Joseph M. Foley

INFECTION AND IMMUNIZATION IN MULTIPLE SCLEROSIS

The possibility that multiple sclerosis is due to an infectious agent has been the subject of many studies over the years. Almost all classes of microorganisms have been suggested as causative at one time or another, including protozoa, spirochetes, rickettsia, and bacteria, but convincing evidence implicating these agents has not been forthcoming. A review of many of these studies has been provided by Harding and his collaborators,’ who added many observations of their own. It seems improbable that any further information is going to emerge from studies of nonviral agents in relation to multiple sclerosis. The role of viruses cannot be dismissed quite so easily. Since Harding’s study, there is little information in the literature on the relation of viruses to multiple sclerosis, except for a few recent studies concerned with m e a s l e ~ . ~ ~ There has not been any adequate test of the hypothesis that multiple sclerosis represents a distorted immune response in nervous tissue to the presence of a preexisting viral infection. Such a hypothesis is worth testing because of the known relation between demyelinative encephalomyelitis and preceding viral infection. There are substantial problems involved in the exploration of the role of any infectious agent in multiple sclerosis. Much of the work in the literature has been done without correlation with stage of the disease. Critical analysis ,Of the clinical course on a prospective basis is essential for the acquisition of accurate information. The long range purpose of the present study is to investigate the possible existence of a viral agent which has a specific relation to multiple sclerosis, in the sense that the streptococcus bears a specific relation to rheumatic fever.

Differential Diagnosis of the Organic Mental Disorders in Elderly Patients

Differential diagnosis of the behavioral disorders of the elderly must be made in the traditional pattern and with the traditional logic of medical diagnosis. It must not be solely or predominantly intuitive. It must not be prejudiced by a preconception that too much life lies behind and too little ahead. It must not be concerned exclusively with morbid anatomy.