A total of 4000 consecutive cholecystectomies performed over a period of 25 years has been analysed to determine whether routine peroperative cholangiography (PC) has influenced overall mortality. The patients have been divided into four cohorts of 1000, the first cohort before the introduction of PC, two covering the period of introduction of PC and the final cohort when PC was an established routine. A significant fall in overall mortality has been demonstrated, but when the patients are divided into simple cholecystectomy and the group undergoing additional choledochotomy there is no significant fall in the mortality rate. The mortality rate for the latter group is three or four times greater than that for the cholecystectomy alone group. The main contribution to the lower mortality is the reduced duct exploration rate following the introduction of PC. The stone recovery rate has improved from 34 to 71 per cent. The use of routine PC during cholecystectomy is recommended.

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This paper records a study of 400 patients admitted for haematemesis and melaena. Emergency surgery was undertaken on selected patients but the overall mortality increased when more frequent emergency operations were performed in the latter half of the series.The proper management of haematemesis and melaena is a constantly recurring problem. Our material consists of 473 patients admitted for haematemesis and melaena between January, 1953, and July, 1958. Four hundred of these (87%) were for proved or suspected peptic ulceration, and the main object of this paper is to discuss the place of surgery in this group. The overall mortality of the ulcer group was 6.25 %. Ninety-eight (24.5 %) were submitted to emergency surgery. The remaining 73 patients (13 %) bled from causes other than ulcer. The Mansfield hospitals serve a population of some 200,000 in a well-defined area. All patients admitted to hospitals and nursing homes for definite haematemesis and melaena are included and classified according to Avery Jones (1956). ANALYSIS OF RESULTSIn the analysis of results, the ulcer group as a whole is considered first, then all patients in the ulcer series operated on in the acute phase or later. Next comes a summary of other operations done for peptic ulcer over the same period. A more detailed account of the emergency operations (that is within 24 hours of bleeding) in the ulcer group and their results follows. The first 200 and the second 200 of the whole peptic ulcer group are then compared. Finally, there is a short section on the causes of bleeding other than an ulcer, and the emergency operations that were done in this group. (58 %) were diagnosed by radiology or at operation. Duodenal ulcers outnumber gastric ulcers by 159 to 70. The acute lesion group (32 %) refers to those patients in whom radiology failed to show an ulcer three weeks or so after admission. The unclassified group (6 %) refers to incompletely investigated patients with strong presumptive evidence of peptic ulceration. The post-operative group (4 %) followed gastro-enterostomy or partial gastrectomy. The whole series mortality is slightly higher for gastric ulcers (10%) than for duodenal ulcers (8.8 %), although the operative mortality was rather higher for duodenal ulcers. The acute lesion group had a mortality of 4.2%. No necropsy was done on the patient who died in the unclassified group. THE ULCER GROUP AS