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EDITORIAL SYNOPSIS This is a study based on 587 patients with acute bleeding from the upper alimentary tract. After excluding 17 with carcinoma of the stomach and 11 with oesophageal varices, the overall mortality was 7-7 %. No fewer than 51 % of patients were over 60 years of age. Emergency surgery was needed in 14-3 %. From follow-up studies it is concluded that elective gastrectomy should be performed in patients with gastric ulcer in whom bleeding ceases after admission. MATERIALDuring the four-year period 1957-60 there were 618 admissions to this unit for the treatment of haemorrhage from the upper alimentary tract. Some patients were admitted on more than one occasion and the total number of patients involved was 587 (Table I). Of this total, 11 (1.9%) were found to be bleeding from oesophageal varices and 17 (2-9 %) from carcinoma of the stomach. Of the remaining 559 patients who are the subject of more detailed study, 285 (51 %) were over the age of 60 and 232 (42%) were women. The age distiibution of the cases is shown in Figure 1. DUODENAL ULCER There were 210 patients in the series found to have a duodenal ulcer: 88 (42%) were over the age of 60 and 47 (22-4 %) were women. There were 10 deaths (4-8 %), the mortality rising to 10% over the age of 60 years. Emergency surgery was undertaken in 25 cases (11-9%), of which five were women, and there were three deaths.GASTRIC ULCER There were 155 patients bleeding from a gastric ulcer and of these 98 (63 5%) were over the age of 60, and 77 (49-5%) were women.There were 26 deaths (168 Y%), the mortality rising to 24-5 % over the age of 60 years. Emergency surgery was undertaken in 51 cases (33 %), of which 23 were women, and there were nine deaths.

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