Epilogue

Alexander Crichton was born in Scotland in 1763, studied at the University of Edinburgh as an undergraduate, and conducted clinical work in London before receiving his medical doctorate from the University of Leiden in 1785. In 1803, he was hired by Tsar Aleksander I (r. 1801–1825) to serve as his personal physician. The appointment was not a surprise. Crichton's father enjoyed a lengthy business relationship with Dr. John Rogerson, Catherine the Great's personal physician; Rogerson recommended Crichton for the appointment.¹ At Edinburgh, Crichton studied anatomy with Dr. John Bell, who had served on three tsarist embassies earlier in the century. During his clinical work in London, Crichton studied with Dr. William Fordyce, one of the men involved in the export of rhubarb from Russia, which had made him a personal acquaintance of both John Bell and James Mounsey, who was Elizaveta Petrovna's physician.² It was not only the social network that had brought Crichton to Aleksander's awareness, as Crichton's professional reputation had been established by his Inquiry Into the Nature and Origin of Mental Derangement in 1798, positioning him as a leader in the medical field in Britain before his Russian career.³

For Crichton, his appointment as the tsar's physician allowed him a range of opportunities in Russia. Along with an apothecary, Konstantin Kirchov, Crichton established a new business to refine vegetable oil on Aptekarskii Ostrov in 1807.⁴ In 1815, alongside two other members of the Academy of Sciences, Crichton edited a volume on the current state of Russian medicine.⁵ The following year, he pursued another opportunity—this time launching an investigation of the treatment of consumption (also known as phthisis or tuberculosis, depending on the physician) in St. Petersburg.

Consumption was a cold disease that had yet to gain attention in Russia, but knowledge of the disease advanced elsewhere in Europe. Physicians still employed a nosological approach to analyze disease presentation and transmission vectors at the end of the century, which kept cold diseases as a significant category for study. In 1793, for example, Dr. Thomas Beddoes published Observations on the Nature and Cure of Calculus, Sea Scurvy, Consumption, Catarrh, and Fever.⁶ It would be the subject of an extensive review in Medical Commentaries the following a year, a publication of which all of the Edinburgh physicians working in Russia remained subscribers, including Matthew Guthrie.⁷ Beddoes employed a nosological approach to address the four major cold diseases. All four were the result of too much exposure to cold moist air, although Beddoes argued the varied nature of the symptoms required varied approaches to treatment. He accepted that putrefaction led to the formation of calculus “stones” (of all sorts) and scurvy. For both, his cure was a compound of “vegetable alkali” to break up the putrefaction. He was aware, however, the cost would be prohibitive for the “poor.” Thus, he provided them an alternate, “fossil alkali,” a compound prepared from crushed natron mixed with soap to make a pill. For either option, if the patient also had a fever, “aromatics, extract of Peruvian bark, &c. may be added.”⁸

Both of the pulmonary diseases resulted from an alteration of the level of oxygen in the blood, whether too much (consumption) to too little (catarrh). Consumption could be solved by treating the patient with a diet known to produce scurvy, “salt meat” and an “oily diet,” as sailors rarely had consumption despite being in the climate that produced it. In addition, “the supply of oxygen at the lungs must also be diminished, by making the patients breathe air with an additional quantity of azotic or hydrogen airs, and by making them sleep in confined rooms.”⁹ Catarrh was the result of “sudden alternations of heat and cold; the cold operating, in his opinion, by accumulating irritability, while the inflammation is not produced until the subsequent and too sudden application of heat.” The preventative treatment was to wear flannel, “avoid spiritous liquors, warm close rooms, and many bed-clothes.”

Even with the ongoing discussions about cold diseases, Crichton's idea to study consumption was a turn from his specialty in mental illness. He lived, however, in Russia during the Napoleonic Era. First, he confronted a personal challenge when the Anglo-Russian War (1807–1812) began after Russia signed the Treaty of Tilsit with France. With his homeland and his employer at war, Crichton opted to remain in Russia and start his new vegetable oil business in St. Petersburg. The timing could be coincidental, but it suggests that his focus was on securing his fortune rather than demonstrating some sort of national loyalty. Britain and Russia returned to friendlier relations in 1812 following the Napoleonic invasion. The subsequent destruction of the Grand Armée inside the Russian Empire demonstrated the need for new studies of the cold and health.

In 1816, Crichton launched a clinical trial for the treatment of consumption in St. Petersburg, following what he later described as a random event. On a walk near his country house outside of the city, he approached a factory that boiled tar as part of the process of producing rope: “I found, to my great surprise, that, although the vapour affected the eyes painfully, yet I breathed the air with perfect ease. In a kind of magazine adjoining to this, where the vapour and odour of boiling tar were weaker, yet strong, the eyes were not affected, and it immediately struck me, that this artificial atmosphere might be of use to a consumptive patient who lived in the neighborhood, and whom I had entirely despaired of curing.”¹⁰ Crichton's new therapy was not grounded in medical theory nor was a response to previous treatments. In his summary of these early cases, he offered no evidence that he was a specialist in cold diseases of any kind. Presented with an opportunity to experiment on the public in St. Petersburg from his connection to the tsar, however, Crichton began treating consumptive patients.

Crichton's first case was a thirty-one-year-old man, N., who “of a delicate, lymphatic constitution, and yellowish pale countenance, having the thorax a little flatter than it ought to be, compared with his stature.” Following a “common cold” resulting from an apparently ill-timed trip to the bania, N. developed the “symptoms of a tubercular Phthisis” indicated by his “aggravated” cough, the “oppression in his chest,” and having “spit a little blood, which soon became very copious.” N.'s previous doctors had tried a variety of chemical remedies, most recently “a slight infusion of rose leaves, acidulated with sulphuric acid, with a little opium added,” but it had failed to alleviate his symptoms. Crichton sent him to the cable factory. He recounted: “The first day he remained in the tar vapour four hours; and in a very short time after entering the room, he says he experienced a sensation of greater ease on his chest. As the weather was hot, and he had no one there to converse with, he fell asleep, but soon awoke with a headache; still the relief in his breathing was so decided, that he resolved to return to the room on the morrow.” Crichton had his patient visit the factory daily and was pleased to observe that “the cough and expectoration had gradually diminished, and at the end of a month he had regained his former strength.” N. resumed his normal life in St. Petersburg when his symptoms soon returned, resulting in an agreement with Crichton to begin “fumigating” his room at night with tar.¹¹

“Mrs. Fitch, 30 years of age, thin, of a livid complexion, rather flat chested” was Crichton's second tar-cure patient. Crichton believed that a cold she caught during her third pregnancy in the fall of 1815 was the origin of her consumption. This might have been the reason for including her in the trial, as Beddoes had argued pregnant women could not be consumptive.¹² When she consulted him in July 1816, “she appeared … in the highest degree consumptive; already a marasmsus had commenced; the cough left her no rest by night or by day; she had a copious exportation of greenish-yellow matter, of a consistence and other apparent qualities of pus.” “Believing her case incurable,” Crichton ordered tar fumigation for her bedroom, “as her state of extreme debility prevented her from being taken to the cable manufactory.” Her recovery surprised Crichton, who allowed her to return to St. Petersburg in September, and she remained in good health a year later.¹³

Encouraged by his two patients’ results, Crichton continued his experiment, selecting a women's hospital (St. Petersburg's Hospital for the Poor) and a men's hospital (the Aboukoff, or City Hospital) as his two best options. With permission from Empress Elizaveta Alekseevna, the Hospital for the Poor's trial was supervised by Drs. Bluhm and Roos, who claimed one ward with “four of five beds” for the purpose. Patients in the ward were subjected to “tar fumigation, (pix liquida) … three to four times a-day” by placing an “earthen vessel over a lamp or heated iron, to cause a slow volatilization, until the air of the ward be sufficiently impregnated with it.” At the City Hospital, Dr. Wochler was assigned, but “the establishment being generally over-crowded with sick, it was not possible to obtain for this purpose more than one small narrow room, where scarcely three beds could be placed.”¹⁴ Both hospitals sought patients in the fall of 1816, but only seven patients (six women and one man) had finished their course of treatment by time the trial was ended in June 1817. Of those seven patients, three died but four were declared cured and were subsequently released.

Crichton's work continued. In 1823, he published a lengthier study on the effects of the tar cure on consumptive patients. Since his 1817 pamphlet, new trials proceeded in St. Petersburg and even extended to the Charité Hospital in Berlin under the direction of the Prussian royal physician, Dr. Hufeland. Crichton supervised a third trial in London in 1820 and 1821. The results were mixed. The Berlin trial produced “results nearly as favourable as in the hospital for the poor at St. Petersburgh,” with one in twelve cured and those “to be allowed to leave the hospital at their own desire, as one to five.” Considering half of his first patients were cured, the 20 percent of the Berlin trial was a significant decline. Even Crichton recognized the London clinic as a failure. For Crichton to continue his experiment, he needed to offer a plausible explanation about the variable results: how patients “in much ruder and colder climates, and which are commonly deemed more injurious to delicate and infirm constitutions” had recovered, whereas those in London's temperate climate had not. No less important was understanding how those “patients in hospitals, and public charities, in cold climates, have advantages which cannot be easily obtained in private practice.”¹⁵ Following the destruction of Napoleon's Army, this was a significant issue.

Crichton's 1823 study of the disease was published in London after he left the tsar's service. Crichton had turned his Russian trial into an experiment that would be more relevant for a British audience. The primary issue was not whether the tar cure was effective, but rather why Russia's cold did not produce more illness than Britain's climate? As Crichton noted, “The scrophulous or strumous constitution is more common in northern and middle governments of Russia than in England, and commits greater ravages and disfiguration than are ever witnessed in this country.” As the poor treated in St. Petersburg had recovered at a far greater rate than those in Berlin or London, something about the Russian peasants simply worked. At the same time, Crichton was aware that Russia's nobility was facing a similar consumptive crisis as Britain was, “especially those who inhabit the two capitals, and the larger cities, who have adopted the European dress and usages, and are under all the tyranny of European fashion as to late hours and other irregularities, to whom may be added the military in Russia, are becoming every day more and more subject to consumption.” He concluded, in agreement with Guthrie and many of his predecessors, that Russian peasant bodies successfully adapted to their climate, producing good health. He remained uncertain, however, which part of their lifestyle was the most important—their warm houses, the bania, or their diet, but one or more of those factors produced people who recovered from cold diseases. Furthermore, once again owing a debt to Guthrie, Crichton argued that Russia's climate was more temperate than expected: “High and frequent winds, one of the richest sources of catarrhal and consequently consumptive cases in this country [Britain], are very rare in the northern parts of Russia.”¹⁶

In the wake of the destruction of Napoleon's army, having Crichton, the tsar's personal physician, suggest Russia's climate was not dangerous may have been difficult to accept in Europe. Indeed, his 1823 text was condemned by the European medical community following its publication.¹⁷ Some of the French medical practitioners who survived the Russian invasion agreed, however. In 1826, for example, Pierre Jean Mauricheau-Beaupré published A Treatise on the Effects and Properties of Cold, because “the Russian campaign, the sight of the suffering originating from cold, of which I have been unhappily witness,—I have myself endured,—what I have read, in short, have induced me to reduce to writing various reflections on this agent, which exercises such great influence over man in health and disease, and to add to them a number of facts from my own observation.” His conclusions confirmed the work done by the Russian Academy of Sciences nearly a century earlier. In fact, he expressly agreed with Johann Georg Gmelin's work from the Second Kamchatka Expedition: “The Russians are lively, acute, active, industrious and enterprising; they are constantly found cheerful in a temperature which is their element; … The rigors of their clime, and their long winters render them eager for amusements; the ordinary pleasures of society, in that season, though less various and brilliant than in happier climes, are not therefore the less keenly relished; their houses resound with them.” Mauricheau-Beaupré argued the contentment of Russia's peasants was well known, having been assured by “the French and English, who have lived in Tobolsk and Irkousk, have assured me, that they did not find in those two principal cities of Siberia, that insensibility and apathy so causelessly attributed to the people of cold regions, nor the horrors that seem attached to the very name of that Province. According to Gmelin, the carnival of Tobolsk is very gay, and amid amusement and drunkenness cold is forgotten.”¹⁸ Whereas Jean-Baptiste Chappe-d’Auteroche read Gmelin as a cautionary tale of Russia's inability to manage its empire to care for the health its population, Mauricheau-Beaupré read Gmelin as the Russian medical establishment would have—that is, as the Russians had overcome the dangers of their climate for successful and prosperous lives.

Mauricheau-Beaupré concluded that the extremely high casualty rate for the French army was simply because they were not adapted to the climate: “Not only on account of the untried influence of extreme temperature on individuals born in another climate, but also on account of the fatigues inseparable from traversing long distances, of an irregular, disorderly, and consequently often unhealthful way of life, in short, of a multiplicity of event and circumstances impossible to foresee.”¹⁹ The men at work in Russia had been arguing against this conclusion on the climate for decades by the time Mauricheau-Beaupré wrote, but the experience of the French army in Russia's coldness only confirmed that the Russians had long since solved the climatic conditions, but foreigners were still in danger.

A French surgeon, Dominique Jean Larrey, agreed with Mauricheau-Beaupré that Russians may have thrived in the cold but felt unquestionably that the French army was not properly prepared for the climate. He wrote that “it is evidence that cold exercises principally its sedative effects on the brain and nervous system. This is strongly proved by the fact, that, on our return from Moscow, those who were destitute of furred caps or had little hair on their heads, were more obnoxious to cold, the head being deprived of its natural heat.” With warm clothing, in other words, the Napoleonic Army's survival rate would have been far greater. This was no small conclusion, as Larrey understood that Montesquieu had observed the “sedative and stupefying influence” of the cold in his Spirit of Law; in Larrey's experience in Russia, however, all that it took to overcome the danger of the climate was appropriate dress.²⁰ Climate was not an unchangeable danger, but rather it was readily manageable (figure E.1).

Figure E.1. Christian Wilhelm von Faber du Faur, “Frozen to Death,” in Blaetter aus meinem Portfeuille, im Laufe des Feldzugs 1812 in Russland (Stuttgart: C. F. Autenrieth, 1831–1834). From the British Library Archive.

The failure of the Grand Armeé was a lesson in the importance of studying the climate and its connection to the body. Both Mauricheau-Beaupré and Larrey turned toward earlier work on Russia and its climate to provide a context for the destruction of Napoleon's forces. French critics in the eighteenth century relied on the Russian Academy's expeditions for proof of the climate's danger and the potential threat to exterminate all life in Siberia. French survivors in the early nineteenth century had been persuaded that Russia's peasants might have successfully adapted to the climate and could enjoy good health. It was in fact those men who failed to adopt an appropriate lifestyle, in terms of dress, diet, and activity, who suffered, whether it was elite people living in Russia's cities or the invading Grand Armée. Guthrie believed while he was writing his final text that a defense of Russia's successes was still necessary, but, by the 1820s, recent experiences seemed to have validated the opinion that it was foreigners, not Russian subjects, who suffered from the climate.

The eighteenth-century contributions from the Russian Empire were not solely relevant for the debates on climate. Numerous physicians produced “thick” ethnographic descriptions of the peoples of the empire and those across the North Pacific. Physicians acting as naturalists studied and documented new plants, animals, and minerals. Both groups contributed to the ongoing taxonomic project to classify all these people and materials. Whereas modern scholars focused on the Atlantic or Indian Ocean worlds have analyzed the ways in which European empires transformed the scientific understanding on bodies, this material was being produced not only in tropical environments but also in extremely cold ones. Russia was no less important for European medical knowledge than the Caribbean islands or India were. The less-than-favorable reception of some of the new work produced in the nineteenth century, like Crichton's, should not be counted against its eighteenth-century accomplishments.

If the climate's devastation of the Grand Armée marked an inauspicious start to the nineteenth century, it is only that much more important to remember Russia's genuine achievements in the previous century. The establishment of the Academy of Sciences supported the taxonomic project. The discovery of new materials, plants, and minerals increased Europe's pharmacopeia. The decades of study on scurvy contributed to Europe's ability to improve therapies for disease. Catherine the Great's smallpox inoculation campaign did improve the health of the empire. Russia managed multiple plague outbreaks and adopted quarantine strategies that prevented the spread of the disease to Europe. The lesson may be that the general impression of Russia and its climate owes more to the prevalence of the humorally influenced language that dominated travel narratives than to any of its material accomplishments. Once Russia became fixed as a cold place in the European imagination, no one may have been able to envision it as a healthy state. French critics may have offered dire predictions, but the only group that faced those consequences were the French themselves. The Russians, as they always had, continued to prosper.