The Empress and the English Doctor

How Catherine the Great defied a deadly virus

Lucy Ward

• Publisher: Oneworld Publications
• Year: 2022
• ISBN:
  9780861542468
• Topic: Historia
• Subtopic: Historia moderna temprana

A TIMES BEST BOOK OF 2022 SO FAR Shortlisted for the Pushkin House Book Prize 2022 'Sparkling history…with a fairytale atmosphere of sleigh rides, royal palaces and heroic risk-taking' The Times A killer virus…an all-powerful Empress…an encounter cloaked in secrecy…the astonishing true story. Within living memory, smallpox was a dreaded disease. Over human history it has killed untold millions. Back in the eighteenth century, as epidemics swept Europe, the first rumours emerged of an effective treatment: a mysterious method called inoculation.But a key problem remained: convincing people to accept the preventative remedy, the forerunner of vaccination. Arguments raged over risks and benefits, and public resistance ran high. As smallpox ravaged her empire and threatened her court, Catherine the Great took the momentous decision to summon the Quaker physician Thomas Dimsdale to St Petersburg to carry out a secret mission that would transform both their lives. Lucy Ward expertly unveils the extraordinary story of Enlightenment ideals, female leadership and the fight to promote science over superstition. 'A rich and wonderfully urgent work of history' Tristram Hunt

1

The Doctor

‘A gentleman of great skill in his profession, and of the most extensive humanity and benevolence.’

Little Berkhamsted Parish Register, 1768

The birth of Thomas Dimsdale was recorded in the form of a neat, handwritten certificate. The new baby came into the world on 29 May 1712, the sixth child and fourth son of John and Susannah Dimsdale of the parish of Theydon Garnon in the county of Essex, England. The document was signed by seven witnesses.

A second scrap of paper also listed on one side the birth dates of Thomas and some of his siblings. On the other was something unexpected: a medical recipe. To cure kidney stones, it instructed, mix saffron, turmeric, pepper and elder bark into three pints of white wine, and take the mixture first thing in the morning and last thing at night. ‘It is proper’, the note concluded, ‘to take a vomit first.’¹

The scribbled remedy was one of many in the Dimsdale household. Thomas’s father, John, was a doctor, as his own father, Robert, had been before him. A generation further back, at the time of the English Civil War, Thomas’s great-grandfather – an active supporter of the Parliamentarian cause – had combined running an inn in the Hertfordshire village of Hoddesdon with a trade as a barber-surgeon.² John Dimsdale had established himself in practice at Epping, a small market town lying among pastures and scattered hamlets in the countryside some seventeen miles north-east of London, just at the tip of the long strip of ancient forest that still bears its name. There, as well as treating those who could afford to pay for his services, he worked on behalf of the Overseers for the Poor of Theydon Garnon, providing basic healthcare for the many impoverished households whose only safety net was parish welfare.

The home-made birth certificate offered another clue to the Dimsdales’ heritage. The family were Quakers: members of the dissenting Puritan sect that had emerged from the Civil War the century before. Refusing to recognise the authority of the Church of England and its ‘hireling priesthood’, members of the Religious Society of Friends, as the Quakers were formally known, rejected parish registers and kept their own independent records of births, marriages and deaths. God was within every individual, the sect believed, and its worshippers trembled at his word.

By the time of Thomas’s birth, Quakerism was officially tolerated in England, but the experience of persecution was fresh in the family’s memory. Grandfather Robert Dimsdale, born across the county border in Hertfordshire, had been a convert in the revolutionary early years of the movement when, following the restoration of the monarchy in England, Quakers faced violent protests, confiscation of property and prosecution for their refusal to swear an oath of allegiance to the Crown or to pay tithes. For all their philosophy of peace, the Friends were judged a threat to the social order. Robert was thrown briefly into Hertford gaol in 1661 for failing to attend church, only to be imprisoned again almost immediately for nine more years for ‘practising physic without a licence’. His work as a doctor, albeit unqualified, had apparently been successful enough to have threatened his conformist rivals.

Enough was enough. Weary of oppression at home, Robert joined thousands of fellow dissenters in search of true religious freedom and ‘a peaceable life’ in the New World, where the Irish Quaker William Penn and fellow Friends had acquired no fewer than three American colonies. Pausing only to snap up five thousand Pennsylvania acres as a ‘first purchaser’ in 1682, the year Penn’s fleet made its stormy crossing to the new colony, the doctor emigrated with his wife Mary and young family to settle on another parcel of land he had bought earlier in Burlington County, West Jersey.

Lying on the opposite bank of the Delaware river from Pennsylvania, West Jersey was already an established colony flourishing under Quaker principles of tolerance, simplicity and religious and political freedom combined with industriousness, honesty and enterprise. The European settlers found a sparsely populated land rich with plant and animal life and agricultural promise. While they did not doubt their right to colonise, they signed treaties with the Lenni-Lenape Indians of the area, developing peaceful relationships that contrasted starkly with conflicts in other settlements.

Though Robert, perhaps missing the familiar meadows and woodlands of south-east England, would return there with his family in 1689, his temporary emigration and investments brought him increased wealth, public status as a member of both the legislature and county court of Burlington, West Jersey, and the experience of living in a community founded on the tenets of his faith. Described by Penn himself as ‘a solid and good man, ingenous [sic] & sufficient’, he would hand on those principles to his sons and, in turn, their children, as well as the family profession: medicine.

Thomas, the baby whose birth date was jotted on the back of a medical recipe, was the child of John Dimsdale, Robert’s eldest son. The family lived on the edge of Epping in a substantial Tudor house called Kendalls, one of the properties bought by Robert on his return from the colonies and handed on to John, who also inherited his father’s medical practice. A cluster of smaller dwellings and outbuildings belonging to the house were occupied by tradesmen, while a meadow attached to the property provided a haven from its noise and bustle and a place for children to play.³

Just a stone’s throw from Kendalls to the north lay the town’s newly built Quaker Meeting House, a thatched, red-brick building attended by the Dimsdales for the modest and mainly silent worship distinctive of their faith. John Dimsdale, in keeping with the tradition of the Friends, had married a fellow Quaker, Susannah Bowyer, who added family money and connections to her husband’s profitable profession. ‘Marrying out’ – choosing a spouse of another faith – was strongly discouraged by the sect, and considerable efforts were made to bring those who strayed back into the fold, as the young Thomas Dimsdale would later discover.

For now, though, Thomas and his seven siblings were brought up in a comfortable household imbued with Quaker values. Principles of truth, equality, non-violence and justice were not simply abstract goals but a code to live by, both individually and in the world. Later in the eighteenth century, Quakers would become leading voices in the movement for the abolition of the British slave trade, social reform, pacifism and public health – all causes Thomas Dimsdale would personally espouse. Susannah Dimsdale, writing in 1751 in her will to Thomas and his only surviving sibling Joseph, was still urging her adult sons to enact their faith, and to educate their own children within it. ‘I desire you both to live in true love and affection one towards another, and to live in the practice of what you know to be right in your own hearts and to shun all manner of evil, so that you may be good examples to your children.’ The imprint of Quaker family life shaped Thomas Dimsdale, and his loyalty and affection for the faith never left him, despite differences to come. Likewise, his network of Quaker friends and acquaintances would play crucial roles in his career, including in the invitation to Russia that would change his life forever.

Thomas’s upbringing gave him a second defining force in his life, besides his faith: the practice of medicine. ‘I lived with my father and attended his practice in physick, which was very great and extensive,’ he wrote later.⁴ John Dimsdale was a surgeon, barred as a Quaker from attending the medical schools at the two English universities of Oxford and Cambridge, who had honed his skills at his own father’s side in West Jersey and Essex. He was paid by the parish to treat its residents under the Elizabethan Poor Law, the English system of locally organised poor relief based around the church and funded by local property taxes and tithes. By law, all parishes had to support ‘the lame, the impotent, the old, the blind’ and others unable to work, supplying those in need with basic necessities such as food, clothing and fuel and providing medical care. There was no centralised national healthcare or welfare system. In Epping, some individual villagers – among them ‘Old Queen’ and ‘Beggar Betty’ – received repeated cash payments, while other inhabitants were given provision in kind: waistcoats, stockings, faggots and re-soled shoes.⁵

The resources and generosity of parishes in distributing poor relief varied widely around the country, but records of payments to John Dimsdale (and later to Robert, Thomas’s older brother) by the Overseers of Theydon Garnon show substantial contributions for medical assistance. Regular sums were paid, often for unspecified services, ranging from £5 to over £18 right up to John’s death in 1730, when a special catch-up payment for any outstanding debts for care of the poor was authorised by the parish. In all, the doctor received over five percent of the Overseers’ total annual expenditure – a proportion that prompted occasional grumbling from wealthy ratepayers and disapproving calls for pre-treatment authorisation.

Of all the demands on English parish coffers, one in particular stands out. An entry in the Theydon Garnon record for 1724 reads: ‘From April 3rd paid for Mary Godfrey when she had the Smallpox £3/3/0. Paid Mr Dimsdale for Mary Godfrey £1/7/-.’⁶ The brief lines shine a light not only on Mary’s case, but on a disease so prevalent and severe it absorbed between one fifth and one tenth of all parish poor relief funds.⁷ Smallpox patients were particularly expensive to treat, requiring attentive care for several weeks and potentially subsequent treatment for long-lasting disabilities. The poor, unable to work when sick or caring for family members, were left facing severe financial hardship, and the cost of burials placed an even greater strain on parish coffers.

The unrecorded voices of the poor themselves are gone, but glimpses of their suffering remain. In the Essex village of Little Horkesley, a letter records the experience of the family of George Patterson, whose wife and five children contracted the disease.

The son about 13 years of age who fell down on Thursday is full of purple spots, so that He is not likely to live many days at all appearance . . . The wife is now likely to fall down, having the usual symptoms . . . they begin to be craving for victuals . . . there must be provision made of that kind, they have no firing nor any thing necessary but what is bought by the penny from hand to mouth . . . If the son dye there will be charges to bury him.⁸

Thomas Dimsdale, accompanying his father on his rounds, could not have avoided witnessing the brutal impact of smallpox, both on individual victims and on his community as a whole. A carriage ride away in London, where he would shortly move to train as a surgeon at St Thomas’s Hospital, the disease was endemic, accounting in 1725 for one in every eight deaths.⁹ In rural areas like his own home county, its presence ebbed and flowed, but the threat of devastating epidemics was always present. And for now, there appeared to be no way to fight back.

The variola virus, the brick-shaped microscopic agent that caused smallpox, was still unknown to the Dimsdales and their medical world, but the symptoms of the disease were all too familiar. After infecting the body through the mouth or nose, the virus would incubate silently for around twelve days, gradually spreading into the patient’s bloodstream. Only then, as sufferers became highly infectious, did the first outward signs of illness appear: a fever, headache and sickness were followed by the emergence of a rash on the face and then body. This developed into hundreds of pustules which oozed, giving off a stomach-turning smell, sticking agonisingly to bedclothes and preventing eating or drinking if they blocked the throat. In the worst cases, known as ‘confluent’ smallpox, thousands of spots merged together in a purple mass, usually proving fatal.

Around a week after the onset of fever, if patients avoided blood poisoning and organ collapse, the pocks dried and scabbed over. Finally, after a month-long ordeal, most survivors were left with pronounced, pitted scars, often accompanied by blindness or irreversible joint damage. Josiah Wedgwood, of the renowned English pottery family, survived smallpox aged eleven in 1742 but suffered an infected and weakened right knee joint that prevented him operating the traditional potter’s wheel and ultimately led to amputation.¹⁰

To try to understand smallpox, early eighteenth-century doctors relied on a medical doctrine based on the classical concept of humours. Defined by Galen, the most influential physician of the Roman Empire who had drawn in turn on Ancient Greek Hippocratic tradition, the theory identified four vital humours: blood, phlegm, black bile and yellow bile, which had to be kept in balance to maintain health. An imbalance in these swirling bodily fluids caused disease, with symptoms such as diarrhoea, sweati...