412 The Philippine Journal of Science 1920 
I cannot agree entirely with the view taken by Krehl in regard 
to the absence of the dyspeptic processes, when he mentions 
certain foods that are harmless to certain individuals and harmful 
to others with supposed anomalies of the nerves, either in the 
central nervous system or in the heart. When there is dis- 
turbance in the function of the organs of digestion, we have 
necessarily to admit that they are no longer working as they 
do in normal individuals. On the other hand, the supposition 
of nervous constitution, or of anomaly of the nerves in the 
central nervous system or in the heart, is equivalent to the ad- 
mission of two preexisting conditions — one, the phenomenon of 
idiosyncrasy, which is congenital in character and consequently 
must not be considered in such cases of cardiac reflex symptoms 
observed in adults ; the other, some nervous affection of unknown 
character manifesting itself in conjunction with certain cardiac 
symptoms. This does not appear to be tenable and is contrary 
to the mass of facts and evidence we have on this question. 
One important fact in eliminating the possibility that such 
cardiac symptoms may be due to cardiac affections is that spe- 
cial demands on the heart muscle, such as active bodily exer- 
cise, are entirely without evil effect and are indeed well borne. 
Certain explanations are offered to establish the connection 
between the cardiac symptoms and the abnormal conditions in 
the abdomen. Krehl takes the intoxication theory as the most 
probable and the one most in accord with modern views. This 
theory still lacks foundation, for we do not know what the toxic 
substances are; all we know is that special forms of dyspepsia 
are particularly apt to bring on disturbances of heart action. 
Another possibility advanced by Potain is that the disturbances 
are due to reflexes from the abdominal organs acting on the 
heart through the pneumogastric nerve. There is undeniably a 
great similarity between many of these heart symptoms and the 
symptoms produced by irritation of the vagus. There are, be- 
sides, two other things that support this view. One is that 
irritation in a part of this nerve is especially apt to be propagated 
to other portions of the nerves, as has been shown by numerous 
observations. For example, we have the case of vagotony or 
marked sensitiveness of the vagus to any stimulant; secondly, 
other symptoms are observed after gastric disturbances, which 
cannot be regarded as due to anything but reflex irritation of 
fibers of the pneumogastric nerve — that is, reflex irritation 
through the lungs. Finally, the rapid disappearance of the 
symptoms, or distinct amelioration of them after copious belch- 
