A quantitative bacteriological study of the appendix wall of 43 children admitted to this unit showed no significant differences between the flora of the histologically normal and acutely inflamed appendices. Bacteroides species, Escherichia coli, and streptococcal species were the commonest organisms isolated and were found in counts of 10(3) to 10(8) organisms per gram of tissue. Bacteroides species were most commonly the dominant flora in both normal and inflamed appendices. The lack of increased counts of organisms in acute inflammation of the appendix suggests an unfavourable environment to bacterial proliferation making primary bacterial infection an unlikely aetiological factor in the pathogenesis of appendicitis.
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