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a phone call from the headmistress of a girls' secondary school. In the earlier part of the morning a few of the girls in the school had complained of feeling dizzy and peculiar, and some had fainted; later in the morning the affection had become epidemic and the girls were going down like ninepins. A medical officer immediately went to the school; the girls looked not only frightened but shocked. Ambulances took 85 of the most severely affected girls to hospital; the rest of the pupils were dismissed and told not to return until the following Monday. Of the girls taken to hospital all but 34 recovered sufficiently in the course of the afternoon to be sent home. Six required readmission over the week-end and three new cases were taken in during this period, but there were no cases among the girls' families or from the community at large.On Monday the school reassembled, and in the course of the morning another epidemic broke out, almost identical to the first in character and consequence. Fifty-four girls were taken to hospital; the school was dismissed for the remainder of the week. Many of the Monday cases had been affected on the Thursday, and, as previously, the symptoms subsided quickly enough to allow the majority to be sent home by the evening. The proportion detained in hospital, however, was slightly higher-54% as against 40%. The more severe symptoms were limited to those cases involved for the second time: of the 30 new cases only 11 (37%) were detained. Though half a dozen cases required readmission over the next few days the rate of discharge was much higher. When the school finally reassembled on the following Monday nearly 60 girls complained of a recrudescence of symptoms, but none required admission, and that was the final event in the sequence.Viewed in retrospect, the epidemic consisted of three spikes with only an insignificant number of cases between ; we refer to these three days as day 1, day 5, and day 12. Inquiries suggested that there had been a premonitory wave of faints the day before the first crisis. On Wednesday, 6 October (day 0), the girls had attended a ceremony in the town's cathedral, and a considerable number had either fainted or felt faint. The complete time course accordingly runs from day 0 to day 12, when the school reassembled. Hospital CasesOn day 1, 85 girls were admitted to hospital within a couple of hours. The striking features were swooning, moaning, chattering of teeth, hyperpnoea, and tetany-the general picture of gross emotional upset. As it was assumed that all but a handful would be discharged by evening, they were put on mattresses on the floor of the nurses' training school. However, the symptoms did not subside as rapidly as expected, and 34 cases required formal admission to the ward that night. By day 4, 20 of the girls were still in the hospital and were continuing to faint or overbreathe to the point of tetany. As attempts to increase the discharge rate led to relapse and readmission, it was accepted that time had to be allowed for the emotional distur...

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MEDIBALITJURNAL 11The occurrence of a mass hysterical reaction shows not that the population is psychologically abnormal but merely that it is socially segregated and consists predominantly of young females.Our reassessment has been possible only because of the generous help we have received from the medical, administrative, and nursing staff of the Royal Free Group of Hospitals. We would like to place on record our appreciation of this co-operation, which has been truly unstinting. Our views are, of course, entirely our own.

In 1955 an epidemic occurred among the staff of a London Teaching Hospital group. The nature of the epidemic remains uncertain. One view is that the illness was a viral encephalomyelitis (Medical Staff Report, 1957); an alternative is that it was a manifestation of anxiety spreading through a population consisting largely of young women (McEvedy and Beard, 1970). This paper reports the results from the follow-up study carried out in 1968–69 on the nuclear group affected by the epidemic and on a matched series of controls.