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The series reported reveals two very definite factors: the tendency of cases of perforated ulcers to be bunched together and the occurrence of this bunching at the onset of warm weather in the spring or just prior to the onset of cold weather in the fall. The temperature factor so pronounced in this area, with its marked seasonal change, would be negated in such semitropical areas as Miami and New Orleans. The environmental upheaval during the “brown days” of Appalachia would not be evident in an urban setting. If environment plays a dominant role in the production of peptic ulcers, different environments must produce variables in manifestations of ulcers. Statistics reflect these variants.