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There is evidence that some event in childhood may determine risk of multiple sclerosis: Elevated titers to measles and other childhood infections suggest a childhood infection. Therefore, childhood infections reported by 30 patients with multiple sclerosis and matched controls were compared. Patients reported a childhood infection between 5 and 9 years (not simply exposure to an infection) more often than controls. The mean age of measles peaked somewhat later (age 7) in patients than in controls (age 4); this differnce approached statistical significance (p less than 0.1). Evidence that host response to measles is age-dependent was reviewed. It was proposed that age of measles (rather than the fact of injection) may influence the risk of developing multiple sclerosis.

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Bladder and Blood Pressure-Szasz and Whyte B is quite pronounced-up to 50 mm. Hg systolic and 40 mm. Hg diastolic-and certainly sufficient to be of clinical importance in some patients.The hypertensive effect is evident when the bladder distension becomes intolerable. There was some suggestion that blood pressure rises gradually as the tension in the bladder rises, even before any sense of discomfort or desire to micturate, but this came only from the pooled observations from the four catheterized patients, and was not substantiated by the blood-pressure measurements made before and after normal micturition. It can be concluded that the average behaviour with respect to retaining one's urine and passing it is not associated with any significantt fluctuations in blood pressure.The rise in blood pressure which accompanies gross distension of the bladder could depend on a number of factors such as anxiety and other effects of pain and discomfort, distension of the hollow viscus, and contraction of sphincters. The results of our experiments suggest that the latter may be an important factor, at least when conscious effort is required to prevent micturition. It is possible that contraction of the sphincters initiates reflex activity affecting the cardiovascular system, but it is also probable that the primary volitional effort aimed at the sphincters should spill over into autonomic pathways leading to cardiovascular centres. This would be similar to the mechanism invoked by those people who can voluntarily accelerate heart rate, raise blood pressure, and stimulate other activities controlled by the autonomic nervous system (Ogden and Shock, 1939;Whyte, 1966). SummaryBlood pressure rose significantly (average 27/20 mm. Hg) in seven normal subjects and four patients when the bladder was distended to the maximum tolerable limit by oral fluid loading or retrograde filling (four patients) through a catheter. Pulse rate was unaffected.There was a positive correlation between blood pressure and mounting bladder pressure for the combined results from the four catheterized patients, but this relation did not obtain in each individual.There was no significant difference in blood pressures taken immediately before and after micturition when subjects followed their habitual practice in determining when to micturate.Blood pressure rose significantly (average 17/12 mm. Hg) whenever subjects without distended bladders voluntarily contracted their sphincters. Pulse rate also rose. The purpose of this paper is to describe nine examples of onset or exacerbation of multiple sclerosis after vaccination or inoculation and to discuss the possible implications of these observations. The first five cases were seen in Newcastle and the remainder in Pruszkow. In five instances the onset of the neurological disease occurred after inoculation, in four (Cases 3, 4, 5, and 9) this was followed by exacerbation of established multiple sclerosis. The cases are summarized in the Case 3In 1955, at the age of 45, 26 years after a right facial palsy a...

Migration from an area where MS is common to an area where it is rare (and vice versa) affects the risk of MS, provided migration occurs in childhood. A childhood infection might explain this effect. Therefore, the age pattern of infectious diseases in different regions was examined. A higher proportion of children showed positive titers to many viral diseases early in life in areas where MS is rare compared with those where MS is common. Also, mortality rates from a variety of infectious diseases correlated negatively with the MS mortality. Thus, infection early in life may "protect" against MS, and conversely, later infection, when the immune system has partially matured, may increase risk. MS may be an age-dependent, host-immune response to childhood infection.

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