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Anyone who has worked with parish civil registers has certainly noticed the many cases of "fevers" recorded in death registers. Few, however, have stopped to ask what those fevers actually represented, what caused them, what symptoms they involved, and how — or whether — they were treated. Even fewer have connected these fevers with one of the most widespread diseases of the past: malaria.
At least in the case of Transylvania, the presence of malaria was long overlooked. The hypotheses circulated to explain these "fevers" were often curious and, in light of new sources, far removed from the real issue. Almost no study has failed to repeat the assumptions that linked fevers to the consumption of unripe fruit or to the greater mobility of men, thereby perpetuating a scientific discourse that we hope will soon be replaced by one grounded in medical evidence.
For centuries, people attributed fevers to "bad air" and unhealthy climates (mal aria — the miasma theory), or to the consumption of unripe and unwashed fruit. The discovery of the transmission vector — the female Anopheles mosquito — came late, at the end of the nineteenth century. This delay meant that both prevention and treatment were fundamentally misguided and, ultimately, ineffective.
AI-generated illustration: the Anopheles mosquito and its habitat along the rivers of Transylvania — the Mureș, Someș, and Târnava
An Exotic Disease in a Traditional Environment
For the nineteenth century, reports indicate that Hungary (which included Transylvania at the time) recorded the highest number of malaria cases in Central Europe. Microbiological studies have revealed the presence of Plasmodium parasites in various soil types. A malaria survey from 1904 shows that the Cluj area functioned as an "island" of infection within a relatively "clean" Transylvania.
Map of the spread of malaria in the Kingdom of Hungary (A malaria elterjedése Magyarországon) — the shading indicates frequency from rare cases to epidemic zones; Transylvania appears relatively less affected than the lowland regions
Digestive symptoms, acute fever, and other clinical manifestations may have led to widespread misinterpretation of the disease, especially since the transmission vector was identified relatively late and only a small proportion of those affected ever reached medical facilities. Research conducted in regions such as Catania or parts of Croatia has demonstrated that the lifestyle of factory workers — predominantly men — was responsible for the higher incidence of the disease among the male population.
When Did Malaria Become a Problem?
When a disease was consistently present within a community and regularly affected people's health, it tended to become normalized — an almost routine part of life. This was especially true when a universal remedy, such as quinine, began to be distributed on a large scale. As long as those affected were engaged mainly in household or subsistence activities, the situation did not raise significant concern for the authorities.
However, the situation changed once people became involved in wage labor. Their inability to work led to different approaches to disease and, implicitly, to the emergence of public health policies. Furthermore, the concentration of large numbers of people in confined spaces — such as labor colonies, often known for their unsanitary conditions — created the conditions for the systematic study of diseases and epidemics that had previously gone largely unquestioned.
Fevers were a familiar occurrence: people endured the consequences of infection without fully understanding how or where they had become ill. As long as their incapacity affected no one beyond their own household, there was little impetus for public health intervention.
The Railway Case: Dr. Genersich and the Workers
A telling example is the construction of the Cluj–Războieni railway line between 1871 and 1873. The high concentration of workers led to outbreaks of malaria, typhus, pneumonia, and eventually cholera. By law, each such enterprise was required to appoint an occupational health physician. The doctor assigned to this site was the anatomopathologist Antal Genersich, who would later become one of the pioneers of public health responses to crisis situations.
Dr. Antal Genersich — anatomopathologist and railway physician, pioneer of public health responses to malaria outbreaks among the construction workers of the Cluj–Războieni railway line (1871–1873)
Over the course of two years, more than 6,500 workers suffered from malaria. Although mortality remained relatively low, the losses and delays caused by workers' incapacity were enormous. A total of 9,556 patients (8,050 men, 1,156 women, and 350 children) were treated either on an outpatient basis or in the field hospital over the course of two and a half years. More than half of them suffered from malaria.
The Hollaender report identifies the causes for which the railway workers were more exposed to malaria: stagnant water filling the ditches near railway embankments. Dr. Genersich did not limit himself to treating the consequences of illness but sought to understand its causes and to devise effective solutions.
Extract from a hospital admission register — recording malaria patients treated in connection with the Cluj–Războieni railway construction (1872–1873)
Malaria in the Carolina Hospital around 1900
Hospital data reveal over 3,300 patients admitted with malaria in just three decades. Most were men, typically between 16 and 30 years old. Admissions peaked in late summer and early autumn, reflecting the ecological and social conditions of transmission.
The analysis below was made on patients hospitalized with malaria at the Carolina Hospital in Cluj in 1872, 1877, 1882, and 1897, totalizing 467 patients. Yet only the more complicated cases reached hospitalization; most were treated as outpatients, and many never sought medical help.
Evolution of malaria cases in Cluj, 1873–1904, and key hospital statistics: 3,300 patients treated at the Carolina Hospital; blood tests confirmed all three types of Plasmodium (vivax, malariae, praecox)
Sample analysis of 467 malaria patients hospitalized in 1872, 1877, 1882, and 1897 — distribution by gender, age, and recorded characteristics
Over three-quarters of the patients were men (362 male and 105 female patients). This is explained partly by men's greater involvement in the labor market and outdoor work. Most of those who ended up in hospital were engaged in some form of paid work — including children aged 12, 13, and 14, who are recorded as servants.
The typical malaria patient was a young man in his twenties, often unmarried and only beginning his adult life. Day laborers and service personnel were mostly classified as poor, with no means of payment, while railway workers had a certain degree of social protection through their employer. Malaria thus reflected both vulnerability and emerging forms of institutional support.
Control and Eradication Measures
After the role of the mosquito in transmitting malaria was discovered, efforts to control its spread followed two main directions. Authorities focused on draining and sanitizing wetlands and marshy areas, considered high-risk environments. Simultaneously, public campaigns were launched to educate people on how to protect themselves from mosquitoes.
Health officials were sent to both villages and towns to inform the population about preventive measures: protecting doors, windows, and other openings with wire mesh to keep mosquitoes out. Leaflets were distributed illustrating the chain of infection and explaining the necessary precautions. Even postcards addressing this topic were printed and circulated. In cases where infection did occur, the standard remedy remained quinine.
Feriți-vă de Tântarii dătători de friguri — public health poster issued by the Direcțiunea Generală a Serviciului Sanitar, educating the population about the Anopheles mosquito and preventive measures
Children's anti-malaria postcard: Copii, voiți anul acesta să nu vă mai înbolnăviți de Friguri? — issued by the Direcțiunea Generală a Serviciului Sanitar, illustrated by R. Lișteava
During the interwar period, in the context of international efforts coordinated in part by organizations that would later evolve into the United Nations, Romania also intensified its interventions against malaria, including the use of DDT.
Map of malaria incidence in Romania, 1938 — Transylvania shows 0–24 new cases per 100,000 inhabitants, almost negligible compared to regions such as Tulcea (approximately 4,000 cases per 100,000 inhabitants)
References
Hollaender Hugo, A malaria elterjedése Magyarországon. Budapest, 1904.
Trhd.ro — database in progress (medical staff, patients, deaths recorded in hospital).
Bistrița-Năsăud County Archives, Serviciul Sanitar 1783/1925.
Original hospital records, Carolina Hospital (Karolina Kórház), Cluj, 1872–1904.
Parish civil registers, Historical Population Database of Transylvania (HPDT).