Epidemiological study of multiple sclerosis in Israel. II. Multiple sclerosis and level of sanitation.

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Abstract
The relationship between sanitation and prevalence of multiple sclerosis was studied by means of a questionnaire which was administered to 241 patients with the disease and to matched controls hi an Israeli population. Sanitary level was based upon source of drinking water, toilet facilities, and degree of crowding. These pertained to the childhood home when the respondent was around 10 years of age. In all categories a greater percentage of patients had higher sanitary levels than controls. These differences were not attributable to a difference in socio-economic status as measured by occupation and educational status. In view of various theories of etiology the results are compatible with an infectious etiology having a long incubation period. Further inquiring as to specific infections or other serious illnesses failed to show a difference between patients and control. If infection is of etiological significance, the patients were more susceptible to demyelination as complication of the infection.