Elixir Sulfanilamide: Deaths in Mississippi

Mississippi’s history with Elixir Sulfanilamide is notable for the fact that the confirmed death toll in the state (as determined by the FDA’s extended investigation) was almost twice that in any other state. The high elixir-related death tally in Mississippi, however, was not due to a disproportionately large volume of elixir shipped to the state, 13 gallons. On the contrary, Alabama and Georgia—states with substantially lower elixir-related death tallies—received roughly 16 and 21 gallons of the product, respectively. Rather the large number of fatalities among Mississippians appeared to be the result of the individual and chance willingness of certain physicians—like the unsuspecting Archie Calhoun of Mt. Olive, Joe Green of Laurel, and John V. James of Bentonia—to write relatively large numbers of prescriptions for the untested product.

Among the 35 drug stores, six physicians’ offices, and one hospital among 34 communities in Mississippi that received Elixir Sulfanilamide (for an annotated Google map of the distribution, go here), the FDA learned that less than 30% of the shipped lots were returned intact to the Massengill firm as a result of its early recall telegrams. Working out of the agency’s New Orleans station, Inspector Roland Sherman was instrumental in not only investigating the first publicized deaths, but in uncovering fatalities by reviewing state death records—which he continued to do into December of 1937. It was ultimately determined that 71 prescriptions for Elixir Sulfanilamide were written and dispensed in Mississippi to 70 individuals (two of whom died in Tennessee (Columbus Bryant and James E. Byrd). In addition, there was at least one over-the-counter purchase of the product (which caused the death of William Corneel Howell).

Elixir-related deaths in Mississippi (23 confirmed, 1 possible, 2 unlikely)

Henry G. Taylor, a 28-year-old “colored” farm laborer from Bentonia, died on September 25th at the Afro-American Hospital in Yazoo City. FDA Inspector Sherman reported this elixir-related death on October 29th, in conjunction with the deaths of four other patients of Dr. James, a white physician from Bentonia.

Dr. James admitted to prescribing six ounces of Elixir Sulfanilamide to Taylor on September 19th, as treatment for gonorrhea. James said that he never saw Taylor again and only heard that his patient had been admitted to the Yazoo City hospital, where he underwent an appendectomy on September 22nd.

Sherman learned of Taylor’s hospital course by interviewing the victim’s surgeon, who also happened to be the hospital’s medical director, “colored” physician Lloyd Tevis Miller. Miller described Taylor’s appendix as “gangrenous” and recalled that the man was in “extreme pain” at the time of admission. Miller also remembered being told that Taylor had been vomiting the night before his admission.

Sherman gained access to Taylor’s hospital records, which are included in the official FDA account. They reveal, importantly, that the patient’s urine output was significantly compromised. Two catheterizations, on September 24th and 25th, produced “not very much urine,” and a “bad kidney condition” was deduced by the hospital staff. In addition, Taylor was noted to be “very restless” on September 24th, a probable manifestation of uremic encephalopathy.

Postoperative hospital treatment consisted of aromatic spirits of ammonia (presumably for recorded restlessness or drowsiness), “hypodermic” normal saline (presumably to stimulate urine production), and sparteine sulphate—an intended “cardiac stimulant and narcotic,” according to the 1917 edition of the Principles and Practice of Pharmacy (Remington JP et al). In addition, a proprietary drug, Nephritin tablets, was administered on three occasions. The medication, as advertised by the New Jersey outfit Reed and Carnick, was a dessicated product “obtained from the cortex and convoluted tubules of fresh, young kidneys, and contained the very enzymes and internal secretions which the normal kidneys themselves make use of in performing their function of freeing the body of its nitrogenous waste products.” The advertised indications for Nephritin were “all conditions accompanied by a suppression of renal function” (The Medical Standard. 1919;42:44).

Despite these interventions, Taylor became unconscious and dyspneic on the morning of September 25th and died at 9:50 am. It was determined, on the basis of the amount of elixir recovered by Inspector Sherman, that Taylor had consumed about 4-3/4 ounces of Massengill’s product.

“Little” Martin Shelby, a 24-year-old “colored” farm laborer from Bentonia, died on September 29th at the Charity Hospital in Vicksburg. Inspector Sherman reported this elixir-related death on October 29th, in conjunction with the deaths of four other patients of Dr. James (including the death of Henry Taylor).

Sherman determined that James had prescribed eight ounces of Elixir Sulfanilamide to Shelby on September 26th, as treatment for gonorrhea and epididymitis. The patient’s condition evidently deteriorated rapidly, because he was admitted to the hospital in Vicksburg, about 50 miles southwest of Bentonia, four days after treatment was begun. Symptoms prompting hospitalization were “generalized weakness, generalized abdominal pain, nausea, and vomiting.”

Like Taylor, Shelby underwent an appendectomy on admission for suspected inflammation of the organ. The operation revealed a normal appendix; however, it was noted during surgery that Shelby’s kidneys were located on his right side—a condition consistent with crossed renal ectopia, a not-infrequent developmental anomaly. The patient’s hospital physicians concluded that the finding was “not considered pertinent.”*

Shelby died one hour after surgery and underwent an autopsy, the results of which were not available at the time of Sherman’s official report. It was determined postmortem that Shelby had consumed about 2-3/4 ounces of his eight-ounce prescription.

* Although the condition, depending on Shelby’s baseline renal function, may have predisposed him to a rapid demise due to the renal toxicity of diethylene glycol.

Franklin Jones, a 28-year-old “colored” man from Bentonia, died on October 2nd. Inspector Sherman reported this elixir-related death on October 29th, in conjunction with the deaths of four other patients of Dr. James (including the deaths of Henry Taylor and Martin Shelby).

Four ounces of Elixir Sulfanilamide were prescribed to Jones on September 26th, as treatment for a “peritonsillar abscess.” In addition, James recommended that Jones gargle with Dobell’s solution, a carbolic acid mouthwash. Three days later, Jones complained of generalized weakness and abdominal pain, and James advised his patient to discontinue the elixir, after he had taken about 2-3/4 ounces.

Two days later, on September 28th, the abscess was noted to be improved, and Jones’s abdominal pain had subsided; but the patient’s family reported that he was experiencing chills and fever. Grove’s Chill Tonic, a proprietary quinine solution,* was administered that evening, at which time Jones complained that “he could not talk clearly and could not see well”—the latter symptom suggesting a direct neurotoxic effect of diethylene glycol. James was summoned the following morning, on Saturday, at which time a glucose and sodium bicarbonate solution was given. Nevertheless Jones died, presumably at home, that night.

* Advertised as “tasteless” by the Paris Medicine Company of Paris, Tennessee.

Joe Hewitt, a 32-year-old “colored” cotton farmer from Deasonville, died on October 4th, presumably at his home. Inspector Sherman discovered this elixir victim by examining state death records, and his full report on this case was submitted to the chief of the FDA’s New Orleans station on December 14, 1937.

Sherman first interviewed the victim’s hometown physician, Homer E. Frizell, more than seven weeks earlier, on October 23rd. Frizell was a direct recipient of one pint of Elixir Sulfanilamide, and he initially reported to the FDA that he had dispensed two-ounce prescriptions “to each of 3 or 4 colored patients.” But the medicine “made them sick,” the doctor said, and he had “emptied out the contents remaining in the pint bottle long before receiving the [recall] wire from Massengill.” Frizell then claimed that he did not know the names of his elixir-treated patients.

When armed later with the information of Hewitt’s suspect death, Sherman revisited the doctor, who then gave up the following account.

Hewitt presented to Frizell’s office on September 29rd with “a severe attack of tonsillitis,” and Frizell prescribed aspirin, two ounces of Elixir Sulfanilamide, and a gargle containing chlorate of potash, phenol, glycerine, and tincture of iodine. Frizell specifically instructed Hewitt to take one teaspoon of the antibiotic solution four times a day.

After consuming an unknown quantity of Massengill’s elixir,* Hewitt was rushed back to the doctor’s office with acute abdominal pain. After vomiting there, Hewitt was treated with two teaspoonfuls of Paregoric and one teaspoonful of aromatic spirits of ammonia—neither of which provided relief. Hewitt was then given a “morphine hypo” and “ortal sodium” by mouth—the latter being a barbiturate.

Sometime unspecified time later, but within a day or two, Frizell was called to Hewitt’s home, where the patient was “still suffering from abdominal pain and slight distention.” Treatment at this time consisted of a soapy enema and cold packs to the abdomen. On October 3rd, four days after Elixir Sulfanilamide was prescribed, Hewitt was febrile, and his mind was “cloudy.” The next day, the patient’s family noted that Hewitt had not voided for several hours. A bladder catheterization at the time produced about “2 grams” of urine. Prescribed treatment, in an effort to stimulate the kidneys, included caffeine (a mild diuretic) and fluids. A few hours after the catheterization, however, Hewitt died of “uremic poisoning.”

* After “ill effects began to show up,” Frizell dumped the unused portion of Hewitt’s elixir prescription and refilled the bottle with another medicine.

Claiborne L(evell) Anderson, a 37-year-old Masonite* employee, from Laurel, died on October 4th at the Laurel General Hospital. The FDA learned of this death on or before October 21st, and the local paper, the Laurel Leader-Call, confirmed the elixir-related deaths of “C. L. Anderson” and four other named, area residents on October 25th.

Anderson was one of several patients of Dr. Joe Green, of Laurel, who prescribed Elixir Sulfanilamide to 10 patients, the FDA learned. In the case of Anderson, Green prescribed six ounces of the liquid antibiotic as treatment for “sore throat and headache” on September 24th. Green was also quick to add, during the FDA’s investigation, that Anderson had suffered with chronic back and flank pain for two years.

Presumptive elixir-related symptoms in Anderson’s case included “extreme” nausea, “acute suppression of urine,” and the spilling of albumin into his urine. Other notable symptoms before hospitalization, reported later to the FDA by Anderson’s wife, included visual problems—suggesting the direct neurotoxic effects of diethylene glycol.

On the evening of September 28th, Anderson was removed to the local hospital, where his symptoms progressed and were later accompanied by hearing difficulties, intermittent hiccoughing, and dryness of the throat. Although no postmortem examination was conducted, the FDA records—presumably informed by Green—indicate that Anderson “appeared” to have a “malignant right kidney,” on the basis of the organ’s “extreme” enlargement and the patient’s longstanding flank pain.

Anderson was buried on October 5th in the Lane Park Cemetery in Jones county. His wife retained his elixir prescription bottle, which held 2-1/2 ounces of the original six-ounce prescription, for “possible legal use.”

During the government’s preparation of its case against Dr. Massengill, the FDA’s Chief Medical Officer, Theodore Klumpp, MD, wrote letters to both Anderson’s widow and his brother-in-law. On March 21, 1938, Klumpp asked whether either remembered when Anderson became “sick to his stomach and vomited.” The doctor wanted to know: Was it before or after Anderson consumed Massengill’s elixir? Evidently the agency found the sequence of events crucial in its case against Massengill. A government envelope was included with each letter to facilitate the recipient’s response.

* According to Wikipedia, Masonite was invented in 1924 in Laurel.

Albert Cole, a 19-year-old “negro” laborer from Laurel, died on October 5th, presumably at his mother’s home. The FDA learned of this case as early as October 21st, and the Laurel Leader-Call confirmed Cole’s elixir-related death, along with the deaths of Claiborne Anderson and three other named, area residents, on October 25th. Like Anderson, Cole was a patient of Dr. Joe Green of Laurel.

Before receiving Elixir Sulfanilamide, Cole had taken seven doses of Neosalvarsan, a synthetic arsenical compound, as treatment for syphilis. He presented to Green on September 24th with an “acute case of gonorrhea,” and six ounces of Massengill’s elixir were prescribed. Cole attempted to take the medication for about two days, despite the fact that it made him nauseated, “drunk-like,” and “dizzy.” After consuming about three ounces of the antibiotic, Cole was given “the usual g. c. treatment” on on September 26th.

On October 2nd, about a week after first taking Elixir Sulfanilamide, Cole developed symptoms of acute nephritis, including suppression of urine production. At some point during this time, Green instructed Cole’s mother to “get a sample of her son’s water but this couldn’t be done,” so she asked a “colored” physician, Dr. D. H. Knaive, to “draw his water.” Apparently all that could be retrieved during catheterization was pus.

Cole died about three days after his renal symptoms were reported. No autopsy was performed. He was buried in Laurel on October 7th.

Hettie Young, an 18-year-old “colored” woman from Sanatorium, died on October 5th, presumably at nearby Magee General Hospital. The FDA learned of this death as early as October 22nd, and the Sunday Item-Tribune of New Orleans reported Young’s death among its nationwide “Fatal Elixir Death Score” on October 24th.

Young received a three-ounce prescription for Elixir Sulfanilamide on September 29th, as treatment for gonorrheal cystitis and vaginitis. The prescription, presumably written by Dr. Wright W. Diamond, was dispensed by the Magee General Hospital, where the doctor was on staff. Directions were to take two teaspoonfuls of elixir four times a day for two days.

It is unknown how much of the medication Young consumed; but after about two days of treatment, she began experiencing “severe pain” in her abdomen. Her pain worsened and was, notably, not eased by the administration of opiates. She stopped producing urine on the fourth day after her prescription was dispensed and lapsed into a coma shortly thereafter. She died on the fifth day after she was given Massengill’s elixir. No postmortem examination was performed.

Young was buried in the New Zion Cemetery in Pinola.

Essie Davis, a 48-year-old “colored” man from Bentonia, died on October 8th at the Charity Hospital in Vicksburg. Inspector Sherman reported this elixir-related death on October 29th, in conjunction with the deaths of four other patients of Dr. James (including the deaths of Henry Taylor, Martin Shelby, andFranklin Jones).

Elixir Sulfanilamide in this case was prescribed on September 18th, as treatment for gonorrhea. One week later, James was called to see the patient, who—despite being “deaf and dumb” at baseline—was able to convey symptoms of “abdominal and chest pain, nausea, and vomiting.” In addition, Davis suffered apparent “urinary retention” and “generalized weakness.” Catheterization, performed by James, yielded about a quart of urine, which demonstrated the spilling of albumin.

Davis was sent to the Charity Hospital in Vicksburg, about 50 miles southwest of Bentonia, at that time (where Martin Shelby was hospitalized). On admission, October 7th, the patient was described as “semi-comatose.” In addition, there was “some difficulty in breathing” and clinical evidence of jaundice. Among blood work obtained, the BUN level was markedly elevated, at 180 mg/dL.

In-hospital treatment consisted of a whole-blood transfusion (500 cc) and intravenous glucose, but Davis died 16 hours after admission. Davis’s elixir bottle was emptied out by a family member, so the amount taken could not be determined by Inspector Sherman.

Leffie Easterling, a 25-year-old “Negro” from Collins, died on October 9th at an unknown location. A patient of Mt. Olive physician Archie Calhoun, Easterling was described in some press reports as a “negress,” but census records suggest that this elixir victim was the 22- or 23-year-old son of Louis Easterling, from Mt. Olive (the patient is recorded as “Lefey” in the 1930 census record). The FDA discovered this death as early as October 23rd, and the Sunday Item-Tribune of New Orleans included Easterling among its nationwide “Fatal Elixir Death Score” on October 24th.

Four ounces of Elixir Sulfanilamide were prescribed by Calhoun on September 30th, as treatment for gonorrhea. The prescription was dispensed by the Calhoun Drug Company, the pharmacy of Calhoun’s brother. On the fourth day of treatment, Easterling experienced “severe abdominal pain, nausea, and vomiting,” after having taken the entire four ounces. Calhoun then prescribed “Elixir of Morphine Hydrochloride” for Easterling’s pain. Eight days after Massengill’s product was prescribed, there was complete suppression of urine, and Easterling died the following day. A postmortem examination was apparently conducted, but the details are not included in the acquired FDA records.

Robert A. Boutwell, a 27-year-old Masonite* employee from Ellisville, died on October 10th at the Laurel General Hospital. The FDA learned of this death as early as October 21st, and the Laurel Leader-Call confirmed the elixir-related death of “R. A. Boutwell,” along with the deaths of Claiborne Anderson, Albert Cole, and two other named area residents on October 25th. Like Anderson and Cole, Boutwell was a patient of Dr. Joe Green of Laurel.

Boutwell had been treated recently for gonorrhea, Green reported to the FDA, and the patient presented to him on September 30th, complaining of a backache and sore throat. Green prescribed six ounces of the liquid antibiotic; however, Boutwell took the medication for only about 24 hours, because it made him “sick on his stomach.”

Boutwell returned to Green’s office on a daily basis for diathermy treatments for his back discomfort, and he was apparently getting on “all right,” because he returned to work on or about October 2nd. However, Boutwell worked only one day, and he returned home to Ellisville, where he was treated in an unspecified fashion by a local physician, a Dr. Carter, on October 7th. Boutwell was admitted sometime thereafter to the Laurel hospital because of “suppression of urine.” The official cause of death, 10 days after receiving Massengill’s elixir, was “acute nephritis” and “uremia.” No postmortem examination was conducted.

Leaving behind a widow, Boutwell was buried in Laurel’s Rushton Cemetery on October 11th. The bottle containing his elixir prescription was held by his father for “legal use.” It is unclear if Boutwell’s family ever brought a suit against the Massengill company.

* According to Wikipedia, Masonite was invented in 1924 in Laurel.

Walter Bell, an 11-year-old “colored” boy from Benton, died on October 11th, presumably at his home. Inspector Sherman discovered this elixir-related death in early December, while reviewing Mississippi death records. Bell’s certificate listed “acute nephritis” as the cause, thereby raising Sherman’s suspicions. The inspector’s full report, like that of elixir victim Joe Hewitt, was submitted to the chief of the New Orleans Station on December 14th, after Sherman interviewed Bell’s prescribing physician, Dr. Homer Frizell of Deasonville (who also prescribed the elixir to Hewitt); Bell’s end-of-life physician, Dr. Samuel H. Wood; and the boy’s mother.

Sherman first interviewed Frizell more than seven weeks earlier, on October 23rd. Frizell was a direct recipient of one pint of Elixir Sulfanilamide, and he first reported to the FDA that he had dispensed two-ounce prescriptions “to each of 3 or 4 colored patients.” But the medicine “made them sick,” the doctor said, and he had “emptied out the contents remaining in the pint bottle long before receiving the [recall] wire from Massengill.” Frizell then claimed that he did not know the names of his elixir-treated patients. However, one of these patients, he did admit, was “a boy who lived on a plantation somewhere near Redmond.”

When Sherman returned to interview Dr. Frizell on December 4th, the doctor claimed that he did not recognize Bell’s name. Back-and-forth interviews with the boy’s mother and Dr. Wood confirmed suspicions that Frizell had, in fact, prescribed the elixir and that the boy’s death was caused by it.

A liquid drug, identified as “reddish” by Bell’s mother, was prescribed by Frizell for the boy’s “abscessed throat” on some unspecified date (but sometime before October 8th). The medication improved the child’s throat symptoms, the mother reported, but it caused vomiting, and this new symptom was followed by the anuria. Wood reported that the boy was brought to him in an unconscious state by his mother on Sunday afternoon, October 10th. The doctor observed edema of the boy’s hands and feet and the absence of a full bladder on attempted palpation. The following day, the boy was found at home in a terminal condition, with “labored” breathing and “bloody mucous” draining from his nose and mouth. He died that evening.

After the boy’s death, his mother “poured the medicine into the fire” along with the bottle. Nevertheless Sherman was able to retrieve a two-ounce bottle, while visiting the victim’s home, from the fire’s remains. He suspected that the bottle had contained the prescribed elixir, but the label was burned off. The mother that her son had taken all but one teaspoonful “or so” of the two-ounce prescription.

Sherman was satisfied that Elixir Sulfanilamide had killed the boy, without reinterviewing Frizell. The inspector wrote a concluding paragraph in his official report:

After learning these facts I did not return to Deasonville to question Dr. Frizell any further. A letter has been written to Dr. Frizell stating the facts in the above case and asking him if he can recall whether this is the boy to whom he gave the Elixir, who lived near Redmond. If Dr. Frizell is unable to recall whether Elixir was given to this boy it may be hard to class this as an Elixir death, but from my experience with these cases, I am satisfied this boy was given Elixir Sulfanilamide and died as a result of poisoning therefrom.

William Corneel Howell, a 38-year-old “colored” sawmill edgeman from New Albany, died at the town’s Mayes Hospital on October 14th. Inspector Sherman reported this case in full to the New Orleans Station on December 9th.

It was learned that Howell had received Elixir Sulfanilamide without a prescription, from his local drug store. The dispensing pharmacist readily admitted to the FDA officer that he had given four ounces of the preparation to “some colored man whose name he did not know.” The reported reason for treatment: gonorrhea. (But Howell himself had claimed during life that he had had taken the medication for an “infected finger.”)

The pharmacist’s over-the-counter recommendations to Howell were to take three teaspoonfuls of elixir in water every four hours for two days and then one teaspoonful in water four times a day for 10 days.* The timing of the prescription was unclear to Sherman, but it was sold sometime before October 5th, when Dr. Curtis M. Roberts was called to the patient’s home.

On that day, Roberts found Howell to be suffering with a “sore throat and slight pain in the left side of the abdomen, and nausea.” The abdominal pain worsened over the next few days, and Howell was admitted to Mayes Hospital on or about October 10th. A urinalysis at that time showed marked spilling of albumin and other signs of acute nephritis. In house, the patient became drowsy, a probable sign of uremic encephalopathy, and anuric. Unconsciousness ensued four days later, at which time the patient died. Howell had probably consumed a total of about three ounces of elixir, given that one ounce remained of his four-ounce treatment bottle.

Roberts admitted to the FDA that, at the time of Howell’s hospitalization, he did not know that his patient had taken Elixir Sulfanilamide; however, the physician began to suspect that Howell’s death was due to the product after “the affair came into newspaper prominence.”

* Although, according to these directions, the entire prescription would have easily exceeded four ounces.

Mrs. Henry (Katie or Katy) Stuckey (née Meadows), a 38-year-old farmer’s wife from Collins, died on October 14th at the Magee General Hospital (where Hettie Young had presumably died). The FDA learned of this elixir-related death as early as October 23rd, and the Sunday Item-Tribune of New Orleans reported Stuckey’s death among its nationwide “Fatal Elixir Death Score” on October 24th.

Like several other elixir victims (including Leffie Easterling), Stuckey was a patient of Dr. Archie Calhoun of Mt. Olive. Elixir Sulfanilamide was prescribed by the doctor on October 9th for an unidentified genitourinary infection. The prescription was dispensed by the Calhoun Drug Company, the pharmacy of Dr. Calhoun’s brother.

Notably a urinalysis before Stuckey’s treatment showed pus, suggesting either a bladder or kidney infection, but no albumin or other abnormalities were reported. Two days after beginning treatment, Stuckey “could retain nothing on her stomach,” and she stopped producing urine. A catheterization of the bladder yielded one “teaspoonful” or urine, which showed marked spilling of albumin.

In addition to anuria, Stuckey experienced abdominal pain and “extreme” nausea at this time. She was admitted to the hospital on an unspecified date with “complete suppression of urine.” Stuckey lapsed into a coma shortly thereafter and died on the fifth day after her first dose of Massengill’s product. She had consumed about 2-1/2 ounces of the liquid antibiotic. Stuckey’s death certificate indicates that she underwent an autopsy, but no postmortem findings are described in acquired FDA records. The empty elixir bottle was retained by her husband.

Stuckey, who left behind minor children, was buried in Oak Grove Cemetery in nearby Smith county. Her burial site was featured in a Life magazine article on the elixir-related deaths in Mt. Olive (November 8, 1937 issue).

Steve Demus, a 25-year-old “colored” man* from Bentonia, died on October 15th at Vicksburg’s Charity Hospital. Inspector Sherman reported this elixir-related death on October 29th, in conjunction with the deaths of four other patients of Dr. James (namely Henry Taylor, Martin Shelby, Franklin Jones, and Essie Davis).

Four ounces of Elixir Sulfanilamide were prescribed for Demus on October 1st, as treatment for gonorrhea. Two days later, Demus complained of “slight weakness,” and James reduced the dosage of the medication. The weakness then “disappeared,” according to Sherman’s report, but six days after treatment began, Demus became “sick at stomach.” On October 7th, James noted that symptoms of gonorrhea had resolved, but that a urinalysis showed marked spilling of albumin. The physician sent Demus to the Charity Hospital.**

On admission, the patient’s physical examination was notable for abdominal “tenseness,” in addition to drowsiness and sleepiness. Demus urinated once on October 10th (three days after hospital admission) but did not void thereafter. Catheterization on “several occasions yielded nothing.” On October 11th, Demus’s BUN level was markedly elevated at 107 mg/dL, and his urinalysis demonstrated blood and albumin. On this day, Demus “became deaf”—suggesting the direct neurotoxic effects of diethylene glycol. On October 12th, Demus lapsed into a coma; he died three days later.

The amount of elixir consumed in this case was not confirmed, because the decedent’s wife emptied out the elixir prescription bottle; however, the widow reported to Sherman that her husband had taken all but a teaspoonful of the four-ounce prescription.

* The 1930 census indicates that a Steve Demus, a farmer and husband of Retha in Yazoo county, would have been about 37 years of age in 1937.

** This was the same day that James’s patient Martin Shelby was admitted to Charity Hospital.

Mrs. Gussie Mae (or Jessie May) Grubbs, a 22-year-old “colored” woman from Mt. Olive, died on October 15th at an unknown location. The FDA discovered this death as early as October 23rd, and the Sunday Item-Tribune of New Orleans included Grubbs among its nationwide “Fatal Elixir Death Score” on October 24th.

A patient of Dr. Archie Calhoun, Grubbs (like Leffie Easterling and Katie Stuckey) received her Elixir Sulfanilamide prescription from the Calhoun Drug Company (on October 5th). The liquid antibiotic was intended as treatment for “severe pyelitis and cystitis,” which was suspected to be gonorrheal in origin. Before treatment, Grubbs’s urine showed “pus” but importantly no other abnormalities.

On the eighth day after the first dose of Massengill’s product, Grubbs experienced “complete suppression of urine.” A catheterization yielded nothing but “shreds of mucus and pus.” Grubbs also suffered “severe abdominal pain, nausea and vomiting” and lapsed into a “semi-comatose condition” shortly thereafter. She died on the tenth day after Elixir Sulfanilamide was prescribed and after having consumed three ounces of her four-ounce treatment. No autopsy was conducted.

Edie (or Eddie) Sullivan, a 49-year-old farmer from Mize, died on October 17th at the Magee General Hospital (where Hettie Young [presumably] and Katie Stuckey had died). The FDA learned of this elixir-related death as early as October 22nd, and the Associated Press reported Sullivan’s death on the same day.

Sullivan was described in the newspaper account as being a patient of Dr. Archie Calhoun of Mt. Olive, but FDA records imply that Sullivan was a patient of Dr. Wright W. Diamond, a physician on staff at the Magee General Hospital (who also treated elixir victim Hettie Young). It seems reasonable to conclude that Calhoun prescribed the elixir, and that Diamond was Sullivan’s hospital physician; however, this is merely inference.*

In any case, it is documented that Elixir Sulfanilamide was prescribed to Sullivan on October 9th as treatment for a “large carbuncle” on the back of his neck. Of note, Sullivan had taken sulfanilamide capsules for three days before the elixir was dispensed, and he “showed improvement” with the tablets. However, five days after taking the first dose of Massengill’s antibiotic soluntion, Sullivan became “markedly nauseated and vomited,” and the elixir treatment was discontinued. Sullivan’s urine production dropped soon thereafter and then stopped completely. These symptoms were followed by coma. Death occurred on the eighth day after the liquid medication was first consumed. Sullivan drank a total of about 2-1/2 ounces of Elixir Sulfanilamide. No postmortem examination was performed.

Sullivan was buried in Oak Grove Baptist Church Cemetery in Mize.

* Although the elixir was dispensed by the Magee General Hospital pharmacy, not the Calhoun Drug Company in Mt. Olive (the retail pharmacy of Archie Calhoun’s brother).

Otis Coulter, a 36-year-old sawmill operator from Mt. Olive, died on October 19th at the Magee General Hospital (like Hettie Young [presumably], Katie Stuckey, and Edie Sullivan). The Associated Press reported Coulter’s death on October 21st (for instance, see the front page of the Laurel Leader-Call), and the FDA began investigating this elixir-related death as early as October 23rd.

Coulter received a four-ounce prescription for Elixir Sulfanilamide and a four-ounce refill from Dr. Archie Calhoun of Mt. Olive, as treatment for gonorrhea. The first prescription was dispensed on October 11st by the Calhoun Drug Company, the pharmacy of the doctor’s brother. On the fourth day of treatment, Coulter began to experience nausea and abdominal pain, and the liquid antibiotic was discontinued. The next day, his urine production dropped, and a follow-up urinalysis revealed marked spilling of the protein albumin, a sign of renal damage.

Coulter was admitted to the hospital on October 17th, “exhibiting suppression of urine and suffering severe abdominal pain, with marked distention of [the] abdomen.” Soon thereafter, his urine production was completely suppressed, and he became delirious and lapsed into a coma. He died on the eighth day after the elixir was first prescribed and after taking a little more than four ounces of Massengill’s product.

An autopsy was performed on Coulter’s body, and tissue specimens were sent to the Lippincott Laboratory in Vicksburg. The kidneys, reported Dr. Diamond to the FDA, were found to be “very flabby,” and markedly necrotic.

Coulter, who left behind a widow (Willie Kate Lingle Coulter) and one-year-old daughter (Myrle), was buried in Rock Hill Baptist Church Cemetery.

James Monroe Vick, a 53-year-old Masonite* employee from Ellisville, died on October 20th in hospital. Vick, like Claiborne Anderson, Albert Cole, and Robert Boutwell, was a patient of Dr. Joe Green of Laurel. His death was reported by the Laurel-Leader Call on October 25th.

Vick received a prescription for Elixir Sulfanilamide on October 12th, as treatment for a chronic prostate infection. According to victim’s widow, who was interviewed by Inspector Sherman on October 25th, Vick experienced nausea and vomiting almost immediately after starting treatment, and these symptoms continued throughout the next week of therapy, along with dizziness. During a scheduled office visit with Dr. Green on Thursday, October 14th, Vick was told to reduce the elixir dosage and to take some other unspecified medication before taking the elixir—presumably as an antidote for the elixir-induced gastrointestinal symptoms.

The next day, Vick developed a headache and had “cramps.” His widow described “green” vomitus. Because Dr. Green was out of town, another physician was called in, who reasonably diagnosed a “bilious attack.” On Monday, October 18th, Vick was intermittently delirious, and he was admitted that afternoon to the hospital. A urinalysis sometime during his illness showed “lots of albumin.”

At the time of hospitalization, Vick complained of head and abdominal pain and “a bad taste” in his mouth. His delirium progressed, and that evening, the hospital nurse observed Vick to be picking at his covers and “talking at random.” Notably he did not void any urine, until he was catheterized (although it is not revealed in FDA records how much urine was obtained during catheterization).

The following day, symptoms of “profuse perspiration,” respiratory difficulties, and blindness were reported. Continuous coughing began, and Vick complained of being “stiff.” He also seemed in “great pain,” according to hospital records and the head nurse (who was interviewed by Inspector Sherman). On the morning of October 20th, the day of his death, Vick sustained a “hard convulsion” and died shortly thereafter, at midday. It is unclear how much elixir he had consumed.

Vick’s death certificate, which was not signed by Dr. Green, listed “carcinoma of gallbladder and stomach” as the causes of death, although an autopsy had not been performed. Vick was buried in Woodlawn Cemetery in Laurel on October 21st.

According to local news coverage, Vick’s body was finally examined at autopsy on or about November 3rd, on order of a local circuit court judge. His organs were reportedly sent to a Vicksburg pathologist for examination.

* According to Wikipedia, Masonite was invented in 1924 in Laurel.

Mrs. Julius Edmond (Nola) Penn (née Derrick), the 62-year-old wife of a “prosperous” Covington county farmer, died in the late evening of October 20th at the Magee General Hospital (where Hettie Young [presumably], Katie Stuckey, Edie Sullivan, and Otis Coulter died). The Associated Press reported this elixir-related death on October 21st (see, for instance, the front page story of the Laurel Leader-Call), and the FDA began its investigation as early as October 23rd.

Like several other elixir victims, Penn was a patient of Dr. Archie Calhoun of Mt. Olive. Elixir Sulfanilamide was prescribed by Calhoun on October 9th, as treatment for “pyelitis” or a kidney infection. The prescription was dispensed by the Calhoun Drug Company, the pharmacy of Dr. Calhoun’s brother.

Before treatment, Penn’s urine demonstrated pus but no other signs of renal dysfunction, like the spilling of albumin. On the seventh day, however, a urinalysis demonstrated the protein, and Penn was admitted to the hospital on October 17th after her urine production dropped substantially. Her symptoms inexorably worsened until “complete suppression of urine set in.” She died 11 days after the first dose of elixir and the day after her 62nd birthday. She had consumed a total of 2-1/2 ounces of Massengill’s product.

Penn was buried in the McNair Cemetery in Covington county on October 22nd. Her burial site was featured in a Life magazine article on the elixir-related deaths in Mt. Olive (November 8, 1937 issue).

Lorene (or Lorece) Lewis, a seven-year-old “colored” girl from a “plantation” about 14 miles from Philadelphia, died on October 20th at home. This case was reported in full on October 22nd by Inspector Sherman, who interviewed an apparently cooperative treating physician, Dr. Robert G. Hand.

Sherman learned that Hand had prescribed Elixir Sulfanilamide, four ounces, on October 10th to the girl, as treatment for an incised and drained inguinal abscess. The liquid antibiotic was apparently tolerated for two days, until the child became nauseated and vomited. The treatment was consequently discontinued by the girl’s mother, and the symptoms were brought to the attention of Hand during a follow-up visit, on October 14th. Hand then prescribed a solution of sodium and ammonium bromides to ease the gastrointestinal symptoms. Because the abscess had “healed,” Hand advised the girl’s mother that no further follow-up was necessary.

Four days later, however, Hand was called to the plantation to see Lewis, who was in a “semi-comatose condition.” Notably she had complained to her mother the previous day that she could not see well—a symptom suggesting the direct neurotoxic effects of diethylene glycol. At the time of the house call, Hand was told that the girl still had trouble retaining “nourishment.” On examination, he detected enlargement of the liver and abdominal tenderness. Her pulse was “accelerated and weak,” despite “good” “heart action.” A recent history of urine production was apparently sketchy. Hand reportedly could not retrieve a sample after more than one attempt (and he found no urine in the bladder postmortem).

At this time, on October 18th, Hand had evidently learned of the danger of Elixir Sulfanilamide (presumably through Massengill’s initial recall wires), and he contacted the company in search of an antidote. The company replied that it knew of none. In desperation, Hand prescribed one dram of sodium bicarbonate orally, as well as intravenously (the latter treatment in a glucose solution).*

The next day, Tuesday, Hand visited the girl three times. He found her pupils to be fixed and dilated, a terminal sign, and he believed that he detected “damage to the retina” during an eye examination.** During the day, she had two episodes of nose bleeding, and blood was detected in a bowel movement. She died the following morning, after having consumed about one or two ounces of Massengill’s elixir.

The remainder of her prescription bottle was kept by the dispensing pharmacist, the Davis Drug Company of Philadelphia,*** for “possible legal use.”

On October 24th, the girl (as “Lorenzo” Lewis) was listed among the New Orleans Item Tribune‘s “Fatal Elixir Death Score.

* Before the Lewis case, and had prescribed Elixir Sulfanilamide to another patient, who also had vomited from the medication. Without knowing of the danger of the product, he administered caffeine and sodium benzoate to this patient, a measure which produced “sudden” improvement, according to his account. On October 20th, the Massengill Company wired the AMA, asking for an “antidote and treatment following Elixir Sulfanilamide.” The medical association replied that it knew of none, and that treatment was “presumably symptomatic.”

** However, the physician admitted that he was “not an eye expert and therefore would not like to be quoted on this point.”

*** This pharmacy was cited by the FDA for returning a full one-pint bottle of Elixir Sulfanilamide that was diluted with water. It was determined that the drug store had dispensed two, four-ounce prescriptions–one to Lewis, and another to a Lois Culberson (who consumed 1-3/4 ounces “without ill effect”)–and had attempted to hide this fact by returning 16 ounces of diluted liquid to Massengill’s headquarters in Bristol.

Emmett (or Eva or Era) Pickens, a 21-year-old “colored” man, from Laurel, died on or about October 21st at an undescribed location. This elixir victim, like Claiborne Anderson, Albert Cole, Robert Boutwell, and James Monroe Vick, was a patient of Dr. Joe Green of Laurel. Inspector Sherman first reported Pickens’s status on October 20th, at which time he was “real sick,” according to Green. The Laurel-Leader Call published Vick’s death, along with the deaths of Green’s other elixir victims, on October 25th.

Pickens received a six-ounce prescription for Elixir Sulfanilamide on October 14th from Green, as treatment for gonorrhea.* After taking three or four doses (approximately one ounce), Pickens discontinued the medication because of nausea. Symptoms of nephritis developed, presumably shortly thereafter, and the patient died one week after the liquid antibiotic was dispensed.

Green, who tended to downplay Elixir Sulfanilamide as the cause of death in some of his patients, attributed mortality in this case to a syphilitic gumma of the brain. No portmortem examination, however, was conducted to verify the diagnosis. The remainder of this patient’s elixir prescription, five ounces, was held by Green “for possible legal use.”

* After receiving “seven shots of arsenic for syphilis.”

Jerry Gordon Strickland, the 33-month-old son of Luther A. and Dorothy (née Gordon) from Burnsville, died on October 22nd at Corinth Hospital. Inspector Sherman discovered this elixir-related death by reviewing state death certificates and reported this case on December 9, 1937.

By interviewing the victim’s father and finding the boy’s treating physician (who had received 24, four-ounce bottles of Elixir Sulfanilamide), Sherman determined that a Dr. Norwood of Corinth had prescribed four ounces of Massengill’s product on or about October 11th, as treatment for the child’s suspected streptococcal pharyngitis. It was reported that the doctor had swabbed the boy’s throat and provided the “blood medicine,” which (he advised) “would drive the poisons out of his system.”

Sherman learned that the child initially tolerated the medication; but after about four days, he began vomiting (after having consumed about 1-3/4 ounces of elixir). At this time, the boy was taken to another local doctor, who documented that the throat infection had “cleared up,” Nevertheless, because of persistent vomiting, hospitalization at Corinth was recommended.

The child was admitted to the facility on the evening of October 16th, at which time he was noted to be vomiting and short of breath. Notably a urine sample could not be obtained, and the boy voided only a very small amount in hospital.* Anuria, along with recurrent vomiting, persisted through hospitalization, and the child became “drowsy and stuporous” three days after admission. In-house treatment included subcutaneous fluids and hot packs. Audible wheezing was treated with inhaled tincture of benzoin. Although a brief period of apparent recovery was observed four days after admission, the boy’s clinical status thereafter declined precipitously. He died six days after hospital admission.

“Infant” Jerry Strickland was buried in Belmont City Cemetery, three months before his third birthday.

When confronted by Sherman in December, Dr. Norwood was apparently reluctant to admit that he had prescribed Elixir Sulfanilamide in this case; however, he could not deny his handwriting on the dispensed bottle, which Sherman had obtained from the victim’s father.

* Although the spilling of protein was not documented in the hospital records, per Sherman, an interviewed laboratory technician recalled that albumin was present in the boy’s urine.

Sallie Louise Brown, a seven-year-old “colored” girl from Benton, died on October 24th, presumably at home. Inspector Sherman discovered this case after reviewing state death records, and he recorded the details on December 14th, after interviewing the treating physician and the girl’s parents.

Sherman discovered that the child had received a two-ounce prescription for Elixir Sulfanilamide from Dr. J. T. Rainier, a white physician in Yazoo City. The medication, which was dispensed by the city’s Carr’s Drug Store on October 13th, was intended as treatment for a streptococcal sore throat and “acute tonsillitis.” Several days after treatment, the girl began to vomit repeatedly, and urine production ceased soon afterward. On October 23rd, a urinalysis (presumably performed by Dr. Rainier) revealed the spilling of albumin. Hyaline casts, white cells, and blood (all possible signs of renal dysfunction) were also detected, but the quantity of urine was insufficient to measure a specific gravity—a routine feature of a urinalysis, which assesses the concentration of the liquid.

During the last days of the girl’s life, she was “partially unconscious,” suggesting the onset of uremic encephalopathy. She died 11 days after Massengill’s product was prescribed and after having taken a little over one ounce.* The official causes of death on the girl’s death certificate (as reported by Inspector Sherman) were “acute nephritis, with uremia,” with a contributory cause of streptococcal pharyngitis.

* Because of the small volume of Elixir Sulfanilamide that had been consumed by the girl, Rainier did not believe that her death could be due to the product.

Possible

Elnora (Mrs. Robert) Perkins, a 46-year-old farmer and farmer’s wife from Itta Bena, died on October 1st at the Colored King’s Daughters Hospital in Greenville, about 45 miles west of her hometown. The FDA learned of this death as early as October 25th, the date of a handwritten report submitted by Inspector R. L. Nelson, who worked out of the agency’s New Orleans station.

Nelson learned that Perkins’s recent medical history was significant for the incision and drainage of a rectal abscess in March at the Greenville hospital. However, she had “never been entirely well since” and presented to her local physician, Dr. Lewis H. Hightower, on September 20th. She reported a three-week history of nausea, vomiting, “obstinate constipation,” abdominal pain, and pelvic soreness, some or all of which began after she lifted a heavy sack of cotton. At the time of her initial visit, Dr. Hightower detected “evidence of specific pelvic infection”* and prescribed four ounces of Elixir Sulfanilamide, which was dispensed that day by Heard’s Drug Store.

On September 24th, four days after the elixir treatment was begun, Perkins reported persistent (but no new) symptoms. Hightower then discontinued the liquid antibiotic and prescribed, instead, a compounded formula of peppermint oil, phenolphthalein, and Cascara Evacuant—the latter being a branded laxative from Parke, Davis & Co. The mixture was to be taken every three hours “till bowels move.”

The next day, Robert Perkins, the patient’s husband, informed Dr. Hightower that his wife was no better. The physician then recommended hospitalization, and on September 25th, Mrs. Perkins was readmitted to the King’s Daughters Hospital, where she was attended by Dr. C. Fred Berry and Dr. Paul Gamble (both of whom were white physicians in the city’s Gamble Brothers practice).

Dr. Berry recollected to the inspector that, during Mrs. Perkins’s hospitalization, she complained of abdominal pain and possibly demonstrated fever.** Two days after admission, she developed a “stiff neck,” a possible sign of a meningeal infection, and “lapsed into a coma.” Death, six days after admission, was attributed to tubercular meningitis.

Limited hospital records indicate, importantly, that Perkins was able to void freely throughout her admission, and that her urinalysis did not show the spilling of protein—a sign that would otherwise be consistent with diethylene glycol-induced nephritis. An autopsy was performed by pathologist E. T. White of Greenville. Although White, astonishingly, did not keep written records of his examination, he was convinced that the cause of death in this case was tubercular meningitis and “was not associated with any drug.”

Perkins had consumed a total of about three ounces of Elixir Sulfanilamide.

* Other FDA notes indicate that Perkins had a history of gonorrhea.

** At the time of the FDA’s investigation, Dr. Paul Gamble was at a meeting in Chicago and, therefore, was not interviewed.

Julia Brown, a 67-year-old woman from Weathersby, died on October 12th. The FDA learned of this possible elixir-related death as early as October 23rd.

It was determined that Brown had received two prescriptions for Elixir Sulfanilamide (one for three ounces and one for six ounces) from two separate doctors in Magee. The antibiotic solution was intended as a remedy for pyelitis, or a kidney infection. The elixir was first dispensed on October 2nd by Magee’s City Drug Store, and a cumulative total of two doses each were taken from each prescription bottle.*

Pretreatment symptoms, consistent with pyelitis, were “severe pain in region of liver, extending to back, [and] localizing over left kidney.” Noteworthy symptoms after Elixir Sulfanilamide was consumed included “extreme nausea and vomiting.” A urinalysis on October 4th revealed pus and “a few casts,” but there was, importantly, no spilling of albumin.** To alleviate Brown’s discomfort, her doctors administered a morphine “hypodermic,” along with oral calomel (namely mercury chloride) and rhubarb, which she vomited. Tincture of camphorated opium (ie, Paregoric), one-fifth grain of strychnine, and Pepto-Bismol were then given. Brown died 10 days after Elixir Sulfanilamide was first prescribed.

* The second prescription was filled two days after the first prescription.

** A pretreatment urinalysis was evidently not performed.

Unlikely

John W. Gibbons, a 72-year-old farmer from Mt. Olive, died on October 9th at the Baptist Hospital in Jackson. The FDA first learned of this possible elixir-related death on October 23rd. Gibbons was a patient of Dr. Archie Calhoun, also of Mt. Olive, who wrote the prescription for Elixir Sulfanilamide. The prescription itself was dispensed by the Calhoun Drug Company (the proprietor of which was Dr. Calhoun’s brother).*

Recognizing Gibbons’s death as being due to Elixir Sulfanilamide was and is confounded by the patient’s preexisting symptoms of an enlarged prostate and probable cardiac disease. Before the use of Massengill’s elixir, Gibbons had already experienced retention of urine, probably as a result of prostatic hypertrophy.

Shortly after prescribing four ounces of Elixir Sulfanilamide for Gibbon’s urinary symptoms on October 4th, Calhoun referred the patient to a doctor in Jackson, who admitted the farmer to the city hospital on October 5th for “acute retention of urine” and a “malignant” prostate. Gibbons’s inpatient therapy consisted of placing a catheter in his bladder to ease voiding. The bladder was also irrigated with boric acid, a contemporary treatment for cystitis. During hospitalization, Gibbons’s urinary output, once he was catheterized, was not obviously suppressed,** and he did not show other signs of renal disease. While waiting for prostate surgery, which was postponed for unclear reasons, Gibbons experienced a devastating cardiac event, likely a heart attack, four days after hospital admission. He died within an hour.

Gibbons’s widow*** (Mary E.) filed a civil suit on October 31, 1938, against The S. E. Massengill in the District Court of the United States for the Eastern District of Tennessee Northeastern Division (Greeneville, Tennessee). A total of $25,000 in damages was requested, including recompense for funeral expenses ($456), hospitalization ($65), and physicians’ and nurses’ services ($60).

On April 19, 1939, the presiding judge granted the plaintiffs’ request to dismiss the suit, without prejudice.

* Court records indicate that the company was charged $12.05 by the Massengill Company for shipping one gallon of Elixir of Sulfanilamide.

** Although gauging urine production would have been difficult with continuous irrigation of the bladder.

*** The plaintiffs, along with Mrs. John W. Gibbons, included the children of the deceased.

Primary sources: New Orleans Report (Elixir Sulphanilamide [Fatalities]) to Chief, Central District. October 25, 1937; letter from R. D. Sherman to Chief, Central District (Death of Jerry Strickland). December 9, 1937; letter from R. D. Sherman to Chief, New Orleans Station (Death of Sallie Louise Brown). December 14, 1937; letter from R. D. Sherman to Chief, New Orleans Station (Death of Walter Bell). December 14, 1937; letter from R. D. Sherman to Chief, New Orleans Station (Death of Joe Hewitt). December 14, 1937; and letter from Roland D. Sherman to Chief, Central District (Death of William Corneel Howell). December 9, 1937. All in FDA historical files (AF1258). Rockville, MD.