The incidence of anginal pain following the ingestion of food has been commented on by most of the writers on angina pectoris, beginning with Heberden,1who stated that "those who are afflicted with it are seized while they are walking, and more particularly if they walk soon after eating." Osler,2in his monograph on angina pectoris, states "Of the exciting causes there are three important elements: muscular exertion, mental emotion and digestive disturbances.... As an attack ends, the patient may belch quantities of gas or pass flatus from the bowel, both with apparent great relief." So marked is the association of pain with upper digestive tract symptoms that Verdon3and later the Jacksons4considered that the pain was of neuromuscular origin, consequent on gas under pressure in a hollow viscus. The increased incidence of anginal pain after meals is explained in part by the increased work