In this respect there is a marked difference between an epidemic and an endemic affection; for when an epidemic disease attacks a city or town we do not discover that the central parts are more exempt than others; indeed, it is rather the contrary; for the most crowded parts of towns and cities are those, if not exactly in the centre, which would be comprised in a space nearer to the centre than the circumference; and it has been in those parts generally where the epidemic influences seem to have exercised the most potent sway. One would more naturally suppose, that a city surrounded by
paludal miasm, and not itself being capable of generating the poison, should be more affected at the circumference, from the simple fact that the paludal germs, which rise in the air, are suspended in the fogs and dews of the atmosphere. These, unless widely dispersed by the winds, would remain within a comparatively confined space; and those situations nearest to them would be most subject to their influence. Besides, it has been shewn, that a small wood or hill, or even a wall, has been sufficient to cut off or obstruct the paludal miasm.
Without enumerating all the known endemic diseases, two or three may be alluded to for our present purpose; viz. that of shewing that endemic and epidemic diseases have a similar origin.[[39]]
It is well known that under certain favouring conditions an endemic may become a malignant and pestilential disease; that Yellow Fever, which is always endemic in the west, Cholera in the east, and the Plague in the south of Europe and north of Africa, every few years takes on an epidemic form, and desolates considerable tracts of country.[[39]]
The Pestilence which raged in the summer and autumn of 1804 in Spain, commenced at Malaga, and remained for a considerable time confined to its
boundaries, in consequence of the measures of precaution that were used, in preventing all communication between the inhabitants of the infected city and those living in the surrounding country. It was only in consequence of persons escaping through the cordon, and passing into the interior of the country, that the disease spread, and extended its ravages to distant places.
It appears to be quite clear, that this disease may properly be considered in the first instance of endemic origin; but the tendencies, atmospheric and otherwise, were such as to favour its multiplication in other districts than that in which it first came into active existence. From this we may infer, that the seeds of the disease were dormant, and only became roused into vital activity by fortuitous circumstances. Dr. Rush states, that the endemic disorders of Pennsylvania were converted, by clearing the soil, to bilious and malignant remittents, and to destructive epidemics. Dr. Copland says, it has been observed, especially in warm climates, and in hot seasons in temperate countries, that when the air has been long undisturbed by high winds and thunder-storms, and at the same time hot and moist, endemic diseases have assumed a very severe and even epidemic character.
Dr. Robertson also confirms this view. "Endemic diseases, in cases of neglect and preposterous management, are found to become more malignant even in the most temperate climates; and to
generate a matter in their course, capable of producing a particular disease in any circumstances. Indeed the origin of every contagious fever unattended with eruptions, with the exception of Plague, must commence in this way." Why Dr. Robertson should except eruptive Fevers and Plague I cannot understand, for they must have had a commencement; and their many points of similarity indicate, if not an identical, an analogous source to other endemic fevers.
It will doubtless be generally acknowledged that endemic and epidemic diseases depend upon some unknown agents, having their source in malarious districts, and being capable of assuming either a contagious or non-contagious character, according to circumstances.