The perforation rate of 20.9% in an environment in which cost is not a consideration is distressing. In 1963, Kendrick and Sharp1 reported a perforation rate of 13.9% in 1109 nonincidental appendectomies performed in US Army Europe Hospitals, which decreased to 9.4% in 1793 cases the year after the medical community knew this diagnosis was under surveillance. In 1970, I2 reported a perforation rate of 14.7% in 156 cases at the US Army Hospital, Bad Cannstatt, Germany. In my own cases, 65% of the patients had symptoms of more than 48 hours' duration, and 43% had a delay in treatment because the primary care physician could not make the diagnosis. Berry,3 commenting on this experience, stated, "The Military Services have complete medical coverage for their forces, so there should be no delay in operating whenever acute appendicitis is suspected."
The failure of the nonsurgeon to recognize the possibility