Abstract

Colin Mumford debates whether trauma to the central nervous system (CNS) may cause multiple sclerosis (MS), or aggravate or accelerate the progress of MS in an established case (Mumford 2002). Trauma may result in breach of the blood–brain barrier. This allows the immune system access to the CNS, and therefore provides a mechanism for trauma to be relevant to the exacerbation of MS. Mumford appropriately asks, ‘how severe should the trauma be?’ but omits to give the answer, ‘severe enough to damage the blood–brain barrier’. Clearly, this must be trauma to the CNS itself, and not to some other part of the body.

Attention is drawn to the case of O’Leary in which the Appeal court had the advantage, in Mumford’s view, of Sibley’s data (Sibley et al. 1991). This was tested in court in the case of Nixon, to which Mumford also refers. In this case, the