Dave P's Bits of History: September 2021

The coronavirus pandemic has made virologists of us all. We have learnt a whole new language of virus-related terms: test and trace, lockdown, social distancing, PPE, self-isolation, delta variant, lateral flow, double-jabbed and pingdemic. At the time of writing the UK government’s main (in England, only) strategy for countering the threat is to promote blanket vaccination. And this has introduced us to another new term: anti-vaxxer.

For those of us who got our jabs as soon as we could, the phenomenon of ‘vaccine hesitancy’ (yet another new term) is hard to understand. Why would people consciously decline to have a medical treatment that could save their lives, or the lives of those close to them? But opposition to vaccination is as old as vaccination itself, dating back to the beginnings of smallpox vaccination in the late 18^th century. It touched my own family too, as my Great-Grandfather, the Reverend Edward Miall Pulsford, achieved modest fame in Scotland in the late 1880s by refusing to allow his youngest daughter to be vaccinated, and campaigning against compulsory smallpox vaccination. I have spoken of my Great-Grandfather in a previous article, in the context of my family’s involvement with the Swedenborgian New Jerusalem Church. In this article I will consider smallpox vaccination and its opposition in the 19^th century, and my Great-Grandfather’s role as Scotland’s ‘Clerical Anti-vaccinator’.

Smallpox and its Treatment

Smallpox is caused by the variola virus, and like COVID-19 its transmission is airborne, passed on by close personal contact, or from infected surfaces. It is fatal in around 30% of cases, and many survivors are left disfigured by scars from the scabby blisters that are its most prominent feature, though they do receive lifelong immunity. Smallpox was endemic worldwide for hundreds, or perhaps thousands of years.

From medieval times, a process known as variolation was the only effective treatment for smallpox. This involved deliberately infecting a person with a small amount of the virus, to try to induce mild illness and subsequent immunity. Variolation was highly risky, and many died from over-infection. The theory behind variolation did however provide the basis for vaccination, which was developed by British physician Edward Jenner in the late 18^th century. Jenner noticed that milkmaids who had been infected with cowpox, a much milder disease, appeared to be immune to smallpox, and reasoned that introducing the cowpox virus into healthy individuals might protect them from smallpox. In a highly unethical experiment (by modern standards), Jenner gave a small dose of cowpox virus to a young boy and then exposed him to the smallpox virus. The lad did not fall ill, and the principle of vaccination (from the Latin for cow) was born. Smallpox vaccine proved highly effective, offering full protection to 95% of those who received it – an ample number to achieve ‘herd immunity’ (another virology term), and by the 1970s, smallpox had been eradicated worldwide. Edward Belognia and Alison Naleway have called the elimination of smallpox by vaccination, “one of the greatest accomplishments of the 20th century, if not one of the greatest human accomplishments of all time”.

Despite its evident benefits, however, smallpox vaccination always had its opponents, and ‘anti-vaxxers’ flourished throughout the 19^th century. Paula Larsson has identified four broad arguments used by Victorian anti-vaxxers, which are still being used by the vaccine-hesitant today:

Minimise the threat of the disease: As late as October 2020, former American President Donald Trump was comparing COVID-19 to seasonal flu, despite ample evidence that it was much more likely to lead to hospitalisation and death. 19^th century anti-vaxxers similarly downplayed the threat that smallpox held for the population as a whole, inaccurately claiming that outbreaks were smaller than they actually were, and that the fatality rate was lower than the 30% of victims that died from the disease.

Claim vaccine causes illness, is ineffective, or both: In the late 1990s, panic was caused by claims by British doctor Andrew Wakefield that the MMR vaccine caused autism in some children who received it, leading to parents refusing to have their children vaccinated against measles, mumps and rubella. Wakefield’s claims were found to have been based on fraudulent studies, and he was struck off the medical register. Despite this, concerns persisted. In the 19^th century, anti-vaxxers had somewhat greater reason to be wary of smallpox vaccination, as medical practice was sometimes slapdash and lacking in concern for hygiene, leading to some who received the vaccine acquiring secondary infections. Also, the vaccine itself could cause severe (and sometimes fatal) side-effects in a small minority of those who received it. Overall, however, the smallpox vaccine was highly effective and safe, and claims of high rates of smallpox or vaccine-induced illness in places where most people were vaccinated were misrepresentations, deliberate or otherwise.

Declare vaccination is part of a larger conspiracy: Internet-spread conspiracy theories have been rife during the COVID pandemic, and many have refused to be vaccinated on the grounds that mandatory vaccination takes away personal freedom, and leaves the person open to becoming a victim of whatever conspiracy they believe in. Such concerns were also prevalent in the 19^th century, with suggestions that compulsory vaccination was designed to increase government control over the poor, or to enrich the medical profession – among other more far-fetched conspiracy theories.

Use alternative authorities that legitimise your argument: As we noted above, the current pandemic has made virologists of us all, and not all pronouncements by those in a position to influence others have been constructive. Social media has provided a platform for prominent anti-vaxxers to promulgate their views. The 19^th century equivalents of the internet were pamphlets, public meetings and advertisements and letters in local newspapers, and anti-vaccination views gained a wide audience. In England, Leicester became a particular centre for anti-vaccination feeling, stoked by the efforts of the Leicester Anti-vaccination League, established in 1869, and its Secretary, J. T. Biggs. Biggs was a Sanitary and Waterworks Engineer and was an active member of the Leicester Board of Guardians, responsible for public health, and was therefore in a prime position to influence those wary of vaccination. In 1871, following a severe smallpox breakout, mandatory vaccination in England was confirmed and strengthened with new penalties for vaccine refusal. Despite this, high numbers in Leicester declined to have their children vaccinated, or to pay the fines for non-compliance, leading to some being marched off to prison, accompanied by cheering crowds. In response, a new approach to smallpox was introduced in the town, which became known as the ‘Leicester method’. This involved public health strategies to promote cleanliness and improved sanitation, and early identification and quarantine of cases of smallpox and those they were in contact with – a 19^th century version of ‘test, trace and isolate’.

Overall, just as today, there were as many reasons for 19^th century ‘vaccination hesitancy’ as there were anti-vaxxers. Some also objected on religious or moral grounds, including some among the growing number of vegetarians, who were concerned that the smallpox vaccine was taken from the lymph glands of calves. However, the majority of the population accepted vaccination, and by the end of the 19^th century, smallpox had declined markedly the UK. But those against compulsory vaccination persisted, and in 1898 a ‘conscientious objection’ clause was added to the legislation in England (the first time this term was used), allowing parents to legally refuse vaccination for their children on grounds of conscience.

Rev. Edward Miall Pulsford – Scotland’s Clerical Anti-vaccinator

My Great-grandfather was born in Islington, north London, in 1844. His father, also Edward, was a self-employed map engraver, and was a member of the Swedenborgian New Jerusalem Church (New Church) at Argyle Square, Bloomsbury. Young Edward Miall (hereafter abbreviated to EMP) became an apprentice to his father, but by his mid-twenties had become a New Church minister. Significantly for his later anti-vaccination stance, his first ministry was to the New Church Society in Leicester, arriving there in 1871, when opposition to vaccination was gathering force in the town.

Edward Miall Pulsford, 1844 - 1899

In 1874, EMP married Ruth Presland, whom he had known at Argyle Square, and became minister of the New Church in Jersey. His eldest three children were born in Jersey: Emily in 1876, Edward in 1878 and Laurence (my grandfather) in 1880. That year, with Laurence just a few months old, the family moved to Alloa in Scotland, where EMP became minister, remaining in that role for the rest of his life. He and Ruth had two further children in Alloa, Elsie in 1883 and Jennie in 1886.

EM Pulsford's wife Ruth (nee Presland)

A New Church contemporary described EMP as “a quiet, somewhat reticent, very courteous gentleman and acknowledged to be a very good pastor because he knew how to look after his people”. In Scotland, he became a pillar of the local community, becoming a member of the Alloa Liberal Committee and the Alloa Society of Natural Science and Archaeology, and playing chess competitively. But in 1887 he started to appear in the local press for his public opposition to smallpox vaccination, and his refusal to allow Jennie, his youngest daughter to be vaccinated.

Compulsory vaccination was introduced in Scotland in 1864. Responsibility for organising vaccination and chasing up, and if necessary prosecuting, ‘defaulters’ was given to local Parochial Boards, responsible for administrating Poor Law provisions. All infants had to be vaccinated soon after birth, and the penalty for refusal was a fine of up to £1, with expenses, or up to 10 days imprisonment. If parents continued to refuse vaccination, they could be prosecuted again after six months – and more times if necessary.

The Inspector reported to the Alloa Parochial Board in March 1887 that EMP had not had Jennie (who by then was seven months old) vaccinated. The Board instructed the Inspector, Mr Bowie to write to EMP to remind him of his responsibilities. EMP failed to respond, and proceedings were brought against him. In April 1887 EMP appeared before the Sherriff Summary Court; the first prosecution for non-compliance with vaccination that the Court had had to address. He pleaded guilty, and asked leave to state his reasons for refusing to have Jennie vaccinated. Sherriff Tyndall Johnstone told him that he was not permitted to make a detailed statement to the court. As a first offence, he fined EMP the minimum amount of 5 shillings, with 1 shilling expenses, with an alternative of 5 days imprisonment. EMP readily paid the fine.

The Sheriff said that he hoped EMP would now comply with the law, but he did not, and in November 1887 he was prosecuted a second time. He again received the minimum 5 shilling fine, but with £1 expenses. In December, he gave a public ‘vindicatory lecture’, in which he set out his concerns with vaccination and his reasons for not allowing Jennie to be vaccinated. His argument focused on health matters – as a good Liberal he was unconcerned with broader matters of personal freedom and he ascribed to no conspiracy theories. He pointed out that there were a number of different vaccines used, and that most doctors who administered the vaccine had little idea what they were putting into infants’ arms, and with what consequences. They had been told that vaccines were effective and failed to look closely at the evidence. That evidence, he thought, was far from conclusive, and he cited figures for smallpox cases in Scotland before and after the introduction of compulsory vaccination, finding little evidence of a decline. He told his audience that there was at the present time a considerable epidemic in Sheffield, England, despite that city having a high rate of vaccination, with many vaccinated people affected. He also cited Leicester, where the local cleanliness and quarantine strategy had reduced case numbers despite low vaccination rates.

EMP went on to tell of the severe consequences of vaccination for some children, leading them to contract diseases such as syphilis, among others. In conclusion he stated that “he intended, for his children’s sake…to have nothing whatever to do with it”.

He was as good as his word, and in May 1888 was prosecuted for the third time. The local authorities were clearly uneasy about having to take him to court again, feeling that the point had been made and that EMP would never comply with the law. Fining him 5 shillings again, Sheriff Johnstone remarked, “I have no choice in this matter. I must just act as a machine”. Following this, the Parochial Board consulted the National Board of Supervision, requesting that they be allowed to drop the matter, but the response was that EMP should continue to be prosecuted. So in March 1889 he made his fourth appearance in court. His fine was just 1 shilling. A tenacious barrack room lawyer, EMP argued that he should be spared expenses, but the Court told him that to be fair to other ratepayers, he should bear the costs of the prosecution, and billed him one guinea (at another public address EMP helpfully told his audience that for an annual subscription of 5 shillings, the London Anti-vaccination league would pay all fines and expenses of those prosecuted for non-compliance).

Not everybody in Alloa supported his stance, however. Following his third prosecution, an opinion piece appeared in the Alloa Advertiser commenting on his case and offering a more positive view of vaccination, concluding, “There has been so much said during the past few weeks against vaccination that people will be rather astonished to learn that there really may be some good in the thing after all”.

In June 1889, EMP was prosecuted for the fifth time. Following this, the Parochial Board appears to have taken matters into its own hands, and instructed Mr Bowie, the Inspector, not to add Jennie Pulsford’s name to the list of those who had not been vaccinated. The prosecutions ceased, but EMP continued to campaign against vaccination, giving public lectures into the 1890s.

How justified was EMP in his stance against vaccination? His argument about the nature of the vaccine and doctors’ lack of knowledge about what they were administrating was somewhat pedantic – how many medical men really know the nature of the medicines they are prescribing? In citing figures regarding the vaccine’s lack of effectiveness, he followed the time-honoured practice of using statistics selectively and without full understanding. There was, in fact, no inconsistency in there being high infection rates in areas with high vaccination rates, as the disease can still spread readily among the unvaccinated. The suggestion that many vaccinated people in Sheffield had subsequently become infected is likely to have been plain wrong, given the proven high success rate of the vaccine. The ‘Leicester method’ of identifying and quarantining cases of smallpox and their contacts certainly did reduce the prevalence of the disease, but (like today’s test, trace, isolate approach) it relied on successfully finding all cases and enforcing the quarantine strictly. It proved difficult to achieve full compliance and (as anyone ‘pinged’ by the NHS COVID app will testify) was highly inconvenient to those who had to quarantine – and did not offer the permanent solution that vaccination did.

As for EMP’s fears of the dangers of the smallpox vaccine: it could certainly present risks if administered in a sloppy or unclean way, and there are known severe side effects that can affect a small minority of those who receive it. But syphilis was not one of them, though it was a common misapprehension at the time, having been promulgated by a Doctor Moseley, an early vaccine opponent.

So modern knowledge, and mainstream 19^th century opinion, could refute EMP’s arguments. But where did he get his views from? Doubtless his qualms about vaccination had their roots in his time in Leicester in the early 1870s, when that town was in the forefront of anti-vaccination feeling. But it is likely that the real driver of his anti-vaccination stance was closer to home. His prosecutions were for refusing to have Jennie, his youngest child vaccinated. But what of his other four children?

His eldest three children, Emily, Edward and Laurence were all born in Jersey. At that time, there was no compulsory vaccination in Jersey, despite the island experiencing a significant outbreak of smallpox in 1875, the year after EMP arrived. We do not know if his Jersey-born children were vaccinated. But his fourth child, Elsie, was born in Alloa in 1883, and because there is no record of EMP being prosecuted at that time, she presumably was vaccinated. Unfortunately, she turned out to have learning difficulties, and needed life-long care. It seems highly probable that EMP attributed this misfortune to the smallpox vaccine, leading to him turning against it when his youngest child, Jennie was born.

Was EMP justified in this belief? Sadly, it is possible. A rare side effect of smallpox vaccination is post-vaccinia encephalitis, which can cause death in infants and children, and can leave survivors with neurological damage. We do not know if this is what happened to Elsie, but it was extremely rare (12 cases per million vaccinated), and there are many other possible genetic and environmental causes of learning difficulties.

Another question that arises is, if EMP believed that Elsie had been brain-damaged by the vaccine, why did he apparently not use this powerful argument in his public pronouncements? It could, of course simply have been his desire to protect his family’s privacy. But there was also at the time a residue of stigma around having a learning disabled child, even in a liberal household such as EMP’s. While Elsie was not sent to an asylum, as many others were, she remained a shadowy figure within my family, being looked after by her mother Ruth, until Ruth’s death in 1929, when she went to be cared for in another household.

Conclusion

EMP kept his anti-vaccination views until his early death in 1899. The year before, the ‘conscientious objection’ clause had been added to English vaccination legislation, but a similar clause was not introduced in Scotland until 1907. By then, smallpox was in retreat across the UK, ironically through the success of vaccination. Jennie Pulsford did not suffer from her father’s obduracy, growing up to marry the architect Ernest Trobridge and having six children of her own. And judging by the eagerness with which his descendants have embraced the COVID vaccine, EMP’s anti-vaxxer stance died with him.