Patient 5, a 44-year-old man, presented in January 1930 with headaches and declining vision for the previous year. Blood pressure was 210/145 and on exam, there was evidence of long-standing papilledema. Ventriculograms did not show any evidence of a tumor. On February 10, the patient vomited a total of 1300 cc of blood over the course of 2 days. On February 17, the patient experienced intense epigastric pain warranting exploratory surgery. Dr. John Powers found “a perforation in the posterior wall of the stomach 1 cm in diameter and 8 cm proximal to the pylorus.”[] This ulcer was surgically closed. The patient died on February 22 with a rectal temperature of 104°. Postmortem exam showed “peritonitis restricted to the lesser peritoneal cavity with terminal septicemia from a gas-producing bacillus… The sutures closing the perforation had been dissolved away, and the stomach was in shreds from autodigestion.”[] No tumor was found.
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.