In the spring of 1989 the largest outbreak of acute Q fever recorded in the United Kingdom occurred in Solihull and surrounding areas of the West Midlands. The diagnosis was confirmed in 147 people, mainly males of working age. Windborne spread from farmland to the south of the urban area was the most likely route of infection. Fever was the commonest symptom, seen in 101 102 (99%) cases, followed by weight loss reported by 83 101 (82%). Headache, often severe, was experienced by 69 101 (68%). The commonest respiratory symptom was breathlessness, 65 102 (64%), followed by cough, 52 102 (51%), and chest pain, 46 102 (45%). Neurological features, seen in 23% of cases, were more prominent in this outbreak than is commonly recognized. Persisting ill health 6 months following the acute episode not due to chronic Q fever was also a prominent feature of this largely urban outbreak.