At the time, Catherine the Great was battling smallpox vaccinations

Baroque portrait of a fashionable ruler.

Enlarge / Portrait of Catherine the Great. Her 1787 letter to Count Piotr Aleksandrovich Rumiantsev – now on auction – called for a national vaccination campaign against smallpox.

During her long reign, Catherine the Great transformed Russia into a center of power in Europe. She was also a leader in public health policy and advocate for a nationwide vaccination campaign against smallpox at a time when many viewed the practice with distrust. A letter from the Empress describing her inoculation strategy is up for auction at MacDougall’s in London. Included in the sale is a portrait of the monarch as “the legislator in the Temple of Justice”, painted by Dmitry Levitsky, who was a favorite at the Russian court in the 1770s and 1780s. The two items are expected to sell for as much as $ 1.6 million.

As we have previously reported, the World Health Organization declared smallpox to be an eradicated disease in 1979, and many people do not remember how devastating smallpox could be. It started with high fever and severe vomiting, followed by skin rash. The victim would then develop wounds, which eventually rubbed over and fell off, leaving scars on the skin. About three out of 10 of those infected died, and the survivors were typically very scarred for life, sometimes even blinded or permanently disabled.

The Chinese inoculated people against smallpox as early as the 16th century. European physicians in the early 18th century relied on variolation (the use of smallpox to induce immunity) to control the spread of smallpox, in which scrapings from smallpox pustules were scratched into a person’s arm or inhaled through the nose. While those who received the treatment continued to develop common smallpox symptoms such as fever and rash, the death rate was significantly lower.

In the late 18th century, a handful of doctors in England and Germany noticed that humans infected with the milder smallpox appeared to be immune to smallpox, and there were a few early vaccination tests in humans. For example, in 1774, a farmer named Benjamin Jesty in Dorset, England, vaccinated his wife and children with smallpox. But it was the English physician Edward Jenner who is credited with bringing the smallpox vaccine into common medical practice after giving a smallpox vaccine against smallpox to the son of his gardener in May 1796.

Catherine the Great’s letter to Count Petr Aleksandrovich Rumiantsev is dated April 20, 1787 and is therefore almost 10 years before Jenner’s medical breakthrough. The monarch had a long-standing fear of smallpox going back to her childhood, and her husband, Grand Duke Piotr Fedorovich, contracted the disease the day before their wedding, leaving him permanently disfigured.

Then, of course, Catherine feared for her son’s health when another outbreak of smallpox struck. She was advised to inoculate her son and heir Pavel Petrovich, but felt it would be “shameful not to start with myself.” This made her remarkably enlightened for the age at which even many Russian doctors opposed the practice. Catherine invited an English physician named Thomas Dimsdale to St. Petersburg, as he had inoculated the entire British royal family and aristocracy against smallpox. She made sure to have a mail van ready for Dimsdale so she could quickly escape if the experiment should go wrong, and Catherine succumbs to the disease and incurs the wrath of her people.

Dimsdale harvested the contents of a smallpox puff from the young son of a sergeant major and used it to inoculate Catherine. She experienced a week of mild discomfort, but announced her full recovery on October 29, 1768. Her son was vaccinated shortly after. “Beginning with me and my son, who is also recovering, there is no noble house where there are no more vaccinated persons,” she wrote in a letter to Count Ivan Grigorievuch Chernyshev, her ambassador to Britain. “Many regret that they had cups naturally and therefore can not be modern.”

Unfortunately, the modernity of being vaccinated against smallpox among the nobility did not seep down to the Russian population as a whole, especially in the outer areas of the empire. It was this that got Catherine’s letter from 1787 to the Count outlining a strategy for a nationwide vaccination campaign. Here is the text of the letter:

Count Piotr Aleksandrovich, among the other tasks of the provincial welfare councils entrusted to you, one of the most important should be the introduction of inoculation against smallpox, which, as we know, causes great harm, especially among the common people. Such inoculation should be commonplace everywhere, and it is now so much more convenient as there are doctors or nurses in almost every district, and it does not require large expenses.

To set an example of this, issue an order at the first opportunity in each provincial town, to count the remaining redundant monastery dwellings or the small monasteries that have been abolished, and build the minimum number of lodgings for the temporary residence of those who are out able to have this inoculation at home; the money needed for this could be borrowed from the city’s revenue. Provincial doctors can rectify this matter, especially since there are now people sent from us who have a low salary in violation of the rules: so when Dr. Gund in Novgorod-Seversky can successfully perform this grafting, so add 300 rubles to his regular salary of the remaining income from the former monastic estates. Incidentally, we remain positive towards you.

The letter is signed “Iekaterina.”

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