PROPHYLACTIC IMMUNIZATION OR VACCINATION 623 



In active immunization for therapeutic purposes the conditions 

 should be carefully weighed and the treatment conducted by one who is 

 qualified to judge of the potencies of harm and good in a vaccine, and 

 who has had sufficient experience to guide him in dosage and frequency 

 of inoculation, the main objects being to tide over and aid nature during 

 an acute infection, and to arouse and stimulate her during a chronic 

 infection. 



In prophylactic immunization the physician should satisfy himself 

 that the patient has no latent or active infection that may be rendered 

 worse during the temporary depression that follows inoculation. It is 

 true that this depression is fleeting and temporary, and that the possi- 

 ble harm incurred may be far outweighed by the ultimate good, but vac- 

 cines should be given with proper discernment and not carelessly and 

 injudiciously. These remarks have no relation to cowpox vaccination, 

 where the good so far overbalances the possible harm that in general 

 all persons should be vaccinated, especially if an epidemic is impending. 



(a) Tuberculosis. There is at present some discussion relative to 

 the harm that may be caused in tuberculosis by typhoid immunization. 

 Probably all will agree that a patient with an active and acute tubercu- 

 lous lesion should be refused inoculation, but when the lesion is quiescent 

 or healed, or in the early latent stage, it is indeed difficult to understand 

 how a prophylactic dose of typhoid vaccine will do more or as much 

 harm as an attack of tonsillitis, rhinitis, or some similar acute infection. 



(6) In diabetes, carcinoma, and other debilitating conditions vaccines 

 should not be administered unless the indications or requirements are 

 unusually urgent. 



(c) Advanced nephritis, especially parenchymatous nephritis, may 

 be regarded as contraindicating the administration of a vaccine. 



PROPHYLACTIC IMMUNIZATION OR VACCINATION 



SMALLPOX 



Historic. Just when and where smallpox vaccination was first 

 practised is not known. The original method of inducing immuniza- 

 tion against the disease by introducing the virus from a smallpox pa- 

 tient into a healthy person through an abrasion of the skin and thus 

 greatly diminishing the virulence of the disease was practised by the 

 Turks during the eighteenth century, the chief object being to preserve 

 the beauty of the young Turkish and Circassian women. In 1878 Lady 

 Mary Montagu, the wife of the British Ambassador at the Ottoman court 



