Perforation of a gastric or duodenal ulcer is a most serious condition. The prognosis is extremely grave unless recognized early and quickly followed by direct and heroic treatment. Of all the acute maladies to which humanity is heir, none is more grave and none more spectacular when attended by successful treatment. The treatment is purely surgical. However, Moynihan 1 reports two cases successfully treated by medical means during the acute stage; but in each instance the cases came to operation at a later date. We occasionally hear of deaths from "acute indigestion," but proper investigation would prove, in the majority of instances, that there was a perforation of either a gastric or duodenal ulcer. This should not occur at the present time. The burden of diagnosis will rest with the general practitioner and, even though an accurate diagnosis may not be made, at least there are always sufficiently grave signs