An analysis of 944 cases of acute appendicitis treated at the University of Kentucky Medical Center from 1966 to 1973 is presented. There were 12 deaths in this series, a mortality rate of 1.3 per cent, and the clinical presentation, operative and autopsy findings are discussed. It is significant that seven of the 12 patients had other serious illnesses that influenced the decision for operation and that operation was delayed over 48 hours in 50 percent. It is stressed that the need for early exploration in the patient suspected of having appendicitis is even more imperative in the individual with concomitant disease. Adequate but immediate preoperative preparation with fluids and electrolytes antibiotics and stabilization of renal, pulmonary and cardiac status is mandatory.