Elixir Sulfanilamide: Deaths in Texas
FDA officials working out of the agency’s New Orleans and Denver stations learned jointly that 17 gallons of Massengill’s Elixir Sulfanilamide had been distributed from the company’s branch in Kansas City, Missouri, to four physicians’ offices and 96 drug stores in 68 communities throughout Texas. (For a larger and annotated Google map of the elixir shipments to Texas, go here.) In addition, one Massengill salesman in Texas had received 76 samples for free distribution.
The FDA’s investigation of outstanding lots of Elixir Sulfanilamide in Texas, which extended into 1938, revealed 10 deaths.
Elixir-related deaths in Texas (7 confirmed, 2 possible, 1 unlikely)
Johnie (or Johnnie) Fay Kay, the 12-year-old daughter of Pink and Delphia (née O’Banion) from Hemphill, died on October 4th. Inspector Roland Sherman discovered this death while reviewing Texas death certificates and related prescription files at the Post Office Drug Store in Hemphill, presumably in the spring of 1938 (see the FDA Oral History Transcript, pages 14-16). Principal causes of death on the girl’s death certificate were “uremia” and “lobar pneumonia.” In the FDA’s typed compilation of elixir-related cases, dated January 17, 1938, a penciled notation indicates that the girl consumed about three ounces (75-90 cc) of Massengill’s Elixir Sulfanilamide. The reason for the treatment, which was prescribed by Dr. Paul F. Strecker, was not detailed. An autopsy was not performed according to her death certificate, and the girl was buried October 5th in the Kay Family Cemetery, across the east Texas border, in Vernon Parish, Louisiana.
When interviewed in 1978 for the FDA’s Oral History Project, Inspector Sherman said that he was particularly intrigued by this case while reviewing prescription files in Texas, because the girl had first received a prescription for Elixir Sulfanilamide followed by one for morphine. He recalled, “[W]henever you found that the name of a person had gotten elixir, and a few days later had gotten morphine, you knew they had reacted to it, because uremia is an extremely painful disease; and they tried to cure the pain with morphine.” After discovering the prescriptions, Sherman went to the home of the child’s parents and asked the mother what she had done with the elixir bottle. “We dug a hole in the front yard,” she replied. Sherman proceeded to unearth the bottle, “while the mother stood on the porch, tears streaming down her cheeks.” The inspector recalled that the bottle was empty, but he wanted to ensure that “no child dug it up and found several ounces left, because they might have drunk it and could have died.”
William Taft Parker, a 27-year-old “tool dresser” for an oil company, died on October 10th at Bethania Hospital in Witchita Falls. The FDA learned of this case, according to a wire sent by FDA Inspector Bryan Eggerton, at least as early as October 25th.
The federal agency determined that Parker, a resident of nearby Holliday, had obtained six ounces of Elixir Sulfanilamide “at his own request,” and as a presumptive treatment for gonorrhea. It was also learned that Parker began taking the medication “on or about” September 29th. The FDA record suggests that the elixir was prescribed by Dr. Joe Seay, 58, of Witchita Falls, and otherwise lays out the following course of events after the prescription was dispensed.
On October 4th, Dr. Seay, along with a junior physician, Dr. William Rosenblatt, 36, visited Parker at home and “found him in very had condition.” The doctors urged “immediate hospitalization,” and Parker was admitted that day to the Bethania facility. Dr. Rosenblatt, the patient’s admitting physician, diagnosed “acute hemorrhagic nephritis” with urinary suppression and uremic coma. The patient’s clinical state was otherwise significant for a distended abdomen—most likely the result of edema or, possibly, liver enlargement.
In-house treatment consisted of blood transfusions, intravenous sodium chlorate, and “glucose hypodermosis.” (The latter term was probably intended to be written as “glucose hypodermics”—indicating the administration of parenteral fluids.) Despite these supportive interventions, Parker died on the morning of October 10th, 11 days after beginning Elixir Sulfanilamide, six days after hospitalization, and five days after his 27th birthday. The death certificate, which listed the principal cause of death as “uremia due to acute nephritis with suppression,” was signed by Rosenblatt.
A gross postmortem examination of the kidneys, performed by Dr. Gordon G. Clark of Iowa Park, was consistent with the admitting diagnosis. (Clark was evidently unaware that the patient had taken Elixir Sulfanilamide. He, therefore, did not conduct a wider autopsy, nor did he examine the tissue microscopically or request any laboratory tests.)
Parker was buried on October 11th in Highland Park Cemetery in Iowa Park.
The FDA reported that the victim had taken about three-and-a-half ounces of his elixir prescription. Given the publicized toxicity of Massengill’s liquid antibiotic in late October, both treating doctors concurred that Parker’s demise was likely due to the product.
Robert Montgomery Goode, a 29-year-old fishing pier operator from Texas City, died on October 10th at John Sealy Hospital in Galveston. Goode received a six-ounce prescription for Elixir Sulfanilamide from Dr. Clarence F. Quinn, 35, of Texas City, as treatment for gonorrhea.
Goode began taking the elixir on October 1st, and his symptoms improved until three days later, when he began vomiting. He then stopped the elixir, after having consumed about four ounces. Progressive signs and symptoms of poisoning over the next several days suggested direct damage to the cranial nerves—eg, throat paralysis, blindness, and facial paralysis (see for instance, Rollins et al , Hasbani et al , and Reddy et al ).
While still an outpatient, Goode was given another prescription—this time for a mixture of cocaine hydrochloride and bismuth subnitrate, a concoction that was likely intended to combat nausea and vomiting.* Goode also demonstrated “definite jaundice,” per the FDA report, and on October 8th, he was noted to be “mentally dull”—most likely the result of renal or hepatic failure or both. Goode was, at this time, given a gluteal injection of Lilly’s concentrated liver extract, presumably for newly recognized anemia. The treatment was repeated the following day, when Goode was admitted by ambulance to the John Sealy Hospital in Galveston, across the West Bay. Despite supportive therapy, he died two hours after arrival, with a diagnosis of “toxic hepatitis.” The condition was first ascribed to sulfanilamide.
An autopsy was conducted by Dr. Mavis P. Kelsey, a young instructor at the University of Texas Medical Branch at Galveston. During the gross examination of his six-feet, 200-pound subject, Kelsey detected jaundice, blood-congested lungs, an enlarged liver, and oversized kidneys—which, on sectioning, showed changes that were consistent with hemorrhagic nephritis. The probable cause of death, on the basis of the postmortem procedure, was “acute hemorrhagic nephritis of undetermined etiology probably caused by a drug.” Goode’s organs were forwarded to Drs. Geiling and Cannon of the University of Chicago, and the results were considered in their published case series in JAMA of nationwide poisonings due to Massengill’s Elixir Sulfanilamide.
Goode’s body was interred at Galveston Park Memorial Cemetery on October 11th. He left behind a wife, Temple (or Tempie), and two children. Goode’s widow, his children, and his mother brought a damages suit against The S. E. Massengill Company relatively quickly. In a court-sanctioned settlement, the results of which were publicized on May 29, 1938, in the Galveston Daily News, the four family members were awarded a total of $3,000 from the firm.** The plaintiffs’ complaint was based on charges of misbranding and a failure to warn that the product contained diethylene glycol. The only evidence introduced in the Texas court was the “brief” testimony of Goode’s widow, who affirmed the relationships of the plaintiffs to the deceased.
* According to a number of contemporary sources—for instance, Bastedo WA. Materia Medica: Pharmacology. 2nd ed. Philadelphia, PA: WB Saunders Co; 1919).
** $1,750 was allotted to the widow, $500 was given to each child, and $250 was granted to the mother (Galveston Daily News. May 29, 1938, p 21).
Levi (or Levy) Kelly, a 19-year-old man from Highbank, died on October 12th. The FDA learned of Kelly’s death at least as early as October 22nd.* The “colored” farmer obtained a four-ounce prescription for Elixir Sulfanilamide on October 2nd, as treatment for gonorrhea, from “negro” physician Allan L. Hunter. The doctor was located in Marlin, approximately 15 miles from Highbank.
Toxicity-related symptoms began the first day after Kelly began taking the elixir, and they progressed in their typical, inexorable fashion for the next 10 days, until Kelly’s death. An autopsy showed “cloudy swelling [of the] kidneys.” Government records conflict on the amount of elixir that Kelly had consumed. One report indicates that he took the medication for only two days; another implies that he consumed the entire four ounces.
Leaving behind a young wife, Kelly was buried in the African-American Zion Rock Cemetery in Highbank on October 17th. His elixir-related death was briefly mentioned in the Galveston Daily News on October 26th, along with the deaths of Texans Mollie Mae Schmittou and Lois Wilkins.
* The date of a wire sent by FDA Inspector Brock.
Elixir Sulfanilamide was prescribed by Dr. Charles F. Bailey on October 2nd as treatment for the girl’s “infected throat.” Despite the fact that this problem “cleared up” 48 hours later, the girl—called Yvonne—was brought to the local hospital by her father on October 5th because of “difficult, rapid breathing.” She was admitted on October 6th with a modestly elevated temperature and anuria. She died eight days later. The official cause was “acute nephritis.”* No autopsy was performed.
Although unaware of the lethal nature of Massengill’s product at the time of the girl’s hospitalization, Dr. Bailey, in highsight, was “positive that the Elixir was the cause of death.” She had consumed probably one ounce of a two-ounce prescription.
The toddler was buried in Ballinger’s Evergreen Cemetery, her tombstone inscribed with the words “Our Darling Yvonne.”
* A death notice printed in the Abilene Reporter News, October 15, 1937, incorrectly noted that the girl died after “an illness of several months.”
Lois Jean Wilkins (or Wilkinson or Wilkerson), the four-year-old daughter of William and Odessa of Centerville, died on October 18th.
A two-ounce prescription for Elixir Sulfanilamide was written by Dr. William Walter Latham of Madisonville, a town about 20 miles due south of Centerville. The antibiotic treatment, which began on October 15th, was intended for an “inflamed” throat, despite the suspected recorded diagnosis of “diphtheria” (which would otherwise be treated with diphtheria antitoxin). Given the elixir prescription, it seems likely that Dr. Latham equally or preferentially suspected a diagnosis of streptococcal sore throat.
Like several individuals who were treated with Massengill’s elixir, the girl showed initial improvement, most probably because of the sulfanilamide. But then her condition deteriorated, with “complete suppression” of urine, abdominal distention, and coma. She died relatively quickly, three days after the first dose of elixir. She had consumed about one-half of a four-ounce prescription. No autopsy was performed.
The girl was buried at Pleasant Ridge Cemetery in Centerville on October 19th.
Mollie May Schmittou,* an 18-year-old student at the East Texas State Teachers College in Commerce, died on October 20th. The FDA learned of this death as early as October 23rd, according to a wire sent by FDA Inspector Eggerton.
A four-ounce prescription for Elixir Sulfanilamide was dispensed on October 11th as a treatment for “boils.” The young woman was admitted four days later to the college hospital, where “toxemia” was diagnosed. Her symptoms were “frequent vomiting, abdominal pains, [and] kidneys not acting well.” Four days after admission she was removed to her parents’ home in Yantis, about 35 miles southeast of Commerce, where she died the following evening.
The originally suspected cause of death was “cerebro spinal meningitis,” but this was changed to “uremia” and “glycoll ethylene poison” on the death certificate. No autopsy was performed. The teenager had consumed less than three ounces of Massengill’s product.
She was buried at Hopewell Cemetery in Winnsboro on October 22nd.
* Photo available at link.
Lillie Maurye Howard, the five-year-old daughter of Homer and Bonnie of Goree, died on October 6th. The girl shared a six-ounce prescription for Elixir Sulfanilamide with her two-year-old sister, as treatment for a streptococcal infection of the throat. The medication was dispensed on October 4th.
The recorded causes of death were Vincent’s angina, also known as trench mouth or acute necrotizing ulcerative gingivitis, and a “blood stream infection.” Notably there were no renal symptoms before death, and therefore the girl’s physician did not believe that Massengill’s product was responsible for her demise. No autopsy was performed.
In this case, about two ounces were consumed, and the remaining four ounces were taken by the girl’s younger sister, without consequence.
Margrita Rosas, the seven-month-old daughter of “itinerant Mexican cotton pickers” working near Tahoka, died at the Mercy Hospital in Slaton on October 7th. This case was investigated out of the FDA’s Denver Station.
The baby was first seen on October 3rd by Dr. Tim Green and described as “critically ill,” with “apparent meningitis symptoms with slight middle ear disturbance and respiratory embarrassment.” Dr. Green wrote a one-ounce prescription for Elixir Sulfanilamide and advised the parents to take the child to the hospital.
Two days later, the baby was admitted to Mercy Hospital in Slaton, “in [her] father’s arms.” She was febrile, restless, and breathing rapidly. In-house treatment consisted of phenobarbital, bromides, and 20 drops of tincture of benzoin inhalant. The former treatments were presumably for restlessness; the latter for a suspected respiratory infection, possibly bronchitis or pneumonia. The right ear was treated with locally applied Mercurochrome, phenol, and glycerine and surgically punctured.
Two days later, the infant received “20 drops of the mother’s blood” by injection. Although meningitis was suspected clinically, two lumbar punctures performed in the hospital did not reveal evidence of infection. The infant died on the afternoon of October 7th. The official cause of death was “acute head infection of sinuses and ear.”
It is unclear how much of Massengill’s elixir the baby had consumed; the best estimate was about one-half ounce. The FDA concluded that an elixir-induced death in this case was questionable.
Mrs. C[larence] D. Hammock (probably Eleanor Agnes, née Gates), a 23-year-old housewife from Hemphill, died on October 14th at the Memorial Hospital in Nacogdoches. This case was noted in post-hoc fashion in the FDA’s typed list of elixir shipments, dated January 17, 1938. Specifically handwritten among information about prescriptions dispensed by the Post Office Drug Store in Hemphill (which included the prescription for elixir victim “Johnny Kay,” aka Johnie Fay Kay) is the verbatim notation, “20 yrs – died – Many drug taken – Prob not elixir death.”
According to the woman’s Texas death certificate, the cause of death was puerperal septicemia (a childbirth-related systemic infection). Elixir Sulfanilamide may well have been prescribed for the condition, and the timely use of sulfanilamide (without diethylene glycol) might have been lifesaving in this case.
Texas birth records reveal that Clarence D. Hammock and Eleanor Gates were indeed the parents of a son, born October 2, 1937.