alone. An ulcer hemorrhage that has manifested itself only as melena is rarely fatal. The absence of clinical shock, as ordinarily defined, may preclude the necessity for operation, irrespective of the low level of which hematocrit and erythrocyte determinations have fallen. Cases of blood dyscrasias should be excluded from emer¬ gency operative procedures. The following patients should be carefully observed as potential operative can¬ didates : a patient over 45 years of age, any patient with hematemesis, a patient experiencing his first hemorrhage, a patient with hemorrhages persisting over 24 hours after admission to the hospital, and a patient hemorrhaging while already following a full medical ulcer regimen. It is usually not necessary or desirable to operate within the first six hours. Operation within 48 hours, however, may be undertaken with much less risk than an operation per¬ formed after many days of persistent or recurrent hemor¬ rhage. A plentiful supply of compatible blood should be available. Subtotal gastrectomy is the most effective oper¬ ative procedure for bleeding peptic ulcer. If a gastrectomy is to be done, it should be done carefully and unhurriedly, provided blood replacement is adequate, inasmuch as compromise procedures are not uniformly satisfactory.The chronic type of hyperventilation is an interesting and often confusing symptom complex. There is a prevalent misconception that hyperventilation syndromes occur infrequently, are characterized by acute, dramatic, but transitory bouts of hyperpnea, and that they culminate in frank tetany. Our experience indicates, to the contrary, that these syndromes are common, generally have a chronic course, present diverse clinical pictures that often mimic serious organic disease, and are usually attended by marked disability.1 PATHOGENESIS In 1937, Kerr and his associates first directed attention to the various manifestations that may result from hyperventilation and emphasized the psychogenic cause that usually exists.2 Since then, however, many other causal factors have been noted, such as severe febrile states,3 infections, intoxications, collagen diseases affecting the central nervous system,4 and reflex sensory stimulation from pathological lesions in remote areas of the body (e. g., prostatic hypertrophy with urinary retention).5 Hyperventilation phenomena secondary to these organic processes tend to occur as acute, short-lived episodes, while the psychogenic syndromes generally have a more chronic course. Psychogenic patterns are often super¬ imposed on organic disorders, particularly those of the cardiovascular system, with mutually adverse results and more complex diagnostic and therapeutic problems.1 As schematically summarized in figure 1, the initial link in the pathogenic chain is hyperventilation, regard-