Patient 6, a 47-year-old man, presented on January 11, 1926, with a 7-year history of suboccipital headaches, a 4-year history of bilateral tinnitus, a 1-year history of ataxia, and a 2-3 months history of right facial palsy and constipation. Exam showed papilledema, nystagmus, moderate bilateral deafness, cerebellar ataxia, and absent gag reflex. Blood pressure was 140/80. A tumor was suspected, but exploration found none. During the surgery on January 26, the patient experienced vomiting and a fall in blood pressure. Cushing noted the absence of cerebellar tonsillar herniation, and he also noticed evidence of upward herniation of the spinal cord.\nOn postoperative day 3, the patient's temperature rose to 104°. Lumbar puncture revealed mildly blood-tinged fluid. The patient's lungs filled with fluid, and he became cyanotic, eventually leading to his death on postoperative day 4. The autopsy reported an aneurysm of the basilar artery that displaced the brainstem, arteriosclerosis, bronchopneumonia, and gastromalacia. A postmortem exam found “the peritoneal cavity [near] the spleen contained 500 cc of brownish dirty fluid containing small masses of mucus. The fundus of the stomach and lower esophagus was found to be completely disrupted and in shreds.”[] The gastric perforation was found to be 15 cm in diameter, extending to the cardia of the stomach and entering the esophagus.[] The presence of brown fluid showed that gastric secretions had been released for some time, allowing for perforation of the stomach.
Patient 4, a 32-year-old woman, presented in November 1930 with stress, an enlarged heart, moderate arteriosclerosis, papilledema, and a significantly elevated blood pressure of 270/150. On admission, she reported a 5-month history of headache, dyspnea, palpitation, and indigestion. Eventually, the patient developed hydrothorax that was relieved by a tap. On January 7, 1931, she became comatose, febrile, and suffered convulsive seizures. She died on January 8 with a temperature of 104°. The autopsy reported “gastric mucosa was found to be intensely injected and to contain numerous, small stellate-shaped recent ulcerations… The mucosa of the duodenum was injected but without ulceration.”[] This patient had a hypertensive crisis that caused gastric ulceration, not due to surgical intervention.