Is multiple sclerosis caused by a silent infection with malarial parasites? A historico-epidemiological approach: part II.

The comparison between the old map of malaria and the later distribution of multiple sclerosis (MS) first carried out in the USA (Part I) is continued in Europe. The Italian 'dilemma' (Kurtzke), meaning the disappearance of the north-south gradient in Italy by recent surveys, can be solved when considering the dependence of malaria transmission in relation to the altitude. Further, the high prevalence of MS in earlier times in Mississippi, Louisiana and in the former province of Lucania in Italy can be explained by preceding epidemics of malaria. Brickner's therapeutic trial with quinine in cases of MS patients is reevaluated, and by this the Jarisch-Herxheimer reaction is shown to exist in MS too. The possible significance of the old and rather forgotten provocative methods for the diagnosis of latent malaria is discussed.