Mallory and Weiss in 1929 reported 15 patients with gastrointestinal bleeding following repeated emesis.7 Autopsy findings in four of the patients demonstrated two or more linear tears in the mucosa of the esophagastric junction as the sole lesion responsible for exsanguinating hemorrhage. In 11 patients, similar histories of excessive alcoholic ingestion and the violent retching of nonbloody material prior to the onset of painless hematemesis were elicited. Since bleeding stopped spontaneously, the existence of the typical lesion was not confirmed. Subsequent reports,1-6,9-13 consisting largely of postmortem studies and case histories of patients treated surgically for this condition, have served to broaden the original idea of its pathogenesis. Our experience with this entity on the surgical services of a large charity hospital suggests that prevailing concepts of its frequency, clinical characteristics, and methods of management merit reappraisal. Material and Methods Thirteen patients admitted to the surgical services of Cook