Over recent decades, the South Branch of the Potomac River, WV, has experienced fish kills and episodes of suppressed health in adult fishes that have spanned small stretches to nearly 120 km of contiguous habitat. Although factors such as endocrine disruption, chemical contaminants, and infectious agents have been detected, no single causal mechanism has been identified. To gain information about the temporal nature of abnormalities, differences in life stage impacts, and potential risk factors, investigations of rank scores of macroscopic indicators of fish health were conducted utilizing seasonal and annual boat electrofishing surveys for Smallmouth Bass Micropterus dolomieu (SMB) and Golden Redhorse Moxostoma erythrurum (GDR). Gill and body abnormalities were assigned rank scores for each fish based on visual severity and were tested for correlation with seasonal climatic (flow and stream temperature) and environmental factors (stream pH, dissolved oxygen, and turbidity). Analyses between juveniles and adults for these species indicated body lesions were more common for adult GDR and gill lesions were more common for adult SMB. Significantly higher rank sums of adult gill abnormalities corresponded with heavy annual mortality of SMB from ages 2-3 (86%), the age at which this species transitions from juvenile to adult length. Higher ranks were frequently assigned to fish of both species for gill and body/fin lesions during summer and fall samples. Low stream discharges and lower pH units correlated with elevations of body raised lesion (GDR) and erosions (GDR and SMB), as well as erosions of gill lamellae (SMB). This study connects the disciplines of fisheries management, fish health, and environmental monitoring, providing information gained through tracking macroscopic conditions of these two indicator species for the focusing of future studies and better understanding risks to fish health.