Latest / Culture Positive: An Infection Prevention Podcast / The Royal Jab
Transcript
- Ally: Welcome to Culture Positive, an infection prevention podcast where healthcare, public health, and real life meet. I'm Allie, and by day I work in infection prevention at an academic hospital, bringing my background in epidemiology and public health into everyday practice. Each week, We'll dive into healthcare stories, public health conversations, workplace realities, and the human side of this work. This is a space for curiosity, honesty, and hopefully some inspiration. I'm glad you're here. Nicknames. Everyone has one. Whether it's something you've had since childhood, a funny memory shared with a friend, or something a little more sentimental. Nicknames can say a lot about a person. And I'll say, some nicknames are certainly better than others. One nickname that's particularly important to me is Brick Wall. Now that might not sound like the most endearing nickname, but to me it's very special. Today we're talking about someone with a pretty impressive nickname of her own, Catherine the Great. Now, some might argue she earned that title by orchestrating a coup to depose her unpopular husband. Others could say it was due to being a champion of the arts. But today we're gonna focus on something a little different. her role in the early history of immunization. Because Catherine wasn't just an empress, an art enthusiast, and a political powerhouse. She was also an advocate for varulation, also known as inoculation, an early method of protection against smallpox. So let's hear it for our girl Catherine the Great, and the role she played in the history of immunization. Let's get into it. First, how about a little background on our girl Catherine? Catherine the Great, Russia's longest ruling female leader, wasn't actually Russian, and her name wasn't Catherine. She was Sophie, the eldest daughter of a German prince who appears to be a bit of a character. In 1744, Catherine arrived in Russia, assumed the title of Grand Duchess, and married her cousin Peter the following year. After nearly eighteen years of an unhappy marriage, Empress Elizabeth passed away, and Catherine's husband Peter ascended to the throne. But his time as emperor was short-lived, lasting only about six months before Catherine orchestrated a coup and took power for herself. September 1762, Catherine was crowned Empress of Russia, beginning a remarkable reign that would last 34 years. But just six years into her reign, a devastating disease would arrive at Russia's doorstep. Smallpox. Smallpox is a very contagious disease caused by the variola virus. Symptoms of smallpox typically appear from 7 to 19 days after being in contact with someone who had smallpox. When symptoms do appear, it may include fever, muscle aches, headache, extreme tiredness, back pain, and vomiting. A few days later, spots on the body appear. They often start in the mouth and spread across the skin. Spots may appear to be red, purple, or brown. The spots tend to start at the top of the body, face and arms, then move to the legs, and finally show up on the trunk, and then hands and feet. Smallpox is extremely painful. The spots that appear eventually become blisters, and the blisters fill with pus known as pustules. Eventually scabs will form and fall off, leaving scars all across the body. Along with the lasting scars to remind those of the disease, there is a high death rate associated with smallpox. Around 30% of those who contract smallpox die. If you were able to listen to an earlier episode, The Smallpox Conquest, you will remember how devastating this disease is. was a major public health problem across the world during the 1700s. In Europe alone, it is estimated that approximately 400,000 people died from smallpox each year. That's an extraordinary number of deaths from a single infectious disease. And Russia was certainly not immune to the problem. There were already measures in place to try to control the spread of smallpox within the Russian Empire. In 1722, Emperor Peter I, also known as Peter the Great, required citizens of St. Petersburg, the capital city, to report cases of smallpox to the authorities. Then, in 1741, Empress Elizabeth I introduced another measure. Anyone living in a household with someone suffering from smallpox was prohibited from visiting the royal court. Until four weeks after everyone in the household had recovered. So there was already some recognition of the importance of reporting cases and limiting exposure to infected individuals. Public health, anyone? But Catherine was about to take things a step further. Rather than focusing solely on controlling the spread of smallpox, she would become an advocate for preventing the disease altogether. On October twelfth, seventeen sixty-eight, Catherine made a pretty remarkable decision. She had herself secretly inoculated against smallpox by an English physician named Thomas Dinsdale. It is believed she is the first person in all of Russia to get inoculated. Now, this wasn't vaccination as we know it today. The procedure, called inoculation, was an early method of immunization against smallpox. It involved deliberately exposing a healthy person to material taken from the sores or scabs of someone infected with smallpox. The hope was to produce milder infection and ultimately immunity against the disease. So where did inoculation actually come from? according to historical records, the practice of using material from smallpox lesions to trigger immunity was documented in China as early as 1549. From China the practice gradually traveled west, reaching the Ottoman Empire sometime in the fifteen hundreds and being established in Constantinople by the mid sixteen hundreds. From there inoculation spread into Europe and northern Africa. And it was through northern Africa that this practice eventually made its way to the Massachusetts colony. Thanks to an enslaved man named Onesimus. Onesimus shared his knowledge of inoculation with Reverend Cotton Mather. Yes, that Cotton Mather, the minister associated with the Salem Witch Trials. Onesimus explained that he had been inoculated against smallpox in Africa, a practice that he understood could protect him from severe illness and potentially make him more valuable to enslavers. Cotton Mather took this information seriously. When a devastating smallpox epidemic struck Boston in 1721, he partnered with a local physician to promote inoculation. The practice wasn't without controversy, but it ultimately helped save lives during the outbreak. Fast forward to 1736. After losing his young son to smallpox, Benjamin Franklin became an advocate for inoculation. He later published information comparing death rates among people who received inoculation with those who contracted smallpox naturally. The numbers helped demonstrate that although inoculation carried risk, the risk of death was considerably lower than it was from smallpox itself. And inoculation wasn't just gaining traction among everyday citizens. It was making its way into military strategy too. During the American Revolutionary War, General George Washington ordered Continental Army troops to undergo inoculation. Smallpox posed a significant threat to the military, and protecting soldiers from the disease became an important part of maintaining the fighting force. Pretty cool, huh? A practice that had been shared across continents and generations was eventually influencing public health and military strategy in early America. And we're still not done with the story, because next we're heading to Russia, where one very powerful woman brought this life-saving treatment to her own people. So, what did this process actually look like for Catherine the Great? Well, the entire procedure was initially kept secret, but after she was inoculated, Catherine developed a mild case of smallpox, but made a full recovery in about two weeks. Here are a couple of fascinating details about the procedure. First, Dimsdale obtained the material used to inoculate Catherine. From a young boy who had smallpox. He actually used material from the young son of a sergeant major, and the pushtules were used to perform the procedure. And here's another interesting twist. When it came time to inoculate Catherine's son, Paul, the material used was taken from one of Catherine's own smallpox pushules. Paul also made a successful recovery. Once news of Catherine's successful inoculation became public, it spread throughout the Russian court. Dimstal went on to inoculate more than 140 members of Catherine's court. But Catherine's influence didn't stop with the royal family or the people closest to her. Her successful experience helped encourage wider acceptance of variolation, also known as inoculation, throughout Russia. She worked to promote the practice, mobilize support among influential members of the nobility, and encourage the development of hospitals and training programs. In other words, Catherine wasn't simply protecting herself and her family. She was helping move smallpox prevention into a much larger public health stage. Catherine used her considerable authority as empress to promote inoculation throughout Russia. She commissioned artwork and other promotional materials to encourage acceptance of the procedure and demonstrate her support for modern medicine. She also rewarded the people involved in her own inoculation, granting aristocratic titles to both her physician, Thomas Dimsdale, and the young boy who had provided the smallpox material. Catherine supported medical innovations that made inoculation easier to perform, even by people without extensive medical training. Through funding from the Imperial Treasury, inoculation clinics were established in major cities throughout Russia. Even in remote Siberia, military physicians brought inoculation to local communities. Some tribal leaders encouraged their members to undergo the procedure. This massive inoculation campaign saw two hundred thousand Russians receive inoculation by seventeen eighty and by eighteen hundred over two million. One could say Catherine is doing the work of infection prevention. She recognized a significant public health problem, supported a prevention strategy, used her influence to build public confidence, and helped expand access to an intervention that could save lives. And isn't that what infection prevention is all about? Identifying a problem, finding ways to reduce risk, and getting those prevention strategies into practice. So what does smallpox look like today? Thanks to the success of worldwide vaccination efforts, smallpox was eradicated. The last naturally occurring case was reported in 1977. And the last outbreak in the United States occurred much earlier in 1949. In nineteen eighty, the World Health Organization officially declared smallpox eradicated. Pretty incredible public health achievement. But here's where things get a little more complicated. Even though smallpox no longer occurs naturally, the virus that causes it, variola virus, still exists in a couple of highly secured laboratory facilities. There is still concern about the possibility of the virus being used in a biological attack. You may have heard the term bioterrorism agents. These are biological agents that could be deliberately released to cause illness or death. The CDC categorizes high-priority biological threats into three groups: category A, B, and C. Category A agents are considered the highest priority because they could pose a significant threat to public health. have the potential for widespread transmission, and can cause substantial illness or death. And you guessed it, smallpox is classified as a category A agent. Following the terrorist attacks of September 11, 2001, and the subsequent anthrax attacks, concerns about the potential use of biological agents, including variola virus, increased. In response, the U.S. government expanded its smallpox preparedness efforts. This included a vaccination program for selected healthcare workers, public health personnel, and first responders who would be a part of an initial response to a potential outbreak. The government also strengthened its vaccine stockpile so that enough doses would be available to protect the US population in the event of an emergency. Now I want to emphasize there is no known immediate direct threat of a smallpox bioterrorism attack, but public health preparedness means thinking ahead, even when the likelihood of an event is low. Smallpox is a pretty remarkable example of why vaccination and public health infrastructure matter. A disease that once caused millions of deaths worldwide is now eradicated from nature. And that's the power of prevention. I'm pretty sure Catherine the Great would approve of that. For our Huddle Corner, a section for some takeaways before signing off, let's hear it for Catherine the Great. She recognized that smallpox wasn't just an individual health issue, it was a threat to the health and stability of her entire empire. She used her influence, resources, and position to promote inoculation and make it accessible to her population. Inoculation was an early attempt to protect people from smallpox, but it came with real risk. The development of vaccination eventually gave us a safer and more effective way to prevent the disease. And through coordinated global vaccination efforts, smallpox became eradicated. Vaccination, public health preparedness, communication, and collaboration remain some of the most important tools in preventing infectious diseases, and we can look to history to prove that. So whether you're working in infection prevention, Public health or healthcare, remember that the work we do today builds on generations of people who pushed medicine forward. Public health progress doesn't happen overnight. It takes curiosity, courage, collaboration, and sometimes a little help from an empress. Thank you for listening to Culture Positive. If you have any questions or ideas for an episode, please send me an email at CulturePositive Pod at gmail.com. You can also Thank you for listening to Culture Positive. If you have any questi Nope. find me on Instagram at CulturePositive Pod. Please like, share, and review the podcast wherever you listen. References for the episode can be found in the notes. Infection prevention is about more than policies and protocols. It's about people. Until next time, stay curious, stay compassionate, and keep building a culture that's truly positive.