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a century has elapsed since the pioneer work of Reginald Fitz, seems proof enough that there remains a good deal of uncertainty, at times, as to methods of management of the patient with appendicitis. Much progress, nevertheless, has been made and is being made, especially as the result of careful clinical studies in large series of cases. Too often, however, papers have been written on evidence obtained by a review of hospital records rather than from personal observation of patients, and therefore the conclusions drawn have sometimes not been as reliable as they should be. Too often, also, statistics have been published as to the effectiveness of treatment without clear differentiation between perforations of the appendix which clinically have remained localized (with a definitely palpable mass) and those which have obviously involved the open peritoneal cavity. We submit here the result of what we consider a careful personal clinical study of well over 1,000 cases of acute appendicitis and its most frequent complications observed by us at the children's surgical ward of the Cook County Hospital, Chicago, during a little more than four years, hoping that from it certain conclusions may be drawn which will be helpful in clarifying the still existing uncertainty as to reliable indications for and against operative intervention.