In chlorosis and anoemia the gastric symptoms frequently play an important part. They all, as a rule, belong to the neurotic derangements of the stomach. Thus anorexia, gastral-gia, hyperesthesia of the stomach, atony, and hyper-chlorhydria are frequently met with. Some writers (Hayem l and others) look upon the gastric disturbances as the primary factor causing the affection of the blood. I concur with Ewald and Rosenheim that in the vast majority of cases the digestive symptoms are only sequelae and not the primary cause of the chlorosis. The administration of iron quickly improves the gastric symptoms.

Heart lesions are frequently attended with gastric disturbances. The latter, as a rule, are due to hyperaemia of the gastric mucosa and consist in a feeling of pressure in the epigastric region, especially after meals, anorexia, belching, etc. Huefler's 2 assertion that there is an absence of free hydrochloric acid in almost all cases of valvular heart lesions is not correct, as has been shown by myself3 and later by Adler and Stern.4 Among twelve patients with heart affections whose gastric contents I have examined, in eight free hydrochloric acid was present, while in four it was absent.

1 Hayem: Bull, medical, 1891, No. 87. 2Huefler: Munchen. med. Wochenschr., 1889. No. 33 3 Max Einhorn: Berl. klin. Wocheuchr., 1889, No. 48. 4 Adler und Stern: Berl. klin. Wochenschr., 1889, No. 49.

Gastric affections not infrequently produce symptoms simulating a heart lesion. Thus, for instance, arhythmia cordis, tachycardia, and occasionally bradycardia are met with in chronic gastric catarrh, in nervous disorders, and in atony of the stomach. Sometimes it is difficult to decide at first whether we have to deal with an affection of the heart or of the stomach. A through examination of the circulatory apparatus and also of the gastric functions will reveal the true nature of the disease.