Flames and thick black smoke poured out of the wreckage of shattered homes, and water gushed out of broken pipes as shocked survivors surveyed the damage, early photos showed.
A tangled medical helicopter lay in the rubble outside Saint John's Regional Medical Center.
Jeff Law, 23, was able to take shelter in a storm cellar and was overwhelmed by what he saw when he emerged.
"I've lived in this neighborhood my entire life, and I didn't know where I was," Law told the Springfield News-Leader. "Everything was unrecognizable, completely unrecognizable. It's like Armageddon."
The emergency manager at the neighboring county of Springfield-Greene was told that at least 24 people were killed before he could rush over to help, a spokeswoman told AFP.
Officials said the last twister to wreak such loss of life occurred in 1953 in Worcester, Massachusetts, when a tornado killed 90 people.
On Saturday, a deadly tornado pummeled the east Kansas town of Reading, killing a man and damaging an estimated 80 percent of Reading's structures, mostly wood-frame buildings.
Meanwhile, a tornado was also responsible for the death of one person in Minneapolis, Minnesota, on Sunday, authorities said. At least 30 others in that city and its suburbs were injured.

A view of the destruction after a tornado blew the roof off the St. John's Regional Medical Center where about 180 patients cowered and were eventually evacuated in Joplin, Missouri May 23, 2011. At least 89 people have died in a monster tornado that left a path of destruction nearly a mile (1 km) wide through the heart of Joplin, Missouri, and directly hit the small Midwestern city's main hospital, local officials said on Monday



Blocks of homes lie in total destruction after a devastating tornado hit Joplin, Missouri May 23, 2011. At least 89 people have died in a monster tornado that left a path of destruction nearly a mile wide through the heart of of the city and directly hit the small Midwestern city's main hospital |