This paper presents clinical data elucidating the natural history of gall stone disease, based on observations carried out on a secluded alpine population treated conservatively for generations. Special circumstances corroborating a statistical evaluation are outlined. Pertinent parameters supporting this study are anatomical findings at operation following the introduction of established surgical procedures into the region, with particular attention to age grouping within the collectives of patients. A total of 130 patients, operated on for gall stones for the first time in their lives, were evaluated, 18 patients undergoing incidental cholecystectomy for asymptomatic gall stones were excluded from this series. Of the remaining collective presenting with clinical symptoms of cholelithiasis, 54% were admitted for complications of the disease, i.e. 15% for acute cholecystitis and 39% for choledocholithiasis (including jaundice in 27%). We conclude that the natural history of gall stone disease in this region implicates the incidence of the above-mentioned inherent complications unless cured electively by early cholecystectomy.