Watch out! Major spoilers ahead.
“My objective was, through my example, to save from death the multitude of my subjects who, not knowing the value of this technique, and frightened of it, were left in danger.”
Hulu’s The Great is a bawdy, funny, visually stunning show billed as an occasionally true account of Catherine the Great’s life. It follows the arc of her coup and subsequent rule after she usurped her husband Peter to become Empress of Russia. With the help of a few comrades, this little-known Prussian princess became a household name and ushered in the Golden Age of Russia. Her tenure as empress saw the building of educational institutions, a new legal code, the extension of Russian borders, and much more.
Being a visionary, Catherine was open to trying new things. This manifests in all sorts of ways in The Great, from the empress bringing paintings to court, to convincing her husband to hold ‘science parties.’ In the episode “A Pox On Hope,” things take a darker turn when mild-mannered servant Vlad contracts smallpox. Catherine discovers that the nobility’s answer to the disease is to burn the serfs and the poor to contain the spread.
There Has to Be a Better Way
Unwilling to murder her servant, Catherine looks for another way. She summons a doctor, Chekhov, who’s quick to suggest immolation. As she searches for answers, her confidant Orlo mentions variolation. The technique, which involved deliberate smallpox infection, was a controversial and risky procedure. The idea was that a doctor would gather the fluid that oozed from a sick person’s pustules. They’d then inject it into a healthy person, giving them a weaker version of the disease. When they inevitably recovered, they’d be immune. You can see how the idea might seem wacky or terrifying to people.
When Catherine receives pushback from the doctor, archbishop, and Peter, she takes matters into her own hands. She gives a grand speech in front of the entire court with a vial in hand. It contains a very unappetizing-looking substance, which she uses to give herself a DIY variolation with a knife she brought. The speech falls flat, people are horrified, and Peter bans the practice.
Did That Happen?
Yes! This is one of the details The Great took from history.
Before the advent of modern medicine, smallpox was a devastating disease. It killed about three out of every ten people who contracted it. It also left survivors gruesomely scarred. Variolation had been practiced for quite some time in Asia, Africa, and the Middle East, but 18th-century Europe was resistant to jump on the bandwagon. This was despite huge outbreaks that killed hundreds of thousands of people, including a few reigning monarchs.
Variolation didn’t start gaining steam in the West until an Italian physician working in Constantinople named Dr. Emmanuel Timoni detailed the procedure and its promise in a letter. The letter was published in 1714 and happened to catch the eye of Lady Mary Wortley Montagu, wife of the British ambassador to the Ottoman Empire. Excited by the prospects, Lady Mary had her two young children undergo the risky process.
She had her five-year-old son inoculated in 1718 and her four-year-old daughter in 1721. Both were successful. The doctor who supervised the former procedure decided to take things further and test variolation on six prisoners from Newgate Prison, London. Officials promised the inmates freedom if they survived, and survive they did. After that, word of variolation spread throughout England thanks to the royal family.
The Great Inoculation
Still, things hadn’t quite caught on in Russia yet. Catherine the Great witnessed the suffering of smallpox firsthand and saw it ravage her subjects. She was intent on bringing variolation home, and so invited Dr. Thomas Dimsdale from Scotland to St. Petersburg. The intention was to have him inoculate Catherine, her son and heir Paul, and 140 members of the court. She wanted to make a show out of the procedure to convince people it was safe.
Dimsdale arrived in 1768. Initially, he was unsure whether smallpox in Russia acted the same way it did in Western Europe. He felt it would be better to try things out on a few commoners to be on the safe side. Catherine refused, adamant that she should be the first in order to maintain the procedure’s credibility. Knowing the dangers Dimsdale faced if she died, the Empress had relays of fast horses waiting to whisk him away to safety.
Things went swimmingly, with Catherine developing a mild case of smallpox that lasted two weeks before recovering. She rewarded Dimsdale with £10,000, a pension of £500 per annum, £2000 for expenses, and a Barony of the Russian Empire for his efforts. Then she set her sights on the rest of the Empire.
Dimsdale returned in 1781 and by that time some 20,000 Russians had been inoculated. Once 1800 rolled around, the number grew to two million. Catherine’s willingness to try a risky procedure and set a convincing example paid off. Her subjects and peers celebrated her efforts and recognized her as a savior to the people. Huzzah!