Patient 7, a 58-year-old man, presented in August 1929 because of a stuporous condition following a 6-month history of headaches. On September 10, Dr. Horrax performed an exploratory procedure and enucleated a metastatic hypernephroma. The patient's condition worsened the next day. His stupor continued with a 104° fever. Dr. Cushing was concerned that a postoperative clot had formed. Despite re-elevation of the flap, the patient remained unconscious, and upon receiving a nasal feeding tube, he regurgitated a large amount of dark brown blood and died. Postmortem exam reported edema of the right cerebral hemispheres. Cushing reported “a bilateral perforation of the esophageal wall communicated with the right and left pleural cavities, each of which contained about 400 cc of brownish mucoid fluid… The margin of the digested area in the thorax showed a border of reddening suggesting that the circulation must have been in… the early stages of the process… [and that] the fundus of the stomach was highly necrotic.”[] Gastric release must have occurred for a long time before blood was regurgitated with gastric fluid.
Patient 11, a 53-year-old man who presented in September 1930, reported working under stress, suffering emotional distress, and vomiting at work over a period of 6 months. Exam showed left hemiparesis, left homonymous hemianopsia, and impaired memory. Dr. Cushing took the patient to surgery to remove nodular meningioma in the right frontal lobe. Surgery was complicated by hemorrhage due to tearing of the anterior cerebral artery segments embedded in the tumor. This resulted in bilateral spastic paralysis. A nasal tube withdrew 50 cc of coffee-ground material with red blood cells evident on microscopy. 2 days after surgery, the patient's temperature dramatically rose to 107°, he “vomited a large amount of bloody fluid,”[] and died.\nOn postmortem examination, Dr. Schulz reported that in the stomach, there were “numerous flecks of the coffee-ground material suggesting changed blood.” Numerous ulcerations “very superficial and were found scattered… both in fundic and pyloric regions.”[] Microscopic exam did not show “evidence of the arterial or capillary disease or any noteworthy constriction of or thrombosis of the vessels,” unlike the previous cases.[]