IT IS NOW one hundred and five years since James Duncan,1 surgeon at the Royal Infirmary in Edinburgh, cited a case of gangrene of the gallbladder with perforation, followed by peritonitis and death. The conditions were observed at autopsy. In 1894, fifty years following Duncan's observation, Hotchkiss2 reported the first case in which operation was performed. In 1895, W. J. Mayo3 reported the first successful removal of a gangrenous gallbladder. Since that time many reports have been published. Gangrene of the wall of the gallbladder is complete necrosis of a portion of the wall in one or more areas. Gangrene of a portion of the gallbladder wall, followed by perforation, is a sequel of acute cholecystitis. The term does not imply that the entire gallbladder is gangrenous. This report deals with 19 cases of gangrenous perforation of the gallbladder which fall into types 1 and 2 of