To the Editor:
— Concerning rupture of the gallbladder through the abdominal wall, the communication in the May 4 issue, by Dr. Arthur B. Coffin of Boston, reminds me of two cases I have seen at autopsy in the Los Angeles County General Hospital. A white woman, aged 64, some years previously had had a cholecystotomy, and shortly before death the gallbladder had ruptured spontaneously through the central portion of the old scar. Gallstones were present. In a white woman, aged 82, the gallbladder had ruptured and a large chronic subcutaneous biliary abscess, not containing stones, was found. The gallbladder contained a number of calculi. These are my observations in about 1,800 autopsies in the last six years.Sir Humphry Rolleston, in "Diseases of the Liver, Gall Bladder and Bile Ducts" (1912, p. 766) states that biliary fistula through the abdominal wall is the most frequently reported variety, and cites