THE EXTENSIVE literature on the management of massive bleeding from peptic ulcer is indicative of the seriousness of this clinical condition. For some time the discussions of this problem were concerned with the relative merits of medical or surgical treatment. It would now seem established that as the great majority of patients who bleed massively from peptic ulcer will stop bleeding spontaneously, surgical treatment for the whole group would be ill-advised. It is generally accepted that the judicious selection of patients who might benefit from surgical treatment will result in a lower overall mortality for the whole bleeding group.
Continuing improvements in the anesthetic management of surgical patients and in surgical techniques themselves, as well as the ready availability of large volumes of blood, should have increased the safety of surgical treatment in any given situation. In addition newer methods of assessment of the adequacy of the circulation, in particular