The Fascinating Mystery of “The Toxic Lady”

The Toxic Lady: A Medical Mystery That Left More Questions Than Answers

A California ER was thrown into chaos when multiple staff members collapsed after treating a patient. Dubbed "The Toxic Lady," this case remains one of medicine’s strangest unsolved mysteries. Was it a deadly chemical reaction—or something even more perplexing?

Medical News

On February 19, 1994, ambulance personnel in Riverside, California were called to attend to a 31-year-old female, Gloria R., who had difficulty breathing and an irregular heartbeat. There had been a history of nausea and vomiting for a few days and the patient had terminal cervical cancer. She was taken to the Riverside General Hospital Emergency Department (ED) and arrived there semiconscious, sluggishly responsive, with shallow breathing and a rapid heartbeat. She soon deteriorated and the ED staff started cardiopulmonary resuscitation. The patient reportedly vomited after intubation. The staff noted an ammonia smell emanating from the patient, and one staff member reported a fruity garlic odor emanating from the patient’s mouth. Staff also described her body as having an oily shimmering sheen. A nurse started an intravenous line and while drawing blood noted white or manilla crystals in the blood, which was also verified by other staff. That nurse then fainted, and a doctor took her place who then herself lost consciousness and started having convulsions. More staff members became ill, and the emergency department chairman ordered the ED evacuated except for staff treating Gloria R, who by then had started donning HAZMAT equipment. The patient was declared dead approximately 35 minutes after arrival.

A HAZMAT (hazardous materials) emergency was declared and a HAZMAT team tested for toxic gases in the ED and found none. Twenty-three hospital employees were affected with various different acute ailments including dizziness, headache, respiratory irritation, tearing, nausea and vomiting. Six staff members were ill enough to require hospitalization. Some staff ended up having longer lasting symptoms such as tremors, muscle spasms, memory lapses, and shortness of breath. The mystery was, how could a possible toxin affect so many staff members and not leave behind any traces? Also why were some staff affected and some not?

An autopsy was performed under strict HAZMAT protocols and the conclusion was that there were no indications of toxic, volatile, or hazardous vapors associated with specimens of Gloria R.’s tissues and body fluids, or in the air samples from the ED. The cause of death was listed as dysrhythmia caused by renal failure.

Due to a lack of any specific toxicological findings, the California Department of Health Services released a report which concluded that the incident was most probably due to an outbreak of mass sociogenic illness (also known as mass psychogenic illness and previously was called mass hysteria). Needless to say, this conclusion was not universally accepted.

An Alternative Explanation Is Suggested

Biological materials and the patient’s files were sent to the Forensic Science Centre at Livermore National Laboratories in California, where after an analysis they postulated an alternative explanation.

They discovered a breakdown product of dimethylsulfoxide (DMSO), called dimethyl sulfone (DMSO2) in Gloria R.’s blood and bile samples. DMSO is a liquid solvent derived from wood pulp that can be absorbed through the skin and has been used in medicine for a number of different indications. It has been used as a topical remedy for musculoskeletal and arthritis pain and has continued to be used as a home remedy. DMSO has also been found to have antianxiety and antipsychotic effects. It is FDA approved for treating pain in interstitial cystitis (painful inflammation of the bladder). DMSO has been used as an antibacterial agent and has even been used in the therapy of cervical cancer. It also has been used to prevent skin damage if a chemotherapy drug leaks out of an intravenous line. It fell somewhat into disfavor when the FDA discovered that the use of DMSO caused serious eye problems in test animals, and they limited research using the drug.

As the patient was in renal failure and DMSO is excreted by the kidneys, if Gloria R. was using DMSO, it would have accumulated in her body. There is no other direct evidence that Gloria R. was using DMSO except for the breakdown product dimethyl sulfone found in blood and bile. Another breakdown product of DMSO, dimethyl sulfide (CH3)2S) has a garlicy odor which one of the nurses in this case stated was present.

Livermore Laboratory scientists postulated that the addition of supplemental oxygen used in the resuscitation allowed dimethyl sulfone to become oxidized to dimethyl sulfate (DMSO4 which contains four oxygen molecules). Dimethyl sulfate has been classified as a chemical warfare agent and can be inhaled or absorbed through the skin. The Livermore Laboratory scientists felt that the reason crystals observed by staff in initial blood samples were not visualized later on was due to the conversion of dimethyl sulfone in those samples to dimethyl sulfate. They demonstrated experimentally that at body temperature dimethyl sulfone dissolved in Ringer’s lactate solution but at 72 degrees F it precipitated out into crystals.

Dimethyl sulfate can cause dizziness, prostration, headache, convulsions, coma, pulmonary irritation, lung damage, and slow heart rate (bradycardia). Many of the symptoms ascribed to dimethyl sulfate were seen in the affected hospital staff, and the doctor, who initially convulsed and also required a ventilator due to irregular breathing, had health problems for a prolonged period after the episode including hepatitis and pancreatitis. It was felt the ambulance crew did not get affected due to the time it took for the administered oxygen to convert the dimethyl sulfone to dimethyl sulfate.

Comments:

This case represents one of a healthcare worker’s major fears, unexpected exposure from a patient to a toxin that can also injure the health care worker. The initial conclusion of mass sociogenic illness is difficult to accept given that convulsions occurred in the physician who then required mechanical ventilation, as well as the documentation of manilla colored material floating in the patient’s blood. It is possible that some of the later victims, after seeing their colleagues affected, did have a psychogenic reaction. Why some staff were affected and some not is still a mystery and does give some credence to the mass sociogenic illness theory but may be the result of actual levels of and timing of the exposure, or just individual variation of response to a toxin. There is no direct evidence that Gloria R. was actually using DMSO, which is problematic. However, the oily body sheen, garlic odor, severity of some of the symptoms, and finding dimethyl sulfone in blood and bile samples lend some support that its conversion to dimethyl sulfate from oxygen used in treatment could be the cause of this mysterious episode. At the time, Gloria R. was dubbed “The Toxic Lady” by the media reporting this story.

If you are interested in reading about a true mass sociogenic/psychogenic episode that occurred in the past, click here to read about The Dancing Plague of 1518 where people danced for days and were unable to stop.

References

Grant PM, Haas JS, Whipple RE, Andresen BD. A possible chemical explanation for the events associated with the death of Gloria R……. at Riverside General Hospital. Forensic Sci Int. 1997;87(3):219-237. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/9248041/
Ramírez, E. and Luza, S. (1967), DIMETHYL SULFOXIDE IN THE TREATMENT OF MENTAL PATIENTS. Annals of the New York Academy of Sciences, 141: 655-667. Retrieved from: https://nyaspubs.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1749-6632.1967.tb34937.x
Rodgers G. The Bizarre Death of Gloria R……. — The Toxic Lady. Kill Zone. December 15, 2022. Retrieved from: https://killzoneblog.com/2022/12/the-bizarre-death-of-gloria-ramirez-the-toxic-lady.html
Jarry J. DMSO Is Not a Cure-All. But the FDA’s Panic Over It Birthed a Myth. McGill Office for Science and Society. 17 Nov 2023. Retrieved from: https://www.mcgill.ca/oss/article/medical-critical-thinking-history/dmso-not-cure-all-fdas-panic-over-it-birthed-myth
Bertelli G, et al. Topical dimethylsulfoxide for the prevention of soft tissue injury after extravasation of vesicant cytotoxic drugs: a prospective clinical study. J Clin Oncol. 1995;13(11):2851-2855. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/7595748/
Drummond Ayres Jr. B. Elaborate Precautions Taken for Autopsy in Mystery Fumes Case. The New York Times. Feb. 25, 1994. Retrieved from: https://www.nytimes.com/1994/02/25/us/elaborate-precautions-taken-for-autopsy-in-mystery-fumes-case.html