CIRCULAR. 
CONFEDERATE STATES OF AMERICA, 
Surgeon General’s Office, 
Richmond, Va., Oct. 16, 1863. 
The pernicious results which have followed the careless employment of 
impure virus in vaccinating the army, require that the attention of medi- 
cal officers be called to the subject, and that they be urged to abstain from 
the use of virus not of specific and from subjects not per- 
fectly healthy. 
In most cases it is perfectly practicable for the surgeon to procure from 
the vaccination (gratis) of healthy infants, sufficient material for perfect- 
ing this protecting process among those under his charge, and' there can 
he no excuse under any circumstances for his inoculating the system 
with that, concerning the purity of which he has any doubt. 
By reason of the rapid increase of our armies, the attention of medical 
officers in field and hospitals, and at camps of instruction, is earnestly 
called to the necessity for continued vaccination, and it is hoped that 
their industry and assiduity in its prosecution, will obviate the call for 
any further instructions on the subject from this office; 
The observance of the requirements of paragraph 50, Regulations for 
the Medical Department, is strictly enjoined. When conscripts not vac- 
< inated are received at regimental head quarters from camps of instruc- 
t ion, the regimental surgeon will forward a statement of the facts through 
this office to the commander of such camp, for his information. 
Blank Forms of Vaccination Reports for the district embracing the 
States of North Carolina, South Carolina, Florida, Alabama and Missis- 
sippi, will be procured by requisition upon the Inspector and Superin- 
tendent ol Vaccination at Columbia, S. C.; and for the district embracing 
the States ot N irginia, Tennessee and Georgia, from the Inspector and 
t Superintendent of Vaccination at Richmond. The reports, properly com- 
-1 letcd, will bo forwarded to this office. 
The following instructions relative to vaccination are published for the 
information and guidance of medical officers. 
SAM’L PRESTON MOORE, 
Surgeon General. 2 
The best instrument for the purpose is an old lancet, with the point 
broken off. The little angles thus formed are admirably well fitted for 
the operation; and the lancet cannot then (as it ought never to) be used 
for any other purpose. Prepare two glass plates two inches by an inch 
and a half. Lay a small piece of crust upon one of them; add a drop 
or two of water; lay the plates together, and grind the crust with the 
water to the consistence of mucilage. Grasp the patient’s arm with your 
left hand, so as to draw the skin tensely. Dip the lancet in the solution 
of virus, and place a little upon several spots in a group over the inser- 
tion of the deltoid muscle. Make several light incisions in each of these 
spots. The incisions should be barely deep enough to draw blood. 
When the hand is. removed from the arm, the gaping incisions close, re- 
taining some of the virus between their edges; and it is therefore not 
liable to be rubbed off. Let the solution of virus and the blood become 
Mode of Vaccinating with the Scab. 
perfectly dry, and then the sleeve may be slipped upon the arm, without 
risk of rubbing off the virus. 
The mode of vaccination by scraping off the epidermis, takes a longer 
time, and the virus, is more liable to be rubbed off. The mode of insert- 
ing a piece of scab within the skin by incision, is more wasteful of virus; 
and as but little of it is dissolved, the remainder is liable to act as a foreign 
body, thus producing suppurative inflammation, and interfering with 
absorption. 
Mode of Vaccinating with Lymph. 
Prepare several pieces of thinly cut bone or whalebone about an inch 
and a half long and one-fourth of an inch wide, and round off an end of 
each, or cut off the barrel of a goose quill at each end. On the seventh 
or eighth day, while the vesicle is umbilicated, and retains its pearly 
lustre, and before the areola has fully formed, puncture the vesicle at its 
edge. Dip the rounded ends of several pieces of bone, or turn round 
one end of a quill-barrel in the clear lymph which oozes from the punc- 
ture, and allow the coating of lymph to dry. One or two more coatings 
of lymph may bo added. Split the quill-barrel into four or six strips. 
These should be wrapped carefully and dated. The virus cannot usually 
be preserved in this mode longer than a week or ten days; but it may 
be procured at an earlier day than the scab, and seems to be more active, 
if procured early. There is reason to believe that the earlier the lymph 
is procured, the greater is its activity. To the lymph, make the in- 
cisions as before, and rub the ends charged with virus upon them. The 3 
blood which oozes from them dissolves the virus, which is thus deposited 
between their edges. 
Spurious Vaccination, as it has been called, which is only a successful 
effort to cast off the poison as a foreign body, is especially liable to occur 
if the virus be not of good quality, or in vaccinations where the system 
is fully protected. 
Diagnosis. 
Always examine the patient not later than the day week after vaccina- 
tion. If the vesicle be umbilicated, if it have a jlear pearly lustre, and 
at the close of the eighth day be surrounded at its base by a narrow 
bright red areola (“ the pearl upon the rose”), the vaccinia is genuine. If 
there be an accuminated pustule, it is spurious; and if it be a primary 
vaccination, it must be repeated. 
To secure the Scab. 
In the best sample of virus, the scab drops, or is ready to be removed, 
on the fifteenth day. The proper rule then in using this virus, is to visit 
the patient on the day week from date of vaccination, for the purpose 
of inspecting the vesicle, and to visit him again on the day fortnight, for 
the purpose of removing the scab. As an additional security, the scab 
may be covered with isinglass plaster two or three days before it shall be 
ready for removal. If this rule be observed punctually, there will be less 
complaint of the want of protective power of vaccinia, and of the loss of 
scabs through the carelessness of patients. 
Appearance of the Scab. 
The scab should be circular or oval, of a light mahogany color, umbi- 
licated, translucent, and when dry, having a resinous fracture. If it have 
been taken from a negro, it will be of a much darker color, nearly black, 
or of a walnut color. If taken from a mulatto, the shade of the scab 
will vary with that of the skin. If the scab have a whitish, yellowish or 
light oak color, and be of a crumbling, scaly character, reject it. 
Soften a piece of gutta percha in boiling water, and roll it into a cylin- 
der about three-eighths of an inch in diameter, between two boards; then 
roll it with a round rule, into tile form of a thick tape, about three-fourths 
01 an mch broad. (In working the gutta percha, the implements used 
as well as the hands should be kept constantly wet, to prevent, the gutta 
percha from adhering.) Cut this tape into pieces about an inch and a 
half long, or cut sheet gutta percha one-fourth of an inch thick into pieces 
To preserve Vaccine. 4 
of the above dimensions. Hold a piece with forceps, near a flame until it 
is well dried and softened. When the temperature is about that of the hand, 
cut the scab, which has been well dried for four or five days, into four or 
six pieces, and lay one of these on the strip of gutta percha, near one end, 
and then double over the other end upon it; press the gutta percha toge- 
ther around the piece of scab, to exclude the air; then roll it between the 
hands, and press the ends with the fingers until it is moulded into the 
form of a capsule. It is better to put up pieces of scab, because when 
a capsule is opened, the contained piece must be used immediately. The 
virus thus hermetically pealed may be preserved in an active state for 
several years. The capsules being small and of tough material, are ad- 
mirably suited for transmission by mail. 
The following rules and regulations are recommended for gefferal 
adoption: 
First.—Select the virus from a stock which has been found to produce 
characteristic effects, and to afford complete protection, and use that from 
infants only, as far as practicable. 
Second.—Observe carefully the appearance of the vesicle on the seventh 
or eighth day. 
Third.—Remove the scab from the fifteenth to the twenty-first day, 
and never accept that carelessly obtained by nurses, &c. 
Fourth.—Select a few scabs; seal them hermetically in gutta percha, 
and lay them aside in a cool, dark place. 
Fifth.—Whenever a soldier, sutler, servant or other employee is re- 
ceived into the army, examine his arm, make a record of his case, and 
revaccinate him. 
Sixth.—At intervals of ten years, revaccinate the entire army. 
Seventh. -—Whenever small-pox may occur' as an epidemic in any lo- 
cality, vaccinate all the men in that locality and also all citizens in the 
neighborhood who have not been recently vaccinated. 
Eighth.—Prohibit the men from vaccinating each other, in order to 
avoid the dangerous consequences of spurious vaccination, and see that 
this regulation is strictly enforced. 
Ninth.—Make careful observations, and keep strictly accurate records 
of all vaccinations. 
Note.—By Circular of December 22d, 1863, medical purveyors were directed to 
issue, upon «he requisitions of medical officers, all material required in the preceding 
processes, with the exception of vaccine, which will be supplied from the Surgeon 
General’s office.