the only one at the clubhouse that day who did not get sick.

As Billy MacCarty recalls it, "Jackson Wright and Erlund Kimball were essentially prostrated at the table. Our immediate reaction was that they had had heart attacks." John Schumacher found the dish so bitter that he consumed an amount "less than the tip of my little finger." He was the least severely affected of the seven who ate any. The others had medium-sized portions and showed signs and symptoms of varying severity and duration.

By this time, Professor Poole had reached a definitive conclusion. The plant with which he had been presented was not the pokeweed widely consumed in the South—Phytolacca americana. Although that plant has a poisonous root, the very young leafy shoots are often served as greens, or potherbs, and are occasionally even sold in specialty vegetable markets. But southern pokeweed is only rarely, if ever, found naturally as far north as the Upper Valley. Frequently found in northern New England, however, is a plant of the lily family called Indian poke, or false hellebore—Veratrum viride. In addition to the confusion invited by their similar common names, the two plants bear at least a superficial resemblance to each other, particularly as they begin to sprout in the spring. In her anticipation of a nostalgic meal, Harriet MacCarty had been betrayed by both of these coincidences. And unfortunately, Indian poke contains, in both its roots and its leaves, highly toxic alkaloids—substances from plants possessing high biological activity—that cooking does nothing to abate.

Upon the mere mention of the name Veratrum, several of the physicians present in the ER that day had an immediate epiphany. Attempts to find medical uses for veratrum alkaloids had been under way for some years. There had been a number of trials to exploit their potency as useful antihypertensive drugs, and there was particular interest in their possible use as a treatment for the hypertension often seen in pregnant women suffering from eclampsia. At least two trademarked preparations were on the market—Veriloid, a mixture of alkaloids from Veratrum viride, and Veralba, composed of approximately equal parts of protoveratrine A and B. The latter was said to be one of the more purified preparations of veratrum alkaloids available for clinical use. But both of these drugs were eventually abandoned because they induced vomiting at a dose that satisfactorily lowered blood pressure. It probably did not help that they were poorly characterized mixtures of alkaloids

On that fine May day in 1966, Harriet MacCarty had come across a verdant patch of greens that she believed to be pokeweed. She'd picked a liberal supply and presented it to Gertie Kimball, suggesting it as an addition to the lunch menu. The shoots were to be cooked in the same manner as spinach.

instead of single-ingredient preparations. Such crude products would not be allowed on the market today. Even back then, the medical literature already contained a handful of reports of overdoses of these medicinal preparations and a few accounts of poisonings from the plant.

By a lucky coincidence, DMS's Department of Pharmacology and Toxicology had among its faculty then the one man in all the world arguably best qualified to explain the effects of veratrum alkaloids. Dr. Herbert Borison, now deceased, had only recently completed seminal studies on the drug's mechanism of action and had found that it was indeed a most unusual, if not unique, medication. Borison's interest in veratrum related to its emetic effect—that is, its stimulation of vomiting. He was an acknowledged international authority on vomiting. Many agents, such as strong alcohol solutions, reflexly induce vomiting by irritating the gastrointestinal tract. Others, such as apomorphine, activate the so-called chemoreceptor trigger zone (CTZ) in the medulla oblongata, the part of the brain that controls involuntary vital functions; this action stimulates a neural pathway that converges on the vomiting center deep in the medulla, which coordinates

the various muscle groups involved in purging.

Veratrum is unique in that it appears to increase neural traffic through a structure in the vagus nerve called the nodose ganglion. This accounts for its emetic effect and presumably for the bradycardia as well. In addition, it is a vasodepressor, reducing the blood pressure with an action mediated through nerves from the carotid sinus to the central nervous system. Accordingly, veratrum's hypotensive effect is especially strong.

None of this brilliant pharmacology, however, was drawn upon during the treatment of the seven stricken individuals in the Hitchcock ER. The care the patients were given, although it was based on sound pharmacological principles, was strictly empirical. In retrospect, however, it turns out to have been exactly what had been previously recommended in published reports, although that was at the time unknown to the physicians.

Billy MacCarty was anxious to be released from the hospital because of his impending final examinations. A member of Dartmouth's Nordic ski team, he had a resting pulse rate in the low 50s and an enviably low blood pressure to match. But these vital signs, which were normal for him, were taken as evidence by his attending physician that he needed more atropine at periodic intervals. Not only was the resulting dry mouth uncomfortable, but he worried that another side effect—visual impairment—would not help with studying for finals. Already knowledgeable about physiology (he went on to become the third generation of his family to go into medicine), he would listen for the footsteps of the nurse coming down the hall. Then he'd leap out of bed and exercise vigorously enough to get his pulse up to a point where, he hoped, the doctors would decide to stop the atropine and discharge him.

As soon as it was clear that all seven patients were out of danger, the teasing began. It was both merciless and prolonged. Dr. Jarrett Folley, who at the time was president of the Hitchcock Clinic, arranged for the cafeteria trays delivered to the hospital rooms of his two colleagues to include generous side dishes of "greens." A frequent quip was: "Let's do lunch at Lake Mitchell. I hear they have a great salad bar." And when "Dumps" MacCarty was finally released and able to go into his office, he found on his desk a Maxwell House coffee can containing a luxuriant growth of Indian poke. The attached card read: "The Revenge of the Native Americans."