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Elixir Sulfanilamide: Deaths in Oklahoma

Although the first fatalities due to Elixir Sulfanilamide did not occur in Oklahoma, elixir-related deaths there were the first to be recognized on a national scale—thanks to the early-warning efforts of Tulsa physicians.

FDA Station Chief Hartigan and Junior Inspector Donaldson, who were dispatched to the city on October 15th, learned that more than six gallons (6.625) of Elixir Sulfanilamide had been distributed from Massengill’s Kansas City, Missouri, branch to 18 drug stores among nine communities within the state. (For an annotated Google map of the elixir distribution in Oklahoma, go here.) In their canvass of recipient drug stores, the FDA men discovered that less than half of the elixir had been returned intact to the manufacturer as a result of Massengill’s recall wires. The agents’ responsibility, therefore, became to locate the whereabouts of the outstanding volume (more than 3-1/2 gallons), which had been used, they would learn, to fill 38 prescriptions for 39 Oklahomans.

These prescriptions were ultimately determined to have caused the deaths of 11 residents, including eight children. The first known deaths in Oklahoma were confirmed by the FDA as least as early as October 16th (per an agency wire of that date). Chief Hartigan detailed all of the elixir-related deaths in Oklahoma in his full report to Central District Chief Clarke, dated November 3rd.

Elixir-related deaths in Oklahoma (11 confirmed)

Robert “Bobbie” Sumner (or Summer), the two-year-old son of J. M. Sumner/Summer* of Leonard, died on September 30th at his aunt’s home in Tulsa.

Hartigan and Donaldson learned that the boy had received a four-ounce prescription for Elixir Sulfanilamide on September 24th from pediatrician David J. Underwood.  This prescription, as treatment for a “cold, sore throat, and malaise,” was dispensed by the Getman Drug Store from a one-gallon bottle that the pharmacy had received directly from the manufacturer.  (Notably this Tulsa drug store supplied 24 [63%] of the 38 prescriptions for Elixir Sulfanilamide that were filled in Oklahoma.)

Five days after beginning the elixir treatment, the toddler stopped producing urine. A pediatric nephrologist, Garabed A. Z. Garabedian, was called in to examine the child. He noted that the boy was vomiting and feverish. Garabedian also observed that the child’s face was “swollen” (a probable sign of generalized edema), his abdomen was distended (a probable sign of ascites), and his urine (what little there was of it) was bloody. Bobbie died the following day, the attributed cause being “acute hemorrhagic nephritis.” Without yet being aware of the toxicity of Elixir Sulfanilamide, Dr. Underwood ascribed the kidney-based fatality to an unusually rapid course of streptococcal nephritis. The boy, it was determined in retrospect, had consumed a total of 1.4 ounces of Massengill’s product.

Once the toxic nature of Elixir Sulfanilamide became known, Bobbie’s father said to Dr. Garabedian that he would file a wrongful death suit against the drug maker. On November 2nd, the Ada Evening News confirmed that J. M. Sumner had been appointed administrator of his son’s estate, as a prelude to legal proceedings against the Massengill firm. Mr. Sumner’s wrongful death claim was in the amount of “approximately” $6,000, the paper reported. The outcome of the suit is unknown to the writer.**

* Probably James Mat Sumner.

** Although it was likely settled, given the company’s declared policy to dispose of all “justified” claims before they were taken to court (see, for instance, the St. Louis Post-Dispatch of December 28, 1937 [“Five elixir death claims settled here”]). In cases of children who died after consuming Elixir Sulfanilamide in the St. Louis area, the Massengill firm paid out $1,000 per case.

Mary Earline Watters, the 11-month-old daughter of Earl F. and Fern of Tulsa, died on October 1st at city’s St. John’s Hospital.

Pediatrician David J. Underwood (also the treating physician of Robert Sumner) wrote a four-ounce prescription for Elixir Sulfanilamide on September 25th, as treatment for suspected streptococcal pharyngitis. This prescription, like that for the Sumner boy, was filled by Tulsa’s Getman Drug Store. After two days of therapy, the girl was having “difficulty with breathing,” and began vomiting.* Four days after starting treatment, she was admitted to the hospital, where she was noted to be anuric.

Heroic in-house treatment consisted of an oxygen tent, blood transfusions, and unspecified “injections.” Nevertheless Mary Earline died six days after receiving her prescription for Massengill’s elixir and after having taken three days’ worth of treatment.** The official cause of death, before the lethality of the liquid antibiotic became known, was “streptococcus nephritis.”

An autopsy was performed by pathologist Ivo Nelson, who—in his investigation of the series of elixir-related deaths in Tulsa—used this case to argue that Massengill’s product was the cause of death. He observed, “This child was bottle fed, and might be considered a more clear-cut case than most, since diet was closely controlled. The age of the child also made for simplification as there was little chance of damage to organs due to other causes.”

The girl was buried in Lawson, Missouri, on October 2nd.

* The girl’s mother also consumed some portion of the elixir (at “twice the dose”) during the same time period; however, the mother also “took large quantities of fluids, water, lemon juice, etc. This […] was probably responsible for her suffering no ill effects,” Hartigan wrote.

** On the basis of the prescription directions, the girl may have taken as much as three ounces of elixir; however, given the fact that she shared the prescription with her mother, it is more likely that she consumed substantially less than three ounces.

John “Jack” King, Jr., the eight-year-old son of John and Katherine (or Kathryn) of Tulsa, died on October 1st at the St. John’s Hospital in Tulsa.  The boy’s death was reported publicly by the Tulsa Tribune on October 15th.  Hartigan obtained the child’s case history by interviewing his parents and the family’s attorney, Thomas Austin Gavin, who was also the victim’s uncle.

Three ounces of Elixir Sulfanilamide were prescribed on September 23rd by Tulsa pediatrician Killis Reese for an unspecified illness (the child reported feeling “sick” while attempting to walk home from school). The prescription was dispensed by the city’s Lincoln Drug Store, which had obtained its elixir supply from the Getman pharmacy. Jack consumed about half of the dispensed medication over the course of a week,* before experiencing anuria—which prompted hospitalization on an unknown date. Death, occurring eight days after elixir treatment had begun, was attributed to “influenza” and “acute hemorrhagic nephritis” by Dr. Reese, who signed the death certificate. The child was buried in the “Holy Family Cemetery” on October 4th.

Attorney Gavin told Hartigan that “the circumstances could not be described as anything other than ‘murder.'” The lawyer retained the prescription bottle as evidence for a possible wrongful death suit; however, it is not clear what legal action, if any, was taken against the Massengill firm in this case.

* The victim’s mother could not state accurately how much of the elixir had been consumed, because a nurse had been employed to take care of the child during his illness.

Millard Wesley Wakeford, the five-year-old son of local hockey star Millard O. (“Sonny Boy”) and wife Natalie from Tulsa, died on October 4th at the city’s St. John’s Hospital.  The boy’s death was reported publicly in a brief notice by the Tulsa Daily World on October 5th. The Tulsa Tribune reported this victim, together with other elixir-related deaths, on October 15th.

On September 26th, Dr. David J. Underwood (the treating physician also of Robert Sumner and Mary Earline Watters) prescribed Elixir Sulfanilamide for the boy and his younger sister, both whom were suffering with sore throats. The prescription, like that of the Sumner boy and the Watters girl, was dispensed by the Getman Drug Store. Both children, at some unspecified time during their treatment, developed anuria and were hospitalized; however, the girl survived. Dr. Underwood initially attributed the Wakeford boy’s death to “streptococcus nephritis.” The child was buried in Memorial Park (presumably in Tulsa County) on October 6th.

On November 4, 1937, the Tulsa Daily World reported that the boy’s father had been appointed the administrator of the deceased’s “estate,” as a prelude to a lawsuit against the Massengill firm. The claim for damages amounted to $6,000. The outcome of the case is unknown.*

* Although it was likely settled, given the company’s policy to dispose of all “justified” claims before they were taken to court (see, for instance, the St. Louis Post-Dispatch of December 28, 1937 [“Five elixir death claims settled here”]). In cases of children who died after consuming Elixir of Sulfanilamide in the St. Louis area, the Massengill firm reportedly paid out $1,000 per case.

Joan_Marlar_small.jpgJoan Marlar (right), the six-year-old daughter of R. R. Marlar and Maise Nidiffer,* from Tulsa, died on October 5th at the city’s Morningside Hospital.  The girl’s death was reported publicly in a brief funeral notice by the Tulsa Tribune on October 7th, before the lethality of Elixir Sulfanilamide became known.

From the girl’s mother, Hartigan learned that Dr. Logan Spann had prescribed Elixir Sulfanilamide on September 26th, as treatment for a sore throat, and that the prescription was “sent out” from the Getman Drug Store and cost $1. After consuming a total of one half of the three-ounce treatment, the girl was hospitalized with anuria. Death was initially attributed to “streptococcus nephritis.” The child was buried in Rose Hill Cemetery on October 7th.

During their investigation, Hartigan and Donaldson discovered that Dr. Spann had deliberately destroyed the pharmacy record of Joan’s elixir prescription. In December of 1937, Joan’s mother received $1,250 from the Massengill company as compensation for Joan’s death.

* The girl’s father was probably Robert “Rob” Roy Marlar, born in 1900 or 1901 in Arkansas. The girl’s mother’s maiden name was Story. She was also born in Arkansas.

Photograph of Joan Marlar from FDA files at NARA (College Park, MD).

Michael S. Sheehan, the six-year-old son and only child of George P. and Helen from Tulsa, died on October 6th at the city’s St. John’s Hospital.  The boy’s death was reported publicly by the Tulsa Tribune on October 15th.  Hartigan obtained the child’s case history by interviewing the mother of the victim on October 20th.

Four ounces of Elixir Sulfanilamide were prescribed on September 27th by pediatrician Killis Reese (also the prescribing physician of Jack King), as treatment for a “sore throat and malaise.” At some unspecified time during treatment, the child became anuric and was consequently hospitalized. An otherwise “strong healthy boy,” according to his mother, Michael died nine days after the elixir prescription was dispensed and after taking all but one teaspoon of the medication.

A postmortem examination, performed by local pathologist Ivo Nelson, revealed necrotic kidneys and degeneration of the liver.

In preparation for a wrongful death suit against The S. E. Massengill Company, a Tulsa court named the victim’s father the administrator of the child’s “estate,” reported the Tulsa Daily World on November 4, 1937. The claim for damages amounted to $6,000. The outcome of this case is unknown to this writer.*

* Although it was likely settled, given the Massengill Company’s policy to dispose of all “justified” claims before they were taken to court (see, for instance, the St. Louis Post-Dispatch of December 28, 1937 [“Five elixir death claims settled here”]). In cases of children who died after consuming Elixir of Sulfanilamide in the St. Louis area, the Massengill firm reportedly paid out $1,000 per case.

Kathleen Estelle Hobson, the eight-year-old daughter of Thomas Marshall and Pearl from Red Fork, died on October 9th at Tulsa’s Morningside Hospital.

The FDA learned that Tulsa physician William R. Turnbow had written a four-ounce prescription on October 1st for Elixir Sulfanilamide, which was intended to treat the girl’s “cold and sore throat.” The prescription was filled by the Red Fork Drug Store and dispensed from a one-pint bottle received from Massengill’s branch in Kansas City, Missouri.

Kathleen continued the elixir treatment for three days, despite clinical deterioration.* Like Joan Marlar, she was admitted to Morningside Hospital with anuria. She died at the hospital, eight days after beginning treatment with Massengill’s product and after taking about 1.4 ounces of it.** The balance of the prescribed liquid antibiotic was “thrown out in the trash and burned by [the] deceased’s mother.”

An autopsy, performed by a Dr. Williams, showed findings similar to those detected by Tulsa pathologist Ivo Nelson in other elixir-related deaths.

In December of 1937, the Kathleen’s father received a $1,000 settlement from the Massengill company.

* According to family history, Kathleen hated the taste of the elixir so much that her mother and older sister had to hold her down to deliver the medication (telephone interview with Charlotte Cox, June 16, 2009).

** October 9th was also the day that Tulsa physicians first wired the AMA about the series of suspect pediatric deaths in their city.

Glen(n) F(rederick) Entler, the 19-year-old son of widower Alfred B. Entler of Tuscola, Illinois, died on October 9th in Tulsa while visiting* his aunt and uncle. Entler’s death was publicly reported through a two-paragraph notice in the Tulsa Daily World on October 10th. The toxicity of Elixir Sulfanilamide not yet being widely recognized, the death notice merely identified that the young man had expired after a “brief illness,” which was described as a “kidney ailment.” Entler’s case, as a possible elixir-related death, became known to the AMA through Dr. Darwin Childs, the prescribing physician. Childs drafted a letter to the medical association on October 11th, revealing Entler’s consumption of the liquid drug.

The FDA learned that Entler had received a six-ounce prescription for Elixir Sulfanilamide on September 28th, as treatment for “acute gonorrhea.” The prescription was filled by Tulsa’s Quaker Drug Company, which had received one gallon and two pints of the liquid antibiotic from Massengill’s Kansas City, Missouri, branch. Anuria developed after Entler had consumed more than four ounces, and he was hospitalized as a result. He died 11 days after receiving his elixir prescription and four days after taking the last dose of medication. An autopsy, performed by pathologist Ivo Nelson, showed findings that were consistent with those of other elixir victims in Tulsa.

Notably Dr. Childs sent the remainder of Entler’s elixir prescription (about 50 cc or approximately 1.7 ounces) to the AMA for analysis “under separate cover” from his October 11th letter. Childs was, therefore, one of the earliest sources of elixir for the AMA’s chemical examination of the product. The contents of this bottle, specifically, were described by AMA chemists in the November 8, 1937, issue of JAMA (Schoeffel EW et al. Chemical examination of Elixir of Sulfanilamide-Massengill. J Am Med Assoc. 1937;109:1532). After distillation experiments, it was determined that the elixir contained 70%-75% “pure” diethylene glycol by volume, and that there had been no chemical alteration of the dissolved antibiotic.

* Or living with.

Charlene Mardell Canady, the four-year-old daughter of Charles K. and Nell, from Tulsa, died on October 12th at the city’s St. John’s Hospital.  Kansas City Station Chief Hartigan and Inspector Donaldson interviewed the victim’s parents on October 16th.

The girl’s mother explained that, owing to her confinement and the recent birth of a child, she “had not been able to given attention” to the girl. Consequently she wanted Charlene to undergo a “check-up,” because the girl felt “out of sorts.” Dr. David Underwood (the physician of Robert SumnerMary Earline Watters, and the two Wakeford children) was consulted, and he prescribed three ounces of Elixir Sulfanilamide for the girl on October 4th—presumably as treatment for streptococcal pharyngitis. (However, the exact reason for the treatment is not explained in FDA records.) The girl became anuric and was hospitalized. She died eight days after receiving the elixir prescription and after having consumed a total of two ounces.

Charlene Mardell was buried in Clinton Oaks Cemetery, and her father retained approximately one-half ounce of the prescribed elixir in the “original bottle.” Whether any legal action was taken by the victim’s family in this case is unclear, however.

Earl-Beard_Tulsa-Daily-World_10-17-37.jpgEarl Lee Beard (right), a 25-year-old air-conditioning engineer, from Tulsa, died on October 16th at an unnamed city hospital. Both the Tulsa Tribune and the Tulsa Daily World reported Beard’s “mysterious” death on October 17th, in conjunction with similar deaths in the area.

Beard received a prescription for eight ounces of Elixir Sulfanilamide from Dr. H. B. Justice, as treatment for gonorrhea, and the prescription was filled by the Getman Drug Store on September 30th. Beard developed anuria and was hospitalized after taking five ounces of the liquid antibiotic. He died 16 days after the elixir was dispensed.

Beard, who was survived by his divorced parents* and a sister, was buried in the Memorial Park Cemetery in Oklahoma City, his hometown. In September of the following year, his mother, Norris T. Beard, pursued a wrongful death suit against The S. E. Massengill Company for $50,000 in damages. Notable claims in the complaint, which was filed in the US District Court for the Eastern District of Tennessee, Northeastern Division (Greeneville), were 1) the victim’s life expectancy was 38.81 years; 2) his funeral costs were $596.43; 3) his hospital bills amounted to $127.00; and 4) the service fees of his physicians, surgeons, and nurses totaled $500.00.

On April 14, 1939, the presiding judge,** George C. Taylor, awarded Beard’s mother $7,500 for “loss of support and pecuniary loss” and $1,000 for “conscious pain and suffering.” In addition, Massengill was ordered to pay the plaintiff’s court costs, totaling $114.20.

* According to deposition testimony, Beard was estranged from his father.

** A jury trial was waived by “all parties.”

Photo of Earl Beard from the Tulsa Daily World. October 17, 1937.

Wilmer L. Morris, the 22-year-old son of Walter V. and Susie of Osage, died on October 27th at St. John’s Hospital in Tulsa. In an interview with the victim’s father on October 21st, Kansas City Station Chief Hartigan learned that Morris had been treated for gonorrhea by Dr. P. G. Hanson, from nearby Cleveland, for “some time.” “[Morris] was in fair condition physically,” Hartigan reported, “and had been working some although [he was] inconvenienced by his disease.” Nevertheless, the illness had not confined the patient to bed, the agent learned.

On October 13th, four days after Tulsa physicians first notified the AMA of the potential danger of Elixir Sulfanilamide, Dr. Hanson wrote a four-ounce prescription for the product, which he gave to the victim’s father. This prescription was filled promptly by the Cleveland Drug Company, which had received two pints of Massengill’s product from the firm’s Kansas City, Missouri, branch.

Morris drank about two-and-a-half ounces of the liquid antibiotic over the course of two days. Symptoms of nausea, vomiting, and flank pain began “almost immediately,” and anuria developed shortly thereafter. The young man was admitted as a “charity patient” to St. John’s Hospital in Tulsa on October 22nd. Morris initially rallied during hospitalization and “his kidneys began functioning again”; however, “after a few days he again became worse” and died 12 days after the elixir was dispensed. A postmortem examination was made by Tulsa pathologist Ivo Nelson, the results of which (curiously) were “not yet available” at the time of Hartigan’s November 3rd report.

In the FDA’s compiled records of elixir prescriptions, it was noted:

The Cleveland Drug Co. and the attending physicians, Dr. P. G. Hanson (D.O.) interposed every possible interference in attempting to trace subdistributions. The attending physician […] changed the records on the prescriptions which had been filed by the drug store.

Primary source: Wm. H. Hartigan to Chief, Central District. November 3, 1937. FDA historical files (AF1258), Rockville, MD.