Seventy years ago Leyden,1 in one of the earliest papers on multiple sclerosis, pointed out that exposure to cold and dampness, concussions to the body and and psychic trauma appear to play a significant rôle in the onset and perhaps in the etiology of the disease. These factors have been pointed out by others.2 In 1922 the commission on multiple sclerosis of the Association for Research in Nervous and Mental Diseases concluded that in a certain percentage of cases the onset of the disease is associated with trauma or infection.3 Exacerbation of the symptoms after trauma, operation, exposure, immersion, pregnancy, infection or severe emotional excitement have long been recognized.
A common mechanism in these apparently unrelated conditions was suggested by Putnam's recent work4 on the pathology of multiple sclerosis. Putnam advanced experimental evidence indicating that the pathologic changes in the disease are the result of multiple
SIMON B, SOLOMON P. MULTIPLE SCLEROSISEFFECT OF TYPHOID VACCINE AND OF EPINEPHRINE ON COAGULATION OF THE BLOOD. Arch NeurPsych. 1935;34(6):1286-1291. doi:10.1001/archneurpsyc.1935.02250240155011