Since the lower end of the esophagus, as well as the stomach, contracts periodically in hunger, the reference of the sensation to the sternum by the ignorant persons questioned by Schiff was wholly natural. The activity of the lower esophagus also explains why, after the stomach has been removed, or in some cases when the stomach is distended with food, hunger can still be experienced. Conceivably the intestines also originate vague sensations by their contractions. Indeed, the final banishment of the modified hunger sensation in the patient with duodenal fistula, described by Busch, may have been due to the lessened activity of the intestines when chyme was injected into them. The observations recorded in this paper have, as already noted, numerous points of similarity to Boldireff’s observations[210] on the periodic activity of the alimentary canal in fasting dogs. Each period of activity, he found, comprised not only widespread contractions of the digestive canal, but also the pouring out of bile, and of pancreatic and intestinal juices rich in ferments. Gastric juice was not secreted at these times; when it was secreted and reached the intestine, the periodic activity ceased. What is the significance of this extensive disturbance? I have elsewhere presented evidence[211] that gastric peristalsis is dependent on the stretching of gastric muscle when tonically contracted. The evidence that the stomach is in fact strongly contracted in hunger--i. e., in a state of high tonus--has been presented above.[*] Thus the very condition which causes hunger and leads to the taking of food is the condition, when the swallowed food stretches the shortened muscles, for immediate starting of gastric peristalsis. In this connection the observations of Haudek and Stigler[212] are probably significant. They found that the stomach discharges its contents more rapidly if food is eaten in hunger than if not so eaten. Hunger, in other words, is normally the signal that the stomach is contracted for action; the unpleasantness of hunger leads to eating; eating starts gastric digestion, and abolishes the sensation. Meanwhile the pancreatic and intestinal juices, as well as bile, have been prepared in the duodenum to receive the oncoming chyme. The periodic activity of the alimentary canal in fasting, therefore, is not solely the source of hunger pangs, but is at the same time an exhibition in the digestive organs of readiness for prompt attack on the food swallowed by the hungry animal. *[Footnote: The “empty” stomach and esophagus contain gas (see Hertz: Quarterly Journal of Medicine, 1910, iii, p. 378; Mikulicz: Mittheilungen aus den Grenzgebieten der Medicin und Chirurgie, 1903, xii, p. 596). They would naturally manifest rhythmic contractions on shortening tonically on their content.] REFERENCES [Footnote 171: Cannon: The Mechanical Factors of Digestion, London and New York, 1911, p. 204.]