in the Douglas Cemetery in East St. Louis.** The county coroner, Leo Madden, certified that the death was “due probably to the ingestion of a drug Elixir Sulfanilamide.”

On December 28, 1937, a settlement of $1,000 was made by The S. E. Massengill Company in response to the death of the Slaughter boy. The agreement, reported by the St. Louis Post-Dispatch (“Five elixir death claims settled here), was the result of claims on record in the St. Louis Probate Court “by means of ancillary administration of the estates of the deceased persons because the Massengill company owns property here.” The company policy became to dispose of all justified claims before they were taken to court.

* How the young boy acquired a typically sexually transmitted disease–if, in fact, the diagnosis was correct–was evidently not a point of curiosity in the investigation of this case.

** Which was reportedly moved to the Sunset Garden of Memory Cemetery in nearby Millstadt to make way for the construction of Interstate Highway I-64 circa 1968.

George W. Nixon, the five-year-old son of Joseph and Mary (née Moore) from Pine Bluff, Arkansas,* died on October 18th at St. Mary’s Infirmary in St. Louis, Missouri. His death, like the deaths of J. D. Kimbrough and Edwin Maurice Slaughter, was reported on October 19th by the St. Louis Post-Dispatch (“Four deaths here among 13 laid to use of new drug”). The boy’s autopsy findings were also included by area pathologist Omer E. Hagebush in his October 19th report to the editors of JAMA.

A compounded mixture of Elixir Sulfanilamide was prescribed by Dr. Henri H. Weathers (physician also of J. D. Kimbrough and Edwin Maurice Slaughter) on October 8th, as a remedy for a “streptococcic throat infection.” One dram of acetylsalicylic acid, 15 grains of phenolphthalein, and 1.5 ounces of Massengill’s elixir were mixed with “simple syrup,” to make a total of four ounces of treatment. The prescribed mixture was produced by the Lincoln Pharmacy of East St. Louis. Instructions were to take a teaspoonful in “a little water” every four hours.

FDA records indicate that the boy drank less than one ounce of the treatment (and that his mother consumed about one-half of the remaining prescriptionpresumably without consequence). Elixir-related “symptoms,” according to Dr. Hagebush’s published report, began the day after treatment was first administered to the child, and the prescription was discontinued on October 11th. It is unclear when the boy was admitted to the St. Louis hospital.

The initial, recorded cause of death, which occurred 10 days after the initiation of treatment, was “acute nephritis following the administration for undetermined kidney infection”; this conclusion, however, was expeditiously amended by the St. Louis deputy coroner to identify Elixir Sulfanilamide as the cause of death. The boy was buried on October 21 in Pine Bluff, Arkansas.

On December 28, 1937, a settlement of $1,000 was made by The S. E. Massengill Company in response to the death of the Nixon boy. The agreement, reported by the St. Louis Post-Dispatch (“Five elixir death claims settled here), was the result of claims on record in the St. Louis Probate Court “by means of ancillary administration of the estates of the deceased persons because the Massengill company owns property here.” The company policy became to dispose of all justified claims before they were taken to court.

* According to the newspaper report of the settlement in this case, the “Nixon boy lived in Arkansas and was visiting in East St. Louis when he died.”

Joseph L. Henry, a 60-year-old switchman, from East St. Louis, Illinois, died on October 18th at St. Mary’s Hospital in St. Louis, Missouri. Henry’s death, like the deaths of J. D. KimbroughEdwin Maurice Slaughter, and George W. Nixon, was reported on October 19th by the St. Louis Post-Dispatch (“Four deaths here among 13 laid to use of new drug”). His autopsy findings were also among the four cases reported by area pathologist Omer E. Hagebush on October 19th to the editors ofJAMA.

On October 8th, Dr. Henri H. Weathers prescribed a compounded mixture to Henry, as treatment for a prostate infection. Following the directions of the doctor’s prescription, the Lincoln Pharmacy of East St. Louis mixed up 30 grains of phenolphthalein and two drams of hyoscyamus* with enough Elixir Sulfanilamide to make four ounces. Directions were to take a teaspoonful of the mixture in a half glass of cool water four times a day.

FDA records indicate that Henry took all but three or four doses of the treatment; Dr. Hagebush estimated that the patient consumed about two ounces of the preparation. Henry discontinued the prescription on October 12th, four days after beginning treatment. It is unclear when he was admitted to the St. Louis hospital, where he died. The cause of death was officially attributed to Elixir Sulfanilamide by the county deputy coroner.

Henry, who was survived by his wife, Rosebud, was buried in Little Rock, Arkansas, on October 23rd.

On December 28, 1937, a settlement of $1,500 was made by The S. E. Massengill Company in response to the death of Henry. The agreement, reported by the St. Louis Post-Dispatch (“Five elixir death claims settled here), was the result of claims on record in the St. Louis Probate Court “by means of ancillary administration of the estates of the deceased persons because the Massengill company owns property here.” The company policy became to dispose of all justified claims before they were taken to court.

* For additional information on the contemporary use of hyoscayamus, see prescribed therapy for elixir victim Martha Agnes Cairns of West Virginia.

Alexander A. Brooks, a 70-year-old “colored” electrician, from East St. Louis, died on October 21st at the city’s St. Mary’s Hospital (six days after J. D. Kimbrough and five days after Edwin Maurice Slaughter died at the same facility). This elixir-related death was reported by the St. Louis Post-Dispatch on same date (“6th east side death from sulfanilamide”).

Brooks was also a patient of Dr. Weathers, who prescribed Elixir Sulfanilamide in combination with codeine sulphate, potassium iodide, and phenolphthalein, as treatment for epididymitis.* The compounded treatment was dispensed by the Lincoln Pharmacy in East St. Louis on October 9th.

“Untoward” symptoms, presumably consistent with diethylene-glycol poisoning, began four days later. It is unclear from government records or other sources when Brooks was admitted to the hospital. He stopped the elixir treatment on October 14th, after having taken an estimated five doses, or about three ounces.

After an autopsy and inquiry, the county coroner, Leo Madden, attributed the death to a “toxic nephritis due to the ingestion of a drug called Elix [sic] Sulfanilamide.” The remainder of the elixir treatment was held by the “family attorney.”

A widower, Brooks was buried in St. George cemetery in Centreville on October 26th.

On December 28, 1937, a settlement of $1,000 was made by The S. E. Massengill Company in response to the death of Brooks. The agreement, reported by the St. Louis Post-Dispatch (“Five elixir death claims settled here), was the result of claims on record in the St. Louis Probate Court “by means of ancillary administration of the estates of the deceased persons because the Massengill company owns property here.” The company policy became to dispose of all “justified” claims before they were taken to court.

Although it would not have been possible for Brooks’s case to have been included in the initial autopsy report submitted by Dr. Hagebusch to JAMA on October 19th, this case (along with the original four submitted by Hagebush) was considered among those compiled by Drs. Geiling and Cannon in their 1938 JAMA report, “Pathologic effects of Elixir of Sulfanilamide (diethylene glycol) poisoning.”

* The St. Louis Post-Dispatch erroneously reported that Brooks was taking the elixir for a “streptococcic throat infection.”

Gertrude Lee (Mrs. Ellis Z.) Black, a 38-year-old housewife, from East St. Louis, died on October 24th at the Homer G. Phillips Hospital in St. Louis, Missouri. The “serious condition” of an unnamed patient at this facility, presumably Black, was reported by the St. Louis Post-Dispatch on October 21st, and the paper publicized this victim’s elixir-related death on October 25th.

The paper and the FDA determined that Black was also a patient of Dr. Henri H. Weathers, who prescribed a mixture of Massengill’s elixir, codeine sulfate, and phenolphthalein as treatment for a streptococcal sore throat on October 13th. The prescription was compounded and sold by the Walter J. Daut Pharmacy of East St. Louis. Black experienced “untoward symptoms” almost immediately after starting treatment, but she managed to consume about two ounces of the preparation, before calling Weathers on October 15th, at which time the prescription was stopped.

She entered the hospital four days later and died five days after admission. The official cause of death was recorded as “acute toxic nephritis following administration of Elixir of Sulfanilamide” by the deputy coroner.

On December 28, 1937, a settlement of $1,500 was made by The S. E. Massengill Company in response to the death of Black. The agreement, reported by the St. Louis Post-Dispatch (“Five elixir death claims settled here), was the result of claims on record in the St. Louis Probate Court “by means of ancillary administration of the estates of the deceased persons because the Massengill company owns property here.” The company policy became to dispose of all “justified” claims before they were taken to court.

William L. Schroeder, a 50-year-old brewery employee from St. Louis, died on October 24th at the city’s Barnes Hospital (where Hazel Fea died two weeks earlier). The St. Louis Post-Dispatch reported this elixir-related death on October 25th (“Two more deaths here from Elixir of Sulfanilamide”).

Through a postmortem inquest (reported by the St. Louis Post-Dispatch), it was revealed that Dr. Louis F. Murray of St. Louis began treating Schroeder for urethritis on October 8th. Murry had purchased one gallon of Massengill’s elixir through a company salesman and had received his supply on October 13th (despite the fact that the firm had received complaints from Tulsa, Oklahoma, three days earlier). On October 14th, Murray prescribed six ounces of elixir to Schroeder, who consumed between four and five ounces over the course of two days, at which time the patient began to experience nausea and “pains.”

Schroeder contacted Dr. Murray, who advised his patient to discontinue the treatment and go to the hospital; however, Schroeder refused. On October 17th, Murray received a telegram from the Massengill company, asking for return of the product. Three days later, a follow-up wire revealed the “poisonous” nature of the liquid antibiotic.

An FDA agent visited Schroeder at his home on October 21st, at which time the agent attempted to confiscate the remaining ounce or so of elixir. But Schroeder refused, stating that he wanted to keep the drug for legal proceedings. Gravely ill with symptoms of acute nephritis, Schroeder was finally taken the following day to Barnes, where he died. The cause of death was officially attributed to Elixir Sulfanilamide. During the postmortem inquest, Dr. Murray admitted to prescribing sulfanilamide tablets to Schroeder, without ill effect, before prescribing Massengill’s antibiotic elixir.

Leaving behind a wife, Matilda,* Schroeder was buried in New St. Marcus Cemetery in St. Louis on October 27th.

On December 10, 1937, it was reported by the St. Louis Post-Dispatch that the Massengill company had reached an out-of-court settlement with Schroeder’s widow, in which she received $2,000. The firm’s attorney, Ruby Garrett of Kansas City, said that the company was “denying its liability in the [elixir-related] deaths,” but that it was settling cases that it deemed to be “justified” and made “in good faith.”

* The couple had been married for only four months.

Possible

Bessie Lee Bosley, a 53-year-old domestic worker, from East St. Louis, died October 8th at the city’s St. Mary’s Hospital. She consumed an unknown quantity of a four-ounce prescription written by Dr. Henri H. Weathers on an unknown date. The treatment was intended, presumably, for a streptococcal infection of the neck and jaw, which was the official cause of death (along with septicemia). The prescription was dispensed by the Walter J. Daut Pharmacy of East St. Louis.

Through the patient’s sister, the FDA confirmed that Bosley, indeed, “had infected teeth and her jaw was swollen and in very bad condition at the time of death.” The sister believed that Bosley had died of the infection.

In addition, the death certificate implied that Bosley underwent some type of surgical procedure during her hospitalization, most probably debridement of the neck or jaw infection, which was likely performed by Dr. Weathers.

Bosley was buried in the Booker T. Washington Cemetery in Centreville, Illinois, on October 10th.

Primary sources
FDA historical records (AF1258), Rockville, MD: General Report from A. E. Lowe to Chief, Central District. October 27, 1937; correspondence from A. E. Lowe to Chief, Central District (with statement from Dr. Weathers). November 26, 1937.
NARA, College Park, MD: Letter from S. W. Ahlmann to Chief, Central District. October 18, 1937 (Box 935, Central District sulfanilamide correspondence).
See also: Hagebusch OE. Necropsies of four patients following administration of Elixir of Sulfanilamide-Massengill. J Am Med Assoc. 1937;109:1537-1539; Geiling EMK, Cannon PR. Pathologic effects of Elixir of Sulfanilamide (diethylene glycol) poisoning: a clinical and experimental correlation–final report. J Am Med Assoc. 1938;111:919-926; and Anonymous. Four deaths here among 13 laid to use of new drug. St. Louis Post-Dispatch. October 19, 1937 (p 3A).