The case is one of the great mysteries of medical history. February 1994 Gloria Ramirez was admitted to the emergency room at Riverside General Hospital in southern California. The 31-year-old suffers from advanced stage uterine cancer. However, she has to go to the clinic because of an acute heartbeat and shortness of breath.
Too young for a racing heart?
It is not the symptoms that are unusual, but the age. Maureen Welch, who worked in the hospital, said that patients with shortness of breath and rapid heartbeat were usually old.
Gloria is conscious, but she can only answer questions with short sentences.
However, what is happening in their environment is much more unusual: several of the clinic's employees who are nearby faint. Some now suffer from shortness of breath and dizziness themselves; six are treated immediately in the hospital.
Doctors and nurses give oxygen and injections for anxiety attacks. Rotuine: Valium, Versed and Ativan should sedate them, lidocaine and bretylium regulate the heartbeat. An “ambu-bag”, a bubble the size of a football, is to replace mouth-to-mouth ventilation through a plastic mask that covers Ramirez's mouth and nose.
The resuscitation fails
Ramirez is still worse. Employees have to revive them with the defilbrator. They take off her T-shirt and press electrodes to her chest that are supposed to get the heart going with electricity.
Mysterious oil film and ammonia smell
The nurses now see an oil film on the young woman's skin. When they try to take their blood, it suddenly stinks. Which says it smelled like chemotherapy, or the smell of blood when people used drugs - the smell of ammonia.
Which passes the injection on to Julie Gorchynski and then loses consciousness. Gloria Ramirez dies 50 minutes after the admission.
Crystalline in the blood
Gorchynski sees unknown crystalline particles in the blood, then she also faints. She breathes quickly and hastily, in between her breath stops completely.
All patients in the emergency room are evacuated.
An infectious disease?
23 out of 37 people in the emergency room fall ill. Most of them are women. They all have the same symptoms: they are short of breath, they tremble, and they feel dizzy. Five of those affected stay in the clinic for one night.
Two of those affected, Susan Kane and Sally Balderas feel a burning pain on the skin.
Necrosis and hepatitis?
Gochynski even has to go to the hospital for two weeks. The diagnosis: hepatitis and an inflamed pancreas. As with the other sufferers, their breath is irregular, over many days.
She also suffers from avascular necrosis, in which blood flows into bone tissue, causing it to die. The person affected can hardly move their knees for months.
Sheldon Wagner, a clinical toxicologist at Oregon State University says: "It takes a damn potent poison to do this."
Cancer or kidney failure?
Scientists autopsy the dead Ramirez under special safety precautions. There is no clear cause: Did the woman's kidneys fail? Did she die of cancer? Or heart failure?
The blood tests of employees who fainted are normal. The Department of Health in California therefore declares that they have fallen into mass hysteria - the loss of consciousness is therefore psychological.
This is not excluded, because fainting does not necessarily indicate serious illnesses. The triggers can be harmless: they jump off the bed too quickly in the morning, they are exhausted after physical work; your body is overheated (this includes fainting during a so-called sunstroke) or you suffer from negative stress.
Emotional arousal can also lead to unconsciousness: fainting at the sight of the dream man or dream woman is not an invention of Hollywood directors, and paramedics have relevant experience with teenagers who have a blackout at Tokio Hotel concerts.
An unspecific symptom
However, it is not quite that simple, because dizziness, shortness of breath and fainting can have many causes: These include disorders of the metabolism as well as anemia, deformation of the chest, but also bone diseases. Injuries, such as badly healed rib fractures, can also cause an increased respiratory rate, as well as poisoning or numerous complaints in the chest area.
Late pregnancies also lead to shortness of breath, diphtheria such as hives, vocal cord disorders such as lung cancer, pneumonia, chronic bronchitis, tuberculosis or pleurisy. There are also funnel breasts, diseases of the diaphragm or disorders of the nerves, muscles and skeleton.
The case comes to court
Those affected are all medical professionals. They know fainting, mass hysteria, and physical reactions to emotional arousal, and none of them were particularly upset when Ramirez came to the clinic.
They worked in the emergency room, and the young woman was as much a patient for her as a thousand others. The fainted employees sue the clinic.
Another laboratory examines what is happening and creates a new hypothesis. The deceased is said to have rubbed himself with a drug that contains dimethylsulforide. This explains both the smell of "garlic", which also has this compound, as well as the oil film on the body.
This DMSO developed into the sulfur compound DMSO2 because the employees gave Ramirez oxygen. The particles in the blood are crystallized particles of the sulfur compound.
Even worse: when Ramirez was revived with the defilbrator, DMSO2 would have turned into gas DMSO4. But that is toxic. Those affected would have inhaled it and therefore they would have lost consciousness.
Family doubts the thesis
Ramirez's family questions this theory - for a simple reason. Gloria would never have used a gel that contained DMSO.
The relatives hire a pathologist on their own to examine Gloria again. But after two months her body is too badly decomposed.
Conspiracy delusion and conspiracy theory
Now the conspiracy theories are rampant. Do the clinic and health ministry want to cover up something?
Rumor has it that there have been several holes in the clinic from which dangerous gas has flowed. There is no evidence of this.
No toxic gases in the body
The autopsy team in Riverside discovered nothing of interest in the body of Ramirez several days after the autopsy, specialists from the Center for Forensic Science in Livermore near San Franzisco took over the investigation in early March 1994.
They analyze the blood, tissue, heart, liver, lungs, brain and kidneys of the dead and look for any gas that could have been found. You will only find nitrogen, oxygen and carbon dioxide, normal elements of the air.
However, Andresen, the team's scientific director, encounters anomalies. Below is a derivative of ammonia. Andresen suspects that the patient's organism reacted to the Tigan agent and formed the derivative.
The body also contains nicotinamide, a substance that is also typical of drugs such as metaamphetamines. According to Andresen, it is very unusual for seriously ill people to intentionally consume such substances.
The third anomaly is dimethyl sulfone in the body. This is also produced industrially, but sometimes the body also produces it itself, namely from amino acids that contain sulfur.
The liver regulates it, and therefore it exists in the body for less than three days, so healthy people never have measurable amounts of it in their blood. However, Ramirez had a high concentration of it in the blood and tissue.
No explanation for the breakdown
However, Andresen emphasizes that the dimethyl sulfone alone does not explain Ramirez's death or the complaints of the emergency room staff.
He believes the patient was taking higher doses of codeine and tylenol, which damage the liver. The ammonia derivative, nicotinamide, and dimethyl sulfone showed that something unusual had happened, but none of it would have resulted in Ramirez's death.
The investigations are concluded with the result that no external exposure to poisons caused death.
Investigations of employees
However, the investigations by the employees continue and reveal an astonishing range of symptoms.
First, fainting, muscle spasms, shortness of breath and dizziness primarily affected women. Second, those who had not eaten suffered primarily. Doctors who had treated Ramirez and touched her skin had not gotten sick.
The official verdict is now: Stress and anxiety attacks as the cause of employee complaints.
Gorchynski's lawyer raises the alarm
Gorchynski, the worst hit, uses a lawyer, doctor Russell Kussman, against the thesis of mass hysteria. She demands compensation of $ 6 million.
Welch confirms that no one in the emergency room panicked or that there was any sign of mass hysteria. She herself left the room calmly before fainting.
DMSO was used in the 1960s as a remedy for pain and anxiety. But animal studies have shown that it damages the eye lenses and leads to blindness in the long run.
However, countless people, including doctors and chemists, continued to use it as a pain reliever for injuries, arthritis and muscle disorders.
However, if Ramirez took DMSO for pain, which is obvious in a cancer patient, that doesn't explain the onset of symptoms among clinic staff.
A dangerous gas
Andresen's director Grant now suspects that DMSO would have formed dimethyl sulfone, and then only two oxygen atoms have to be added and the gas dimethyl sulfate is formed.
But this is very dangerous: it kills tissue cells that are exposed to the air, for example in the eyes, mouth and lungs. In the body it leads to convulsions, delirium, paralysis, coma and damage to the kidneys, heart and liver. It can even kill and is considered a nerve gas for biological warfare.
The problem, Grant said, was that Ramirez's body would not have released enough dimethyl sulfone to produce a serious dose of dimethyl sulfate.
How did the poison come to Ramirez?
The researchers are designing two scenarios for how Ramirez came into contact with DMSO. First, she could have rubbed a cream on her skin that contained phencyclidine, known as the drug "Angel Dust". That would also explain the nicotinamide in the blood - it is an extender. But the drug itself was not found in the body, so this scenario was considered impossible.
In the second scenario, Ramirez rubbed DMSO on her body herself. That would explain the oily film and smell of garlic. The oxygen mask on her face would have resulted in a high dose of dimethyl sulfone.
The scientists conducted an experiment to see how much dimethyl sulfone can accumulate in the blood at normal body temperature. They found that the substance forms white crystals at room temperature. That explained the crystalline particles in the blood.
The possible consequence: When Susan Kane took blood from the dying Ramirez, the dimethyl sulfone crystals would have turned into the dangerous gas.
Criticism of the guest thesis
Other chemists in the United States are storming Grant's and Andresen's explanation. Hans Reich of the University of Wisconsin doubts that dimethyl sulfone could change in the human body.
Colleagues see no connection between the symptoms of the clinic staff and documented dimethyl sulfate poisoning. University of New Mexico's Jack de la Torre even says, "First of all, when you are exposed to this gas, you start to cry." However, nobody in the clinic had tears in their eyes.
An unsolved puzzle
The only thing that is certain is that the Ramirez case shows that bizarre chemical compounds can arise in the human body. However, exactly what happened to her and the people in the Riverside Clinic remains a mystery 23 years later. (Dr. Utz Anhalt)