In a prospective study of gall stone related deaths in a single Health District, the biliary tract was examined at necropsy in 1701 cases and 8078 death certificates were searched. Gall stones were identified as the cause of death in only 21 cases (0.26%) but in 291 subjects found to have gall stones or cholecystectomy at necropsy, the mortality was 3.4%. The necropsy prevalence of gall stones in the adult population was 17.1% but nine out of 10 subjects with gall stones had not had a cholecystectomy and women were three times more likely to have had their gall stones removed than men. There were five postoperative deaths (mean age 60 years) with an operative mortality for cholecystectomy in the district of 1.2%. Death due to unoperated gall stones was identified in 16 subjects, most of whom were very elderly women (mean age 81) but carcinoma of the gall bladder was only found in one woman of 90 with gall stones. The prevalence of gall stones rose with age in both sexes but the cholecystectomy rate per head of population at-risk declined sharply in the seventh decade in women and the eighth decade in men. There are a large number of people with unoperated gall stones in the population but gall stone related deaths are very uncommon. The cholecystectomy rate in Britain, however, seems to be rising and it is suggested that if this trend continues there may be an increased number of deaths.
