Russian Empire: Public Health Through Enlightened Despotism
"Te Deums of praise were sung in churches, an allegorical ballet entitled ‘Prejudice Defeated’ celebrated the victory over folk superstitions, as well as themed theatrical productions and fireworks. […] National holidays were announced for the days of Catherine and [her son] Paul’s variolation—to be celebrated in perpetuity as a continuing reminder of this practice.” (Grant, 2019, p. 162)
Empress Catherine II of Russia
Portrait of Empress Catherine painted by a follower of Johann Baptist von Lampi the Elder in the 1780s .
In 1768, Empress Catherine II of Russia, known to many nowadays as "Catherine the Great", was variolated against smallpox alongside her heir, Grand Duke Paul. This was not a private affair, a medical procedure quietly performed beyond the public's eye. Instead it was a national sensation, a propagandistic act to promote a new technology and remove any fear that lingered around it.
Strong measures against smallpox were not unheard of in the Russian Empire. In 1722, Emperor Peter I (the Great) required all citizens of St. Petersburg, the capital city, to report any case of smallpox to the authorities. In 1741, Empress Elizabeth I forbid anyone who lived with a person suffering from smallpox from visiting the royal court until four weeks after everyone in the household had recovered.
Among the common people, however, practices were more variable. Vladislav Osipovich Gubert reports in an 1896 book that some peasants in the Empire prepared a sort of smallpox potion: "powdered smallpox scabs were mixed with honey, and placed in a new and previously unused container, left to ferment for thirteen days then the sweet liquid was drunk by children to produce a mild case of smallpox" (Grant, p. 142). Methods like this could serve as a valuable alternative to professional variolation, but other techniques were pure superstition. Siberians killed dogs amidst outbreaks so that evil spirits would not be attracted to their barking; elsewhere peasants marked their skin with small burns to trick demons into thinking they were already infected.
It was these unscientific practices that Catherine hoped to discourage through her public variolation. She particularly wanted to bury the idea that using smallpox samples for variolation caused the sample donor to die. Catherine was fond of the intellectual movement known as the Enlightenment, which promoted reason and challenged long-established traditions and superstitions. Notably, Catherine regularly communicated with the leading French philosopher Voltaire, himself an ardent proponent for variolation. Of course, she was also very aware of the danger that smallpox posed to herself and her dynasty. In 1767, the Austrian Empress Maria Theresa was disfigured by smallpox and lost her daughter Maria Josepha to the disease, the third of her children to die from smallpox. A successful variolation would protect both her family and her realm from needless death and disarray.
Catherine employed her immense authority as Empress to promote variolation. She produced propagandistic arts to promote modern medicine, decorated her inoculum donor and physician with aristocratic titles, and supported medical innovations that made variolation easy enough for lay people to perform. Through the Empress's treasury, variolation clinics were established in major cities. Even in far off Siberia, military physicians brought variolation to citizens and tribal leaders compelled their members to receive the treatment.
Although the ultimate success of variolation in the Russian Empire was due to the efforts of several individuals-- from the early variolation adopted by Count Orlov to the serfs who learned to perform the procedure for their communities-- Catherine the Great's autocratic authority and leadership was central to the campaign and demonstrates the influence state power can have in supporting public health.