Tri-ortho-cresyl phosphate (Jake leg blues)

Yesterday's entry on diethylene glycol reminded me of another public safety incident that occured pre-FDA: Jake leg.

Jamaican ginger extract, or "jake," was just like the extracts you buy at the grocery store today - full of alcohol. During prohibition, a lot of people realized it made a decent substitute for real booze. As far as I know, extracts can't use denatured alcohol - they're intended for consumption.

Soon, the treasury department wised up to this and declared that ginger extract had to have a certain amount of dissolved solids. Solomonic - if you wanted ginger extract, you were getting ginger extract. The idea here was that it'd be so gingery as to be unpalatable.

If you have an eye for sketchy deals, you might be one step ahead of the story - why not up the solid content with something that doesn't make the extract noxious as a beverage? Enter the unfortunate choice of adulterant: triorthocresyl phosphate.

The adulterant was tasteless and - it was thought - benign. Shortly, however, it became clear something was amiss. (below text from this presentation)

Early in 1930, American newspapers in the south and midwest began to report on a strange new paralytic illness that eventually had affected some 20,000 people. This first major epidemic was soon linked to the consumption of Jamaica ginger commonly referred to as "jake" by those using the fluid extract as an alcohol substitute during the prohibition years. The association was initiated by two Oklahoma doctors named E. Miles and W.H. Goldfain (Parascandola, 1994).

The alcoholic extracts of Jamaica ginger was not considered as the culprit at the time, because it had been used in the United States since the 19th century, long before the advent of the Prohibition (of the 1930s). Working closely with colleagues in other bureaus and laboratories, Dr. Maurice Smith of the U.S. Public Health Service eventually and shortly confirmed that tri-ortho-cresyl phosphate (TOCP) was the compound responsible for the jake leg syndrome. Because of its relatively low acute toxicity, TOCP almost escaped blame as the poison causing the epidemic. Yet fortunately or unfortunately, TOCP was firmly identified as a constituent of the adulterated jake. And the same delayed paralysis symptoms were seen in rabbits and some other species dosed with a 2.5% solution of TOCP in 80% alcohol (Smith and Elvove, 1930).

Gerhard Schrader would work out over the coming decade something that wasn't fully appreciated at the time - organophosphates can be quite toxic. Some of them we know as insecticides, some of them we know as WMDs. Oftentimes, the difference is more a matter of degree - many organophosphates are neurotoxic, and TOCP was one of these.

Eventually, it was tracked down to two men, Harry Gross and Max Reisman. This excellent article (pdf) gives the below text; the whole thing is worth reading.

The poisoned Jake samples obtained from privies and cesspits ultimately led investigators to Harry Gross and Max Reisman, two Boston brothers-in-law. Both of these men had been involved in shady businesses and known to law enforcement ror years. It was 1928 when Gross and Reisman rented the third and fourth floors of a building in Boston, renamed their business Hub Products and went into fulltime production of Jamaica ginger extract. They shipped the Jake around the country in big barrels, which they filled at night and labeled "liquid medicine in bulk." After some complaints from customers about the quality of their Jake, and reassurance from Celluloid Corporation that TOCP was harmless, Hub Products bought a hundred and thirty-five gallons of it. That was enough TOCP to adulterate 432,000 bottles of Jake and to paralyze tens of thousands of people.

The whole thing is a bizzare episode in drug safety and American history; jake paralyzed tens of thousands of people! it probably would have gotten more press and attention if it didn't a) involve alcohol, allowing people to diminish the tragedy as a mere moral shortcoming, and b) disproportionately affect the poor.

A small body of music emerged from the Jake Leg epidemic. The earlier-linked article chronicles some of this, but if you have access to the Annals of Internal Medicine, John Morgan and Thomas Tulloss (a physician and an english professor!) wrote a great article: "The Jake Walk Blues: An Toxicologic Tragedy Mirrored in American Popular Music." Ann. Int. Med. (1976), 85:6. 804-808. It covers both the cultural and scientific aspects better than I have here.

From the paper: