Appendicitis is a mark, not a result, of a high grade of civilization. To have had an operation for it is one of the insignia of modern rank and culture. Our new biologic aristocracy, the "Appendix-Free," look down with gentle disdain upon their appendiciferous fellows who still bear in their bodies this troublesome mark of their lowly origin. In short, the general impression prevails that appendicitis is a new disease, a disease which has become common, or perhaps occurred at all, only within the last quarter of a century, and which therefore--with the usual flying leap of popular logic--is a serious menace to our future, if it keeps on increasing in frequency and ferocity at anything like the same rate which it has apparently shown for the past fifteen years. As this feeling of apprehension is in many minds quite genuine, it may be well to say briefly, before proceeding further, first, that, if there be any disease which absolutely and almost exclusively depends upon definite peculiarities of structure, it is appendicitis, and that these structural peculiarities of this tiny, cramped tag of the food-canal have existed from the earliest infancy of the race. So it is almost unthinkable that man should not have been subject to fatal disturbances of this organ from the very earliest times. On the post-mortem table, the appendix of the lowest savage is the same useless, shriveled, and inflammable worm as that of the most highly civilized Aryan, though perhaps an inch or so longer. Secondly, there is absolutely no adequate proof that appendicitis is increasing in frequency among civilized races. It is only about twenty-five years ago that it was first definitely described, and barely fifteen that the profession began at all generally to recognize it. But all of us whose memory extends backward a quarter of a century can clearly recall that, while we did not see any cases of "appendicitis," we saw dozens of cases of "acute enteritis," "idiopathic (self-caused) peritonitis," "acute inflammation of the bowels," "acute obstruction of the bowels," of which patients died both painfully and promptly, and which we now know were really appendicitis. In short, from a careful study of all the data, including the claims so frequently made of freedom from appendicitis on the part of Oriental races, colored races, less civilized tribes, vegetarians, and others, we are tending toward the conclusion that the percentage of appendicitis in a given community is simply the percentage of its recognition,--in other words, of the intelligence and alertness, first of its physicians, and then of its laity. As an illustration, my friend Dr. Bloodgood kindly had the statistics of the surgical patients treated in the great Johns Hopkins Hospital at Baltimore investigated for me, and found almost precisely the same percentage of cases of appendicitis among colored patients as among white patients.