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1. 1. It is evident that the problem of gastrointestinal hemorrhage will never be described adequately in any single paper or treatise. Written descriptions will never replace clinical acuity. 2. 2. Certain clinical facets of this problem are emphasized in an attempt to provide a workable program for massive gastrointestinal bleeding. 3. 3. A salvage rate of 100 per cent can be assumed if only one case of massive bleeding is rescued by surgery. 4. 4. For the best results, early decision for surgery will bring about much greater success, thus supporting the original contention of Finsterer. 5. 5. Surgery is the decision of choice in that group of patients having more than one episode of massive bleeding. 6. 6. As has been emphasized by Dunphy, 11 repeated syncope is the single most important symptom relative to early surgery. 7. 7. The combined teamwork approach, utilizing the internist, roentgenologist, surgeon and anesthetist concurrently, will reduce the overall hospital mortality for this most fearful condition.

To the Editor:— In the ANESTHESIA PROBLEM OF THE MONTH ( 198 :655, 1966), "Pneumothorax During Surgery," a description is given of a bilateral pneumothorax occurring as surgery was beginning. Obviously, from the protocol, no definitive surgery had been initiated when the pneumothorax occurred. This case was very splendidly handled; however, I wonder about the judgment displayed in going ahead with the surgery after the very major complication of bilateral pneumothorax had occurred. It seems to me that sounder judgment would have been to consider the tracheostomy as a first stage, to treat the pneumothorax, and then, returning at a later date, to perform the definitive surgery as the second stage of the operation. I should appreciate Dr. Hamilton's comments.