Deathfromacute appendicitis inchildhood isnow sorarethatitsoccurrence calls foraretrospective study ofanyunusual features ofthecase.A fatal casewithcomplications apparently associated with ortheresult ofinfection bythebacteroides groupof organisms prompted aninvestigation intothepart played bythese bacteria. A review oftheliterature andonefatal andonesurviving casewerethesubject ofaprevious paper(Gunn, 1956). Since thattime five further cases ofbacteroides infection havebeen encountered. Itisthepurpose ofthispaperto record these cases andtoemphasize theimportance oftheearly recognition andtreatment ofthis infection.An account isgiven oftheproblem asit presented tous. Case1. A girl aged8 years wasadmitted witha 48-hour history ofabdominal painbeginning centrally, spreading totheright iliac fossa andaccompanied by nauseaandvomiting. The clinical findings were: temperature 101-80 F.,pulse rate120perminute, tendernesslocalized toMcBumey's point withguarding in theright iliac fossa andrebound tenderness inboth iliac fossae, bowelsounds present butfaint, white cell count8,000 perc.mm.A diagnosis ofacuteappendicitis wasmadeand,atoperation twohourslater, a gangrenous, unperforated appendix wasremoved from thepelvis. Therewasnoobvious spread ofinfection beyond theappendix andthewoundwasclosed withoutdrainage. Theappendix contained Gram-negative bacilli andGram-positive cocci. There wasnogrowth onaerobic culture andanaerobic cultures werenot o made. Penicillin andstreptomycin weregiven intramuscularly forthefirst 48hoursbutthegeneral condition didnotimprove andterramycin wasthen substituted. Lateonthesecond post-operative daythechild's condition deteriorated rapidly overa fewhours. Repeated abdominal examination revealed bruising spreading rapidly around thegridiron incision. The diagnosis ofintraperitoneal haemorrhage after slippingoftheligature ontheappendicular artery was * A paperreadatthemeeting oftheBritish Association of Paediatric Surgeons heldinEdinburgh inJune, 1957. madeandafter resuscitation withbloodandplasma laparotomy wascarried out.Whenthegridiron incision wasopened, therectus andoblique muscles wereblack andnecrotic withevil-smelling greypusbetween the musclelayers. Therewasnoevidence ofperitoneal haemorrhage orleakage fromtheappendix stump.A specimen ofpuswastakenforinvestigation andthe woundedges wereapposed withafewinterrupted sutures. Thesubsequent course wasmarkedbythedevelopmentofinfective lesions inthesuperficial tissue, the pleural andpericardial cavities andthesubphrenic areas (Figs. Iand2).Treatment consisted ofaspiration anddrainage asindicated, blood transfusion (5pints over 15days) tocounter afalling haemoglobin level andan attempt atantibiotic coverbyrepeated sensitivity tests, thereports ofwhichwereonlyreceived after anecessary delayoffourdays.The organisms isolated, their sensitivity toantibiotics, andtheantibiotics administered aredetailed inFig. 3.Penicillin andstreptomycin werediscontinued because oflackofresponse and terramycin wassubstituted. Erythromycin wasadded because ofthepassage ofloose stools whichweresug