[ 4 ° ] 
and Pneumonia, they are here not so often victims of Beri-Beri. The 
Chinese suffer less from Dysentery and Pneumonia but more from 
Tuberculosis. A similar difference is observed amongst Negro and Indians 
(mainly from Calcutta) in British Guiana. Tuberculosis is the pulmonary 
disease of the Negro, and he rarely gets Pneumonia, whilst the Indians, 
the Aboriginals and the Europeans are rather less subject to Tuberculosis 
but much more so to Pneumonia. 
The prevalence of fatal Malaria amongst the Chinese is noteworthy, 
as the Tamils are equally exposed to infection, and are by no means exempt 
from mild attacks. This susceptibility to Malaria in the Chinese is probably 
due to the smaller amount of Malaria in China than in the Madras 
Presidency or Ceylon, so that the Chinese have not suffered the early and 
repeated infections necessary to induce immunity. Two-thirds of the 
fatal cases were in persons who had been in the country four years or less. 
The fatality amongst Chinese when introduced into badly Malarial 
countries, such as West Africa, is well known, and the same occurred with 
Chinese imported into British Guiana. Fortunately this disease can be 
controlled as results here have shown, but without serious and persistent 
efforts to reduce the amount any natural increase in the Chinese population 
outside the towns cannot be anticipated. 
The occurrence and causation of Malaria in these States has been 
already considered. 
Tuberculosis. 
Tuberculosis is now one of the most important diseases in the country, 
and according to all the evidence seems to have become much more preva¬ 
lent during the last few years. 
As a cause of death, judging from these returns, it ranks second only to 
dysentery. The medical history of other tropical countries has shown that 
this is a usual sequence of the imperfect adoption of European methods of life. 
The increased cost of land results in overcrowding. The small rooms and 
houses built in European style are much more expensive than native houses. 
They can only be remuneratively leased to persons drawing $10 to $15 a 
month usual wages if overcrowded. In such houses air is usually admitted 
in comparatively few places and so a draught is produced. 
In the tropics, particularly in sleeping persons, the skin is very 
susceptible to slight changes in temperature, such as those produced by a 
draught, so that for the sake of comfort and to ensure an equable temperature 
such ventilating holes are frequently stopped up by the inmates of the house 
and the ventilation reduced to a minimum. 
The dry cement or wooden floors are rarely more than brushed and 
never disinfected. Expectoration is indulged in freely. 
Under these circumstances Tuberculosis introduced into a house, work¬ 
shop, gambling room, theatre or temple, has every chance of spreading. 
The increase in the towns and, at present, the inefficiency of such regulations 
against overcrowding, etc., as exist, suffice to explain the large percentage of 
Tuberculosis now present, and to give serious grounds for fear that this 
disease will assume more serious proportions and affect the other races here 
resident who now suffer to a smaller extent. 
In the great majority of the cases the disease has been acquired in the 
Federated Malay States. Of 37 in which the length of residence is recorded. 
