Abstract Cimetidine is thought to have accelerated the reduction in elective peptic ulcer surgery but its effect on the incidence of perforated peptic ulcer has not been reported. A 15-year (1966–1980) review of peptic ulcer surgery in a district general hospital is presented. Since cimetidine became available (November 1976), the mean annual number of elective operations has fallen from 91·4 to 50·5 (45 per cent reduction). The number of perforations has fallen from 40·6 to 36·5 (10 per cent reduction). One hundred and five patients treated for perforation (97 duodenal, 8 gastric) from 1978 to 1980 were reviewed in detail. Of the 64 patients with a chronic ulcer, 8 were taking cimetidine when their ulcers perforated and a further 8 had been on the drug previously. Cimetidine has substantially reduced elective peptic ulcer surgery. There appears to have been no equivalent reduction in the incidence of perforation.