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But dimethyl sulfone itself couldn't knock out an emergency room, so when Andresen flew to Riverside on April 12 to brief the coroner, his conclusion was that he had found nothing that looked like a poison. Andresen recalls some anxious questioning by the coroner's office in hopes of finding a smoking gun, but he insisted that it appeared Ramirez had simply taken a lot of codeine and Tylenol, which in large, sustained doses can damage the liver. He also highlighted the findings that had intrigued him: the amine that might have caused the ammonia-like odor, the nicotinamide, and the dimethyl sulfone. "There clearly was something unusual going on, but nothing that could have resulted in Ramirez's death or the emergency room symptoms," Andresen says. He was discouraged. "I remember thinking, `How could I spend this much time and not find anything?
led to an official report that the health department released on September 2. The conclusion: The hospital staff most likely experienced "an outbreak of mass sociogenic illness, perhaps triggered by an odor." In other words, they'd been felled by stress and anxiety. In support of this "mass hysteria" theory, Osorio and Waller cited the lack of evidence for a poison and the fact that women were more likely to suffer severe symptoms, both hallmark signs of mass hysteria. In addition, they pointed out, neither paramedic who had treated Ramirez in the ambulance became ill--despite the close quarters and their having touched her skin and some of her blood after starting an intravenous line. However, Osorio and Waller did not rule out the possibility that some substance poisoned emergency room staff who had worked directly over Ramirez.
Grant mistook dimethyl sulfone for dimethyl sulfoxide, or DMSO--the only difference between the two chemicals is that DMSO has one oxygen atom, not two...DMSO has a checkered past. During the mid-1960s a flurry of research showed it had remarkable healing powers, easing intractable pain and reducing anxiety But the rise of this potential wonder drug was stopped suddenly when animal tests showed that prolonged exposure to DMSO altered the lens of the eye. Fearing that a DMSO drug might ruin people's eyesight, the Food and Drug Administration ordered companies to cease clinical trials of the drug in 1965. The FDA later relaxed that policy and in 1978 approved a 50 percent solution of DMSO as a treatment for interstitial cystitis, a condition marked by painful urinary tract lesions that occurs predominantly in women...."People use it for a variety of ailments, from arthritis to muscular strains," says George Rutherford, California's state epidemiologist. But given its potential side effects, it's a dangerous remedy because in its readily available hardwarestore grease-cutting form, it's 99 percent pure...In chemistry little changes can sometimes lead to big results. Add one oxygen atom to DMSO and you get dimethyl sulfone--you change one solvent to another. But now add two oxygen atoms to dimethyl sulfone--which in chemical notation is written ([CH.sub.3]).sub.2][SO.sub.2]--and you get dimethyl sulfate, ([CH.sub.3]).sub.2][SO.sub.4], a truly nasty chemical. Vapors of dimethyl sulfate, the index explained, kill cells in exposed tissues, such as the eyes, mouth, and lungs. When absorbed into the body, dimethyl sulfate causes convulsions, delirium, paralysis, coma, and delayed damage to the kidneys, liver, and heart. In severe cases, the vapors kill.
a classified Department of Defense document, issued in 1987, called the "Reference Book on Chemical Warfare Information." It reported that a ten-minute exposure to half a gram of dimethyl sulfate dispersed in a cubic meter of air can kill a person. (Although dimethyl sulfate has been tested as a nerve gas, it has apparently never been manufactured for use in war.)...The Livermore team was able to cull details about the symptoms of dimethyl sulfate exposure from the reference book, as well as from a safety sheet that accompanies any dimethyl sulfate purchased by industry. (A liter of liquid dimethyl sulfate sells for around $32.) The match between the symptoms experienced by the hospital staff and the symptoms of dimethyl sulfate exposure was uncanny. Of the 20 types of symptoms reported by the staff, from the fainting to the convulsions to Gorchynski's hepatitis, only one--nausea and vomiting--is not a symptom of dimethyl sulfate exposure.
the Livermore team thought the more likely event was that Ramirez had rubbed DMSO on herself to relieve the pain from her cancer. That would account for the oily sheen and garlicky odor observed by the staff. Ramirez's family has since denied she was using DMSO or PCP before her death, but if she did use a DMSO gel for her pain, it would have been far from unusual--it's been estimated that two-thirds of cancer patients use some kind of unprescribed home remedy for their disease.
They conducted an experiment to see how much dimethyl sulfone could accumulate in the blood at normal body temperature. They dissolved the compound in a transparent liquid called Ringer's solution, which is basically all the ingredients of blood minus red blood cells. "We found we could load it up in the Ringer's solution to an appreciable extent without any sweat," says Grant. (The autopsy, the researchers note, had found that Ramirez had a urinary tract blockage. That could have aggravated the buildup of dimethyl sulfone by preventing it from being flushed out of her system.)...When they cooled a vial of this Ringer's solution crammed with dimethyl sulfone to room temperature (about 70 degrees), they were greeted by a good sign. "The solution became supersaturated, and dimethyl sulfone began to form beautiful white crystals," says Whipple, who did the experiment with Grant. In real blood those crystals might have appeared manila-colored. Thus this process could have produced the crystals that had been observed in the syringe in the hospital, particularly since emergency rooms tend to be cooler than most rooms--about 66 degrees....
When Susan Kane drew blood at the hospital, however, the cool temperature had slowed the breakdown of the dimethyl sulfate. Appreciable amounts of it built up in the syringe, and some of it vaporized out of the blood. This was the gas that poisoned the emergency room staff. Dimethyl sulfate doesn't vaporize easily--the Merck Index lists its boiling point as 370 degrees. Nevertheless, according to Grant and other chemists, some fraction will still vaporize at room temperature. The crystals of dimethyl sulfone turned into dimethyl sulfate as well and vanished from sight. In the end, all of the dimethyl sulfate either vaporized or broke back down in the blood into its constituents. And thus the macabre chemistry of that night hid most of its traces from investigators.
BUT THE THEORY HAS PROVOKED a backlash from other scientists. Several organic chemists have scoffed at the step-by-step change of DMSO into airborne dimethyl sulfate. "I'm pretty skeptical," says Hans Reich, an organic chemist at the University of Wisconsin at Madison. Reich doubts that dimethyl sulfone would split apart in the human body's relatively cool environment. "I have used it as a solvent up to at least 300 degrees," he says. Other scientists don't see a match between the symptoms of the hospital staff and some of the symptoms of industrial workers who have been accidentally exposed to dimethyl sulfate. "The stuff is like tear gas," says Jack de la Torre, a physiologist and professor of neurosurgery at the University of New Mexico. "When you're exposed to dimethyl sulfate vapors, the first thing that happens is it makes you start to cry." None of the hospital staff reported tearing or other eye irritation. Furthermore, many other known effects of dimethyl sulfate usually take several hours to hit, and yet the fainting spells and other symptoms at the hospital began to occur minutes after the supposed exposure.
One of the harshest critics of the Livermore theory is a scientist who did much of the clinical research on DMSO in the early 1960s. Stanley Jacob, a physician and medical researcher at the Oregon Health Sciences University in Portland, doubts that significant quantities of the suspect chemicals could have been produced from DMSO. In fact, Jacob says, the Livermore scientists should never have allowed the Riverside coroner to release their report. "It's like that silliness with cold fusion, except this has the potential to hurt people," he says. His office has received dozens of calls from worried women being treated with DMSO for interstitial cystitis. "I just tell them the dimethyl sulfate theory is a chemical impossibility," says Jacob.
other scientists come to Livermore's defense. Marc Micozzi, director of the National Museum of Health and Medicine in Washington, D.C., is one. Micozzi is a forensic pathologist who has helped investigate dozens of unusual deaths. He points out that forensic investigations often fail to find the actual smoking gun, but they can still come to valid conclusions. "No one clue gives a perfect fit to explain a death, but when all the clues are added up, you get a pattern. Sometimes it's a pattern that we've never seen before," he says, such as the Riverside case. "But even though there's no way to prove Livermore's scenario, I think they gave us a report that's quite interesting and analytical," he says....Nevertheless, he thinks the hypothesis is a good one. "I've gotten messages on my answering machine from chemists who say it's an impossible conclusion," says Andresen. "But most hadn't even read our report, and some of them change their minds after I explain our hypothesis." It is true, he notes, that no one has done experiments to show that dimethyl sulfate is produced when dimethyl sulfone breaks apart and recombines with the body's sulfates. Yet chemists have on several occasions discovered that seemingly "impossible" reactions turn out to be quite possible.
thanks to the publicity of the Riverside case, they'll have no problem shifting from one eldritch tale to another. They're swamped with calls and letters urging them to get to the bottom of a host of mysteries, from Gulf War syndrome--the symptoms suffered by some U.S. soldiers who fought in the Persian Gulf--to sudden infant death syndrome. "People are frustrated and want us to look at these cases from a chemistry point of view," says Andresen.