One of the most interesting, and tragic, episodes of mass poisoning in U.S. history involves “jake paralysis“. The first depiction in the medical literature was in a June 1930 New England Journal of Medicine article, that described an epidemic of motor neuropathy that occurred in the midwestern and southern states. As I explained in the “Toxicology Rounds” column in Emergency Medicine News:
Onset of this condition was usually heralded by lower leg muscular pain and tingling, rapidly followed by weakness that often also involved the upper extremities. Distal deep tendon reflexes were diminished. Sensory function remained intact or was only minimally affected.
The author of the NEJM article, Dr. Benjamin T. Burley, wrote that “The exact etiological factor i this paralysis has thus far escaped identification.” It is unfortunate he seems not to have followed popular culture closely, because earlier in 1930 blues musicians such as Tommy Johnson were already recording songs like “Alcohol and Jake Blues” that not only described the ravages of this epidemic, but also pointed to the causative agent:
I drink to much of Jake, till it done give me the limber leg
(And that’s sure to mess you up)
Drinking so much of Jake, till it done give me the limber leg
If I don’t quit drinking it every morning, sure gonna kill me dead
“Jake” was Jamaica Ginger Extract, a preparation that was 80% ethanol by weight. During prohibition (1919-1933), it could be legally sold in pharmacies for treatment of various ailments such as menstrual cramps and indigestion.
Of course, jake could also be used as a legal alternate source of intoxicating alcohol. In an attempt to assure that jake was unpalatable in undiluted form, U.S.P. standards required that a certain amount of solid or resinous material remain after the volatile liquid was boiled off. Although this residual solid was assumed to be ginger, manufacturers would sometimes use other additives to reduce costs.
In 1930, one make of jake, Hub Products of Boston, started adding tricresyl phosphate, an industrial organophosphate. Thus, “jake paralysis” was a manifestation of organophosphate-induced delayed neuropathy (OPIDN). By the end of the epidemic, thousands of individuals were left with residual persistent paralysis and paresis.
To read my Emergency Medicine News column about jake paralysis, click here.
There was an excellent New Yorker magazine article about jake leg in 2003. To read it, click here.
A very interesting 2-part film about “The Jake Leg Infamy” was presented at the 2009 North American Congress of Clinical Toxicology. It is a definite must-watch:
Adulterated Drugs Now and Then: Cocaine and Jamaican Ginger Extract