‘Cholera, malaria, typhoid fever – on the Danube Delta’s silent threats’

This fragment is included in chapter 9 of the volume ‘The European Commission of the Danube, 1856-1948. An Experiment in International Administration’, Balkan Studies Library, vol. 27, Brill, 2020.

The volume is available in open access here.

On 30 July 1865, an Ottoman transport steamer arrived from Istanbul in the roadstead of Sulina. Two men on board had died from cholera during the voyage. The crew disembarked at once, and as several people suffered from choleric symptoms the entire crew was isolated. Twelve new cases were recorded, and five people died during the next two days. On 2 August, Dr Jellinek, the Commission’s chief physician, noticed a person sick with cholera among a group of labourers who had come from Galați. Another case, an employee in the service of the deputy governor, was discovered the same day. The epidemics would last for most of August 1865 and purged the entire settlement. Among its 3,000 inhabitants, half fled, but 300 of the 350 people who contracted the disease allegedly died.[1] The town was devastated, and further action needed to be taken to combat the spread of the disease.

As a communication hub along major Black Sea and Danubian routeways, Sulina was often confronted with such terrible, to borrow from Jürgen Osterhammel, ‘mobile perils’.[2] In Russian times, Sulina was chosen to host a quarantine station, but its sanitary regulations were considered ‘burdensome in the extreme’ to international trade and shipping. Article 15 of the 1856 Paris Treaty stated that more balanced quarantine regulations had to be drafted, which should favour, as much as possible, ‘the circulation of ships’.[3]

When cholera struck in 1865, health policies along the Maritime Danube were implemented by a Sanitary Service of the Mouths of the Danube, subordinated to the Istanbul-based Superior Health Council. This international institution was established in 1839 and aimed to regulate shipping in Ottoman ports.[4] At the Danube, it advised the imposition of more rigorous sanitary measures, which hindered both commercial navigation and the movements of river police during epidemic outbursts such as that of 1865.

The Commission was in a difficult position, forced to choose between more sanitary safety and its own survival, as its budget, technical works and institutional success depended on free circulation of ships along the Maritime Danube. The 1865 Public Act regulated quarantine procedures as a compromise between ‘the guarantees of [sanitary] security and the needs of the maritime trade’. It also detailed health procedures and the possibility of instituting additional quarantine establishments in case of new epidemics.[5]

When Romania acquired the Danube Delta in 1878, sanitary regulations had to be updated. According to an agreement concluded in 1881, sanitary norms applicable at the Lower Danube (including sanitary tariffs) were drafted, together with the Commission, by an International Health Council based in Bucharest, which in fact was never established. As further proof of honest cooperation, the Romanian Health Office in Sulina was led by the same physician that directed the Commission’s hospitals, who made sure that health policies were accessible to both Romania and the Commission.[6]

Sulina was exposed to many other sanitary hazards. Situated in a marshland with poor drinking water supplies, infected by miasmas, and tormented by mosquitoes, the town was often the victim of malaria and typhoid fever. Immediately after its establishment, the Commission set up a hospital in Sulina, and another one at Tulcea, although the latter closed in 1860. The first chief physician was a certain Engelhardt, probably a relative of the French commissioner, soon followed by Jellinek, a graduate of the Viennese medical school. That this was a very good position is shown by the number of doctors who sought to replace Jellinek, when he retired in 1870. Nineteen candidates applied for the position, and they were selected based on their ‘technical aptitudes’, ‘moral qualities and character’, and ‘knowledge of foreign languages in use at the Lower Danube’. Five applicants were preselected, and the winner was Frenchman Valentin Vignard, a physician formerly in the service of the Messageries Impériales shipping company. Vignard would live in Sulina for the next seventeen years.[7] Medical journals of the time published several of his scientific contributions, including an article entitled ‘De la nécessité dans l’état moderne de la création d’un Ministère de médecine publique’ (1880). After a brief interlude, a new chief physician, Romanian Petrescu Hagi-Stoica would stay in office for the next three decades, between 1890 and 1921.

Fig. 21. The hospital of Sulina (1930)

Source: The National Archives of Romania, Galați Branch

In its initial stage, the Sulina hospital was hosted in a rented house and exclusively treated the Commission’s staff. In 1860, European commissioners decided to open the hospital to ship-owners and Ottoman employees of the local Harbour Master’s Office. In March 1861, a new regulation established that half of the available beds were to be reserved for the treatment of international seafarers, and the other half for the Commission’s lower staff. All patients admitted into the hospital had to pay a small daily fee, and the establishment was also open to local inhabitants. In 1863, the Commission decided to increase its tariff and use the extra income for opening the hospital to seamen of all nations. A proper building to serve as the naval hospital was completed in 1869, and it included an isolated pavilion for cholera cases. A new regulation was drafted, implementing free treatment for the Commission’s pilots, lower staff and workers. Medical staff included a chief physician, assisted by a physician and two nurses. It functioned in this structure until 1893, when a separate hospital for epidemic diseases was built, in line with developments in medical science.[8]

A good indicator of the efficiency of Sulina’s public services can be seen in its malaria cases. Of the patients admitted into the hospital in 1868–1870, 31.2 per cent suffered from malaria, a proportion that fell to 25.33 per cent for 1871–1880, followed by 14.77 per cent, 7.94 per cent, 4.34 per cent and 3.13 per cent for the next four decades.[9] The Canadian traveller mentioned above referred to this when she visited the ‘little gem of a hospital’ on the Commission’s property: ‘Typhoid and dysentery used to take an annual toll of many lives until the fine new waterworks were installed and the water carefully filtered and oxygenated. Now these diseases are almost unknown. Malaria only gets the newcomers – the Sulinites seem immune.’[10]

But despite her optimistic conclusion, there was something utterly frail and unhealthy at Sulina. The introduction of public services and imposition of modern hygiene regulations improved the inhabitants’ quality of life, but the neighbouring marshland left its imprint on everyone and everything, in human bones and house structures. Everything was damp, and houses were slowly sinking. Stone could hardly be used as a building material, as the dampness would immediately attack it. With ground water lying less than one metre deep, houses were as frail as the health of Sulina’s inhabitants. Underneath Sulina’s modern appearance lay an inconvenient structural weakness.[11]

Table 8

Movement of patients in Sulina’s Central Hospital, 1861–1920

PeriodNumber of hospitalised patientsDays of hospitalisationCategories of patients
MedicalSurgeryTotalSeamenPilots and Commission employeesSulinites

Source: La Commission, 503 (Annexe XXIV)

[1] Jules Girette, La civilisation et le choléra (Paris 1867), 277–278 and Reports from Commissioners, Inspectors, and Others, vol. 40 (London 1875), 53. See also Hartley, A Biography, 207–208.

[2] Jürgen Osterhammel, The Transformation of the World. A Global History of the Nineteenth Century (Princeton 2015), 185. Sulina can be compared with the situation of the Suez Canal, as described by Huber, Channelling Mobilities, 241–271.

[3] Congrès de Paris, 11.

[4] Birsen Bulmus, Plague, Quarantines and Geopolitics in the Ottoman Empire (Edinburgh 2005); Nermin Ersoy, Yuksel Gungor, and Aslihan Akpinar, ‘International Sanitary Conferences from the Ottoman Perspective (1851–1938),’ Hygiea Internationalis 10.1 (2011): 53–79.

[5] London Gazette, No. 23105, 24 April 1866.

[6] La Commission, 353–356.

[7] CADN, CED/B/19 (Correspondence to Commissioner Avril), f. 304–312 (Proceedings of the Executive Committee, 4 August 1870).

[8] La Commission, 334–337.

[9] Ibid., 345.

[10] Pantazzi, Roumania, 125.

[11] F. Brunea-Fox, ‘Farmecul Dunării: Sulina,’ Realitatea ilustrată 83–84 (1934): 16–17.