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February 27, 1987

Toxic Shock Syndrome: Back to the Future

JAMA. 1987;257(8):1094-1095. doi:10.1001/jama.1987.03390080084039

In words that would transmit the heart-sinking fear of the contagion across 24 centuries, Thucydides dutifully chronicled the clinical features of the plague of Athens. The horrifying epidemic would not only kill tens of thousands of soldiers and civilians, it would alter the course of the Peloponnesian War, and change history.

Although the awful spectacle was depicted as "men dying like sheep,"1 the pestilence was notable for far more than just its numerical devastation. It was a bewildering constellation of signs and symptoms that no physician or historian had ever recorded before. Its victims, previously in good health, were suddenly stricken with high fever, sneezing, coughing, and hoarseness. They rapidly developed nausea, vomiting, and diarrhea, with a puzzling combination of conjunctival and oropharyngeal hyperemia and erythroderma. So unbearable was their fever that many of the sick plunged themselves into cooling water to relieve their "agonies of unquenchable thirst." Despite