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Elixir Sulfanilamide: Deaths in South Carolina

The investigation and confiscation of Elixir of Sulfanilamide in South Carolina was coordinated out of the FDA’s hub in Atlanta, under the direction of veteran Station Chief John J. McManus (see Deaths in Florida and Deaths in Georgia). From an October 20th dispatch out of the FDA’s Eastern District office, McManus learned that 11 gallons of elixir had been distributed to two doctors, nine pharmacies, and one hospital training school in the state (for a Google map of the distribution, go here). Seven recipients were located in Charleston, but the remainder were scattered among five small towns in or near the state’s southern coastal plain or Lowcountry.

On direct orders, native South Carolinian Monte Rentz, 31, a junior inspector stationed at Tampa, Florida, proceeded to his home state. In addition, the Atlanta Station telephoned officials at Charleston to assist with the local confiscation and investigation in that city. In response, the FDA received “valuable assistance,” McManus reported, from Dr. Leon Banov, director of the Charleston County Health Department. (Notably the local investigation of a string of five suspect deaths in Charleston had begun about a week earlier, shortly after Tulsa physicians began separately investigating elixir-related deaths in their city.)

Unfortunately South Carolina did not employ its own drug inspectors. Therefore the inspection of the state outside of Charleston was left to Rentz. The FDA quickly determined that most of the distributed elixir in South Carolina, eight-and-a-half gallons, had not been returned to Massengill headquarters in Bristol, Tennessee.

In his efforts to trace the whereabouts of one of these gallons, Rentz received deliberately vague or outrightly false information from Dr. Johnston Peeples, 50, of Estill, who had written (it was later determined) seven prescriptions. Initially Dr. Peeples insisted to Rentz that all of his elixir-treated patients were alive and well. The tenacious inspector would discover otherwise.

Ultimately 19 prescriptions in South Carolina were discovered, causing nine deaths. In addition to the seven prescriptions written by Dr. Peeples (which caused four deaths), another seven were written by Dr. J. A. C. Jackson of Charleston (causing five deaths). Dr. Alexander S. Blanchard,* 48, of Williston, who had received five gallons of elixir, wrote four prescriptions, none of which resulted in death.

* When visited by Rentz on October 23rd, Blanchard “was very much confused due to illness in his family, and could give no information regarding his patients who had taken the Elixir.” However, Blanchard was apparently cooperative with the agent during a follow-up investigation.

Elixir-Related Deaths in South Carolina (9 confirmed)

Oscar Chisolm, a 26-month-old “colored” boy,* died on September 30th at Roper Hospital in Charleston. In their investigation of one gallon of elixir that had been shipped to McFalls Pharmacy, local health officials and Inspector Rentz learned on October 22nd that seven prescriptions had been dispensed from this supply. All of these prescriptions, it was determined, had been written by Dr. Jackson, a local “colored” physician.** One of these prescriptions was dispensed on September 24th to the Chisholm boy. The antibiotic elixir was intended to cure his sore throat.

According to a report in the February 1938 issue of the Southern Medical Journal by pathologist Kenneth M. Lynch of the South Carolina Medical College, Chisolm was admitted to Roper Hospital “in a stuporous state” on September 30th. The boy’s creatinine and BUN levels were dangerously high, at 6 and 105 mg/dL, respectively. Chisolm died “about 13 hours later” of “uremia from acute nephritis.” (The South Carolina death certificate also listed “lobar pneumonia.”)

Lynch’s autopsy revealed “markedly” enlarged, necrotic kidneys and “disintegration of the epithelial lining of the secretory portion of the tubules.” The liver was also moderately enlarged.

On October 2nd, Oscar Chisholm was buried in Jacksonboro, according to his South Carolina death certificate. It was apparently never determined how much of the two-ounce elixir prescription the boy had consumed.

* Parents were Oscar and Rosetta.
** According to FDA correspondence, two of these prescriptions, one to a “colored woman” and one to a seven-year-old “colored girl,” caused “no ill effects.” Letter from J. J. McManus to Chief, Eastern District. November 16, 1937. NARA, RG88, FDA general correspondence, 1937. College Park, MD.

Ella Blanche Washingtona three-year-old “colored” girl,* also died on September 30th at the Roper Hospital in Charleston. Like Oscar Chisolm, the girl had received a prescription from Dr. Jackson, which was filled by McFalls Pharmacy on September 24th. Death was attributed to “acute nephritis” and “uremia,” the underlying cause of which was unknown at the time of death. The amount of elixir consumed by the toddler (from a three-ounce prescription) was never determined, and the reason for treatment was not described by the FDA. An autopsy was not performed.

According to her South Carolina death record, Ella’s remains were removed to Mount Pleasant, a suburb of Charleston, on October 3rd.

* Parents were Marion and Margaret.

Pearl Locklair (née Miles), a wife, mother, and 37-year-old “colored” domestic worker for a private family, died on October 4th at Roper Hospital in Charleston. Like the Chisolm boy and the Washington girl, Locklair received her elixir prescription from Dr. Jackson. The liquid antibiotic was intended to treat a “retropharyngeal abscess or tumor.” Locklair’s prescription, like those of Jackson’s other patients, was filled at McFalls Pharmacy on September 24th.

According to Dr. Lynch’s report, Locklair was admitted to the hospital on September 29th and “developed a state of anuria with coma.” On the date of her death, Locklair’s creatinine and BUN levels were 19.2 and 135 mg/dL, respectively, indicating profound renal dysfunction. It was initially believed that renal failure was due to an infection.

Findings from an autopsy, performed two days after death, were similar to those of the Chisolm boy. Locklair’s remains were removed to Early Branch (Hampton County), South Carolina, on October 10th. The amount of elixir consumed by Locklair (from a six-ounce prescription) was apparently never determined.

In 1942, Massengill finally settled a damages claim from Locklair’s estate for $1,500, plus $150 for expenses and court costs.

Susie Mae DeLoach, a 16-year-old farmer’s daughter* from Brunson, died on October 7th, about one month shy of her 17th birthday. Inspector Rentz uncovered this death during his extended investigation of one gallon of elixir that had been shipped directly to Dr. Johnston Peeples of Estill.

From the girl’s primary physician, Dr. Folk, Rentz learned that DeLoach had developed a skin infection on her leg, which occurred after a barbed-wire injury on September 27th. The injury was first treated locally with an antiphlogistine and ichthyol ointment. But “the infection spread and [the girl’s] heart was being effected [sic].” Consequently Folk prescribed the cardiac stimulants strychnine (1/60th grain) and tincture of digitalis (10 drops) to be taken alternately every six hours.

Rentz’s report continued:

The family of the girl asked Dr. Folk if he would mind calling Dr. Johnston Peeples in for consultation. He had no objection and Dr. Peeples examined the girl. He decided to give Elixir Sulfanilamide in an attempt to control the infection. A 2 or 3 oz. bottle of the Elixir was left for the girl by Dr. Johnston Peeples.

After consuming a total of about two ounces of the medication, the teenager became very nauseated, and she was directed to stop the treatment on September 30th or thereabouts.** Between that day and her death, the girl’s kidneys “ceased functioning entirely.” Catheterization of the bladder on one occasion produced only about two ounces of urine. Death was originally attributed to “streptococcus infection of leg followed by kidney suppression.”

DeLoach was buried in the Terry (or Thames) Cemetery the day after her death. After Rentz “secured” the “definite information” of this death, “he pointedly accused Dr. Peeples of prescribing [Elixir Sulfanilamide] to this victim and the Doctor finally admitted that he did.”

* Parents were Thomas W. and Mae.
** It is unclear from the FDA records who ordered DeLoach to stop the treatment, Dr. Peeples or Dr. Folk.

James Stewart, a 10-year-old “colored” boy* from Union Heights, died on October 12th at the Roper Hospital in Charleston, a month shy of his 11th birthday. Like Oscar ChisolmElla Blanche Washington, and Pearl Locklair, Stewart received a prescription for Elixir Sulfanilamide from Dr. Jackson. The four-ounce treatment was dispensed from the McFalls Pharmacy on September 24th.** The reason for the therapy was not described by the FDA.

Dr. Lynch’s published medical report indicates that the boy began vomiting on or about October 1st, and that the vomiting progressed in relentless fashion. On October 11st, the child was admitted to the hospital in a “comatose state,” and his prognosis appeared dismal.

His temperature ranged around 95 to 96 degrees in the morning of his admission day and from 100 to 98 in the evening. On the next day it was from 98 to 96 degrees. No urine was passed and a catheter in place produced only a few drops. His vomitus was bloody on October 12, his stools were tarry and he was bleeding from both nostrils.

Despite receiving a fluid challenge of 1,500 cc (one-and-half liters) intravenously and another 500 cc subcutaneously, the boy’s creatinine and BUN levels remained dangerously high, at 12.4 and 165 mg/dL, respectively.

After an autopsy, which revealed kidney changes similar to those in Chisolm and Locklair, “it became apparent to the [hospital] staff members concerned that something unusual had been encountered.” Consequently “the health authorities were warned that these people might have been poisoned, and an investigation for the possible causative factor was begun,” wrote Lynch. Another suspect death at the hospital (that of Washington [who did not undergo autopsy]) and an outside case (Ward St. John O’Brien) elevated the suspicion that a “new” sulfanilamide elixir preparation was the culprit.

The Stewart boy was buried in Ladson, South Carolina, on October 15th.

* Parents were Cupit (or Cupid) and Lillian.
** Dr. Lynch’s article in the Southern Medical Journal indicates that the prescription was dispensed on October 2nd.

Ward St. John O’Brien, a 38-year-old, married “negro” cook from Charleston, died on October 13th at the city’s Hospital & Training School. Like Oscar ChisolmElla Blanche WashingtonPearl Locklair, and James Stewart, O’Brien received his prescription from Dr. Jackson. The prescription was filled on October 6th at the McFalls Pharmacy of Charleston.

According to Dr. Lynch’s report, O’Brien “developed dizziness, nausea, epigastric pain and vomiting about October 8th.” Two days later, he was anuric; specifically “catheterization of the bladder produced only blood and pus.” On October 13th, “permission for a blood examination was secured.” Among O’Brien’s laboratory results: creatinine and BUN levels of 13.8 and 127 mg/dL, respectively.

Lynch continued: “Upon this autopsy there was further assurance that we were dealing with a lethal poison of particular influence on the kidney.” It was later determined that O’Brien had consumed all of his four-ounce elixir prescription between October 6th and 8th.

O’Brien was buried in the Humane and Friendly Society Cemetery, a historically African-American cemetery, in Charleston on October 14th.

Harry M. Terry, a 34-year-old laboror from Estill, died on October 14th. From Dr. Bertie Johnston, a cousin of the evasive Dr. Johnston Peeples (see Susie Mae DeLoach), Inspector Rentz learned that Terry had received a four-ounce prescription for Elixir Sulfanilamide, which was prescribed by Dr. Peeples as treatment for gonorrhea.

Dr. Johnston admitted to Rentz that he had visited Terry’s home on October 13th and “found a bad kidney condition with complete suppression of urine, nausea, and intense pain.” The doctor could retrieve only “a little blood and puss” from urinary catheterization. It was during this home visit, that Terry showed the bottle of elixir to Johnston, stating that he had received the medication from his brother, who had obtained it from Dr. Peeples. Terry further stated that he had taken all but about one ounce of the elixir, and that the only other medication that he had taken was one dose of “Black Draught,” a commercial laxative.

The death certificate, signed by Dr. Johnston, listed “acute uremia” and “acute nephritis” as the causes of death. Terry was buried in Mt. Carmel Cemetery in Estill on October 15th.

During Rentz’s last visit to Dr. Peeples, the physician finally admitted that he had supplied the four ounces of elixir to Terry’s brother. Notably Dr. Johnston told Rentz that he had informed his cousin of Terry’s death and that “therefore, Dr. Peeples knows all of the details and has as much information as Dr. Johnston has.”

John McDaniel (or J. J. McDanil), a 35-year-old “colored” lumber mill worker from Luray or Ellenton, died on October 14th at the Cohen’s Bluff Camp of the Hendrix Lumber Mill in Estill. On October 22nd, Dr. Johnston Peeples of Estill initially told Inspector Rentz that “he had dispensed Elixir Sulfanilamide to two negroes whose names he could not recall.” But, the doctor assured, he had seen these patients “recently,” and they were in “good health.”

Finding Dr. Bertie Johnston through uncertain means in the small community (see Harry M. Terry), Rentz interviewed the doctor and was advised that McDaniel had died of anuria and uremia, probably as a result of taking Elixir Sulfanilamide. Dr. Johnston further stated that McDaniel had recently seen Dr. Peeples. In a perplexing move, Johnston then asked Rentz what he should list as the cause of death on McDaniel’s death certificate.*

On October 27th, Rentz reinterviewed Peeples, who declared in head-spinning fashion that he hadn’t given the elixir to “any negroes.” Rentz then specifically asked Peeples about McDaniel, and the doctor replied that 1) he had not given him any Elixir Sulfanilamide; 2) McDaniel had died of “hemorrhagic fever”; and 3) he had signed the death certificate “as such.”

Rentz persisted: Was he the last physician to have seen McDaniel? No, Peeples replied. But the doctor “felt like the negro was his patient and that he knew Dr. Bertie Johnston would not object to him signing the [death] certificate.”

Rentz continued his investigation by interviewing Mr. L. P. Harrington, superintendent of Cohen’s Bluff Camp of the Hendrix Lumber Mill, where McDaniel had died. Harrington stated that McDaniel “had been sick only a short time,” and referred Rentz to McDaniel’s brother-in-law, sister, and boss, Theodore Foxworthy.

Harrington called over Foxworthy, who revealed that McDaniel had seen Dr. Peeples sometime during the first week of October. An inspection of employment records showed that McDaniel had quit work because of illness on October 8th. Alluding to African burial traditions, Foxworthy added that it was the local custom “to send all medicines, glasses, spoons, etc. with the body at death.” Foxworthy said that he had duly packed up McDaniel’s property in his “shack,” including possibly a bottle of red liquid, and had sent the items with the body. Rentz searched the hovel but found no medicine bottles.

Rentz then interviewed McDaniel’s brother-in-law at the camp, who said that McDaniel “was buried in ‘Dixons Graveyard’ about 2 miles north of Ellenton, S.C., and he confirmed that the medicine, dishes, etc. that went with the body was put on the grave.” The two proceeded “over dirt roads” to the cemetery, stopping on the way at the home of McDaniel’s brother-in-law and sister. There Rentz met another sister of McDaniel, visiting from Detroit, and a brother (possibly William McDaniel of nearby Aiken county).

An interview with McDaniel’s Ellenton-based sister largely supported information from Harrington and Foxworthy. McDaniel had seen Dr. Peeples on October 2nd and 3rd, she confirmed. Moreover, she said, Peeples had visited the camp on October 4th and had given “some red liquid medicine” to McDaniel, who had become “very ill” on or about October 8th. Thereafter Dr. Johnston was summoned more than once to attend McDaniels, and perhaps alternately with Peeples. The sister stated that “the doctors changed medicine practically every time they came,” and that the remaining bottled drugs were placed on her brother’s grave. Rentz wrote of his continuing journey, with McDaniel’s relatives, to the gravesite**:

Together with the four negroes I began the trek to the grave a-foot. We walked over fields and initially came upon a little wooded knoll with the single grave with fresh earth on it. It was stated others of the family were buried here, but there was no sign of tombstone or grave.

The fresh grave, instead of flowers had bottles, dishes, spoons and a part bottle of tomato catsup on it. The Detroit sister picked of the bottle of catsup and said “You know that’s no way to do” — modernistic!

Upon examination of the several bottles of liquid medicine on the grave one 4 oz. bottle containing about 1 oz red liquid resembling the fatal Elixir was collected and identified as Inv. 43875-C, as check for Elixir Sulfanilamide. Three other bottles containing some liquid but not appearing to be the Elixir were also taken, but will not be submitted unless the above sample shows that it is not Elixir Sulfanilamide.

The sample (Inv. 43875-C) had a label on it which was badly weatherbeaten but it can clearly be seen that it is the label of Dr. Johnston Peeples, Estill, S. C. The bottle as submitted for analysis still shows some of the dirt from the grave around the cork. The bottles were inverted with the necks stuck in the soft dirt on the grave.

* Not being a physician, Rentz openly deferred the decision to Johnston. An examination of McDaniel’s South Carolina death certificate reveals that it is not signed by any doctor. Written in faint ink under the cause-of-death section is “Cause unknown no doctor.”
** According to McDaniel’s death certificate, he was buried in Bush Cemetery in Hampton county. If recognized during the 1950s, McDaniel’s grave, whether in Dixon’s Graveyard or Bush Cemetery, may have been moved along with the entire town of Ellenton, SC, owing to the construction of the Savannah River nuclear reservation.

Willie Badger, a 25-year-old laborer from Scotia, died on October 18th. Through undescribed means, Inspector Rentz found two physicians who were willing to admit that they had treated Badger.

Dr. Marion Peeples reported that Badger was brought to him by the man’s friends on October 13th. The physician administered “a hypodermic of morphine” for otherwise undescribed pain and instructed Badger’s attendants to bring the patient back the following morning; but the doctor never saw Badger again.* This Dr. Peeples denied prescribing Elixir Sulfanilamide.

Dr. Jack Wertz of Estill admitted to Rentz that he had first seen Badger two days before his death, on October 16th, when the patient was in “critical condition.” Urinary catheterization produced only “a few drops of blood and puss.” The following day, Badger’s respirations were labored, and there was some bloody discharge from his nose. Wertz “washed out the bladder with Permanganate of Potash Solution [an intended antiseptic], gave hypodermic of atropine sulfate, and forced fluids.” The doctor, unaware that Badger had received Massengill’s elixir, also prescribed sulfanilamide tablets. On October 18th, Wertz found his patient unchanged. He reirrigated the bladder, but Badger died later that day.**

On October 27th, when Rentz reinterviewed Dr. Johnston Peeples about the patients to whom he might have prescribed Massengill’s elixir, the physician flatly denied giving any of the medication to Badger. Rentz then proceeded to Badger’s home, where he interviewed the decedent’s wife. She claimed that her husband had seen Dr. Johnston Peeples on October 2nd. She further said that when Badger came home from this visit “he began taking some red liquid medicine and some pills,” which he had received from the doctor. Badger reportedly “went to bed sick” on October 6th.

What happened to the medicine, Rentz then asked. Badger’s wife replied that “all of the medicine had been thrown out in the weeds and grass away back of the house.” The inspector then dutifully searched the area and found a four-ounce bottle containing about two-and-a-half ounces of red liquid, resembling Elixir Sulfanilamide. The bottle’s label showed the name and address of Dr. Johnston Peeples and directions for use.

Several weeks later, on December 6, 1937, FDA Chief Wat Campbell responded to a letter from attorney George Warren of Hampton, who represented Badger’s wife. Campbell wrote that an analysis of the contents of the bottle discovered on Badger’s property had not yet been made by the FDA. He added,

[A]s a Governmental agency, whose duties are strictly limited by statute, we cannot undertake such an analysis for the purpose of acquiring evidence to be used in a suit between private parties. It has not been determined at this time whether or not an analysis of this particular prescription will be necessary in connection with our law enforcement operations. If such an analysis is made for the purpose of the enforcement of the Federal Food and Drugs Act, it is quite likely that the Department would make a certified copy of such analysis available to you.

Campbell offered to return the original bottle with its label and “a portion of the contents.” The outcome of any litigation between Badger’s widow and the Massengill Company is unknown.

* Marion Peeples reported that he had to leave for Cincinnati. It is presently unclear what relationship Marion Peeples had to Johnston Peeples.
** A search of the South Carolina death records reveals no entry for a “Badger” or variant surnames for October 1937.
Primary source: Letter from J. J. McManus to Chief, Eastern District. November 11, 1937. FDA historical records (AF1258), Rockville, MD.