—In an otherwise healthy patient with an established diagnosis of bleeding peptic ulcer, what, if any, are your indications for emergency operation for hemorrhage? What if the source of bleeding has not been established?
—The prima-facie indication, of course, is evidence that proper measures short of surgery have not controlled the hemorrhage. Unfortunately, there is no reliable test to determine whether or not the patient is continuing to bleed. The man of average weight may lose as much as 1,500 cc. of blood, if protected in a reclining position, without visible evidence of shock. If he is allowed to stand, or if his trunk is tilted upward, as in fluoroscopy, shock may for the first time become evident. The best treatment when bleeding is initially seen is prompt and adequate blood transfusion, while at the same time the source of bleeding is being searched for. If, after adequate