Modern supportive care which prolongs life in critically injured or septic patients is often complicated by major gastric bleeding. Since 1967, over 300 patients on the emergency service at Detroit General Hospital have required transfusion for this disease. Thirty-eight of these patients in whom bleeding did not respond or only temporarily remitted with ice-saline lavage underwent surgery. Eighteen died. Sequential photographic studies of the gastric mucosa performed prior and subsequent to bleeding revealed a wide spectrum of erosions limited to the body of the stomach. Gastric hypersecretion was present in most patients. Studies of gastric mucus were done, and histologic and electron microscopic studies were performed. Vagotomy and distal gastrectomy were the most effective operations for control of hemorrhage. Nevertheless, vagotomy and pyloroplasty are advised in selected patients who meet certain, well-defined criteria.