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.
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.