328 surgeons' reports PENNSYLVAMIA thirteenth UISTRICI'. 



large infusion of tlie descendants of Scotcb-Irish emigrants aud recent emigrauts Iroin Ireland, 

 Wales, Germany, and England. 



The land is mostly tilled by its owners and tlieir families, aud is divided into moderate-sized 

 farms. Farming and grazing are the principal occupatious, altbougU in limited portions of the 

 district the miniugof coal and iron-ore with the smelting and manufacturing of iron are carried on, 

 aud also the manufacturirig of lumber. This class of workmen, with a large percentage of mechanics, 

 shop-keepers, and professional men, make up the adult male population. 



The prevalent diseases are mostly from atmospheric vicissitudes, vicious diet, (or rather cook- 

 '^ry,) overnnich labor, and insufficient clothing; cotton in the last instance having been used too 

 much in place of wool. The food is sufficient and wholesome when properly (;ook( d. Wheat, maize, 

 buckwheat, potatoes, milk, butter, and ap,iles are the chief articles of diet ; beef, mutton, and fowls 

 are not scarce ; and sugar, tea, aud coffee are coMimoiily us(>d. iMalarions diseases are rare, except 

 along the Susquehanna Valley. During the time the North Pennsylvania Canal was excavating 

 along the river-valley, and for several years alter its completion, malaiious fevers prevailed exten- 

 sively, but for six or seven ye.irs they have been infrequent. 



The early settlers were laborious, and underwent many privations while opening this heavily- 

 timbered region for cultivation, and those labors and privations show their effects on the present 

 generation, their children and grandchildren. The labor and privations undergone by the early 

 .settlers were detrimental in an especial degree to the women during the period of gestation and 

 suckling, and even now the work of woman is too incessant and long-continued during those 

 periods. 



In this climate of elevati-d and hilly regions, the vital organs on which the greatest demand is 

 made are those contained in tiie thorax ; and, from the constant calls on them for undue activity of 

 function, they are preilisposed ti> suffer most frequently from disease. The highest ratio of exemp- 

 tion is from diseases of the lungs, the effects of repeated attacks of pneumonia, emphysema, and 

 tuberculosis; and from orgaiiir disease of the heart, in most cases consequent u])on rheumatism. 



Itlieuaiatism is a very commo^i disease, and although, under the instructions contained in para- 

 graph 85, Kevised Regulations Provost-Marshal-Geueral's Barean, the ratio of exemptions is not 

 large, yet, as the fruitful origin of cardiac disease, the ratio should be increased. Perhaps the rheu- 

 matic diathesis can be Just ly attributed to diet anil vicious cooking, although attacks of the disease 

 are generally excited by exposure to wet and cold with insutih;ient clothing. As cotton is dethroned, 

 the sovereigns of the Xorth may perhaps in future be clothed in wool, to their equal benefit. 

 Organic disease of the brain is infrequent; so of the abdominal viscera. Chronic diarrhoea is 

 quite irequent since the return of so mauy from the Army. 



The ratio of exemptions from defects and injuries of feet is very high, yet very few defects of 

 feet are natural, being generally the result of wounds and injuries. This arises from the fact that 

 a large number of the men are axmen, engaged in chopping the timber prei)aratory to clearing the 

 land, or in preparing lumber for fuel and in rolling logs. The number ot fractures, dislocations, 

 diseases of the bones and joints, is large ; to the usual causes operating in other places maybe 

 added the causes mentioiu'd in the last ])aragraph, together with a caielessness in having medical 

 treatment at the time of, or soon after, the accident, the man being olten remote from home in the 

 forests. 



Inflammation of the pi'riostcum is mistaken for rheumatism or bruise, and treated by domestic 

 remedies, and does not generally come under a physician's care until [ins has formed. 



Hernia occurs most frequently in those who make violent exertions in lilting weights beyond 

 their strength, as in log-rolling, in clearing land and lumbering, and in men engaged in working in 

 iron. I think the ratio isgreater per thousand in theforeign poi)ulation than in Americans. Permanent 

 physical disability, when not, connected with organic disease, is largely ilue to overwork, prolonged 

 beyond the strength. Prolajisus ani is quite frequent, and in every case (except one) originated in 

 cliiidliood. ILeniorrhoids, old and ulcerated internally, are not a lieipient cause of exem[)tion. 

 Aiuemia caused by hiemorrhage from hajmorrhoidal tumors of not long standing is oftener the 

 cause of disability. The ratio is not large. 



Decided deafness, with chronic purulent otorrhoea, shows alarge ratio. This generally originates 

 in cliihiliood as a* sequel of eruptive levers, and of neglected otitis from colds. Physicians are 



