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The Sick Shriners

18 at Alice Peck Day Hospital, and four at the VA Hospital in White River Junction, Vt. All but three were released the same day, and those three—all of them at MHMH—were kept only overnight.

In addition to the Shriners, Mary Hitchcock handled 20 other "regular" emergencies the same day. The emergency room staff was stretched thin and the housekeeping staff faced a horrendous cleanup problem, of course, but Hitchcock could actually have accommodated many more patients overnight. The Hospital had over 100 more beds back then than it does today, and the patient census was always lowest on the weekends because whenever possible, staff made an effort to process discharges on Fridays.

There were several felicitous footnotes to the incident, however. One is that it made Bird and the late Dr. Elizabeth French, a pathologist, aware of the need for better training in IV insertion. They put together teams to make sure that medical students and interns got practice in quickly starting IV lines. And the experience gained by hospital staff in caring for the inundation of Shriners was of great value in a subsequent, much more serious disaster. Just two years later, a Northeast Airlines passenger plane, attempting to land at Lebanon Airport in bad weather, crashed in a remote area on Moose Mountain. There were 32 fatalities and 10 survivors who required urgent treatment.

But lessons learned for the future were all well and good. Learning what had sickened the Shriners was a more immediate concern. It quickly became apparent that those affected were all part of a five-bus caravan that had carried more than 200 Shriners, family members, and guests up from the Shrine's Melha Temple in Springfield, Mass. The group had stopped at 10:00 a.m. to eat box lunches at a picnic area near Wilder Dam on the Connecticut River, just south of Hanover.

The program for the 1966 Shrine game reveals that it was the 13th year for the event—an unlucky coincidence.

The communal meal strongly pointed to food poisoning as the cause of the sickness, but what type? Food-borne diseases are a major public health problem, with an estimated 76 million cases annually in the United States.

These clowns took part in the 1966 parade, the same year that almost a hundred Shriners took very ill at the game.

The communal meal strongly pointed to food poisoning as the cause of the sickness, but what type? Food-borne diseases are a major public health problem, with an estimated 76 million cases annually in the U.S. Chemical adulteration of the food could not be ruled out, but it seemed unlikely since no one had noticed a peculiar odor or taste. So suspicion fell on bacterial contamination.

There are a number of different types of bacterial contamination, including the very dangerous Clostridium botulinum, which could be ruled out immediately on the basis of symptoms and circumstances. Botulism occurs most commonly when improperly sterilized food is sealed in the anaerobic environment of a can or jar.

Some other common bacterial causes of food poisoning are various species of salmonella, pathogenic varieties of Escherichia coli, and Staphylococcus aureus. Fresh poultry and eggs are a frequent source of salmonella. The organism is found in the intestines of poultry and can contaminate meat at the time of slaughter. Pathogenic E. coli is occasionally carried in the intestines of cattle, and undercooked hamburger is often involved in outbreaks of E. coli-related illness.

When food affected by either salmonella or E. coli is unrefrigerated and/or undercooked and then ingested, living bacteria of either type can multiply in the human intestines. Fever is often present, since such illnesses are actually an infection rather than a true poisoning. The symptoms are mainly abdominal cramps and diarrhea, and they generally occur from 16 to 72 hours after ingestion of the contaminated food. Such infections can be quite serious and prolonged, but the majority of those stricken recover completely.

But in the Shriner outbreak, the patients' signs and symptoms were typical of food poisoning from Staphylococcus aureus— one of the most common causes of food-

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