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Background Mass psychogenic illness may be difficult to differentiate from illness caused by bioterrorism, rapidly spreading infection, or toxic substances. We investigated symptoms attributed to exposure to toxic gas at a high school in Tennessee.
Methods In November 1998, a teacher noticed a "gasoline-like" smell in her classroom, and soon thereafter she had a headache, nausea, shortness of breath, and dizziness. The school was evacuated, and 80 students and 19 staff members went to the emergency room at the local hospital; 38 persons were hospitalized overnight. Five days later, after the school had reopened, another 71 persons went to the emergency room. An extensive investigation was performed by several government agencies.
Results We were unable to find a medical or environmental explanation for the reported illnesses. The persons who reported symptoms on the first day came from 36 classrooms scattered throughout the school. The most frequent symptoms (in this group and the group of people who reported symptoms five days later) were headache, dizziness, nausea, and drowsiness. Blood and urine specimens showed no evidence of carbon monoxide, volatile organic compounds, pesticides, polychlorinated biphenyls, paraquat, or mercury. There was no evidence of toxic compounds in the environment. A questionnaire administered a month later showed that the reported symptoms were significantly associated with female sex, seeing another ill person, knowing that a classmate was ill, and reporting an unusual odor at the school.
Conclusions This illness, attributed to toxic exposure, had features of mass psychogenic illness — notably, widespread subjective symptoms thought to be associated with environmental exposure to a toxic substance in the absence of objective evidence of an environmental cause.
Source Information
From the Epidemic Intelligence Service, Epidemiology Program Office (T.F.J.), and the Environmental Health Laboratories, National Center for Environmental Health (E.W.G., D.L.A., D.B.B., J.W.B.), Centers for Disease Control and Prevention, Atlanta; the Communicable and Environmental Disease Services, Tennessee Department of Health, Nashville (T.F.J., A.S.C.); the Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville (A.S.C., W.S.); and the Tennessee Department of Health, Upper Cumberland Region, Cookeville (D.H.).
Address reprint requests to Dr. Jones at the Tennessee Department of Health, CEDS, 4th Fl., Cordell Hull Bldg., 425 5th Ave. N., Nashville, TN 37247.
Related Letters:
Mass Psychogenic Illness Attributed to Toxic Exposure at a High School
Miller C. S., Ashford N. A., Goode M. D., Black D., Welch F., Murray V., Heuser G., Rifkin A., Jones T., Craig A., Schaffner W.
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Full Text
N Engl J Med 2000;
342:1673-1675, Jun 1, 2000.
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