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Lancet with a steel blade that folds into the
tortoiseshell handle, used by doctors to
administer smallpox vaccinations

Smallpox was more feared than the enemies bullets. When the Civil War began, vaccines that used human scabs as their source were an unperfected new product. The procedure for administering the vaccine was itself so crude that it often created problems. Each man would wait in line for a doctor to cut his arm three or four times with a knife, then put a little of the vaccine into the wounds. The doctors "wholesale slashing and cutting of arms" gave the men sore arms for 10 days.

Smallpox thrived in dirty conditions and affected soldiers and civilians alike. Prisoners of war on both sides died of the disease. Many poor blacks living in dirty refugee camps on the outskirts of Washington, D.C., also perished of smallpox. Their clothes were often sold to secondhand shops, thereby spreading the virus, which could live in the clothes for 18 months.

The Confederate army saw their first cases of smallpox after contact with Yankees at Sharpsburg. With an outbreak threatening their army, all Confederates were ordered to be vaccinated. Doctors went out and vaccinated healthy children and then used the scabs to make more vaccines for their soldiers. Many soldiers, not willing to wait for the doctors, vaccinated one another using dirty pocketknives and scabs from fellow soldiers. Their contaminated, large cuts often resulted in nasty infections.