668 ACTIVE IMMUNIZATION 



cines should be given with proper discernment and riot 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 

 in Constantinople, observing this practice among the Turks, had her 

 own son and daughter inoculated and was largely instrumental in estab- 

 lishing the practice in Europe. 



As regards the prophylactic value of this method of inoculation in 

 England and continental Europe, statistics are incomplete, but the 

 literature of contemporary writers shows that protection was usually 

 complete. The induced disease was not, however, always mild, and not 

 infrequently assumed an unexpected virulence that not only proved dis- 

 tressing and even fatal to inoculated individuals, but also constituted a 

 source of infection to a community. While, therefore, the underlying 

 principles were sound, and while these early attempts at preventive 

 immunization mark an epoch in the history of medicine and of the world, 



