A retrospective survey was carried out on adult medical admissions to Kamuzu Central Hospital, Lilongwe, Malawi during the period January to December 1986, and results compared with those obtained in Queen Elizabeth Central Hospital, Blantyre in 1973. There were 4700 admissions which was more than twice the number seen in Blantyre. However, the age distribution, the pattern of disease and the overall hospital mortality were similar. Infections (malaria, pneumonia, tuberculosis, gastroenteritis/dysentery and meningitis) were the most common cause of admission, and the major causes of death were still tuberculosis, pneumonia and meningitis. Smoking related diseases were uncommon, and there was no documented case of ischaemic heart disease. The reasons for the importance of periodic surveys, such as the present study, are discussed.