Godfrey: Tr1orthocresylphosphate Poisoning 689 an Epidemic of Triorthocresylphosphate Poisoning*

THE INGESTION of a neurotoxin with subsequent paralysis of a large number of persons is not a commonplace event. One epidemic was reported in 19301 in which it was estimated that up to 20,000 persons in the southern United States suffered from drinking "ginger jake" with resultant "jake paralysis". The toxic ingredient involved was triorthocresyl phosphate. The same contaminant was responsible for a recent epidemic of poisoning with the resultant paralysis of approximately 10,000 natives of Morocco. The outbreak occurred around five cities in Morocco following the Feast of the Prophet at the end of August 1959. It affected only Moslems, and only those Moslems who lived in the poorer native quarter of each city. It was their habit to purchase cooking oil from bulk containers. The supply of regular cooking oil (olive) was adulterated by the addition of up to 20% of high-compression engine oil which contained triorthocresylphosphate (T.C.P.) The presenting complaint of most patients was aching pain and tenderness in the calves, with difficulty in walking and loss of light touch perception in the hands and feet. This sensory disturbance cleared in one to two days and was replaced by motor weakness involving, first, the muscles of dorsiflexion and eversion of the foot and a little later the calf muscles, progressing to inability to stand