Ulceration and Malacia of the Upper Alimentary Tract in Neurologic Disorders

CUSHING 1 in 1931 offered convincing evidence for the revival of once-discarded theories of the neurogenic origin of peptic ulcer. He directed attention to the interbrain (diencephalon) as a parasympathetic center. From this center, apparently tuberal in situation, fibre tracts pass backward to relay with the cranialautonomic stations of the midbrain and medulla, of which the vagal nucleus is by far the most important because of its influence upon the lungs, heart and upper alimentary canal. Concern over the death, with acute gastrointestinal symptoms, of three patients who had undergone craniotomy for tumor in the posterior cranial fossa caused him to seek an explanation for the postmortem findings common to all, hemorrhagic necrosis with perforation of the esophagus or stomach. More cases with a similar outcome were analyzed. Experimental and pharmacologic evidence was introduced to document findings of medullary or third ventricular compression, intraventricular tumor, cerebral edema, or less well-defined