Abstract 1. 1. The three fundamental principles propounded by the Empyema Commission still form the basis of our modern therapy of empyema. 2. 2. A uniform method of treatment combining the principles of open and closed surgical drainage is presented. 3. 3. Four hundred and seven children with empyema were treated by this method over a ten-year period (1926–1936) with a mortality of 10.3 per cent. Thirty-five additional patients with empyema were treated by the same method during 1936–1937 with a mortality of 8.6 per cent. 4. 4. There is a definite parallel between the mortality of pneumonia and empyema in any given series of cases treated over a period of years. 5. 5. The frequent use of fluoroscopic and Roentgen observation is very necessary in the follow-up period of treatment to gain the best results. 6. 6. Patients showing evidence of scoliosis complicating the empyema should be placed on a Bradford frame. 7. 7. Where reexpansion of the lung is slow, the Wangensteen method of suction materially shortens the period of morbidity. 8. 8. In treating empyema, individualization must be practiced, since each patient demands his own particular form of therapy. 9. 9. Cases are presented illustrating the various types of empyema and their subsequent treatment including results. 10. 10. The following recommendations are made: 10.1. ( a) The combined interest of the pediatrician, roentgenologist, and surgeon is important in the careful management of a child ill with empyema. 10.2. ( b) Careful clinical and roentgenologic examination (anteroposterior and lateral positions) is necessary. 10.3. ( c) Aspiration for diagnostic (culture of pus) and therapeutic purposes should be done up to the point of frank pus. 10.4. ( d) The combined method of trocar-cannula-catheter drainage followed by open drainage is recommended. 10.5. ( e) Attention to details which include blood transfusions as indicated, preservation of the normal water balance and nutritional status of the patient are essential to successful management.