Two hundred sixty-six acute perforated peptic ulcers have been treated at the Louisville VA Hospital from its inception in May, 1946 to the end of 1961 (Table 1). During this period, only a small minority, 25 patients, have been treated by definitive surgery at the time of perforation, but in recent years we have come to feel it is the procedure of choice in selected circumstances. The first 183 perforations, all treated prior to 1955, have been previously studied and reported8 (Table 2). Most (175) of these had been treated by simple suture. While the mortality for simple suture in that group was satisfactory, only 2.3%, we elected to analyze critically the postoperative courses after simple suture to determine if a more aggressive attack on the acute perforation might be warranted, as suggested by many European surgeons and some surgeons in this country.2,3,7,9,10 Of the 175 perforations treated