DANVERS — The state Department of Public Health found no environmental factors contributed to an outbreak of vocal tics and repetitive hiccups in a reported 19 students at the former Essex Agricultural High School in Danvers and the former North Shore Technical School in Middleton during the winter of 2012-2013.

While the three exhaustive reports by the agency’s Bureau of Environmental Health make recommendations to improve indoor air quality, they give the school buildings a clean bill of health. But investigators do not say what led to the students exhibiting vocal tics and hiccups.

“DPH conducted an investigation into possible environmental exposures and the prevalence of acquired vocal disorders reported among female students who attended either Essex Agricultural and Technical High School or North Shore Technical High School,” said Department of Public Health spokesman David Kibbe, in an email.

The Salem News obtained a summary of the final reports on Nov. 20 after a public records request that was first filed on Aug. 27. 

“The results of observations and air measurements taken during the three (indoor air quality) environmental investigations at both (Essex Aggie) and (North Shore Tech) identified no environmental or indoor air conditions that would indicate the presence of a common environmental risk factor expected to result in neurological effects to students,” a summary of the investigation concludes.

Since the incident, both schools have closed and merged into Essex Technical High, a massive vocational and technical school that opened this fall on the campus of the former Essex Aggie.

“The bottom line is we want to ensure the safety and welfare of the students,” said Essex Technical High Superintendent Dan O’Connell, who was the superintendent at the former North Shore Technical High when the incidents were reported — and then vanished — two years ago. O’Connell said he was pleased that no environmental factors led to students hiccupping, though it may never be known what led to the onset.

“I wish we had a resolution and a why,” O’Connell said, praising the diligence of the Department of Public Health.

Air, water tested

The state reports rule out air pollutants or environmental factors in the two schools, which had about 450 students each, as a cause for the vocal tics and hiccups.

Investigators tested drinking water from coolers used by sports teams and looked at pesticide use at athletic fields at the former North Shore Tech on Log Bridge Road and on East Street in Middleton, adjacent to the former East Street landfill. They found no cause for concern from water samples from the coolers, or from summer spraying of the fields. They also looked at any possible exposure to chemicals from the 2011 explosion at the Bostik adhesives factory on Boston Street in Middleton, and again, found no cause for concern.

The state studied the excavation and removal of petroleum-contaminated soil during the construction of Essex Tech, adjacent to Essex Aggie, but found students were never let near this work.

2,600 physicians contacted

The state said 19 students were reported to have vocal tics or chronic hiccup symptoms, but it does not provide a breakdown of which school they attended. Fifteen were identified at a parent meeting in February 2013, and four more families contacted the state later on. The state then reached out to 2,600 physicians in 51 communities to see if they had fielded any incidents from the two schools.

All but one of the students with vocal tics/chronic hiccups were girls. 

Nine students gave their consent for the state to review their medical records. They ranged in age from 15 to 18 years old.

One student had suffered vocal tics for four years, having been diagnosed with Tourette’s Syndrome. 

Eight of the nine student played sports, but other than that, “no common medical factors were identified among the group that would suggest a common neurological, mechanical, infectious, or toxic etiology based on the information contained in the medical records,” the state report says.

Two of the individuals had possible family predisposition for vocal tics through a family history of seizures.

Mass hysteria? 

Robert Bartholomew, an American-born medical sociologist who lives in New Zealand, believes the hiccups were a case of mass psychogenic illness. He has written three books on mass hysteria, including one on incidents in schools. 

Bartholomew, who teaches in the Department of History and Social Sciences at Botany Downs Secondary College in South Auckland, defines mass psychogenic illness as the “rapid spread of illness symptoms for which there is no cause. It’s psychogenic.” 

The reports says, “based on results of the medical records review, the crude prevalence estimate for the students with confirmed vocal tics/chronic hiccups at the schools is estimated at one percent, which appears consistent with the prevalence estimates for tic disorders available in the scientific/medical literature.” 

“They seem to be saying that tics are common in the regular population and hence, the outbreaks at the two schools should not be surprising,” Bartholomew said in an email to The Salem News. “But why the sudden clustering of tics — and why aren’t these clusters breaking out at other schools?”

However, the Department of Public Health’s Kibbe said the investigation did not turn up a case of mass psychogenic illness.

“The DPH investigation did not observe a mass psychogenic outbreak, as the number of cases appears to be within the range of prevalence expected as normal,” Kibbe said.

Incidents of mass hysteria in American schools seem to be surging, and studying the cases at Essex Aggie and North Shore Tech might explain if social media played a role, Bartholomew said. Bartholomew, who also filed public information requests for additional information from the state Department of Public Health, said the state does not want to give a diagnosis of mass psychogenic illness, because it’s not popular. 

“Historically, parents don’t like it, and they try to mask the controversy,” Bartholomew said. “Covering up diagnoses does no one any good.” 

It’s not lost on Bartholomew that cases in the two former schools happened in what was once Salem Village, home to one of the nation’s most famous instances of mass hysteria, the Salem witch hysteria of 1692.

The problem is that in cases where the public fails to get a diagnosis, the incidents can flare up again, he said.

Staff writer Ethan Forman can be reached at 978-338-2673, by email at eforman@salemnews.com or on Twitter at @DanverSalemNews.

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