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 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.[]