All deaths for five years reported in this community from gastrointestinal bleeding were reviewed. In 80 of these 110 patients the location of the bleeding source was determined at autopsy or laporatomy. The clinical accuracy in the recognition of these sources was 60%, but only 43% of peptic ulcers, the most frequent lesion, were properly recognized. Most inaccuracies arose from the physician's reluctance to take positive diagnostic steps. Rather, there was a tendency to rely heavily on blood transfusions and anticipate that the bleeding would stop. Serious associated diseases were present in over 2/3 of these patients and contributed to this reluctance. The consistent annual mortality rate of 2.6% in bleeding peptic ulcer suggests that a new and vigorous approach must be taken with these patients if the number of deaths is to be lowered.