Multiple Sclerosis in a Country Practice.

Recent literature on multiple sclerosis is extensive yet our ignorance as to aetiology remains total. Toxic, infective or allergic causes, heavy metal metabolism, swayback disease of sheep, high social class, primitive sewage disposal, a temperate climate, Scandi-navian ancestry, these and many other factors have been suspected, investigated, discussed. Inevitably there have also been surveys of various communities in an attempt to find out the incidence of the disease, and perhaps in a rather hapless sort of way to see if such information could give a hint about causation. This paper is such another. The Peak district of Derbyshire has always been, fortunately for itself and for the surrounding cities, a rather backward area. Road communications were always poor and the packhorse was used here later than in other counties. Although Strutt and Arkwright contributed very early to the local industrial revolution and we are by no means exempt from increasing suburban infiltration, the population has remained comparatively static and the life of the countryside has remained intact. This practice covers about 80 square miles of the Peak district, taking in some 14 villages and 3,300 people. Previous Surveys A survey of multiple sclerosis in this area is not quite new. Campbell in 1948, after a postal survey remarked that the incidcnce in the Bakewell area, 4 miles away, was above average. He gave a figure of 20 per 100,000 for England but of 50 or 60 per 100,000 for that area of Derbyshire. White and Wheelan's survey of the Kingston, Ontario figures showed an incidence of 77 per 100,000 but when transient and hospital cases were removed this figure dropped to 57. This accords closely with the recent survey of northeast England in which the incidence of cases reported by urban practitioners was 57 per 100,000 and by rural practitioners 62 per 100,000. Allison's survey also leads us to treat 60 per 100,000 as a reasonable baseline.