Abstract A review was carried out of the pattern of biliarytract disease in Malaya where the population consists of three major groups: Malays, Chinese, and Indians. The review was based upon (a) a study of the comparative incidence of operations for biliary disease in the six large general hospitals serving West Malaya, and (b) a more detailed study of 120 consecutive patients undergoing operations on the biliary tract in the University Hospital, Kuala Lumpur. Biliary-tract disease requiring operation is common in Malaya, and appears to be more common in Indians and Malays than in the Chinese. Two distinct patterns of biliary-tract disease are encountered. The majority (two-thirds) of the patients have a disease similar to the Western type of cholelithiasis, but the remaining one-third have a disease, ‘Oriental cholangitis’, of a distinctly different pattern, with a different sex ratio, a high incidence of infected bile, and the almost invariable presence of jaundice and soft stones in the common duct. Oriental cholangitis was found in Chinese, Indian, Malay, and Aborigine patients in this survey, and is not, therefore, confined to the Chinese and Japanese as previously suggested.