In a small island community with a population of less than 100 residents, nine persons died and five experienced severe illnesses during the period from November 1986 to May 1988. Their initial symptoms were sore throat and fever. Renal failure and hepatitis developed within one week after the onset. Oral mucosal ulcer developed in some cases. After one week, progressive respiratory failure and dyspnea developed evidently and severe respiratory distress and hypoxia preceded those fatal cases. Chest X-ray findings revealed bilateral diffuse multiple cystic lesion with occasional multiple large emphysematous bullae. Based on these features paraquat poisoning was diagnosed and route of poisoning was investigated. In three sources of drinking water, trace amount of paraquat was detected in November 1988, six months after the incidence of recent fatal case. In November 1988, soybean sauces and soybean pastes from 12 households were found contaminated with high concentration of paraquat, the cause could not be identified. The possibility of the contamination of drinking water as the cause of this mass poisoning has been suggested.