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 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. <>

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, 3 Jan 2012. Web. 6 Oct 2015. <>


10 most recent comments | Show all 39 comments

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

There was an LA Weekly article that came out years after this all occurred that said that what had actually occurred was that a member of the hospital staff had been manufacturing Methamphetamine in the hospital basement and had been storing P2P (a liquid form of amphetamine)in the IV bags. Apparently, one of the bags ended up in the ER that night and was injected into the body of Gloria Ramirez. I'm currently searching for the article and will provide a link to it once I find it.

wendenator, Van Nuys, CA
February 28, 2015 10:24am

Having been a nurse for 17 years prior to change of career and working in both the ICU and ED, I can say for certain that a crew as experienced as those in that hospital that night would have anything but succumbed to a "sociogenic" meltdown like that. We have to deal with some of the most horrific things at times: infections producing smells that will sicken the inexperienced, gangrene/ necrosis stemming from any number of wounds, etc. Doctors and nurses working with and around these things, working with the gore of motor vehicle accidents that do occur, stabbing and gunshot victims don't pass out or get hysterical over smells, blood, guts, brains or protruding bones. Hell, we eat lunch talking about these cases sometimes and certainly don't lose our lunch! In addition, though I am certainly no forensic or organic chemist, it seems there is a possibility, even if remote, that DMSO2 formed and somehow became DMSO4. Now, no, I can't fully articulate how that could happen any better than I can explain idiopathic pain that multiple people experience and are seen for around the world. How does the pain happen if there's nothing to cause it? If we knew, it wouldn't be idiopathic now, would it? ;) Anyway, for those of you men who think yourselves stronger in the stomach than a veteran ED nurse/doctor who also happen to be female, try being an ED tech working with them. I've seen many macho men blow chunks at things we brush off routinely.

Kabryianithayia Shethebat, La Crosse, Wisconsin, USA
June 17, 2015 4:23am

I can't speak for the chemistry (it's not my area of expertise) but if the patient did use DMSO, any number of chemicals in or on her body could have well leeched into the skin of the people directly caring for her. The danger of DMSO is not the chemical itself but whatever it dissolved and carried through your skin with it. If it gets on your skin, supposedly there is a 'garlic taste' as it enters the rest of your body. (I have not tested this directly as I have never known to get it on myself while using it). Standard practice at our university is to double glove when using it, because it can even get through latex or nitrile gloves. So it seems rather plausible that a few patients got an unexpected toxic dose of something (chemotherapeutic agents, topical medicines in the ER?) via the DMSO while others may have gotten progressively lower doses or had a psychological response.

ALM, Pittsburgh, PA
July 7, 2015 12:01pm

Having read all the posts, and vaguely remembering the original news item, I posit this: what is ALL the explanations or ones very close were true, with the exception of the poor hygiene theory, and most likely very little if any of the social mass hysteria had any effect, due to trained and experienced hospital staff being exposed the daily horrors of their professions?
The mention of meth fumes from a vent, and the other post referring to a later story that Methamphetamine precursor P2P (1-Phenyl-2-Propanone) may have been unintentionally administered by IV, because someone at the hospital involved in meth cooking had been storing it in IV bags that found their way to the ER?
P2P has the chemical formula C6H5CH2C(O)CH3. Assuming that oxygen was administered to the patient in transit, AND that she had been using DMSO, which received additional levels of Oxygen bonding in vivo, followed by unwitting administration of P2P, could that perfect storm at some possible temperature and pressure alone, have resulted in formation of the sulfate compound, and crystalline precipitate from drawn blood? There has been no mention of what type of chemo, if any was present in her system, or if her condition would have pumped any hepatically (in the liver) built up compound, causing some other further reaction, also not knowing what chemotherapy would have been used on her condition in that year and stage of her illness.

-The Thought Monkey Who Knows Squat

The Thought Monkey Who knows Squat, NYC, NY
July 14, 2015 4:20pm

Every mass hysteria case this article references cites no actual illness being found in the patients involved, and it only being their personal perception. By contrast, find me one other case where very real illnesses such as apnea, hepatitis, pancreatitis, AND necrosis of the bone marrow were produced by mass hysteria, let alone all of them at the same time.

"Sociogenic" illness is a pseudoskeptical explanation, and everyone who stops and thinks about it will know it.

Fort, Indianapolis, IN
August 28, 2015 8:37am

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