While rarely considered a ‘skin’ disease per se, smallpox has nearly always been seen as an imprintation of the skin. The story of smallpox contains two figures who visibly exhibited the disease: the pustuled sufferer and the pitted survivor. Its terrible symptoms and sequela were undeniably unique and practically universally recognizable. Robert John Thornton's description of smallpox in 1805 maintained that ‘no disease … presents a more melancholy scene’. Following the earliest symptoms of backache, intense fever and delirium, an eruption of pimples mature into pustules, which then ooze pus before sinking into depressions on the skin. These distinctive ‘pocks’ cluster on the face, neck and arms, and mark an individual as a smallpox sufferer. In severe cases, the ‘human face divine, bereft of every human feature, then exhibits the most distressing sight, being one mass of corruption’. Often permanent, these seams and scars also identify the smallpox survivor. Fortunately, a single attack conferred immunity to the disease; if it had not, Thornton believed, ‘the human race would have presented a frightful spectacle of corroded scars and mangled deformity, or, what is more probable, would have become extinct’.

The competition between two medical responses to smallpox – inoculation and vaccination – underlines the complex interstices of skin and visuality. More than practically any other affliction, smallpox was consistently associated with the terrifying ability to see disease and to visualize infection. Its social meaning resided within practices of displaying the body and, in particular, the skin. It represented contagion inscribed in the flesh of the dangerous sufferer and immune survivor; written across the face, smallpox was shockingly and necessarily spectacular.