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The Great and The Small: Women, Politics and Medicine

An interview with Lucy Ward

“This whole book is about a woman using her body — in a personal sense, as a mother protecting her son, but also as a political tool… to promote an extraordinary scientific procedure.”

With Women’s History Month and International Women’s Day both falling in March, the recent publication of The Empress and the English Doctor: How Catherine the Great defied a deadly virus is very well-timed.

The author, Lucy Ward, is a former journalist for The Independent and The Guardian. She also campaigned for greater female representation during her time as a Westminster Lobby correspondent. With such a passion for women’s empowerment and a fascinating herstory to tell, Lucy was an ideal ‘Author Spotlight’ guest.

A woman smiling and holding a book, stood in front of some trees and flowers

Could you offer an outline of the story behind The Empress and the English Doctor?

It’s the story of how Catherine the Great, the Empress of Russia, summoned Thomas Dimsdale, a Quaker doctor from England, to inoculate her against smallpox in 1768. Inoculation was the precursor of vaccination; doctors would give someone a tiny amount of a particular disease to develop immunity against it. At this time, smallpox was sweeping across Russia and the rest of Europe. It was an incredibly dangerous disease; 1 in 5 people who caught it died, and almost everybody did get it at some point in their lives. Catherine the Great was terrified; there was an epidemic of smallpox at her court and she was concerned that she or her son would catch it.

So, the book is about the meeting between a country doctor, who had developed a way of safely inoculating against smallpox, and an Empress in a glittering court in St Petersburg. It’s about the doctor’s journey to get there, his time with the Empress and the incredible bond of trust they developed — both risking their lives in this situation. I also tell the story of the development of inoculation, an extraordinary technology that came before Edward Jenner and his research into vaccination.

The virus and vaccination aspects of your book are very topical. To what extent do you think readers could interpret Catherine the Great’s story as a reflection of current events?

I think there’s enormous resonance with current events. I actually got the contract to write this book as lockdown began in the UK. Although COVID-19 is a serious disease, it’s not as extreme as smallpox. But I think there’s still a sense of understanding and comparison with how people felt, in terms of fear and containment. When smallpox struck communities in Britain and elsewhere in Europe, people had to close markets and schools; they retreated to avoid it. All these concerned voices came ringing down the centuries to me; I found stories about how people were too afraid to go to areas that spread disease, like London.

Obviously, there’s also a close connection between inoculation and vaccine development. My book explores the reactions people had to inoculation. Some people — particularly doctors in Britain — were very enthusiastic about it; once they compared the likelihood of death from natural smallpox versus inoculation, they realised it worked. The elites bought into it, but among other members of society — especially the poor — there was genuine concern. They didn’t trust it, didn’t understand how it worked and didn’t know people who had actually had it done, so it took a long time for that technology to be embedded.

The other connection I found is pandemic leadership — how those who govern us handle extreme situations in which people are afraid and economies are threatened. And, concerning inoculation and vaccination in particular, how leaders convince people to take a small risk to avoid greater risk. One of the most interesting things about Catherine the Great is that she inoculated herself to protect her own life and her son’s, as part of a wider campaign to promote inoculation across her empire. She knew that Russians would be very wary of this technology because they had specific superstitions about it. They believed that, if someone with smallpox had pus taken to inoculate someone else against it, the person donating the pus would die. Catherine knew that wasn’t true, so she wanted to use her own infected matter to inoculate her son; she was really anxious to address that superstition head-on.

So, she had herself inoculated and immediately made it public. She had parties, set off fireworks, had a big orthodox mass, and commissioned a ballet and poetry — all to amplify this event and set an example. That was her leadership style; she understood that, with something as potentially scary and strange as inoculation, you need to prove that you’ve done it and survived so others can do it too. It’s a clever political strategy and we’re seeing parallels today — how many politicians have been photographed with their shirtsleeves rolled up? The single most powerful thing you can do to persuade people is say, ‘You can trust me because I have gone through this process myself’.

I’m particularly interested in the conflict between scientific understanding and public superstition or misinformation. It does seem like we are reliving history and repeating past mistakes. What, if anything, has changed since the 18th century?

When we look back, from the vantage point of 2022, at how people dealt with inoculation as a precursor technology to vaccination, they were reacting in extremely recognisable ways. Catherine was inoculated in 1768, but inoculation actually came to Europe from Turkey in about 1720. People had been practising forms of inoculation in parts of Asia and Africa for hundreds of years, so it’s not a European invention. An extraordinary woman called Lady Mary Montagu witnessed smallpox parties, where women would carry pus around in a walnut shell and dab it on the arm of a child. That child would have a mild case of smallpox and then recover. She was overwhelmed by this, as her brother had died of smallpox. She had her children inoculated, brought the idea back to London and advocated for it. Then doctors became interested and started to introduce it.

Remarkably, this immediately gave rise to anti-inoculation. For example, a doctor called Thomas Nettleton had read about inoculation in the Royal Society’s journal and decided to try it himself, after a wave of smallpox hit his community. So, he used these reports like a manual and his attempts to inoculate people were a success. He reported that he was already experiencing criticism — essentially fake news — from people saying it didn’t work. As a doctor, he knew he could save lives, but patients were being put off and he wasn’t able to help the children he thought he could.

The same thing happened in 1722, when the Princess of Wales had two of her children inoculated. It was a massive advertisement for this technology, yet people were even more strongly opposed to it. Vicars denounced it from the pulpit, claiming it got in the way of God’s intention to try or punish us. People said that it wasn’t right to give somebody a disease to prevent one they may never get — to which doctors argued that almost everyone would get it. So, after this royal experiment, there was criticism from groups referred to as ‘anti-inoculators’; this kind of vocabulary from 300 years ago is something we recognise today, with the anti-vaxxers. That scepticism has never gone away.

People were most willing to be inoculated when they felt most threatened by smallpox, because fear is a big driver in accepting a medical treatment that you don’t fully trust. We’ve seen a similar thing recently, and I suppose that fear is a part of human nature that doesn’t ever change. The important thing to recognise about inoculation and vaccination is that doctors operate in this borderland space between science and psychology; hard facts still have trouble when they run up against human emotion. Even if people recognised that it was safer to get inoculated than to catch smallpox, the psychology of that risk isn’t so simple — we won’t always do the thing that is rationally best for us.

Today, there are a minority of real anti-vaxxers whose superstitions seem older than the 18th century, but there are also many sceptics with trust issues. This is why Catherine the Great wanted to show people that it was safe by inoculating herself and her child.

As a woman, Catherine’s attitude and actions regarding her body were fairly radical for the era. Why is she such an extraordinary character in the smallpox saga?

From the outset, Catherine comes across as extraordinarily self-possessed and is extremely clear about what she wants to do with her body. This whole book is about a woman using her body — in a personal sense, as a mother protecting her son, but also as a political tool: ‘I will take this risk for you, my people, and then you will have faith to do the same’. Catherine compares herself to Christ and acts like a mother to her people, so she’s very conscious of the significance of her actions.

In the book, I draw on the papers of Thomas Dimsdale, which his family kindly gave me. The doctor wrote extensively about meeting Catherine; he was impressed by how much she knew about the technology and how determined she was to go ahead with the operation. Even though he had a good track record, people could still die from inoculation, so she was risking her life. She acknowledged the danger for him by putting a carriage outside the palace and a yacht moored in the Gulf of Finland to spirit him away in case it all went wrong. The whole story is like a thriller, it’s remarkably tense.

Thomas wanted to do some trials on her conscripts first, which didn’t go well. He was really anxious, but she said, ‘Don’t worry, my life is my own’. This is an extraordinarily modern sentiment — she really was determined to take charge of her life and her body, and she’d made this decision herself. She had a sense of self-control but sometimes threw caution to the wind, which is an appealing quality in a famous woman and an extraordinary leader.

The sentiment that ‘my body is my own’ still resonates today, especially in light of the #MeToo movement and the increase in sexual harassment disputes. Have attitudes towards Catherine changed since her own era?

One of the most relatable things about Catherine is that she was constantly fighting contemporary attitudes towards her, as a ruler, that were influenced by the fact that she was a woman. She actively defied expectations of the female body: she was brought to Russia as a German princess to marry the heir to the throne and, although she felt isolated, she found a sense of freedom and physical exertion through horse riding. There’s a sexual undertone to the way she talks about it in her memoirs; she enjoys this physicality, this sense of her body.

But there were also several instances where she was treated by doctors who damaged her body: after a miscarriage, the foetus wasn’t fully removed from her womb and she got an infection; on another occasion, she nearly died from being bled multiple times. She’d had terrible encounters with these unskilled medical professionals, but I think she saw in Thomas a doctor she trusted. Also, by choosing inoculation as a preventative strategy rather than a treatment, she could take control by making her own decisions. She actively chose to do it, which I think is quite powerful. She then decided how to communicate her experience, giving Thomas permission to write and publish a report detailing all of her symptoms; his medical notes even mention how he couldn’t purge her during her period. We really see the physicality of this woman, this flesh and blood person, which is quite remarkable.

With regard to how women in the public eye — and especially women in politics — are treated, we know that the first biographies of Catherine included a lot of details about her sex life. She was portrayed through that lens from the beginning, and it’s the same story if you Google ‘Catherine the Great’ today. It suits people who want to attack a woman in power to use her body against her; they wouldn’t treat a man like that. Later in Catherine’s reign, Russia was a real threat to other European powers — partly because she fought wars that accumulated a lot of territory. There’s a famous satirical cartoon called ‘An Imperial Stride’ that depicts her with one foot in St Petersburg and one in Constantinople; all the male European leaders are looking up her skirts as she steps across the map of Europe, and they’re making lewd comments about her physicality to bring her down.

So, what I hope to do in The Empress and the English Doctor is to demonstrate that the demeaning, sexist portrayals of Catherine throughout history are far less important than how she used her own body to promote an extraordinary scientific procedure.



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Lucy Hoyle

Lucy Hoyle

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