Wearable Immunity: Beauty Lessons from the Pockmarking Era

Wearable Immunity: Beauty Lessons from the Pockmarking Era

This pandemic’s “mask wars,” as with the 1918 flu pandemic and HIV/AIDS in the 1980s, have prompted reflections on how the visual cultures of disease prevention have shaped the cultures of fashion. It is timely to think again about how markers of health protection have been donned and displayed and to ask what lessons history provides for today’s conflicts over immunity displays.

I was prompted to consider these questions in a new way by Kentucky Senator Rand Paul, who after recovering from COVID-19 in May stood out as practically the only person in Senate chambers not wearing a mask. “I have immunity . . . I can’t get it again, nor can I transmit it,” he told reporters. “So of all the people you’ll meet here, I’m about the only safe person in Washington.” More recently, he advised Americans who have already had COVID-19 to “throw away their masks, go to restaurants, live again, because these people are now immune.”

Paul’s attitude reflects the assumption that sickness confers personal protection and an equally common yearning to express this protection in some tangible, visible way, such as a naked face. Although masklessness may not catch on as an emblem of immunity (as it has of political affiliation and masculinity), debates over mask-wearing have already started to intersect with cavalier promotions of herd-immunity, attempts to monetize and claim special privileges from previous COVID-19 sickness, and even willingness to contract the virus and “get it over with.”

Great importance historically has been placed on how people express immunity claims, which can reveal the fraught and slippery meaning of “immunity” itself. It also demonstrates that “possessing immunity,” in addition to being a medical designation, has played a part in the cultural experience of gender, race, and beauty.

Illustration of people engaged in innoculation
Allegorical representation showing smallpox resisted by an inoculating woman. (Abbé Jean-Joseph-Thérèse Roman, L’inoculation, Poëme en Quatre Chants [1773])

The history of smallpox inoculation is an excellent case in point. Probably as long as humans have encountered smallpox, they noticed that surviving it meant protection from a second attack. Added to this was smallpox’s uniquely visible stigmata; survivors usually sported permanent pockmarks, often on their faces, for everyone to see.

Smallpox was the most visually ubiquitous disease of the eighteenth century, continually blemishing susceptible persons. According to a Romantic-era German aphorism, “Few remain free from small-pox and love.” It was truly the golden age of pockmarks, with tell-tale blemishes defining normal skin and rich local lexicons describing subtle differences in facial complexion. Newspapers in Georgian England described runaway servants or wanted criminals as “pock-marked,” “pock-pitted,” “pock-fretted,” “pock-holed,” “pit-marked,” or “full of pock-holes,” as well as those easily identified by lack of smallpox scars.

The connection between bodily scarring and immunity doubtlessly contributed to the emergence of smallpox inoculation – in other words, strategic self-infection. Many today are familiar with the story of Lady Mary Wortley Montagu, who had been a famous beauty in the English royal court before contracting a disfiguring case of smallpox at age 26, and who wrote movingly about her disappointment and changed fortunes. Later, in Constantinople, Lady Mary observed the deliberate inoculation with pus from smallpox pustules and eventually prevailed upon her physicians to replicate the process on her daughter in 1721, jump-starting a movement for inoculation in England.

Less well-known is the role played in all this by premeditated bodily scarring. Also known as “variolating” or “engrafting smallpox,” inoculation usually proved much less deadly than the wild-caught disease and averted the worst forms of pustular eruption. Nonetheless, persons rarely escaped receiving at least a few tell-tale scars (they were getting genuine smallpox, after all).

While it faced some resistance, by the 1760s inoculation was widely viewed as a relatively safe and precise procedure. One zealous promoter maintained that if any patient ended up receiving twenty or thirty pustules “he is said to have the Small-pox very heavily.” The good pocky-doctor was purportedly able to prevent his patients from having more scars than they would choose by his “inestimable medicine” (a trade secret, naturally).

Inoculatees aimed for the right sort of discrete scarring to prove their immunity. Pockmarks were sometimes a prerequisite for employment for servants and doctors, as well as a serious consideration for prospective marriage partners or purchases of the enslaved. William Buchan’s bestseller, Domestic Medicine, stated that “such as have not had the small-pox in the early period of life are not only rendered unhappy, but likewise in a great measure unfit for sustaining many of the most useful and important offices.” Pockmarks might blemish one’s looks, but they could also “befit” a person all the more reason to control the outcome with inoculation.

A woman sits topless in the corner of a room, overseen by another person
William Hogarth’s etching of a Turkish Bath, probably influenced by legends of fair Circassian concubines. (English edition of de La Motraye, Travels throughout Europe, Asia and into Part of Africa… (1724).

There were, nonetheless, powerful disparities at work in the visual culture of pockmarks. Indeed, “referring to men, [smallpox] spoke of the danger to life; referring to women, of the danger to beauty.” A commentator in 1721 claimed that inoculation exemplified a “Tender Regard for the Health and Beauty of all; but especially of the more agreeable Part of Creation, I mean the Fair Sex.”[1]

The rising popular image of inoculation was of a “victory for beauty” – primarily for women, and as appreciated by men. Oliver Goldsmith’s 1773 play, She Stoops to Conquer, has a nettling matron opine: “I vow, since Inoculation began, there is no such thing to be seen as a plain woman. So one must dress a little particular, or one may escape in the crowd.” To be sure, this may likely have been a sarcastic send-up of poets like William Lipscomb, who earnestly linked the fate of the nation with the reputation of its women’s faces. He portrayed Lady Mary as fired by “Pure patriot zeal” to bring inoculation home from the East: “Full well she knew when Beauty’s charms decay’d / Britannia’s drooping laurels soon would fade.”

On the other hand, inoculation never lacked for detractors, and its marketing as a preservator of feminine enticements was attacked for fueling immodesty. Inoculators had “invited the Timerous, as well as the most Beautiful of the Fair Sex, to be fond of this Practice,” one critic seethed. Inoculation, like smallpox itself, could provoke stark messages about female vanity and its inevitable comeuppances. One parable told of a famously beautiful woman fastidious to safeguard her treasure but keen to purchase only a couple of pustules from the inoculator; as it happened, she had no more than that, but the two scars fell upon her eyes and she was thereby blinded by the attempt.

The cultural association between smallpox and female beauty was further solidified by a lurid Orientalist fantasy involving child sex trafficking. Voltaire famously attributed the origins of inoculation to the Circassian peoples of the northern Caucasus, surmising that “the Circassians are poor and their daughters are beautiful, and indeed it is in them that they chiefly trade” as concubines to the harems of Turkey and Persia. The travel writings of Aubry de La Motraye claimed he had witnessed inoculation among the Circassians, described as an oasis of (white) physical perfection among a multitude of “deformed” folk. English and French medical theorists considered the strange glamour of the concubine an effective tool to promote inoculation, almost universally agreeing that it had been invented by “rustic old women” to preserve the value of handsome girls (constantly described as embodying a sort of primordial Europeanness) auctioned to wealthy Eastern princes.

Do ladies everywhere “not care about their beauty?” asked Voltaire, who advocated inoculation as a piece of courageous fashion. While he assumed the answer to be obvious, others were less sure, given that it ran counter to the narrative of severe pockmarks correcting women’s vanity. The Circassian flesh trade was held up by Quaker Sophia Hume as proof to her mind that inoculation was a wicked practice. Yet, despite the dubiousness of the entire story, the figure of the Circassian concubine became a central trope within Western discussions of smallpox immunity. It also contributed a cornerstone to the fascination with “white slavery” and the many voyeuristic depictions of Eastern harems that crop up in European art for two centuries.

To be sure, the myth was never entirely precise as to its meaning: were Circassian girls inoculated because they were beautiful, or beautiful because they were inoculated? This vagueness allowed strategic immunity to become tied to the possibility of acquirable, wearable “whiteness.” English commentators, for example, debated whether inoculation might allow some of that legendary Circassian comeliness to be imported into the national physiognomy – if foreign contagion might be “Naturalized to our Advantage.”

It is difficult to say just how much smallpox inoculation was practically embraced as a beauty aid, but it is clear that the procedure sparked a cultural conversation around the preservation of beauty almost as much as the preservation of health. Having become wearable and flauntable, immunity was perhaps destined to be gendered and raced, even though the beauty of inoculation rested on guaranteeing a little bit of pockmarking.

Today we should be conscious of how responses to COVID-19, including the rollout and promotion of new vaccines, will hinge in part on the visible exhibition of immunity, which might even be seen as beautiful.


    1. Jacob de Castro Sarmento, A dissertation on the method of inoculating the small-pox (London, 1721), 1.

Matthew Newsom Kerr is Associate Professor of History at Santa Clara University. He is author of Contagion, Isolation, and Biopolitics in Victorian London (Palgrave, 2018) and is currently working on a cultural history of smallpox, inoculation and vaccination in the 18th and 19th Centuries.