How Begum Samru, Lady Montagu, and Catherine II of Russia, shaped the history of smallpox

In the eighteenth century, the fortunes of a tawaif (courtesan) and nautch girl (court performer), Farzana un-Nissa, turned dramatically when she married a European mercenary and turncoat, General Walter Reinhardt Sombre, who changed sides several times in the turbulent politics of the time.

Farzana was of Kashmiri descent, and after converting to Catholicism, took the name Joanna Nobilis Sombre. Following her husband’s death, she inherited his vast wealth and estate and became the ruler of Sardhana, located in present-day Meerut, Uttar Pradesh. She was buried in Jharsa, present-day Gurgaon, which was her cantonment and military base.

Today, this remarkable concubine-turned-noblewoman is remembered for her extraordinary feats as a military leader, having commanded troops in important battles against the British, before ultimately yielding in the early 19th century. Her astuteness, courage and strategic leadership have earned her a distinct position in British imperial history.

More fascinatingly, she occupies a curious position in the cultural history and myths around smallpox in India. As per legend, she offered prayers at the site when her son contracted smallpox, and miraculously, he recovered. It was after this that the site became revered as a dwelling spot of the goddess, and she is said to have become a patron of the deity.

The site of her prayers remains popular even today. It is now the Shri Mata Sheetla Devi Mandir, located in the middle of Gurgaon’s busy landscape of malls and metro lines, and continues to draw pilgrims every year.

The wider context of Sitala worship in India becomes important to understand here. In the 19th century, when a case of smallpox appeared in a family, the woman of the house made a vow to make a shrine to the form of the goddess to supplicate her if the patient recovered. In the first few days of the onset of smallpox, nothing was administered to the patients except for incantations and herbal decoctions. Such practices reveal to us the entwinement of diseases with supernatural influences on one hand, and healing with worship on the other. At one point, the worship of Sitala in India was arguably more widespread than medicine, although she received patronage mainly from the poorer sections of society, who were more likely to turn to gods rather than science.

Historically, Sitala was once considered to be a benevolent goddess. However, over time, especially from the 18th century onwards, she became imagined as a capricious, dangerous, disease-inflicting deity, who was easily angered. In fact, in some folk portrayals, she was represented as an intimidating and vindictive goddess who spread infected pulses in villages, leading to epidemic outbreaks of smallpox and other contagious diseases. Historian Sanjoy Bhattacharya has observed that acute cases of smallpox were treated by Indians as a benefaction, and a severe case of it was seen as a sure sign of divine retribution. Believed to be an incarnation of Parvati, Sitala is worshipped particularly on the seventh and eighth days of the Hindu month of Chaitra (March-April), following the Hindu festival of Holi. The enduring belief in the deity’s healing powers today symbolises the power of folk cultures in impacting healing practices, and the role of divinity in matters related to infectious diseases.

The name “Sitala” or “Sheetla”, also meaning “thandi”, “the cold lady”, and “she who loves the cool”, is derived from the Sanskrit root sita, meaning “cold”. This association is due to the fevers that result from smallpox and indicate a manifestation of the goddess. The iconography surrounding Sitala reflects this and is reminiscent of various other deities: she is typically portrayed sitting on an ass and holding a broom in one hand and a jar of water in the other, to signify the “coolness” of the disease. She is supposed to dwell in neem trees, so the patients were supposed to be fanned with its leaves to appease her. In most contemporary depictions, she is typically shown carrying a winnowing sheaf or a fan, which suggests air and likely implies the need for ventilation and freshness. It was a common practice to wear medals of such inscriptions as protective amulets to fend off the disease in children and adults alike.

While supplicating gods shaped popular responses to smallpox in India, societies were also experimenting with other forms of prevention. Interestingly, another mother who wanted to safeguard her children from smallpox, Lady Mary Wortley Montagu, an English aristocrat of London, came to occupy a prominent position in the narrative of humankind’s battles with smallpox.

The controversial aristocratic traveller and her risky experiment

In 1717, Lady Mary was living in Constantinople as the wife of the British ambassador. At this time, she discovered that it was a common practice in Ottoman Turkey to administer smallpox pus into the skin of a healthy person to trigger an immune response. This was known as ingrafting, which served as an effective, as well as tried and tested, prevention against smallpox. Keen to protect her son and daughter, and having survived it once in her life, she then arranged for both to be inoculated through the process of variolation.

Technically, variolation involved an intentional infection that was meant to create an immune response in the body of the recipient and protect them from a lethal form of the disease. The method involved subcutaneously injecting small amounts of smallpox material (pus from the pustules of a recently variolated individual) into a healthy person with a lancet or a needle. In India, a form of the practice is said to have been operational before 1000 BCE, when it was first discovered that inducing smallpox deliberately could lead to future immunity.

In the early 18th century, when Lady Mary promoted variolation, doubts and fears prevailed in Britain towards such an experimental method, which, compared with the Jenner vaccine that came a century later, was indeed risky. Not only could a deliberate infection lead to a virulent attack of smallpox, but it could also trigger an epidemic. Moreover, it could also lead to the transmission of other diseases that spread through the blood. For instance, syphilis was linked to inoculation; many doctors were shocked to find people developing syphilis after being variolated, even in the 19th century. Cross-infection was a major reason why there were reservations about harvesting lymph matter. In fact, it took a long time for the modern vaccine to be accepted by people across the world. And it took about two and a half centuries since Lady Mary’s variolation of her children for smallpox to be finally eradicated.

Lady Mary is now widely known for her pioneering efforts in popularising variolation across Europe during this time. She managed to convince and inspire many to get inoculated from the elite classes, including her friend, the Princess of Wales, Caroline of Ansbach. As the century progressed, variolation continued to be practised before the invention of the modern vaccine and was introduced to the American colonies. Since it required elaborate processes involving diet and rest, it was usually adopted by the affluent classes. Several aristocratic individuals opted for it, including King Louis XVI of France and King Frederick II of Russia.

A royal gamble at the winter palace

Variolation also came to be widely practised in Russia in the 18th century, and once again, a mother played a crucial role in its adoption and spread.

Reminiscent of Lady Montagu, Catherine II of Russia, also known as Catherine the Great, was indeed motivated (in part) by her strong maternal instincts to protect her child from the ravages of smallpox, which was a constant threat in the second half of the 18th century across parts of Europe. In 1768, unable to isolate herself and her son and only heir, 13-year-old Paul, the Grand Duke, from the crowded city of Saint Petersburg, where a smallpox epidemic had spread, she decided to adopt the process of variolation.

The renowned English physician Thomas Dimsdale was asked to perform the procedure on the royal pair. Dimsdale had become seasoned in smallpox inoculation and had published his landmark treatise explaining his methods just the year before, in 1767. The work had spread across Europe, ensconcing him as one of the principal voices on preventative treatment at the time.

It was the month of August when he was summoned to the Winter Palace by the Empress. At the time, he was working at the Wolff House, which had been turned into an isolation hospital, on the outskirts of the city. The note delivered to him was written by the chief advisor to Catherine II of Russia and tutor to her son, had been both urgent and intimidating: “…To your skill and integrity will probably be submitted, no less than the previous lives of two of the greatest personages in the world, with whose safety and tranquillity and happiness of this great empire are so intimately connected.”

Dimsdale did not require a note of such kind to understand how high the stakes were. Not only had the results from the tests in the Wolff House been erratic, but in Britain, King George III himself was keenly interested in the direction of his work. For that moment, Britain’s reputation as well as the credibility of Western science itself seemed to lie in his hands. Besides, if he failed in the immediate task of inoculating the Empress and the future Tsar, the little confidence people had towards science and medicine would give way to chaos and superstition. And there was his own life to consider. If the Empress regnant were to die at his hands, he would likely be killed by her people before he could leave for home.

Naturally, he was nervous, but there was no turning back. Catherine was determined to undergo the operation so she could get her child to undergo it after her. The procedure took place in the privacy of her chambers, and Dimsdale used lymph from a boy he had brought with him.

The procedure worked, and soon after, Paul was inoculated as well.

Although Catherine was like any other mother wishing to protect her child from the ravages of a deadly scourge, she was also motivated by the desire to create scientific understanding around the disease and its prevention. By publicly placing her body as a specimen of the variolation process, she wanted to demonstrate the effectiveness of the scientific method, encourage medical advancements, and challenge long-standing prejudices. After the procedure, she publicised it intentionally to dispel the general fear towards it within Russia.

Perhaps this bold and dangerous act was to be expected from her. After all, she was an intellectual (who had declared that she read books for three purposes: entertainment, education and information, as well as philosophical insight). She was a ruler of extraordinary mettle, fortitude and strategic planning. She was highly ambitious, and throughout her reign, she was focused on political expansion, as well as cultural and scientific development. When she seized the throne from her husband, Peter III, after a coup d'état that she is said to have hatched herself, she was already popular and liked by the powerful elite, despite being an outsider (from Stettin, Prussia). By the time she underwent the operation at the hands of her English doctor, she had already been in power for six years and was well-versed in the courtly patterns of Saint Petersburg.

Indeed, Catherine’s efforts caused a ripple effect, and she set an example for the world. News of her act travelled even to America. She remains the only reigning monarch to undergo the procedure at a time when most were afraid of it. Following her public endorsement of variolation, she went on to initiate a mass campaign, and by 1800, almost 6% of the Russian population was inoculated. Under her regime, public health proliferated as she focused intensely on improving healthcare. Overall, Russia witnessed a growing influence of the European Enlightenment and scientific ideals. The time became known as the golden period of Catherine II.

The personal is always political

Today, ideas like vaccine hesitancy, prejudice against modern and experimental medicine, and faith-versus-science make such histories even more relevant. As far as smallpox is concerned, the 19th century figures most prominently in discussions around its prevention, but the century preceding it, and the figures that preoccupied themselves with gaining a better understanding of the deadly scourge, deserve attention.

Begum Samru, Lady Mary, and Catherine II shaped the narrative of smallpox in distinct and important ways. All three were mothers, operated either on knowledge or belief, and either influenced social perception of the disease or changed the course of its prevention. While one contributed to the formation of cultural and social meanings attached to the disease, one succeeded in popularising variolation in Europe, and the third used an ingenious way to herald a new age of smallpox prevention in her empire.

Yet, despite their intriguing position in the narrative of smallpox, each woman remains wrapped in myths and misconceptions. Begum Samru is a cult figure in British imperial history, but is often reduced to a trope of an exotic tawaif who had a reversal of fortune and supposedly ingratiated obscure deities. Lady Mary, despite her important work, is often depicted as an eccentric, hodophilic aristocrat who “luckily” discovered variolation. Meanwhile, Catherine is made notorious in history through gossip and misappropriations, for being a usurper and having a string of affairs – she was the typical “enlightened despot”.

Women’s History Month inspires us to examine these histories and question the role of women in shaping society in different contexts. In particular, reassessing women’s position in mainstream historical narratives of health and medicine allows us to explore their contributions both as caregivers and as scientific patrons, advocates of science. Ultimately, all three were staunch believers in the fact that even an ancient disease as aggressive as smallpox could be confronted and treated. Whether their actions were shaped by faith, maternal love or scientific vision, they influenced the story of smallpox in critical ways.

These histories are explored in greater detail in In Sickness and in Death: How Faith, Medicine and Race Shaped British India, a forthcoming book by Ipshita Nath (HarperCollins).