Mass psychogenic systemic illness in school children in relation to the Tokyo photochemical smog.

To clarify the pathogenic mechanism of epidemics with acute systemic neurobehavioral illness associated with photochemical air pollution in Japan, we re-examined our past records in sixteen junior high school children, and compared them with major epidemics that occurred in 1970-1972 during which time Japanese society faced a new and unusual type of air pollution ("Tokyo smog"). Dysfunction of alveolar-arterial gas exchange, together with respiratory alkalosis, was newly found in these children, who suffered from chest discomfort, ocular irritation, emotional distress, tetany, and unconsciousness. It was concluded that anxiety reaction, precipitated by the physical effects of photochemical oxidants and athletic performance, possibly led to many outbreaks of mass psychogenic systemic illness (hyperventilation syndrome) among school children.