Patient 9, a 25-year-old man, presented in June 1929 with suboccipital headaches associated with vomiting. The patient reported that in May 1929, while fatigued from a long car drive, he endured a severe suboccipital headache and vomiting. He also experienced seizures that consisted of neck retraction, dizziness, sweating, eye protrusion, and arm flexure. Cushing wrote that the patient was reportedly taken to the hospital in late May for “gastric symptoms.”[] On examination, the patient had a rigid neck, bilateral abducens palsy, bilateral Babinski reflex, hyperreflexia, and a choked disc of 4 diopters. Ventriculograms showed some evidence of obstructive hydrocephalus at the foramina of Monro and a filling defect of the third ventricle. He was given four radiation (X-ray) treatments and the pressure symptoms subsided for 1 year.\nIn 1931, his gastric symptoms returned, and a recurrence of the tumor was suspected. He received three additional radiation treatments, and the symptoms disappeared. However, the symptoms recurred again in January 1932. These symptoms were more indicative of a duodenal ulcer. He received radiation at the third ventricle, and he improved. However, several weeks later on March 3, barium studies confirmed the presence of a healed duodenal ulcer following the radiation therapy.[]
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.