THE SUCCESSFUL management of patients with massive upper gastrointestinal hemorrhage requires knowledge of the pathology of lesions responsible for bleeding and familiarity with the available methods for their prompt recognition. In addition, understanding of the physiology of the bleeding state, affected as it is by age, rate of bleeding, and concomitant diseases, is necessary for continuous assessment of the patient's condition. These and other factors determine the choice of therapy, and, in particular, the timing of surgical intervention.
The problem of management is particularly challenging on the wards of a large municipal hospital, where patients often arrive in an advanced stage of illness. The experience of many physicians who have studied this problem on the wards of the Boston City Hospital has emphasized the value of a working plan of management. The following discussion comprises one such broad outline which has proved practicable. Since patients with this syndrome are routinely