An incision was made in that part of the arm where issues are usually placed, deep enough to pass through the scarf skin, and just to touch the skin itself,and in length as short as possible, not more than one eighth of an inch. “These methods seem to have been attended with a good measure of success, and in spite of the risk of infecting the patient with virulent smallpox, there was a comparatively small proportion of deaths.

Hero Dust. By James Kemble, Ch. M., F.R.C.S. Methuen & Co., Ltd. 6s. net.


MR. KEMBLE, the eminent surgeon, takes a great interest in the diseases and disorders of historical personages. He wrote a valuable book Idols and Invalids, in which he described the medical history of Henry VIII, Columbus, Judge Jeffreys, Madame de Pompadour, Lord Nelson and others. That book was reviewed in this magazine in July, 1933.

He had followed this book by another volume of medical-historical studies in which he described from the doctors point of view the lives of Mary, Queen of Scots, Epicurus, John Milton, Catherine the Great of Russia, Beau Brummell and Omar Khayyam. This is an exceedingly readable and delightful book. The following pages from the life of Catherine, the Great will undoubtedly interest many readers and will give a general idea of the character of Mr. Kembles writings:.

“Catherine throughout her life enjoyed comparatively good health. She never drank, she had no interest in food, her table was usually a most frugal and unimaginative display. Her major vice was men; her minor vice was snuff.

Following that illness with pneumonia just after her arrival in Russia, she suffered at times from various lesser complaints; she had measles, occasional attacks of headaches, and once had been obliged to leave church in the middle of matins because of violent colic, the inconvenient and embarrassing consequences of a supper of oysters. There were also two other valetudinary occasions which left vivid impressions on Catherines mind, one was a tooth extraction when she was a girl of twenty, and the other was her inoculation against smallpox.

“In her diary, written years afterwards, Catherine says of her tooth:.

I sent for her Majestys physician Boerhaave requesting him to have the tooth which had tormented me so much for the last four or five months extracted. At last he sent for Gyon, my surgeon: I sat on the ground, Boerhave on one side, Tchoglokoff on the other, and Gyon drew the tooth; but the moment he did so, my eyes, nose, and mouth became fountains, whence poured out from my mouth blood, from my eyes and nose water.

Gyon in extracting the tooth, had carried away with it a portion of the lower jaw, to which it was attached. I was put to bed and suffered a great deal during four weeks. I did not leave my room till the middle of January 1750, for the lower part of my cheek still bore, in blue and yellow stains, the impression of the five fingers of Monsieur Gyon..

“If in these her tender years she had been so upset and truly terrified at this minor operation, later in life at the age of thirty-nine when she resolved to be inoculated against smallpox, she showed a very different spirit. Smallpox in Europe, and especially in Russia, was at that time raging in a series of epidemics which caused a most terrible toll of death. In Russia alone some two million people died in a year. Inoculation as a preventive, while it was becoming more and more widely practised in England. had not yet been introduced into Russia.

And therein lay Catherines courage; she was prepared to submit herself for inoculation as the first test case in order to be an example to her subjects. In England the method then in use was the inoculation, just under the cuticle of the skin, of matter from a pustule either taken from a patient actually suffering from smallpox in the natural way, or from one who had been recently inoculated.

The most accomplished performers of the operation were the members of the Sutton family, all of them unqualified practitioners, who had set up an Inoculation House near Ingatestone in Essex. Thomas Dimsdale, M.D., copied and elaborated their method, and soon had both a high reputation and a growing practice. In 1767 he published his book called The Present Method of Inoculation for the Smallpox. In this he sets out his preparatory treatment consisting of abstinence from all animal food and fermented liquors, the administration of a powder composed of calomel, compound powder of crabs claws and tartar emetic, followed by Glaubers salts the next morning. As for the actual operation:.

An incision was made in that part of the arm where issues are usually placed, deep enough to pass through the scarf skin, and just to touch the skin itself,and in length as short as possible, not more than one eighth of an inch. The little wound being then stretched open between the finger and thumb of the operator, the incision is moistened with the matter, by gently touching it with the flat side of the infected lancet. This operation is generally performed in both arms, and sometimes in two places in one arm, a little distant from each other. Neither plaster, bandage, or covering is applied, or in any respect necessary..

“These methods seem to have been attended with a good measure of success, and in spite of the risk of infecting the patient with virulent smallpox, there was a comparatively small proportion of deaths.

“When Catherine in her wisdom finally decided to be inoculated and to introduce the procedure into Russia, it was Thomas Dimsdale, then practising at Hertford, who was chosen to undertake the mission. He took his son Natheniel with him as his assistant. After his arrival at St. Petersburg he first carried out several tests and trials upon persons of Catherines age, sex, and constitution, and finally, on October 12th, 1768, inoculated the Empress herself. He writes:.

The child I had fixed upon as the most proper subject, and on whom the smallpox just began to appear, was then asleep; we wrapped him up in a pelisse, and conveyed him to the coach, into which we entered, and were immediately conveyed to a gate of the palace next the Milione. We were conducted up a pair of back stairs, and were met by Baron Cherkasoff, who accompanied us to the Empress. The inoculation was soon performed, one puncture being made in each arm, after which my son returned back to Wolff House, with the child, and intimated to the family there (who were anxious to know what had been done) that I had inoculated the child of a nobleman.

“To Dimsdales immense relief everything proceeded excellency and with the most successful results. On November 2nd following, the Grand Duke Paul was inoculated, the matter being taken from the pustules of the Empress. Both patients were completely recovered in some twenty-one days. Catherine was as generously grateful as Dimsdale was relieved and satisfied with the result.

He was created a baron, handsomely rewarded, and after inoculating a great many of the nobility of Russia and establishing an Inoculation Hospital there, finally returned to England the following year. He lived to the age of eighty-nine, which was just a little too long, for in 1798, two years before his death, Edward Jenner published his Inquiry in which he disapproved the practice of inoculation and propounded the first principles of vaccination, which soon was completely to replace


“Of Catherines ability as a ruler no panegyric is necessary here. Even by those who consider her a bad woman, she is considered a good empress. Her title of The Great she more than amply merited. Within her realm she instituted a new prosperity, formulated a new code of laws, built and maintained hospitals, and governed her people with both exemplary justice and fitting decorum. In external affairs she approached the powers of Europe with a wise diplomacy, she added to her empire in the Crimea, and took a very active and, for Russia, a very advantageous part in the partitions of Poland.

“But at last she too must come to the cold tomb. Her life had been an excessively strenuous one, and now past sixty, her health was beginning to suffer the strain. She had lost all her teeth, she was very fat, her legs began to swell, and she was incapable of any degree of exertion; no doubt she had developed good hard pipe-stem arteries. Genet, one of the diplomats at the court, says she showed certain signs betokening dropsy. A little later Catherine wrote to a friend: I fancy it is gout in my stomach.

I am trying to drive it out with pepper and a glass of Malaga that I drink every day. In February 1796, though she was obviously failing in health, she would not allow herself to admit it. She wrote to Grimm: I am gay, gay as a lark. Up to the present I am in excellent health. Over the heads of her regular physicians she called in a quack named Lambro-Cazzioni; he recommended bathing the feet in iced water, whereupon Catherine became worse and was threatened with congestion and apoplexy.

“On the evening of November 5th 1796 she retired early. The next morning she got up sooner than was her custom, had her usual five cups of strong coffee for breakfast, and went back to her room. She had taken a throne which had formerly been used by the kings of Poland and more recently by her own Poniatowsky, and had installed it in her antechamber as a commode.

Here, on this morning of November 6th about nine oclock, as if in retribution for her disrespectful gesture, Catherine had a seizure, and was found by her attendant fallen unconscious to the floor, her face convulsed, foaming at the mouth, the death-rattle already in her throat. She had apparently had an apoplectic stroke. Zubov was quickly on the scene, followed by Dr. Rogerson who straightaway bled her. She never regained consciousness, however, and died thirty-seven hours later. At the post-mortem it is reported that two stones were found in the gall bladder.

“Catherine was sixty-seven, proud in disposition and brilliant in intelligence to the last. In her diary she writes: If I may be allowed the expression, I venture to assert, in my own behalf, that I was a true gentleman one whose cast of mind was more male than female; and yet I was anything but masculine, for, joined to the mind and character of a man, I possessed the charms of a very agreeable woman”.

James Kemble