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of an exceedingly aggravated character. This too is the season at 

 which we have the greater amount of exanihematous diseases, such 

 as scarlatina, rubeola, erysipelas, &c, though from these diseases 

 being supposed to depend more on a specific contagion or an epidem- 

 ic constitution of the air, than on any local causes, I have hesitated 

 to embrace them among our diseases. They are evidently, however, 

 under climatical influences, and therefore modified by situation. This 

 ia also the season of mild intermittents, though these most generally 

 show themselves as relapses. We have also many irregular forms of 

 periodical disease, consisting principally of painful nervous affections 

 of the head and face. As a matter of course, many of our uncured 

 winter diseases run into this season, and are greatly aggravated by 

 the sudden changes of temperature. 



In the month of June' we have more or less of cholera infantum, 

 often the accompaniment of remittent fever. Attacks of diarrhoea in 

 adults, with the same accompaniment are not uncommon ; and as 

 summer advances, especially if the season be dry, the various forms 

 of bilious disease are displayed in greater abundance. At this 

 season also our principal manifestations of cholera have been made. 

 As this disease wears somewhat the appearance of an exotic, not yet 

 having been acclimated, I hesitated to include it among the diseases 

 of Iowa. But I could not with propriety omit all notice of it, and as 

 it may often re -appear, the sooner our Physicians become familiar 

 with its progress the better. In my judgment it depends on a mixed 

 origin, a something from abroad which may be a sine qua non, and 

 a local cause sufficient to develope it. The circumstances which con- 

 stitute this local cause are very well known ; they are heat, moisture 

 and filth, within and without the crowded habitations in which, as a 

 general rule, the disease is most prevalent and most destructive. 

 When really epidemic, the whole population of a city is immersed in 

 this local cause. 



As autvimn advances, the peculiar diseases of this season manifest 

 themselves. These consist of intermitting fevers of every grade, 

 from the mildest to the most malignant form, constituting the conges- 

 tive chill, so much dreaded by doctor and patient. Intermitting fever 

 is especially the disease of new settlements, as well as of our bottom 

 lands; as a general thing it i? mild and manageable, though liable to 

 return unless the patient is removed from the malarious district in 

 which it originates. This is essentially an autumnal disease, although 

 an occasional vernal attack may be looked for among recent settlers. 

 It has been observed repeatedly that those new comers who are bad 

 ly provided with the necessaries and comforts of life are almost sure 



