388 surgeons' repoets — Missouri — third district. 



Intlainmatory fevers are more active, and iu tbeir treatment bloodletting is more frequently 

 demanded, in tbe mountainous country than iu the swamp districts. The cause of tliis, I believe, 

 is due to the fact that among tbe iuhabitants of the mountains a vigorous condition of health is 

 enjoyed, a higher tone of the nervous system exists, and a greater percentage of iron is present iu 

 the circulation, which circumstances give energy to inflammatory action. Typhoid fever made its 

 appearance in Southeast Missouri about ten years ago, since which time it has prevailed more or 

 less every year. During the last four years, it has increased in frequency and intensity. The causes 

 of this are, I think, to Im found in the habits of camp-life and the privations to which civil war 

 subjects a people, the wretched habitations, unwholesome food, and mental depression so com- 

 monly seen among the refugees at military posts and garrisoned towns of this State. 



Erysipelas is frequently met with iu the mountainous district, generally assuming the erratic 

 or phlegmouic form, and is easy of cure; while, in the malarious or swsnnp district, at times it 

 appears as a malignant epidemic. The "black tongue" of New Madrid is a gangrenous form of 

 this disease, generally attacking the throat, and accompanied by typhoid symptoms, which prove 

 speedily fatal in a majority of cases. Hernia is of frequent occurrence, and is, in part at least, 

 owing to the occupations of the inhabitants, who, iu raising buildings, felling timber, rolling logs, 

 and performing other heavy work necessary to clear land and open mines in a new country, must 

 of necessity subject themselves to frequent strains. 



Phthisis i)ulmonalis is more frequent in the mountains than along tlie marshes. It would seem 

 that-tbis and bilious affections are antagonistic diseases; that climate and locality, which favor the 

 one, tend to retard the development of the other; and that medicines beneficial iu the one are often 

 hurtful in the other. 



Lead-colic, or mine-sickness, as it is called here by miners, is frequently met with about smelt- 

 ingestablishuients and the lead-mines, and is induced by careless handling and want of cleanliness 

 upon the part of the operatives. ' Ague and mild forms of bilious fever occur along the water- 

 courses in the mountainous districts during the mouths of August and September. 



The undulating portion of this district is embraced in the counties of Saint Franyois, Madison, 

 Saiute Genevieve, Perry, Gape Girardeau, Bollinger, and Wayne. The lauds are in general pro- 

 ductive; the whole country well timbered ; the water of a good quality, but not so uniformly pure 

 and cold as in the mountainous country. With the exception of the lead and cobalt mines of Mad- 

 ison County, (which also yield nickel,) no mines are worked in the counties last named. Gold iu 

 small quantities is found near the Saint Franj'.ois River, in the county of Madison. Large beds of 

 black oxide of manganese and kaolin are Ibund in Bollinger and Perry Counties. With the excep- 

 tion of the Salt Springs of Perry County, (which have not been worked for many years,) I am not 

 aware of the existence of mineral water in the undulating portion of this district. 



A large majority of the inhabitants are engaged in agricultural pursuits, and are intelligent 

 and respectable. Many German families have, withiu the last twenty years, emigrated to this dis- 

 trict, and a number of neighborhoods are almost w-hoUy made up of that class of citizens. The 

 diseases peculiar to this section of the district are similar to those of the mountainous counties, 

 with this difierence, that bilious diseases are more common, and phthisis less so ; remitting and 

 intermitting bilious fevers are common from July to October; dysentery, bilious diarrhoea, and 

 cholera infantum are more or less prevalent also. 



During the hot season, if the winds prevail a day or two from the south, the malaria gen- 

 erated in the great swamp regions of Southeast Missouri is wafted to the higher country, and not 

 iinfrequeutly sickness is produced by causes which have been generated at <i great distance from 

 the locality where the effects are displayed. The malaria thus generated and brought by the south 

 winds becomes less pernicious to the health of the inhabitants iu a ratio with the distan(-e from 

 or elevation above the swamp country, until, at the distance of one hundred miles, or an elevation 

 of one thousand feet, its effects cease to be obser\ed. 



During the winter-season, i>neumonia, rheumatism, catarrh, and other affections, induced by 

 vicissitude of climate and habits of exposure, are met with,' but are generally quite manageable. 



The swamp portion of this congressional district is embraced in the counties of Scott, Jlissis- 

 sippi, New Madiid, Butler, Stoddard, Dunklin, and Pemiscot. In the county of Cape (Jirardeau, 

 and about six miles south of the city of that name, the nndiilating portion of this district is abruptly 



