Elixir Sulfanilamide: Deaths in Virginia and West Virginia

The government’s investigation of Massengill’s elixir in Virginia and West Virginia was coordinated out of the FDA’s Baltimore Station. From this hub, FDA veteran Frank L. Wollard assigned three inspectors, McKay McKinnon, Jr., Louis Leahy Judge, and James C. Pearson, to retrieve outstanding lots within the combined territory of 67,000 square miles [1]. The FDA’s efforts were complemented by several Virginia state health officials and, in West Virginia, by 24-year-old Joseph E. Settle, Jr., from the state health department. Their search, including the retrieval of any bottles secreted within the coal-rich Allegheny Mountains along the states’ common border, prompted an investigation of 10 prescriptions in Virginia and eight in West Virginia.

During the government’s extended investigation of Dr. Dibrel Crowder Mayes, of Church Road, Virginia, who had received seven pints of Elixir Sulfanilamide, Inspector Pearson learned of two deaths that were deliberately concealed by the doctor. Likewise in West Virginia, persistent efforts by the FDA led to the discovery of two deaths among the patients of an African-American physician in Beckley, Dr. Robert J. Howard, who initially refused to name his vulnerable clients.

Elixir-related deaths in Virginia (2 confirmed)

Martha “Bettie” Agnes Cairns (née Green), a 24-year-old farmer’s wife and mother, died at the Petersburg Hospital in Petersburg, Virginia, on October 7th, 16 days before her 25th birthday. This case was discovered by Inspector Pearson on November 19th, while he reviewed death certificates at the state capital [2]. The first listed cause of death on Cairns’s record was “acute pyelo-nephritis,” a kidney infection. This information likely prompted Pearson to revisit Dr. Mayes in Church Road, a hamlet about 20 miles west of Petersburg. Pearson was still trying to determine the whereabouts of several missing ounces of Massengill’s elixir from the seven pints that Mayes had received.

Persistent investigation by Pearson and two state drug officials ultimately led to the discovery that Mayes, who initially denied any knowledge of Cairns, had indeed prescribed Elixir Sulfanilamide to the woman on September 25th. The therapy, which was intended as a remedy for gonorrhea, led to the development of a “severe headache,” flank pain, and profuse vomiting. Cairns was admitted on October 5th to the Petersburg Hospital, where it was noted that her urine was scant and “cloudy.” Despite an “intravenous injection of saline sucrose solution,” her condition declined precipitously in the hospital, and she “lapsed into a semicomatose condition” the day after admission. Death occurred at about 3 am on October 7th. She had consumed a total of about four ounces of Massengill’s elixir.

Cairns was buried in the Blandford Cemetery at Petersburg.

Robert Harrison Mayes, the seven-year-old son of Joel Harrison and Elizabeth (“Betty”) of Church Road, Virginia, died on October 17th. Like Bettie Cairns, the Mayes boy expired at the Petersburg Hospital. Inspector Pearson conducted an extended investigation of this case, during which time it became evident that Dr. Mayes had attempted to conceal the fatality [3]. The FDA appears to have learned of the suspect death in late October or early November through the state pharmacy board, which had been alerted by the child’s parents.

Through lengthy interviews with Dr. Mayes, the victim’s parents, and the boy’s hospital physician, Pearson eventually discovered that Elixir Sulfanilamide had been prescribed by Dr. Mayes on October 4th for the boy’s “typical streptococcus sore throat.” One week later, Robert was vomiting and unable to retain food. An examination by Dr. Mayes at the time revealed a “slightly enlarged liver” and mild edema. Two days later, the boy was anuric, and he was hospitalized with a diagnosis of nephritis. Blood work obtained during admission showed a BUN level of 120 mg/dL. Catheterization of the bladder yielded only 30 cc (about two tablespoons) of urine, which contained a large amount of spilled albumin. Hospital treatment consisted of twice-daily intravenous glucose, as well as oral sodium salicylate and fluid extract of glycyrrhiza. The latter treatment, also known as wild licorice, was probably intended as a remedy for gastrointestinal upset or apparent liver dysfunction. Terminal clinical signs, including cardiac “failure,” were evident on October 15th. Four days after admission, the boy died of uremia and “complete urinary suppression.” It was initially “uncertain as to the exact quantity” of elixir consumed by Robert, but a later FDA report indicated that the child had taken a total of three ounces.

Robert was buried on October 18th in the Little Flock Primitive Baptist Church Cemetery at Wilson’s Corner, Virginia. Two days after the funeral, the boy’s father read “about a new red medicine, Elixir Sulfanilamide, killing a lot of people,” in the Roanoke Times. The parents then retrieved their son’s prescription bottle, and after comparing the two names, they concluded that the drug was “what had killed their boy.” The father asked a friend to write to the Virginia Board of Pharmacy at Richmond, thereby alerting state officials to the elixir-related death.

Elixir-related deaths in West Virginia (2 probable)

William Irvin (or Irvine), a 17-year-old “colored” student from Beckley, West Virginia, and the son of Isiah (a coal miner) and Ruth, died at the Beckley Hospital in the very early morning hours of October 11th, 12 days after his 17th birthday. This case was discovered presumably after January 17, 1938 (given a penciled addendum in the FDA’s typed compilation of elixir shipments and related deaths) and as a result of the protracted investigation of Dr. Robert J. Howard, an African-American physician in the coal-mining town. The doctor had received two pints of elixir directly from Massengill’s Bristol plant.

Although repeated interviews with Dr. Howard in late October, conducted by FDA Inspector Judge and state official Settle, failed to produce any information about casualties among the doctors’ elixir-treated patients, the FDA ultimately discovered that Irvin had obtained Elixir Sulfanilamide from Dr. Howard. It is unclear how the agency obtained this information. Possibilities include a parallel investigation by state or FDA officials in the state capital, including an examination of death records. The teenager’s death certificate listed acute nephritis and uremia as causes of death, and these conditions—especially in an otherwise healthy young man—might have prompted further investigation.

Little information about Irvin’s clinical demise is provided in acquired historical records. A penciled notation in the FDA’s typed compilation of elixir shipments and prescriptions indicates that Irvin died after consuming about one ounce of a three-ounce treatment. According to the boy’s West Virginia death record, he was medically attended from October 8th to October 10th (presumably the duration of his hospitalization) by Dr. D. C. Ashton, a white physician who signed the certificate [4].

Irvin was buried in Greenwood Cemetery (presumably Greenwood Memorial Park, a historically black cemetery), in Beckley.

Jonathan Walter Lyons, a 35-year-old, married [5] white coal miner from Beckley, West Virginia, died at the Beckley Hospital (like William Irvin) in the early morning hours of October 18th. Information in FDA records about this patient, who was also treated by Dr. Howard, is limited. Lyons’s death was “probably from Elixir Sulph,” scribbled an anonymous FDA official in the agency’s compilation of elixir shipments and their whereabouts, dated January 17, 1938; however, there was “no proof.”

The victim’s death certificate (again, like that of William Irvin) was signed by Dr. Ashton, who documented the cause of death as “uremia following acute pyelonephritis,” or kidney infection. Lyons was attended by Ashton from October 13th to the time of his death (the time span was presumably the duration of the victim’s hospitalization). The decedent consumed an unknown quantity of the antibiotic elixir.

Lyons, who left behind a wife and several children according to census records, was buried on October 19th in Stanaford, West Virginia.

N.B.–A search of available, online West Virginia newspapers failed to return any death notices, obituaries, or reports otherwise describing the deaths of William Irvin or Jonathan Lyons.

1. See for instance, letter from Louis L. Judge to Chief, Baltimore Station. October 21, 1937; letter from McKay McKinnon, Jr., to Chief, Baltimore Station. October 23, 1937; letter from J. C. Pearson to Chief, Baltimore Station. October 24, 1937. letter from K. F. McClure to Chief, Baltimore Station. October 25, 1937; letter from McKay McKinnon, Jr., to Chief, Baltimore Station. October 25, 1937; letter from McKay McKinnon, Jr., to Chief, Baltimore Station. October 27, 1937; letter from James C. Pearson to Chief, Baltimore Station. November 16, 1937;  letter from F. L. Wollard to Food and Drug Administration. November 19, 1937; letter from F. L. Wollard to F & D Administration. November 24, 1937. All at NARA, RG88, FDA general correspondence, 1937. College Park, MD.
2. Letter from J. C. Pearson to Chief, Baltimore Station. November 20, 1937. FDA historical files, AF1258. Rockville, MD.
3. Letter from F. L. Wollard to Chief, Central District. November 18, 1937; letter from J. C. Pearson to Chief, Baltimore Station. November 20, 1937. FDA historical files, AF1258. Rockville, MD. It is unclear what familial relationship, if any, existed between Dr. Mayes and this patient.
4. Probably Dudley Curtis Ashton.
5. To Doris Buckland.