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Medical History Blues: The Curious Case of Jake.

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Historians and scholars of medical humanities mine the (mostly) Western literary classics for the first descriptions of illnesses we have now categorized and studied. But why not explore popular culture as a historical source as well? Can art forms like the blues—the progenitor of jazz and other modern musical forms—contain also clues to medical mysteries of yesterday?

One such example takes us back to the years of prohibition and to the "clever" entrepreneurs who tried to bend its laws.

With recreational alcohol banned in the country most people turned to alternate sources to slake their thirst. The ones who could afford it frequented high priced and highly illegal speakeasies that smuggled banned libations from Canada. The rural poor, often having access to stills, made moonshine but low-income urbanites had no choice but to turn to medicinal concoctions like rub alcohol and Jake. Known colloquially as "Jake," this extract of Jamaican Ginger was a patented medicine that happened to be 160 proof but, for the most part, was harmless. Consumed in the back rooms of drug stores , it was mixed with either coffee or Coke.

Soon the Treasury Department caught on to the consumption of medicines in lieu of spirits and made some changes to an existing law to discourage it. The United States Pharmacopeia (USP) required that all pharmaceuticals containing alcohol, among other substances, had to be a minimum of 4% solid. The regulators often tested this by boiling the alcohol and water away and weighing the solids that were left behind. The treasury department, during prohibition, doubled the amounts of solid required. This made Jake very bitter and unpalatable. Different substances, like molasses, castor oil and herbs, were added to satisfy the new requirement yet make its taste acceptable to consumers. None worked until two unscrupulous brothers in law from Boston—Max Reisman and Harry Gross—stumbled upon an industrial plasticizer called Tri-Ortho-Cresyl-Phosphate (TOCP), that allowed them to meet the new regulations without adulterating the taste. They marketed their Jake in January of 1930.

TOCP is a neurotoxin; a chemical that is particularly toxic to nerve cells, and tends to affect the longer nerves in the limbs and those of the spinal cord. The resulting epidemic left almost 50,000 people, mostly economically disadvantaged men partially or totally paralyzed. By the end of the year the association between the tainted medicine and the paralysis was established and the batches containing TOCP pulled from the market. Reisman got probation and Gross two years in jail.

The first person to make the association between the illness and the Jake was not a physician or a chemist but blues singer Ishmon Bracey
Ishmon Bracey
b.1901
, who recorded "Jake Liqour Blues" in March of 1930, one of the first of the songs that mention Jake and its ill effects on health, especially impotence. TOCP also caused a characteristic high stepping walk, as victims had lost all feeling in their legs, dubbed Jake Leg or Jake walk.

Jake liquor, Jake liquor, what in the world you tryin' to do?
Everybody in the city messed up on account of drinkin' you....
You have numbiness [sic] in front of your body, you can't carry any lovin' on.


Another delta bluesman, Tommy Johnson—a fictional version of whom was made popular in the 2000 film O, Brother Where Art Thou?," made a similar observation in "Alcohol and Jake Blues," when he lamented "I drink so much of Jake, till it done give me the limber leg."

Other blues and folk musicians who also recorded songs about the epidemic include the Allen Brothers, with their "Jake Walk Blues." recorded May 5, 1930 where they poignantly bemoaned:

I can't eat, I can't talk
Been drinkin' mean Jake, Lord, now can't walk
Ain't got nothin' now to lose
Cause I'm a Jake walkin' papa with the Jake walk blues.


Others who recorded Jake related pieces include the Mississippi Sheikhs and "Jake Leg Blues," recorded June 11, 1930, Daddy Stovepipe and Mississippi Sarah, with their version of "Jake Leg Blues," recorded in 1931, and Willie Lofton, with his own "Jake Leg Blues," from August 24, 1934.

Even after medical professionals made the connection and targeted the problem, a significant number of cases continued to occur until the entire tainted batch was consumed or destroyed. The contribution of the musicians who had made the association early was ignored until the late 1970s when Dr. John Morgan, a physician, pharmacologist and professor at the City of New York University Medical School, made the discovery. Calling himself a pharmacoethnomusicologist, he studied this phenomenon in depth and discovered 17 tracks about the epidemic. He first published his findings in 1982 in the Journal of American Medical Association.

Morgan, who passed away in 2008, left a large, unpublished archive of Jake related interviews, music and other documents.

Should we always look for medical descriptions in Shakespeare's or other highbrow literary works? Are medical humanities scholars missing a wealth of information that may come from more colloquial and therefore, in the eyes of academia perhaps "baser" forms of entertainment? For decades the history of the Jake epidemic, with its cautionary tale of poorly monitored of pharmaceutical manufacturing, survived only in a handful of scratchy vinyl discs by a few, long gone, blues and folk artists. Morgan used to say about the epidemic that it ..."is almost completely about class. If someone had poisoned the Canadian source of bonded Scotch, something would have been done." Can we say the same thing about only looking for the history of disease in "higher class" sources? Aren't we missing something essential in our study of the history of medicine? After all illnesses strike all people equally, and the expression of their impact finds its voice in all forms of cultural outlets.


References
Baum, D. Jake leg: How the blues diagnosed a medical history. The New Yorker. 2003; 9.5:50-57.

Jake Leg: Could It Happen Again? at http://www.medicinereport.com accessed October11th 2011

Friedman, E "Jake Leg," Other Poisonings, Physicians as Canaries, and the FDA. The Medscape Journal of Medicine. posted on 4/28/2008

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