“You are now called, Sir, to the most important employment that perhaps any gentleman was ever intrusted with. To your skill and integrity will probably be submitted no less than the precious lives of two of the greatest personages in the world.” Thomas Dimsdale was about to discover the truth about his secret mission to Russia. Dimsdale, a doctor from the English country town of Hertford, was renowned for his success as an inoculator and had been persuaded to make the gruelling journey to St Petersburg to introduce inoculation to the Russians. As Russia’s foreign minister now revealed, Dimsdale’s first patients would be none other than Catherine the Great, Empress of All the Russias, and her son, the Grand Duke Paul.
DR DIMSDALE didn’t want to go to Russia. He was no longer young and ambitious, and had no need to go seeking fame and fortune: he had already made a name as one of England’s most successful smallpox inoculators and had all the money he needed. So when Catherine the Great, empress of Russia, sent for him in July 1768, Dimsdale made his excuses.
Catherine was not so easily refused. Although she too was no longer young, her ambition showed no sign of abating. In 1762 she had seized her husband’s throne, colluded in his assassination and instigated wide-ranging reforms that would establish Russia as a great European power. One of her many ambitions was to modernise medicine, then practically non-existent in Russia. Catherine was convinced that one of the best things she could do to improve the health and wealth of the nation was to protect her subjects from smallpox. In her view that meant inoculation.
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Other countries had been inoculating against smallpox for decades. The technique was simple: make small incisions in the skin and insert fluid extracted from smallpox pustules into the wounds. As long as the fluid came from people with mild cases of the disease, the virus should be weak enough to trigger only a harmless bout of fever and a few pustules while protecting against future attack. In Russia, however, the idea was still considered dangerous and devilish, and Catherine decided to set an example. She would be inoculated first, followed by her teenage son, the Grand Duke Paul.
Catherine wasn’t motivated entirely by concern for her subjects. During the 18th century, smallpox was responsible for one in 10 deaths in Europe, and in 1767 an epidemic in Siberia had killed 20,000 Russians. Catherine was keenly aware that wealth and rank were no protection. In 1730, the 14-year-old Emperor Peter II had died from smallpox, and shortly after her own coronation one of her court ladies had died on the eve of her marriage to Russia’s foreign minister.
“In 1730, the 14-year-old Emperor Peter II died from smallpox”
Catherine turned to England for a doctor. Inoculation had been practised there since the 1720s with impressive success. Smallpox was fatal in around 30 per cent of cases and survivors were often left blind or crippled. Inoculation could prove fatal, but only in around 1 per cent of cases. Dimsdale was highly experienced and was said never to have lost a patient. His reputation had even reached Russia, where Baron Cherkassov, head of Russia’s new Medical Chancellery, had read Dimsdale’s recently published book The Present Methods of Inoculation for the Smallpox. “If his practice was as successful as his theory was plausible,” concluded Cherkassov, “he must be a very able physician.” An envoy was dispatched to London to hire Dimsdale.
The doctor at first turned him down. The Russians tried again, this time offering ÂŁ1000 in expenses to ease the awfulness of the journey. On 28 July 1768, Dimsdale and his son and assistant Nathaniel set off. A month later they were in St Petersburg, standing before Count Nikolai Panin, foreign minister, guardian to the Grand Duke Paul, and the man whose bride-to-be had died so tragically. Only then did Panin tell Dimsdale the real reason he had been brought to Russia: to inoculate the empress and then her son.
Some men might have been terrified by the prospect. What if it all went horribly wrong? There were whispers that the doctor had arranged that on the appointed day a coach and horses would be waiting should he need to make a fast getaway. Dimsdale’s own account suggests that if he wasn’t nervous he was at least more cautious than usual. To reassure the empress and those critics who argued that what worked in England might not work so well in Russia, he offered to test his technique under local conditions on some less illustrious bodies. For herself, Catherine thought it unnecessary. “If the practice had been novel or the least doubt of the general success had remained, that precaution might be necessary,” she said. Her son, though, was young and not as robust as she, and a few tests might be sensible.
Dimsdale set up a small hospital and acquired two “volunteers”, 14-year-old cadets from a regiment of guards. He might have wished he hadn’t. Immediately after inoculation, one cadet was “seized with great sickness and vomitings, attended with other symptoms of fever”. Dimsdale was furious. Everyone would blame the inoculation, but in his view the boy had brought the sickness on himself by stuffing himself with dried fruits. Catherine offered to undo the damage: “You shall perform the operation on me and my example will tend to re-establish the reputation of the practice.”
For his own peace of mind Dimsdale inoculated four more youths. To his immense annoyance, not one developed any pustules. How would he explain this second disaster? Obviously, he said, they had all had the disease before but had forgotten or perhaps never known what had made them ill. To add to his woes, when he tried to collect poxy matter from a child, he discovered why people were so fearful of inoculation. “The mother threw herself on her knees… and made a plaintive cry,” reported Dimsdale. Why the anguish? In Russia, he was told, “people believed that although inoculation may be salutary to the inoculated, yet it produces certain death to the person from whom the matter is taken”. To this child’s parents, he was no better than a murderer. Persuading Russians to embrace inoculation was going to be hard.
None of this deterred Catherine, who insisted on being inoculated as soon as possible. The date was set for Sunday 12 October. For several days before, the empress followed Dimsdale’s instructions, eating only bland food, taking vigorous exercise, and on the eve of the operation taking a mercurial powder as a purgative. On Sunday evening, the Dimsdales collected a small boy with suitably ripe pustules and rushed to the palace, carrying the sleeping child up a back stairway to the royal apartments.
Dimsdale dipped his lancet into the fluid from the child’s pustules. He then made a small incision on the inside of each of Catherine’s arms, gently wiping the matter from the blade into the wounds. Once the operation was over, the empress retired to her summer palace to recuperate. By Tuesday, she showed signs of infection and a week later had a small scattering of pustules. By 28 October, Catherine had recovered and returned to court.
Catherine had wanted to provide the poxy material for her son’s inoculation: that would dispel forever the myth that donating pox caused certain death. Unfortunately, Paul caught chickenpox and his inoculation had to wait. Several aristocrats were inoculated with fluid from Catherine’s pustules instead – and the empress did not die.
The Grand Duke’s inoculation in the first week of November was also a success. “The boy had got small pox in a very favourable and satisfactory manner, four pustules in the face and I suppose about 20 more in all,” reported Dimsdale.
The once reluctant doctor now reaped his reward. Catherine made him a baron, paid him £10,000 plus an extra £500 a year for life. Her decision to set an example also paid off. Opposition vanished almost overnight, and Russia’s aristocrats lined up for inoculation. Within weeks Dimsdale had inoculated 140. As he wrote to a friend in Hertford, one noble Russian was so grateful that he gave him a purse of gold roubles so heavy Dimsdale “went limping out of the house”.
Before he left Russia, Dimsdale advised Catherine on the organisation of a national programme of inoculation. She set up a hospital for the poor, offering a reward to those who were inoculated. Landowners across Russia followed suit and opened clinics in the provinces. The fatality rate from inoculation was lower even than in England.
“Business can last but a little while,” Dimsdale told his friend in Hertford. “For they are inoculating in every quarter in my way and with good success.” Already assured of a place in Russian history, that was unlikely to bother him much. He returned home even more famous than when he left and so wealthy that he gave up doctoring and started a bank.
