Two thousand and twenty-one patients treated surgically for acute cholecystitis over a 42 year period with a mortality of 3.4 per cent are reported. This experience reveals that acute cholecystitis among patients 65 years of age and older is a serious condition and is associated with an appreciable operative mortality. However, nonsurgical management results in an even greater mortality. An aggressive surgical approach, cholecystectomy without prolonged delay after the demonstration of calculous disease of the biliary tract, is urged. In the future, this should diminish the proportion of patients 65 years of age and older with acute cholecystitis.