The mass poisoning in Morocco was distinctive in its relation to imperialism and the Cold War, but there had been cases of mass cresyl phosphate poisoning before. Tasteless, odorless, and soluble in vegetable oil, triorthocresyl phosphate has a particular tendency to find its way into the food supply through a variety of means. In 1930 and 1931, as many as sixteen-thousand people were poisoned in the American Midwest through the adulteration of Jamaican ginger extract, or
“jake,” an alcoholic patent medicine. In that incident, an unscrupulous entrepre-neur had used triorthocresyl phosphate to circumvent government regulations stipulating the minimum solid content of alcoholic “medicinal” extracts. An-other case affected hundreds of women in the 1930s who had consumed a parsley extract abortifacient that included the toxic chemical. There were also several cases in Germany in the 1940s in which food shortages had led to the use of engine oils in cooking as well as the accidental poisoning in 1940 of ninety-two Swiss soldiers after machine-gun cleaning oil was mistaken for cooking oil. In 1942, forty-one people in Verona, Italy, were afflicted with paralysis, which has been traced to ground contamination caused by the use of discarded military en-gine oil containers in the handling of farm compost and manure.6 In its scale, the Moroccan case was most like the American jake poisoning; in its causes, it also resembled the German incidents, in which poverty incentivized the substitution of machine oil for vegetable oil, and the Verona case, in which the outbreak was caused by improper repurposing of military surplus material.
In 1959 Morocco, it took some time for investigators to determine the chem-ical and human vectors by which imperialism, industrial capitalism, and the Cold War had led to mass paralysis in Meknes. Initially, polio or other viral infection was suspected. The appearance of a few cases between August 31 and September 2 followed by an explosion of cases between September 18 and 24 suggested a pattern of contagion. Indeed, the delayed onset of paralysis follow-ing consumption of the poison mimicked the incubation period of a contagious disease, making the true origin of the crisis difficult to identify. In addition, all of the afflicted lived in poor neighborhoods, suggesting disease vectors re-lated to housing patterns and unsanitary living conditions, such as sewage or insects.7 Fearing the outbreak of some new virus, King Mohammed V ordered
the cancellations of all festivities for the September 19 celebration of Mouloud, which had already brought pilgrims to Meknes from the surrounding region.
The King also banned all travel and public meetings; public pools and athletic facilities were closed.8
Yet the symptoms did not correspond to polio or any other known illness, and blood and spinal fluid showed no infection.9 By the end of September, the hospitals in Meknes were overwhelmed, and the sick were being housed in ad hoc locations. The French military hospital in Meknes opened beds to the af-flicted, and French military doctors arrived from Casablanca to help treat the influx of patients.10
In late September, Dr. Youssef Ben Abbes, the Minister of Public Health, met with doctors from the Avicenna Hospital in Rabat, and the staff of the National Institute of Health. The doctors and investigators were puzzled by the odd dis-tribution of the malady. While all of the victims were poor (typically the families of day laborers), the very poorest members of the society (who had been too poor to buy oil that month) were spared, as were infants. Furthermore, the “absolute immunity” of Europeans (with one exception) and of Jewish Moroccans seemed to defy explanation simply in terms of superior sanitation, and very few of the fifty thousand people who traveled to Meknes from other regions for the cele-bration of the Mouloud in mid-September had become afflicted. Of the hundred Moroccan soldiers stationed in Meknes, only two suffered from paralysis.11
Several patients had pointed to the strange, dark, reddish-colored oil as the probable cause of their affliction. One family, described by a doctor Baillé, had noticed that a bottle of cooking oil that they had recently bought was unusually dark in color—in hindsight, “as dark as old motor oil.”12 After using the oil to cook a meal, they had been concerned enough to offer a portion to their dog.
After the dog seemed to suffer no ill effects, they went ahead and ate, but remem-bered the strange oil after they later fell ill.
The experts, however, were not to be convinced by anecdotal evidence alone.
Albert Tuyns, a Belgian epidemiologist working for the World Health Organi-zation (WHO), began to investigate the outbreak, applying the methods of the
“new epidemiology” of the period, which included expanding epidemiological analysis to include maladies other than infectious disease. Tuyns initiated a sur-vey of 250 patients on September 21 and found that cooking oil was the common factor in all the responses. This conclusion was also supported by the correlation of paralysis cases, noticed by the Ministry of Health, with the areas frequented by street vendors who sold fried pastries and by the suspicions of the patients themselves.13
When the cooking oil was identified as the cause of the paralysis, the inves-tigators suspected a neurotoxin was involved and sent a sample of the oil to the Institute of Hygiene in Rabat. The initial chemical analysis on September 30 indicated the presence of “phosphates, phenols, and cresols.” World Health Or-ganization investigators identified triorthocresyl phosphate as the culprit, al-though other triaryl phosphates and cresol phosphates also present were later seen as having a significant role.14 These chemicals were binding with acetyl-cholinesterase in the neural synapses, causing a buildup of the neurotransmit-ter acetylcholine and a breakdown in the functioning of the motor neurons.
This diagnosis was not good news; there was no pharmaceutical cure—the only course of treatment was physical therapy, and in certain cases of severe spasticity, orthopedic surgery.
Once the chemical cause of the affliction had been determined, the focus of the investigation shifted from the epidemiologists to the police. By October 9, the Moroccan government’s Criminal Investigation Division in Meknes tracked the tainted oil to a warehouse in Meknes, where they discovered a second ship-ment of “six tons of oil in 31 drums ready for bottling and delivery to consum-ers.”15 Initially, the investigation focused on Meknes, and warnings to the public identified only the local brands Le Cerf and El Hilal as potentially dangerous.
Soon, however, it became evident that this was not a localized disaster; nor was it contained. The number of diagnoses continued to rise sharply around the country, reaching ten thousand within a few weeks. On October 28, the Moroc-can government declared a “national calamity” and provided emergency funds (one hundred million francs) to the Ministry of Public Health for rehabilitation and treatment of those afflicted.16 The government also began a public informa-tion campaign, warning the public against the purchase of any oil that was not bottled in a factory, and identifying twenty of the more inexpensive brands of cooking oil sold throughout the country as potentially dangerous. Orders were issued that all persons should turn over bottles of the suspected brands to the police, and the government announced that that house-to-house searches would be conducted to confiscate any undeclared household stocks. Following the ini-tial arrests of alleged culprits in Meknes, interrogations led the investigators to other wholesale centers in Fez and Casablanca, from which the toxic oil had been sold across Morocco, and thirty-one people were arrested. The authorities seized 190 metric tons of suspected oil, including 600 kilograms of machine oil.17 As in the Chélif region of Algeria in 1954, however, the mountainous territory in parts of Morocco and the dispersal of the rural population inhibited the disaster response, and authorities feared that the inhabitants of villages in areas “with
neither radio nor roads” might continue to possess and consume adulterated supplies of oil.18
The impact of the disaster extended beyond the individuals afflicted and was economically devastating to entire families. Minister of Health Youssef Ben Abbes estimated that “there are at least 30,000 made destitute” by the disas-ter.19 Abdelmalek Faraj, head of the National Institute of Health, noted that 80 percent of the afflicted were unskilled workers, who lived by means of their physical labor. Such workers had already been struggling to sell their labor in an economy characterized by high unemployment; for the newly disabled, finding work would be impossible. Moreover, as Faraj noted, afflicted families often lost both wage labor and the unpaid labor of women and children, producing a des-perate situation.20 Medically, the long-term prognosis was equally grim. WHO physicians offered little hope of recovery, stating that “a probable 10,000 cases, including small children, will be completely paralyzed for the rest of their lives, and their upkeep will depend on the good will of their neighbors or the State.”21