90 THE IRISH MEDICAL ASSOCIATION

negligible. Every year some 40 to 70 outbreaks arereported to the Ministry of Health and in 1933 therewere 66 outbreaks so reported with 15 deaths in thesalmonella group alone. Often the article of foodcannot be proved guilty ; the police (so to speak)suspect the criminal, but evidence is insufficient tobring home the crime. But in every case theauthorities depend in the first place on the willingcooperation of the practitioner to bring his suspicionsto the notice of the medical officer of health and toensure that specimens are preserved pending his

investigation.

FOOD ALLERGY AND DIGESTIBILITY

STRICTLY speaking, the term " food allergy "implies the entrance into the blood stream of an

unchanged food protein absorbed from the intestineand escaping destruction in the liver. Such an

occurrence, as Alvarez 1 points out, is more likelyto bring about disturbances away from the intestinaltract (e.g. urticaria) than local digestive symptomslike colic, nausea, or diarrhoea. In actual practice,however, supposedly allergic disorders such as

migraine, angioneurotic oedema, and urticaria are

not very often traceable to food sensitisation ; thus inAlvarez’s cases of severe urticaria, seen at the MayoClinic, it seldom proved possible for him or for thepatient to pin the blame on any food. Another

difficulty is the fact that supersensitiveness to somefoods is apparently intermittent, varying with exercise,climate, and especially with fatigue and nervous

strain. Finally, one has to reckon with an immensevariety of possible noxse ; and it is no advantage,from the patient’s standpoint, that the commonestfoods such as bread, milk, and eggs seem also to bethe commonest offenders-not the more easily delect-able delicacies such as strawberries, caviare, or patede foie gras. Alvarez and Hinshaw make the

interesting suggestion that much of the digestivetrouble caused by foods is due purely to irritationof the intestinal mucous membrane by the chemicalsor cellulose they contain. On this view the"

digestibility" of a food depends not upon its

protein sensitisation action but upon some directlocal effect, in the alimentary tract, of other sub-stances besides proteins. Among 500 patients suffer-ing (for the most part) from indigestion, Alvarezfound that 7 per cent. were unable to drink milkbecause of severe distress; and 3 per cent. could noteat eggs, while many suffered after eating onions,apples, and cabbage. Chocolate, radishes, tomatoes,cucumbers, beef, coffee, lettuce, and many otheifoods were noted by patients as causative of indi-gestion. Such lists could of course be readilyparalleled by many physicians, but extreme care

is always necessary in drawing conclusions from

patients’ own deductions about their digestive capa-cities. Unfortunately Alvarez and Hinshaw’s ques-tionnaire gives no indication of the manner in whicl:these various foods may cause their distressingeffects, but their paper serves the valuable purpose ojemphasising the importance of factors other thar

protein sensitisation in producing food indigestionIn our issue of June 29th Dr. W. C. D. Maile andDr. K. J. L. Scott draw attention to the well-knowreffect of water taken with food in increasing th(

absorption of such a substance as sugar from th(

stomach, and to the fact that boiled milk is somewha-more rapidly emptied from the stomach than unboiled

1 Alvarez, W. C., and Hinshaw, H. C.: Jour. Amer. MedAssoc., June 8th, 1935, p. 2053.

and if such a relatively simple process as gastricemptying-time may be regarded as any indicationof digestibility of foods it is evident that very smallchanges in the composition of a meal may producequite obvious changes in

"

digestion." At the same

time, minor psychic disturbances have so great aneffect on gastric secretion and motility that all suchobservations have to be treated with reserve.

THE IRISH MEDICAL ASSOCIATION

AT its annual general meeting last week the IrishMedical Association gave approval unanimously tothe proposal to amalgamate with the branches of theBritish Medical Association situated in the IrishFree State. For the last year and a half negotiationshave been taking place between the representativesof the two associations and a draft agreement hasbeen arrived at. This provides for the estab-lishment of an autonomous Irish Free State MedicalUnion, consisting in the first instance of the membersof the two existing associations who are resident inthe jurisdiction of the Irish Free State. Membersof the Union who leave the Irish Free State to residein Great Britain will automatically become membersof the British Medical Association, and members ofthe latter who go to reside in the Irish Free Statewill become members of the Union. From the pointof view of the British Medical Association the Unionwill be regarded as a group of branches and will berepresented by one member on the council of theAssociation. The Union will, however, be, as regardsits work at home, completely autonomous, and willbe responsible for its own government and by-laws.The members of the Union visiting London willbe privileged to enjoy the amenities of the BritishMedical Association hours to use its library.The Irish Medical Association has shown wisdom

in deciding as it has. With a history of ninety-sixyears of useful work for the public and the professionto its credit a decision to merge its individuality in

, a newly formed organisation could not be under-taken lightly. It was clear, however, that the main-

,

tenance of two professional organisations in Ireland,engaged in almost identical work, was wasteful and’

cumbrous. Moreover, although there was cordial

cooperation between the two bodies, neither couldclaim the prestige, influence, or authority that goesof right to a single representative organisation.

. It is designed that the amalgamation of the two,

associations should lead to members of the profession‘

who have hitherto been unattached now giving their adherence to the Union. There are between

two and three thousand medical men practising in. the Irish Free State, of whom probably about. one-third are members of one or both of the

: existing organisations.

L LIVERPOOL VOLUNTARY HOSPITALS.-The report of the Commission which recently investigated the positionf of the voluntary hospitals of Liverpool has led toL the establishment of a Liverpool Voluntary Hospitals

i Board, which has now had its first meeting. The elevenl members include Prof. Henry Cohen, F.R.C.P., Mr. C. A.

L Wells, F.R.C.S., Mr. J. Bagot Oldham, F.R.C.S., and

el Prof. R. E. Kelly, F.R.C.S. The board is to investigatet the proposals of the Commission and advise the nine

. teaching hospitals of Liverpool on their problems ; it is’

also authorised to negotiate with the municipal authorities.The Commission took the view that the governing bodies

.

of the four general hospitals must be amalgamated.