The Toxic Lady

In 1994, fumes from a woman's body knocked out most of an emergency room staff. What happened?

by Brian Dunning

Filed under General Science, Health, Urban Legends

Skeptoid #291
January 3, 2012
Podcast transcript | Listen | Subscribe
 

Television news lit up in the United States in February of 1994 when a 31-year-old woman, Gloria Ramirez, died in a hospital emergency room. She'd been acutely ill with advanced cervical cancer, and when she began having pulmonary and respiratory problems, she called paramedics. Soon after she was brought to the emergency room at Riverside General Hospital in southern California, she passed out, and never regained consciousness. So far, there had been nothing unusual or medically out of the ordinary.

One the nurses drew blood from Ramirez, and noted that it both looked and smelled strange. It had an ammonia-like odor, and several people noticed manila-colored crystals floating in the blood. While the emergency room fought to reverse Ramirez' rapidly deteriorating condition, some of the staff began falling ill. Symptoms included dizziness and fainting, a sensation of burning on the skin, nausea, apnea, tremors, even paralysis. Ramirez died, and as her body was moved into isolation, those attending her also fell ill. The emergency room was evacuated to the parking lot. In all, 23 people became ill. Five were hospitalized. One nurse was kept in the hospital for ten days with tremors and apnea. The most seriously ill, a doctor in residence named Julie Gorchynski, stayed in intensive care for two weeks, contracting apnea, hepatitis, pancreatitis, and necrosis of the bone marrow which crippled her legs for months and required at least three surgeries.

Television crews arrived about the same time as the Riverside County hazardous materials team, and as southern California flew into a panic that a woman's body was knocking people out with its fumes, it was hardly noticed that the hazmat team came up empty handed. They found nothing unusual inside the emergency room. They searched for every kind of toxic substance they were equipped to find, and detected nothing that could account for the staff illnesses.

The task fell to the coroner, whose pathologists were charged with autopsying the toxic body. It was the most unusual autopsy the county had ever seen: doctors wearing full airtight suits with respirators, in a special sealed room. They took samples of everything: her tissue, her blood, even air from the bodybag she'd been in. And the final analysis? Nothing. The coroner's office found nothing inconsistent with a victim of cervical cancer, and like the hazmat team, nothing that would have knocked out the hospital staff or been harmful in any way.

The toxic lady, it turned out, was not toxic at all, by the all measures the doctors knew to employ.

And yet two members of the emergency room staff still lay in the hospital with undeniable physical medical conditions, and the rest of the staff all recalled the odors and strange looking blood. Something real had happened that night in February, and all the signs were that Gloria Ramirez, or something inside her, was the cause. Nevertheless, it couldn't be found with any certainty. Many investigations led to dead ends. And in September 1994, nearly seven months after the toxic lady felled the medical staff, the health department released its official report. Ramirez died from cervical cancer, and nothing else. The emergency room victims were found to be free of any explicable medical causes, and were determined to have suffered from a mass sociogenic illness, triggered by a frightening odor of unknown origin.

A sociogenic illness is one that is caused or influenced by social factors, rather than by a physical disease agent. It's a form of mass hysteria where the effect is a perceived illness. The concept of sociogenic illnesses is controversial, and labeling any event to be one always causes dissent and challenge. It's a diagnosis that almost nobody will accept.

During the 1990 gulf war when the first Iraqi SCUD missile struck Israel, 40% of the nearby civilians reported symptoms consistent with a gas attack, exactly as they expected; despite no chemical warhead being in the missile. In 1998, 800 Jordanian schoolchildren were vaccinated, and 122 were admitted to the hospital for what they believed were side effects; but for nearly all of them, no ill effects were found at all. Hundreds more schoolchildren fell ill in Belgium in 1999 after having drunk Coca-Cola, though nothing was found wrong with the beverage and none of the children had anything show up on blood tests. All three of these events are believed to be examples of sociogenic illness. In all cases, the epidemic was probably triggered by a very few victims who responded to some unknown triggering cause, probably a real reaction to something. But the cause was misinterpreted as whatever was obvious at the moment, and others who had been exposed to the same misinterpreted trigger experienced acute stress and fear, and the mass sociogenic illness was initiated.

Much about the Riverside toxic lady episode is consistent with this diagnosis. There were a number of startling surprises when Gloria Ramirez arrived at the emergency room. Besides the ammonia-like smell to her blood and the strange manila crystals in it, staff noticed that the skin on her abdomen had a weird oily appearance and smelled like garlic. Any one of these, or especially all of them together, might have triggered fear, nausea, or other stress reponses in the nurse who drew the blood, which she and others may have interpreted as a physical response to toxic gas. And notably, almost all of the victims were female, and females are historically far more susceptible to sociogenic illness, according to a literature survey published in the British Journal of Psychiatry in 2002. No toxic residue was found by the hazmat team or by the coroner's team. The paramedics who had answered Ramirez' call and brought her to the hospital also came into contact with her blood when they started an intravenous line, and reported no ill effects at all. Despite its seeming improbability for an experienced emergency room staff, the sociogenic illness explanation was not only a good fit for the toxic lady incident, it was almost an open-and-shut case.

But in spite of the official report, toxicology investigations had been going on behind the scenes the whole year. When the coroners found nothing, they enlisted some outside help from an impressive source: the Lawrence Livermore National Laboratory in northern California. Since there wasn't much doing in the cold war business in 1994, Livermore had set up a forensics lab to offer their expertise to law enforcement agencies who might need it.

While on center stage the sociogenic illness explanation was offered, and Dr. Gorchynski filed a $6 million lawsuit against the hospital, backstage the Livermore team was hard at work. To make a long story short, they finally pieced together a scenario that some see as plausible, and some not so much. Their breakthrough came from gas chromatograph mass spectrometer analysis of the samples from Ramirez, and also from the headspace, which is the air between the sample and the lid of the container. The spectrometer showed one surprising peak that couldn't be accounted for by the drugs Ramirez had been given: a concentration of dimethyl sulfone.

Dimethyl sulfone is one oxygen atom away from a similar chemical, dimethyl sulfoxide, commonly called DMSO. DMSO is sold as a gel in hardware stores as a powerful degreaser, and it's also used by athletes to rub onto sore muscles. In fact, many people put it on their skin to relieve pain from conditions like arthritis. It's not really great for you, but people do it anyway. DMSO also caught the attention of the Livermore researchers because it would explain the greasy appearance of Ramirez' torso and the garlic-like odor.

When the paramedics gave Ramirez oxygen in the ambulance, the high oxygen concentration in her blood would have combined with the DMSO they theorize she had self-administered to relieve pain from her cancer, and formed the dimethyl sulfone observed in the spectrometer results. Ramirez' family insisted that she did not take DMSO, but the spike on the spectrometer is pretty hard to argue with, and she certainly would not have been the first cancer patient to do that. Moreover, her cervical cancer had caused kidney failure (which is actually what killed her), and any DMSO would have built up to very high levels in her blood. In the Livermore researchers' tests to reproduce the process, dimethyl sulfone in blood — when cooled below body temperature by being withdrawn in a syringe — formed nice white crystals, which when viewed through blood plasma, were a dead ringer for the manila-colored crystals reported by the hospital staff.

The problem is that dimethyl sulfone wouldn't have hurt anyone, and this is where the Livermore findings have become a bit controversial. If some of the dimethyl sulfone molecules had broken down in her bloodstream, they would have combined with sulfates to form dimethyl sulfate, which is a powerful nerve gas. It produces all the same symptoms that struck the emergency room staff, with the exception of nausea. It even causes the hepatitis and pancreatitis that struck Julie Gorchynski. When the paramedics started the IV line in the ambulance, the conversion of DMSO to dimethyl sulfone was only just beginning and there would have not been any dimethyl sulfate nerve gas to affect them. But by the time the hospital staff worked on her, there was just enough to knock out those working close to the drawn blood, which is exactly what happened.

Some chemists find this conversion of dimethyl sulfone into dimethyl sulfate to be implausible, but the Livermore researchers argue that this would have inevitably happened to at least some small amount of it. It's impossible to know for sure if this is what happened to Gloria Ramirez, because if it had, all the suspect compounds except the dimethyl sulfone would have evaporated away or broken back down into constituents that are normally found in the body, effectively covering their tracks and eluding the hazmat teams and the coroners. By November, even People magazine reported that the mystery of the toxic lady had indeed been solved, citing Ramirez' use of DMSO as the ultimate cause.

Tip Skeptoid $2/mo $5/mo $10/mo One time

So there were now two pretty solid theories left standing, the sociogenic illness and the DMSO. Neither is perfect, and both have sound criticism.

We don't know for an absolutely certainty, and probably never will, what caused the tragic events on that February night in Riverside. But a review of the facts shows that the title of "toxic lady" is unfair and undeserved. There was nothing toxic about Gloria Ramirez; just an all-too-young cancer victim doing her best to stay alive at the end of a painful and horrible illness. Hopefully we learned something from her case that will prevent future injuries.

Brian Dunning

© 2012 Skeptoid Media, Inc. Copyright information

References & Further Reading

Adams, C. "What's the Story on the Toxic Lady?" The Straight Dope. Creative Loafing Media, Inc., 22 Mar. 1996. Web. 30 Dec. 2011. <http://www.straightdope.com/columns/read/999/whats-the-story-on-the-toxic-lady>

Bartholomew, R., Wessely, S. "Protean Nature of Mass Sociogenic Illness: From Possessed Nuns to Chemical and Biological Terrorism Fears." British Journal of Psychiatry. 1 Jan. 2002, Volume 2002, Number 180: 300-306.

Editors. "Doctor Faults State Report On Faintings." New York Times. 4 Sep. 1994, Newspaper.

Gleick, E. "Solved: a Medical Puzzle." People. 21 Nov. 1994, Volume 42, Number 21: 107-108.

Stone, R. "Analysis of a Toxic Death." Discover Magazine. 1 Apr. 1995, Volume 16, Number 4.

Watson, R. "Coca-Cola Health Scare May Be Mass Sociogenic Illness." British Medical Journal. 17 Jul. 1999, Volume 319, Number 7203: 146.

Weir, E. "Mass Sociogenic Illness." Canadian Medical Association Journal. 4 Jan. 2005, Volume 172, Number 1.

Reference this article:
Dunning, B. "The Toxic Lady." Skeptoid Podcast. Skeptoid Media, Inc., 3 Jan 2012. Web. 22 Dec 2014. <http://skeptoid.com/episodes/4291>

Discuss!

Was it 1994 or 2004? The article states both.

Dale H., Ventura Ca.
January 3, 2012 9:32am

Oops! 1994 is correct. It's fixed now. Thanks!

Brian Dunning, Laguna Niguel, CA
January 3, 2012 10:15am

Odd, I just heard some football players talking about DMSO on the radio the other day.

David, Colorado
January 3, 2012 10:36am

The DMSO discovery was, indeed, interesting. While DMSO is metabolized into dimethyl sulfone, I am highly skeptical of any dimethyl sulfate production (I'm an organic chemist). Surely, someone has considered the fact that MSM (methylsulfonyl methane) and dimethyl sulfone are one in the same compound! Why aren't those who take MSM as a "dietary supplement" producing dimethyl sulfate?

Great show, Brian!

Darrell, Oklahoma
January 3, 2012 12:34pm

Just a question about the text number you mentioned at the end.
Is this service available for other countries, namely Australia?

Marius vanderLubbe, Nullabour Plain, Australia
January 3, 2012 3:41pm

Great show, I've listened to all of your podcasts and they're almost all excellent, but this is my favorite by by far. Well done!

Andrew Chase, SLC
January 3, 2012 6:41pm

Hi Brian

Love the show. This is a very interesting article indeed! Just out of interest, if the theatre was roughly 50 cubic metres in volume, assuming a concentration of at least 1 ppm of dimethyl sulfate, then the total milligrams excreted by the "toxic lady" would be about 275 mg! Assuming a weight of 60kg, that's about 4.5 µg/L in her bodily fluids. Seems impressive that she survived much longer after that concentration formed (by the defib?)

Nick Emblow, Brisbane
January 3, 2012 11:22pm

"Some chemists find this conversion of dimethyl sulfone into dimethyl sulfate to be implausible, but the Livermore researchers argue that this would have inevitably happened to at least some small amount of it."

Thats the bit I like best Nick

Mud, Sin City, NSW, Oz
January 4, 2012 2:27am

No reason why both explanations can't be correct: small amount of dimethyl sulfate causes weird smell and mild symptoms, touching off sociogenic illness.

Cambias, Massachusetts
January 4, 2012 5:50am

It must have been a bit of a stretch for the doc's lawyer to pin Hepatitis on this event.

Vincent Najger, Cairns Australia
January 4, 2012 12:45pm

I don't see why both could not be correct. Plus, some people are far more affected by exposure to certain chemicals than others. Each person interprets these exposures in their own context. If a person has reacted to chemicals or smells in the past, there is a tendancy to react to any exposures as threatening. It's just the way our minds work--if you passed out from say, paint thinner fumes, then any time anything resembling that smell comes up, one tends to recoil. It's self-preservation. Sometimes it's not in our best interest of course, and one can often override the reaction by stopping and evaluating whether this reaction is real. I definately agree that the poor woman is remembered for the wrong reasons.

Sheri, Wyoming
January 4, 2012 12:52pm

I agree. Some combination of both explanations may be more likely than either on its own.

Brian Dunning, Laguna Niguel, CA
January 4, 2012 1:12pm

At 3 minutes & 24 seconds into the recording of this episode, I think you meant to say 1994, instead of 2004. Oops! Maybe you should include a disclaimer with episode now?

It might just be the way my brain works, but a mistake like that would impede my comprehension of this episode.

Thank you, and keep up the good work!

Jeremiah Leonard, Albuquerque
January 5, 2012 9:52am

Sociogenic illness doesn't explain Gorchynski's pancreatitis at all. I'm glad they didn't just call it sociogenic and stop investigating. Too often "sociogenic/psychogenic illness" is just a convenient and virtually unfalsifiable non-explanation that stifles further inquiry, sort of like god-of-the gaps.

Max, Boston, MA
January 7, 2012 5:21pm

overwhelmingly, sociogenic diseases and hypochondrias get in the way of real medical work Max... Its quite common for boards and task groups to sort through 30,000 + documents just to find out they have been barking up the wrong tree.

Usually a syndromes turn out to be due to interauricular tissue transitions. Better known as trend hypochondria.

I am quite happy with sociogenic disease.

Mind you, Brian, Its pretty easy to refer to an MSDS when dealing with a percieved or real disease.

PS I am insensitive to hypochondriacs I meet many every day. If the alternative medicine sales/practices/goods and supplements are a good indicator (and they are) the west has a sociogenic disease plague that is..astoundingly profitable.

Please can I have some of that dingo water? Once through the dingo..I drink the hard stuff in private...

Mud, Sin City, NSW, Oz
January 10, 2012 1:56am

The referenced Straight Dope article put a different spin on the sociogenic illness theory.

"Baffled officials came up with one inane explanation after another. The coroner's office said the ER staff were sickened by the 'smell of death.' The California department of health services blamed the whole thing on mass hysteria. This POd the victims no end, particularly Dr. Gorchynski, who was in the worst shape. She was in the hospital for two weeks, stopped breathing repeatedly, came down with hepatitis and pancreatitis, and later developed bone rot in her knees.
Finally some folks with IQs in the triple digits got into the act."

Max, Boston, MA
January 10, 2012 2:27am

I find it amasing that after a long term reading skeptoid folk still cant work out that an individual case of pancreatitis is an individual case of pancreatitis.

Mud, Sin City, NSW, Oz
January 10, 2012 6:44pm

Back in 1994, the sci.skeptic Usenet newsgroup had extensive discussion of the "Toxic Lady" incident, and the most comprehensive examination was by Camilla Cracchiolo, R.N., who assembled a "Toxic Lady" FAQ, which is gone from its original location but may be found here: http://totse2.net/totse/en/politics/green_planet/toxlady.html

Cecil Adams of "The Straight Dope" covered the story in 1996: http://www.straightdope.com/columns/read/999/whats-the-story-on-the-toxic-lady

Jim Lippard, Phoenix, AZ
January 14, 2012 10:41am

How is it that no DMSO or MSM commenter, including one chemist, has mentioned the high levels of O2 administered, clearly stated in the article?

A combination of both theories is not unreasonable, but I accept no component of sociogenic factor in the severe elements reported.

danR, Vancouver/Canada
January 26, 2012 4:22pm

Re: the severe elements cannot be sociogenic;

Several years back, I had some health problems:

I presented at the doctor 7 times in a year with so much blood in my urine that it was visible, even without testing, prior to each emergency call to the doctor, I was passing out, feeling terrible and generally was sick enough for my partner to put in emergency calls to my doctor (We get instant emergency appointments here).

Each time, samples were sent for overnight analysis, nothing was found. I had scopes inserted in orifices at both ends, ultrasounds done and a variety of other gynacological and intestinal checks done...all clear. The last time I had it, the bleeding was so severe I was ordered to bed for 10 days, with instructions to take my temperature every hour, and if it increased, call the hospital immediately.

The cause? Finally, when everything else had been ruled out, I was sent to speak to a psychiatrist at the hospital. I had been suffering from stress caused by an undiagnosed anxiety disorder (which I am almost completely over, almost 4 years later). Yup...completely psychogenic. With hindsight, the doctor should maybe have noted that most times I felt better immediately after seeing the doctor, but, I am glad she ruled everything else out first before sending me off to the psychiatrist.

So yes,while most sociogenic/psychogenic illnesses are mild, they can also cause severe symptoms, in rare cases.

Amanda, Denmark
March 25, 2012 6:35am

Well, this is much less disturbing than what I read about her on another forum...

Daniel, Fremont CA
July 29, 2012 9:39am

"Sociogenic illness doesn't explain Gorchynski's pancreatitis at all."

It's quite possible that she already had it and it hadn't been diagnosed.

I know paediatric medicine can very stressful and has a high rate of burn out and heavy drinking and I imagine working the Emergency Rooms must be as bad. Maybe Dr Gorchynski liked a few drinks to unwind.

Jim E, Kent UK
September 13, 2012 3:10am

Wow the power of the human mind and body is amazing! Just when we think we know everything turns out we know nothing!

Aonica, Cambridge ma
November 22, 2012 10:37pm

Both are plausible enough. In my opinion only the fact that Ramirez' family insisted she didnt take any DMSO is indicative enough and so one needs to seriously consider sociogenic factors of illnesses involved. I think a small amount of both theories meets the truth. Combined, they make a strong case. But we can never really know for sure. I think that both happened. The conversion of dimethyl sulfone into dimethyl sulfate is plausible enough and even if a small amount did indeed convert, it's logical to think that some of it is responsible for Gorchynski's pancreatitis. Many thanks Brian.

Yanis K., Greece
November 26, 2012 2:41am

THIS IS ALL DUE TO THE FACT OUR GOVERNMENT WANTS CONTROL SO THEY ARE PUTTING THESE DISEASES OUT AND TESTING THEM ON THE POOR PEOPLE.
PEOPLE BE AFRAID BECAUSE OUR GOVERNMENT IS GOING TO WIPE OUT 1/2 OF OUR POPULATION TO CONTROL US EASIER THIS IS TRUE EXAMPLE ABOVE
GOD BLESS US ALL

KIM, SACRAMENTO
November 28, 2012 12:09am

Well, I doubted her veracity at first, but my goodness the capslock just sold me on it.

OT: I still find this case bizarre, and even though the explanations all sound feasible it still feels like we're missing an element. I don't like unsolved connundrums and this one always feels like no answer will be good enough unless we can prove great big chunks of it.

Jimmy, England
December 6, 2012 8:12am

YEAH!

And Oswald used a MAGIC bullet to shoot JFK & Connolly?

YEAH!

Larry Silverstein (JEW) owned the 3 buildings that IMPLODED on 911 & collected billions on insurance, but it was MUSLIMS that were blamed for the destruction of the Twin Towers & Tower 7.

YEAH!

Americans are a bunch of TV lemmings! If it the TV man says it, its got to be the Truth!

YEAH!

Louie the Lip, New York
January 1, 2013 12:05pm

Well, lemmings makes a change from sheeple, I suppose.

Darren, Liverpool, UK
February 1, 2013 10:03am

Could it have been as simple as she smelled bad?

failed kidneys (she couldn't expel waste), cancer and bad hygiene led to a confluence of odor. Which spooked the nurses and caused the drama.

Norb, Atlanta
February 14, 2013 11:48am

I came across a reference to the Ramirez case in Houck and Siegel's "Fundamentals of Forensic Science, the text for a forensic science class that I'll be teaching in the fall. As an organic chemist with over 35 years of experience and having worked with dimethyl sulfide, sulfone and sulfate, I was immediately puzzled by the bizarre explanation of how dimethyl sulfone was converted to the sulfate in vivo. Since my doctoral thesis concerned sulfur chemistry, and I have considerable expertise in this area, I know that it is easy to convert a sulfide to a sulfoxide, and a sulfoxide to a sulfone, as the oxygens are added to the sulfur atom. In order to produce the sulfate from the sulfone, however, one would have to cleave carbon to sulfur bonds, insert an oxygen atom between them and then reassemble the bonds. There is no known mechanism to support this and such a reaction has never been observed either in vitro or in vivo. It just doesn't happen and to suggest otherwise is just pseudoscience.

The sociogenic disease hypothesis is still the most logical explanation

Dr. A. Friedman, Chicago, IL
July 23, 2013 5:20pm

Thanx for that. It goes to a few posts and collective chemistry expressions in the comments section.

Should you enjoy skeptoid note that we normally don't title ourselves on skeptoid. If derision and dissent based argument isnt enough, attacking a title may be an even lower form of fallacy that one invites.

Pick an ugly naming theme so the natives relate.

Madime Dantefer, Greenacres by the sea Oz
August 14, 2013 3:42am

"The Toxic Lady
In 1994, fumes from a woman's body knocked out most of an emergency room staff. What happened?"
- Brian

Maybe she only took a shower twice a year.....?

Ron, Calgary Alberta Canada
May 15, 2014 5:25pm

The sociogenic theory doesn't hold water to me.

Emergency room personnel see and smell MUCH worse than this every day--chronically unwashed homeless people who have fouled themselves, gunshot victims, diabetic carbuncles, TB, gangrene .... You name it, gross and smelly and disgusting is their stock in trade.

The personal example a prior poster gave was actually a psychosomatic illness, caused by a long-standing internal trauma. A sociogenic response is different: mass panic, fueled by ignorance and nerves. Again, not likely in emergency room personnel who see people with transmissible diseases and traumatic injuries on a daily basis.

I hate to say it, but IMHO the sociogenic theory was more easily accepted in large part because the doctor and assisting personnel were female. Yes, even objective trained scientists have biases. Plus, it beats "idiopathic condition of cryptogenic origin." The victims did it!

I realize there are problems with the DMSO theory, but we have no idea what other chemicals were mixed with the DMSO.

I also read an interesting investigation that posited that the cause was meth fumes leaking through an air vent. The emergency room is located in a county that is practically meth central.

Anyway, resorting to "panicked women freaked out" is a cheap shot, when the real answer is, "We still don't know."

Dark Side, San Rafael
September 25, 2014 11:37am

I've read that the IV tubes and bags used on her were discarded and never tested, and that he body was improperly stored and had badly decomposed before the autopsy. So the best chances for detecting an actual toxin were considerably reduced. Certainly an odd case.

Doug, Berkeley
December 6, 2014 12:02pm

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