The mortality from acute appendicitis has been reduced, but the sharp difference in the morbidity and complications associated with perforation demands a policy that will minimize the possibility of delay in operation or failure to diagnose acute appendicitis. The decrease in mortality is largely due to the quality of care within the hospital, and possibly to the less frequent use of cathartics, but not to a decreased incidence of perforation. The suggestion is made that the failure to decrease the incidence of perforation of the appendix may be related to the nature of pediatric practice.