The Epidemic Hysteria Dilemma

sir.—Outbreaks of illness among schoolchildren can be dramatic and perplexing events for school officials, physicians, and public health professionals. Such outbreaks can pose pitfalls for their investigators, especially when the diagnosis of epidemic hysteria is considered. In 1986, we were asked to investigate an outbreak of possible foodborne illness in sixthgrade students at a school in Connecticut. The outbreak occurred while the students were practicing the school song for graduation ceremonies. At least 39 of the 72 students became ill over a half-hour period. Symptoms most frequently reported were abdominal pain (74%), headache (67%), sweating (64%), weakness (62%), and dizziness (54%). The physical examination findings were normal and symptoms resolved for most within three hours of illness onset. Three teachers who had eaten food served at the party became nauseated later in the afternoon. Further questioning suggested that their illnesses may have been associated with the perception of having