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Jamaican Ginger Extract (known in the United States by the slang name Jake) was an early 20th century patent medicine that provided a convenient way to bypass Prohibition laws, since it contained as much as 85% ethyl alcohol.

Jake in itself was not dangerous, but the U.S. Treasury Department, which administered the Prohibition laws, recognized its use as an illicit alcohol source and required changes in the solids content of jake to discourage drinking. Such jake was extremely bitter and difficult to drink.

A pair of amateur chemists and bootleggers, Harry Gross and Max Reisman, worked to develop a non-toxic adulterant that would pass the test, but still be somewhat palatable. They settled on a plasticizer, tri-o-tolyl phosphate (also known as tri-ortho cresyl phosphate or TOCP), that fooled the test, preserved jake's drinkability, and was thought to be non-toxic. However, TOCP is, in fact, a potent killer of certain cells in the nervous system in human beings, especially in the spinal cord. This type of paralysis is now referred to as organophosphate-induced delayed neuropathy (OPIDN).

In 1930, large numbers of jake users began to lose the use of their hands and feet. Some victims could walk, but they had no control over the muscles that normally enable them point their toes upward. Therefore, they would raise their feet high with the toes flopping downward, which would touch the pavement first followed by their heels. The toe first, heel second pattern made a distinctive “tap-click, tap-click" sound as they walked. This very peculiar gait became known as the jake walk and those afflicted were said to have jake leg, jake foot, or jake paralysis. Additionally, the calves of the legs would soften and hang down and the muscles between the thumbs and fingers would atrophy.

Within a few months, the contaminant was identified and the contaminated jake was recovered, but it was too late for many victims. Some users recovered full or partial use, but for most, the loss was permanent. The total number of victims was never determined, but is frequently quoted as 30,000 to 50,000. Many victims were migrants to the United States and most (but not all) were poor and consequently had little influence either politically or socially. They received very little in the way of assistance, and aside from being the subject of a few blues songs in the early 1930s, they were almost completely forgotten.

Jake leg is a plot element in the novel Water for Elephants, where it appears to be quite accurately described.

• Baum, Dan, "Jake Leg", The New Yorker September 15, 2003, p.50-57. (PDF)
• Kidd, J. G, and Langworthy, O. R. Jake paralysis. Paralysis following the ingestion of Jamaican ginger extract adulterated with triortho-chesyl phosphate. Bulletin of the Johns Hopkins Hospital, 1933, 52, 39.
• Morgan, John P. and Tulloss, Thomas C. The Jake Walk Blues: A toxicological tragedy mirrored in popular music. JEMF (John Edward s Memorial Foundation) Quarterly, 1977, 122-126.
• Sara Gruen, (2006). Water for Elephants : A Novel. Chapel Hill, NC: Algonquin Books. ISBN 1-56512-499-5. 

• The Epidemiologic Side of Toxicology (slides 6 - 10 deal with the Jamaica Ginger Epidemic)
• Songs about jake leg.
• Links to external chemical sources