Talk:Smallpox

Mortality in Introduction

In the second paragraph of the introduction, the article states that V. major has a 30-35% mortality rate, and that V. minor has a 1% mortality rate. In the third paragraph, it says of all those infected, 20-60% are killed. These quotes are inconsistent (omitting unstated and very strange error bars in the data presented in paragraph 2) and ought to be fixed by a knowledgeable editor. DAID (talk) 10:35, 7 October 2009 (UTC)

Mortality numbers discuss only European history. As I understand, smallpox was largely responsible for the literal decimation (i.e., reduction by 90%) of native immunologically naive populations in North and South America. — Preceding unsigned comment added by 205.82.145.139 (talk) 18:42, 30 March 2012 (UTC)

• Decimation means reduction by 10%. Graham Colm (talk) 19:46, 30 March 2012 (UTC)

300-500 million sounds excessive. The references themselves say "some estimates" and therefore are not to be trusted. Can we have some real reference for this or take it out altogether? Chengiz (talk) —Preceding undated comment added 01:50, 6 March 2013 (UTC)

Catch-all phrasing in early disease

Regarding Edward VI of England and smallpox: Contemporaries attributed Edward's early death to "consumption" - but tuberculosis as a distinct disease was unknown at the time. During this period in Europe, consumption, or "Phthisis", was a name attributed to various diseases with symptoms such as emaciation (serious loss of weight), debility, cough, hectic fever, and purulent expectoration. Edward's personal journal, as well as several court accounts, note that he had recovered from an apparently mild case of smallpox only weeks before his death. He resumed his regular activities, including travel, but relapsed suddenly and died. Although he was only of modest size and weight, Edward's health had been considered good until his last illnesses, i.e. no long term evidence of a history of tuberculosis. Will look for a source I read not long ago. WBardwin (talk) 07:04, 13 October 2009 (UTC)

Here is something from the web: There are varying schools of thought about the cause of Edward's death -- like many young Tudors before him, he wasted away prior to his death, and his final illness has been traditionally believed to be tuberculosis. However, he had also contracted either smallpox or measles in the year before he died, and his wasting could also be attributed to diabetes, which frequently becomes severe during the growth spurts of adolescence. It is known that he was treated with medicines that contained arsenic, and that he had many of the symptoms of arsenic poisoning while on his deathbed (his hair and nails had fallen out, he was covered with ulcers, and there was a peculiar smell, similar to garlic, on his breath). Many medicines used at the time contained arsenic, and it was sometimes added to wine as well, so whether Edward's death was hastened by deliberate poisoning or not is questionable. [1] But I read quite a comprehensive discussion of Tudor health in hardcopy. Somewhere............WBardwin (talk) 07:15, 13 October 2009 (UTC)

A map

This is an interesting map [2] Doc James (talk · contribs · email) 21:27, 9 December 2009 (UTC)

Taxonomy Box

When the subject is a horrible virus that has no ecological niche other than to cause pain, suffering, and death, is the taxo box a thing that is really useful to have? It's not like the life form (if a virus can be considered "life") contributed to biodiversity or the functioning of the ecosystem. It is thus unlike other species that humans have eradicated. The genocide committed against the smallpox virus was undeniably beneficial to humanity, with no effect on the biosphere - unlike the Dodo, the Scimitar Oryx, the Guam Rail, and the Mason River Myrtle. Is there a property of the taxobox (or could there become one) to show an intentional, humanitarian eradication of plagues? This would also fit in the box for polio, where it would read something like "Critically endangered - but not yet accomplished." ☯ Z.S. ☠ ......(talk) 02:20, 27 April 2010 (UTC)

IUCN Red List Extinct in the Wild

I am removing this category, because while smallpox may be eradicated, it is not on any of the IUCN red lists! Try searching for it here if you don't believe me. 71.188.115.167 (talk) 03:02, 28 June 2010 (UTC)

Now the table says "extinct", which is false. It may have no official IUCN status, but it is "extinct in the wild", not "extinct". Samples of the virus still exist, and it may be (maliciously or by accident) reintroduced to the wild.--Azarien (talk) 14:06, 22 July 2010 (UTC)

The Virus is not completely eradicated, there were cases of Smallpox in India, in a town called Uta Pesh sometime between 2002 and 2003, National Geographic published an article about it in its monthly magazines sometime around this time.

Also if you check this link, posted earlier this year, India is the last refuge for the virus. Smallpox Jitters India After 28 years —Preceding unsigned comment added by 66.21.147.129 (talk) 20:07, 29 October 2010 (UTC)

Save that there have been zero confirmed smallpox cases since shortly before it was announced globally eradicated. Zero. None. At all. Every case turned out to be some other pox virus.Wzrd1 (talk) 04:55, 30 November 2012 (UTC)

File:Child with Smallpox Bangladesh.jpg

I suspect this has been raised before, but is there any reason File:Child with Smallpox Bangladesh.jpg is not used in the article? J Milburn (talk) 19:11, 12 August 2010 (UTC)

Agree. Doc James (talk · contribs · email) 18:47, 6 September 2010 (UTC)

That picture was removed because it's absolutely nightmarish. Lots of people complained about it here. Wikipedia is an encyclopedia written for everyone, not only medical professionals. Evenfiel (talk) 23:22, 14 October 2010 (UTC)

What is wrong with this image? The others do not properly display the dimple. If we do not have a proper image of small pox in the lead and this disease comes back and people do not recognize it we have done the world a disservice. Returned the image again. Smallpox is BTW a disturbing disease. Little over a hundred years ago it was the leading cause of death in North America. It is one of the successes of modern medicine via vaccination. Russian and the USA still hold stockpiles of the stuff to us as biological warfare.Doc James (talk · contribs · email) 20:50, 24 October 2010 (UTC)

This picture is currently a featured picture. Doc James (talk · contribs · email) 14:47, 9 November 2010 (UTC)

GA Review

This review is transcluded from Talk:Smallpox/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Garrondo (talk) 18:26, 16 November 2010 (UTC)

I have taken a quick read of the article and it is great. I believe it is clearly above GAN, and there should be no important issues. Nevertheless I suppose the intention is to take the article to FAC so I will try to do a more in depth, useful, review as I have time (I myself have a GAN at a similar point). I also have to say that I am not a physician but a psychologist working in neurology research, so a I will not be able to check for accuracy, but I will for readership.

Some general comments:

• The article is very, very long, and therefore horrible to load. While I understand that sometimes seems a good idea to have all content in a centralized article in this case it is probably worth summarizing and creating a subarticle of the history section. At this point even the history section by itself could pass a GAN!!!
• To follow MEDMOS sections a "society" section could be created with two subsections: warfare and famous patients. (I would eliminate the and culture from the name per having warfare as subsection.
• When finishing writing a disease article I find it useful to try to eliminate the name of the disease as many times as possible in the article: overuse is most of the times the case. I will probably be also a good idea to do it here: a first clear example from classification: There are two clinical forms of smallpox. Variola major is the severe and most common form of smallpox, with a more extensive rash and higher fever. Variola minor is a less common presentation of smallpox, and a much less severe disease, with historical death rates of 1% or less can be converted into There are two clinical forms of smallpox. Variola major is the severe and most common form, with a more extensive rash and higher fever. Variola minor is a less common presentation of, and a much less severe disease, with historical death rates of 1% or less

Lead: summarizes adequately the article and it is interesting. As minor comments:

• It should be the most accesible part of the article: it would be a good idea to explain the meaning of Maculopapular
• Specific date of death of the Ramses is probably not needed in lead: everybody knows that they are ancient...
• 2 times year in the same sentence is not very nice. In er year during the closing years
• In the last 2 paragraphs it is quite clear that it was a terrible disease. Maybe some of the numbers could be eliminated for the sake of simplicity... with half of them is probably enough to make the point. Similarly it is quite clear that numbers are stimations, so there is no need to say it each time.
• Month of erradications unneded in lead (been bold and eliminated myself).

Classification Does a nice job classifying the disease subtypes according to symptoms.

Signs and symptoms

• Orofaringeal and respiratory are not the same?
• the virus seems to move from cell to cell: do not know much about virology, but this hardly seems an accurate description.
• An explanation of toxemia?
• bleeding into the skin: Sounds strange although it may be me since my mother-tongue is not English.
• This form develops in perhaps 2%: perhaps sounds strange. In addition all paragraph is unreferenced.
• In the early, or fulminating form, hemorrhaging appears on the second or third day as sub-conjunctival bleeding turns the whites of the eyes deep red. : Not sure I understand this sentence: too technical, akward wording, not clear meaning...

More to come...--Garrondo (talk) 19:35, 16 November 2010 (UTC)

Comment Hi, hope you don't mind me dropping in uninvited. I've had this article on my watchlist and my "to-do" list to bring to GA/FAC, so I'm glad someone else has picked up the ball! I've dropped a number of cite needed tags to various places that need them. There's more citations needed in the "Famous sufferers" section, but the whole section needs to be written into paragraphs rather than isolated sentences. Let me know if you need help with finding sources Nergaal, I have access to a lot of literature on the subject. Good luck! Sasata (talk) 19:07, 16 November 2010 (UTC)

I fully agree with comment above.--Garrondo (talk) 19:35, 16 November 2010 (UTC)

Comment I rewrote and expanded this article way back in December 2007, with the intention of taking it to FAC. I've kept an eye on it over the years, but unfortunately real life got in the way and I never found the time to get it up to FA-caliber snuff. I am happy to see that it has now been nominated as a GA. A few notes:

• I spun out a LOT of the original history section to its own article already, but the History of smallpox article is a mess, perhaps if the history article were cleaned up some of the information in the main article could find a home there.
• Most of the disease information (i.e. signs, complications, treatment, diagnosis) came from the CDC pink book (ref 18 in current version) or the AFIP (ref 4). If you are looking for citations for specific numbers they probably came from one of those sources.
• The "sufferers" sections will likely require a lot of work. One suggestion might be to turn it into List of smallpox sufferers or something. For a similar approach see List of poliomyelitis survivors.

Please let me know if I can be of any assistance.--DO11.10 (talk) 22:52, 16 November 2010 (UTC)

• Woow. Lots of things to fix. I thought this would make a good GA when I read it. Shooting for FA would be a nice idea but I am not sure I have the time in the near future to deal with something like that. I will try to fix the issues listed here over the weekend. Nergaal (talk) 05:17, 18 November 2010 (UTC)

Since the nominator will have time difficulties ammending the proposed changes and does not have the intention of taking the article to FAC in the near future I'll leave my comments as proposals for future improvement and a do a review only of GAC. If in the future this comments are fixed and anybody thinks it could be useful I will probably be willing to continue with the started review.--Garrondo (talk) 14:40, 23 November 2010 (UTC)

• 1. Well-written: Yes: I (a non expert) followed it easily, and learnt a lot of a disease I did not know. As pointed above some technical terms should be explained in the future
• 2. Factually accurate and verifiable: Yes: sources are of medium to high quality and most content is sourced.
• 3. Broad in its coverage: Yes, although it may be too broad, as pointed above with the history section. I found the article to be quite demanding due to its very broad coverage
• 4. Neutral: Yes
• 5. Stable: Yes, although there seems to be some debate over image use.
• 6. Illustrated, if possible, by images: Yes.

Please please take down that picture, it gives me nightmares, and I'm 42. I wonder how many people this pictures has scarred for life. God! —Preceding unsigned comment added by 99.146.20.134 (talk) 03:45, 17 November 2010 (UTC)

Sorry, but Wikipedia is not censored. Reaper Eternal (talk) 03:47, 17 November 2010 (UTC)

does anyone know if shes ok? (p.s.: i would move the pic down.)Jake1993811 (talk) 09:55, 30 December 2011 (UTC)

• Comment/question Have people gone mad? Who is there here who thought smallpox was a cutesy little childhood malady that we can now ignore, together with syphilis and seasickness? If you want to sit back and tsk tsk smugly about a disease that in its final 3/4 century or so, long after a cheap and effective vaccine had become available, took more human lives than all the wars of that century combined, and ruined more lives than it took, then go and read something else; this one is not for you. And if the picture is what it takes to convince you of that, then you needed it. If sanitised tragedy is your preferred genre, read about the history of Manchester United F.C. or about the career of Errol Flynn. For you the highly unsanitary likes of smallpox, plague, yellow fever or the like are unsuited, and you will never wish to understand what they once meant to people and to nations. HIV is a picnic in comparison; so is Ebola and it will remain so until it mutates into seriously human-contagious form. All that is fine, as long as you don't have to look at a nightmarish picture? Did you not want to know the dread of such a sickness or why it was dreaded? The article is about the facts and one fact is that no matter how great the eventual triumph of scientific medicine, the disease was hideous, which is what the picture shows. Obscenity? The real obscenity is the idea of consigning that picture, and by implication the sufferings of that child, to the waste-basket of history. Her picture is a lesson, an item of education too dearly bought to pay for in advance, and too valuable to discard in retrospect. If you want to ignore it, read something else, watch something else, but don't try to hobble the education of serious students by indulging your own grizzlings. JonRichfield (talk) 12:41, 3 April 2014 (UTC)

Sick child picture

Is it necessary to have such a disturbing picture at the top of the article, or anywhere in the article for that matter? What do pictures of children add to the article that pictures of adults would not? —Preceding unsigned comment added by Flailing12 (talk • contribs) 00:19, 17 November 2010 (UTC)

Some Wikipedia people obviously have horrible taste. What if a child saw that awful picture? Wilsonbond (talk) 03:59, 17 November 2010 (UTC)

Are we supposed to find a nice picture for this horrible disease? Small pox was once the leading cause of death in the United States. Millions suffered and died. This is one of the great successes of medicine / immunization. It is one of the only disease that has ever been illuminated. Thus this picture stays. It reminds those who protest that we should no longer immunize children why we started in the first place. Hopefully people do see it so they understand.--Doc James (talk · contribs · email) 04:04, 17 November 2010 (UTC)

Replying to "What if a child saw that awful picture?" I showed my 2.5, 5, and 6 year children that picture this afternoon, explained to them what the disease was, how it killed so many people, what a virus is, etc. They are now more knowledgeable, and were not in the least "disturbed" by having seen it; rather, they were interested and inquisitive, and asked questions, which led to further wiki-exploring. What's the issue? Why should the rest of the world be forced to submit to your standards of "offensive"? Sasata (talk) 04:48, 17 November 2010 (UTC)

You don't get it. Just like an article on human reproduction does not need a pornographic picture, an article on a disease does not need a horror picture. It's not censorship, it's common courtesy. It's the same idea as not to tell colorful jokes at work place. Wilsonbond (talk) 04:27, 17 November 2010 (UTC)

Sure, the picture makes my heart hurt for the kid, but the image does it's job of showing the nastiness and horror of the disease.--intelati^talk 04:34, 17 November 2010 (UTC)

Smallpox was a horrible disease; trying to show it as something else isn't truthful. If people get offended by the truth, that's their problem. Allens (talk) 11:54, 18 October 2011 (UTC)

You don't educate people by offending them, that picture (not that poor girl) offends people. Wilsonbond (talk) 04:40, 17 November 2010 (UTC)

It is a great picture and the best one I have seen that illustrates the disease. Do you have a better one? Doc James (talk · contribs · email) 04:55, 17 November 2010 (UTC)

What you are pursuing is sensationalism, so don't pretend it's all for the truth. I'm sure there are plenty of less graphic picture of that disease. Just to show you what bad taste means:　Brandon Lee's death footage was destroyed without being developed, because watching it would be in bad taste. Thank god people like you did not get your dirty hands on that! Wilsonbond (talk) 05:02, 17 November 2010 (UTC)

This is simply what smallpoxs looks like. We are not going to censor it. Please WP:AGF. Doc James (talk · contribs · email) 05:22, 17 November 2010 (UTC)

Agreed that it is a good picture: smallpox was a horrible disease, which thankfully has been erradicated. We describe symptoms both with words and images, and for the latter I believe this is a great image. I am no physician, I did not knew how smallpox looked like and the image was produced a high impact on me, but also gave me more info in a single second that all the symptoms subsection.--Garrondo (talk) 07:17, 17 November 2010 (UTC)

On a side note: please do not make personal attacks or assume bad faith.(See: WP:civility)--Garrondo (talk) 11:44, 17 November 2010 (UTC)

This picture may be an efficient representation of the disease, however, it's pretty much on par with gore. For example, one could have a picture of a car accident with a severed head in the wikipedia page for decapitation. This would be the most likely modern cause of decapitation and it would accurately portray the article. You could also argue decapitation is a horribly socking thing, that needs an equally horribly shocking picture. Yes yes, I call strawman on myself, but to the point; Gore images affect the readability of the article for some users. It's not at all uncommon for children to have to research smallpox, so at the least there should be a way of hiding the image, like a link that says [hide image] above it. Rather than being artsy and trying to maximize representation I suggest we maximize the amount of information portrayed when deciding which picture to use. Technically a mound of rotting dead babies with smallpox is a better representation of the disease, but it's obviously in bad taste. As neutral writers we do not need to add more dramatic emphasis or find the most poetic representations, the content will speak for itself. Showing smallpox lesions are enough, having it be a child at an advanced stage only furthers the gore level while not contributing information. Furthermore, if a picture is used, it should be attached to the symptoms section. The physical manifestations are not the only definition of the disease. JimmyRuska (talk) —Preceding undated comment added 08:38, 22 November 2010 (UTC).

Feel free to propose or provide a superior image. There is a discussion about creating image settings for children and the faint of heart / easily offended. Not sure where they are currently in this process but this will make all potentially offense images easier to self censor. Wikimedia is in the process of hiring further staff so hopefully this will be possible soon. Doc James (talk · contribs · email) 09:15, 22 November 2010 (UTC)

Articles like rinderpest, HIV use a different approach, articles like chickenpox and measles use the physical manifestations, but in a more tasteful way. I do not know what is standard practice and I have no suggestions other than the assertion the current picture is probably inappropriate. I only passed by because there seemed to be debate and I felt strongly to chime in; as far as image rights and implementation, I am clueless. It's important to differentiate the level of gore though. Think back to what popular culture often uses for horror, you find: zombies, mutants, demons, dolls, aliens, and basically anything that looks like a diseased or horribly mutated, diseased or injured humanoid-looking creature, especially with detail in the face. The brain is used to automatically gauging attractiveness as a natural method of finding a healthy mate. The more carnage, the more deathly or sickly the picture is, the higher the emotional response will be, more so than any non human-looking entity could ever elicit in terms of reactive horror. On a scale of things that will most likely make people uncomfortable, I think a little girl, probably near death and covered with scarred sticky pustules ranks up there with a picture of a needle going into someone's eye, somewhere at the top of the scale of max-discomfort-inducing-efficiency. It's pretty strong, and not just another typical medical picture. JimmyRuska (talk) 09:56, 22 November 2010 (UTC)

The image can impose an emotional harm on the reader who may be passing by doing research on the subject. I agree with the person above, that the image of the little girl covered in diseases is very graphic. Some may argue it is needed to show whafft smallpox look like, and there is a lack of alternative. In that case, at the very least, there should be a warning on the image. Personally, I have had two nights of nightmare because I stumbled upon this article. Respectfully Yours. 68.6.110.128 (talk) 05:04, 11 December 2010 (UTC)

I am trypophobic and clusters of holes bother me physically (throat tightening, hands itching, skin crawling) as do clusters of bumps like the image (or what I could make of it; I closed it very quickly). Many people who have trypophobia may even start to hyperventilate if they see images that bother them. The image is a safety hazard for trypophobic people and others who are bothered by clusters of bumps/holes. I think the image should be removed for this reason. 72.219.176.11 (talk) 10:07, 2 March 2011 (UTC)

50-70% of physicians use Wikipedia weekly. No physician in practice less than 30 years has seen an active case of smallpox. If we do not see images as they are suppressed due to concerns of causing harm to trypophic people and a delay in a smallpox diagnosis occurs millions of excess people could die as a result. The risk that smallpox recurs is not that small. Both the USA and the former USSR have large about of smallpox in weapon form. Also we are an encyclopedia. This our goal is to provide the sum of all human knowledge. This is part of that knowledge.

So to conclude I am more worried about preventing real world nightmares. This can be done by not only educating people about how horrible small pox is but working with the USSR and the USA to decrease there stockpiles of this infectious disease and may be even eliminate it entirely. Doc James (talk · contribs · email) 17:04, 2 March 2011 (UTC)

That some percentage of physicians use Wikipedia seems irrelevant. It's not a resource for physicians; one expects specialists would have their own, specialized resources. The justification that this image would allow people to more rapidly identify smallpox doesn't seem applicable to the vast majority of users. Obonicus (talk) 02:47, 28 November 2012 (UTC)

This image does bother me, but I think it's not the rash, rather her black eyes. Could we change it to this image instead?

I would certainly vote to use a different picture. Seeing it makes me want to exit the page - not read on and learn more.Tklink (talk) 21:18, 11 May 2011 (UTC)

I like the current image. It illustrated the condition well. Doc James (talk · contribs · email) 21:33, 11 May 2011 (UTC)

Another vote for replacing this image with one less graphic. It may be that medical professionals need to consult an accurate representation of the disease; if this is the case I should hope that they consult an appropriate medical text, so that Wikipedia can remain usable for the rest of us. IronSheep (talk) 01:19, 1 July 2011 (UTC)

I've moved that image further down in the article. Evenfiel (talk) 13:38, 7 August 2011 (UTC)

No consensus for the move thus returned. Soon people will have a way to keep from seeing disturbing images on Wikipedia. Doc James (talk · contribs · email) 04:28, 9 August 2011 (UTC)

No consensus? As far as I'm concerned, there is no consensus for this photo to be in the lead. You're being egoistic for not taking into account several users complaints. Moving the photo further down is not hurting the article in any way, since the other lead picture is perfectly fine and your beloved photo will still be available to everyone. I'm proposing a solution to this conflict, while you're not proposing anything. Evenfiel (talk) 08:23, 9 August 2011 (UTC)

Wikipedia is not censored. The best image goes in the lead. The image in question is a "featured image" and is in color. You could try a request for comment. My proposal is that soon people who do not wish to see certain images can self censor themselves without forcing censorship on others.Doc James (talk · contribs · email) 19:01, 9 August 2011 (UTC)

The picture belongs in the lead. Smallpox was an horrendous disease and it is our duty to describe it as such. This image speaks volumes and alone goes a long way to explaining the enormous worldwide effort that went into eradication. I can't see how this image makes Wikipedia unusable. Does this mean that we should hide the truth? Seeing this image is an extremely important part of "learning about smallpox". I am probably right in thinking that no commentators here have seen a case of smallpox. I have. You have to see the symptoms of this disease to fully understand it. If casual readers are put off by the image, they are probably not that interested in learning about the disease. Wikipedia is not censored. If it were, I would not contribute to it. If our humble article has any tiny influence on making sure that suffering like this never happens again we should be very proud. Graham Colm (talk) 20:05, 9 August 2011 (UTC)

Agree completely with Graham. If this image is in peoples minds and if small pox ever gets out of the labs in which it exists having people remember this image has the potential to save millions of lives. If this pushes people to help the former USSR and USA protect / eliminate its stockpiles of the disease we at Wikipedia have done something great.Doc James (talk · contribs · email) 20:13, 9 August 2011 (UTC)

Could you explain to me how to move that picture further down in the article can be classified as "censoring" or "hiding" it? What I am trying to do is to give people time to decide whether they really want to keep on seeing pictures about smallpox or not, while saving the worst of the lot for the last. If they decide they do and continue reading the articles, or just seeing the pictures, at least they knew what was coming at them. What you are trying to do is to use shock & horror tactics in order to make people realize what a horrible disease it was. I see that both of you are doctors, so I guess you're quite used to seeing all kinds of deformities or bizarre aspects of human body. Unlike you, the vast majority of people have nothing to do with medicine and are uncomfortable with such pictures. As for Doc James's proposal that people will be able to self censor, this is a moot point, since the vast majority of Wikipedia users don't even have an account.

Anyway, if you wanna keep up with your shock & horror tactics, you still have a lot of work to do here in Wikipedia. You can start by going through the whole list of Sexually transmitted disease and change the lead photos for the most horrible pictures you can find. Pretty much all of these articles have a rather tame picture in their lead. Evenfiel (talk) 00:54, 10 August 2011 (UTC)

The point is not shock and awe but to accurately represent disease. It appears that we shall have to agree to disagree on this one.Doc James (talk · contribs · email) 02:30, 10 August 2011 (UTC)

Yes, the point is shock and awe. The other pictures shows the child with several pustules in his body, but in a less graphic way. You also chose to ignore my main point. I'm not removing the picture from the article, but just moving it further down. There is no consensus to maintain this picture. At least half of the users who posted here would like to see it replaced. I'm proposing a possible solution for this conflict. We don't need to remove it from the article, only from the lead. Evenfiel (talk) 10:53, 10 August 2011 (UTC)

Graham, which of the several images of smallpox is most typical of the disease? IMO, there is a tendency in medical publications to have illustrations that are towards the worst end of the scale for the same reason that books for identifying minerals or flowers or birds only show perfect specimens, rarely seen in the field, because they boldly illustrate the features. Although that approach has its merits, there is a danger that readers (physicians or lay) get the impression that it is commonly that bad. If that poor girl is typical of what occurred (in the third world, say) then I'm happy for it to the be the lead in this article. If the alternative offered by Evenfiel is actually more typical (even though it might not look much different to a bad case of chickenpox) then we should use that and move the worse-case image to later in the article.

The current image does highlight how much more potentially scarring and deadly smallpox is compared to chickenpox. So it is useful for the lead for that reason. But it is shocking and if untypical then I don't support it in the lead. The "Wikipedia is not censored" card is easy to play but we wouldn't, I hope, argue that this image would be a good choice to illustrate disease, infectious disease, infection, etc. Whereas we might be quite happy with a picture of someone sneezing to illustrate those. -- Colin°^Talk 12:16, 10 August 2011 (UTC)

The fact that it is in color I consider important.Doc James (talk · contribs · email) 15:26, 10 August 2011 (UTC)

The image is typical of variola major. I have seen more severe cases – unpublished images from the collection of the late Thomas Henry Flewett. The haemorrhagic form was even more extreme but less common. I don't know the full provenance of the monochrome picture of the girl, but to me it looks like a convalescing case. Smallpox only resembled chickenpox in the early stages of smallpox infection. This is what smallpox infection looked like. Let's hope we never see it again. Of course we could not justify its use to generically illustrate the more common and benign infectious diseases, but it belongs in this article and in the Lead. I concede that a colour picture of an adult showing these typical signs would be preferable, but I don't know of a free one we could use.Graham Colm (talk) 17:50, 10 August 2011 (UTC)

I dont find the image particularly disturbing and think it does authentically portray the effects of the disease on people. However - for a encyclopedic purposes an image showing the symptoms of the disease in a specific infected person is not the appropriate image to use in the infobox - rather a picture of the microscopic virus itself is whats called for here; it is much more general to the subject of the article. A quick scan at other wikipedia articles about infectious diseases (HIV, flu, cold etc) reveals this is the common precedent. So,I would propose we lower this picture where it is more relevant (in the discussion of symptoms) and replace it with the microscopic image of the virus. Solid State Survivor (talk) 21:13, 10 August 2011 (UTC)

We frequently use images of disease to illustrate said disease. Jaundice... Doc James (talk · contribs · email) 00:41, 11 August 2011 (UTC)

The effect of small pox is of more interest than the structure of the virus. Keep the sick child picture. Jim1138 (talk) 01:39, 11 August 2011 (UTC)

Thanks for the speedy response Doc. An image of the symptoms of a disease is not synonymous with a picture of the disease itself. With a disease like smallpox (one where there is a definite viral agent) a picture of the virus itself is most synonymous with the disease (for instance we would say a person infected with the virus who emited no symptoms carries the disease). The Jaundice article you reference uses its picture appropriately since Jaundice is itself a sort of symptom brought about from other health issues such as heptitis or liver failure.Solid State Survivor (talk) 01:57, 11 August 2011 (UTC)

Smallpox infection does not give rise to asymptomatic carriers. This is one of reasons why it could be eradicated. The image illustrates smallpox infection. Graham Colm (talk) 05:25, 11 August 2011 (UTC)

This article is about smallpox the disease, not variola virus. Our infectious disease articles are a bit inconsistent wrt whether the virus has its own article or not. Please nobody suggest rotavirus should have a picture of the symptoms in the lead :-) Colin°^Talk 08:00, 11 August 2011 (UTC)

The picture is scary as hell. It's not simply disturbing; it's actually haunting as it lingers in your head, and I'm a person who does not get scared easily. Wikipedia should not have "scary as hell" shock images, at least not in the lead. The reason behind this is because the image literally pops up when the page loads and can catch people by surprise. Wikipedia is an encyclopedia for research and education. Likewise, the image is very "artsy" in its composition (specifically the darkness of the eyes). The image seems to have been made to be deliberately disturbing and not simply a representation of the affects of the disease. — Preceding unsigned comment added by Anikom15 (talk • contribs) 05:51, 14 August 2011 (UTC)

I was rather taken aback by the striking photo. Like most people under the age of 40, I have never seen a real case of smallpox. Thank goodness I never will. In my opinion, the photo appropriately illustrates the nature of the disease. Axl ¤ [Talk] 23:19, 14 August 2011 (UTC)

We all hope we never see this disease but a number of countries still have large receives of it in culture vats ready to release upon the world at short notice either by accident or on purpose. Our best chance will be to identify it as soon as possible. Thus everyone needs to know what it looks like.Doc James (talk · contribs · email) 18:35, 18 October 2011 (UTC)

I am amazed that discussion about the use of this picture, despite its length, is exclusively centered on your reactions to it and never raises the question whether or not the actual person shown in it agrees to her picture being made public use of. Oh, I forgot: she's not white and she's poor, so she does not have any rights at all as far as Americans are concerned. 62.62.170.136 (talk) 07:07, 2 April 2012 (UTC)

I do not believe this is a reasonable objection. This is a file photo provided by the US Centers for Disease Control for illustrating the effects of smallpox. It is one of many such photos published in the public domain by the CDC library illustrating diseases from around the world. The place to register objection to this type use would be with the CDC and the US public health establishment, not Wikipedia. --MillingMachine (talk) 13:58, 17 May 2012 (UTC)

Link to image filter referendum

The Wikimedia Foundation has been working on a personal image filtering system for a while. There is information at meta:Image_filter_referendum/en. The basic idea is that any individual person would be able to say "I personally do not choose to see pictures that are gross/religiously offensive/pornographic/whatever, so please don't show them on my personal computer screen". You would get to pick and choose the types of images, rather than a one-size-fits-none approach). It is meant to be easy to override, so that if you don't normally want to see images of this type, but you change your mind for one page, then you would just have to click on it to override the setting (so what this doesn't do is provide a reliable system that would let parents prevent children from seeing pictures that the kids want to see, but the parents don't want them to look at).

The referendum has not started yet, but you can leave your comments at the talk page on Meta. Since "nauseating medical images" hasn't been discussed as much as other categories, they might like to hear from some of you. WhatamIdoing (talk) 21:08, 14 August 2011 (UTC)

Image

The Variola has two horms, the minor form of varioala does not have such rash distribution hopefully. The image is of a severe form of Variola major I believe. --Aleksd (talk) 17:05, 24 November 2011 (UTC)

Sure but that is no justification to remove the image. --Doc James (talk · contribs · email) 06:07, 25 November 2011 (UTC)

It is 2013 and nothing has been decided. I've never took part here, but just so you know, I've used the main picture (the very graphic one) several times to scare my adult friends. Therefore, the picture is basically a macabre laugh-stock among adults. I see some of the users are pretty keen to the picture (and I have no idea why; what would be the personal interests behind this?), what I find to be very macabre as well; since smallpox has been erradicated, it is impossible to determine whether the poor girl's condition was average (thus a proper illustration) or if she was suffering a terribly advanced stage of the disease. Searching google images, I do face several horrendous picture, but none of them gets even close to the disturbing state that the current picture gets me in. Again, please consider all the users claim that have surfaced here. Wikipedia is not to be censored; neither it is to be scary when there could be many other less-shocking portraits of the disease. Please, put your personal keenness to the picture aside this. — Preceding unsigned comment added by 189.73.166.240 (talk) 18:18, 29 March 2013 (UTC)

Given that you have used this image simply to scare your friends and your attempts to turn the poor child into a laughing stock, it is difficult to even consider your arguments about the ethics of its use. This is a serious and well referenced article on an horrendous infection. Although eradicated, the disease is extremely well documented and this image is typical of the clinical signs. Graham Colm (talk) 18:59, 29 March 2013 (UTC)

Eradicated as a circulating infection yes but not in the lab. While I have never seen a case I still keep it in the back of my mind. If a case was ever to appear early identification could save million of people. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:59, 29 March 2013 (UTC)

I hardly believe that Wikipedia would be the first resource of information a serious physician would resort to in case of identifying an unusual disease; a non-physician is not allowed to give diagnosis and they would go for a doctor in the earliest visible stage of the disease, as strong as it is. People with no doctors around (e.g., extremely poor areas in poor countries) hardly have access to the internet or any interest in medical articles from Wikipedia whatsoever. In any event, many other pictures seem to be just as accurate and, still, their graphic content is visibly less disturbing. As for the scaring and the laughing stock parts, it is just a clear example of what derogatory use this picture has been having, instead of being informative. It can even scare the public away from the page, what makes all the very useful information, developed over the years, simply invisible. If it is to victimize the girl as being a laughing stock, she has been having the most negative exposure as the main picture on the page. Finally, if the (pacifying) idea of placing the girl's picture elsewhere in the page, what would keep the article's accuracy and would assure early identification should another outbreak happen, has been rejected, I can only assume we are clearly before bad faith. — Preceding unsigned comment added by 200.180.179.101 (talk) 04:30, 30 March 2013 (UTC)

Other image

There is another image, File:Smallpox child.jpg.

Said file should have more information. Child's gender? (Girl, I think.) Nationality? Time when the scene took place? Did the child survive?

The file at the top, of the Bangladeshi girl (reminds me of Rahima, but it can't be) is appropriate. It is very mild compared to this. It illustrates how terrible a disease smallpox was. Besides, it is a featured picture.--Solomonfromfinland (talk) 07:21, 18 December 2013 (UTC)

Edit request from Jdselbin, 28 December 2010

{{edit semi-protected}} I can provide the citation needed for the following:

If successful, a red and itchy bump develops at the vaccine site in three or four days. In the first week, the bump becomes a large blister (called a “Jennerian vesicle”) which fills with pus, and begins to drain. During the second week, the blister begins to dry up and a scab forms. The scab falls off in the third week, leaving a small scar.[citation needed]

It can be found at:

http://www.bt.cdc.gov/agent/smallpox/vaccination/faq.asp

If the vaccination is successful, a red and itchy bump develops at the vaccination site in three or four days. In the first week after vaccination, the bump becomes a large blister, fills with pus, and begins to drain. During week two, the blister begins to dry up and a scab forms. The scab falls off in the third week, leaving a small scar.

Jdselbin (talk) 02:42, 28 December 2010 (UTC)

Done, thanks. Adrian J. Hunter^{(talk•contribs)} 12:33, 28 December 2010 (UTC)

Close paraphrasing

The above edit request suggests there may be problems in this article with close paraphrasing. The changes that would convert text in this source to text from the current article are superficial:

If the vaccination is successful, a red and itchy bump develops at the vaccination vaccine site in three or four days. In the first week after vaccination, the bump becomes a large blister (comma removed) (called a “Jennerian vesicle”) which fills with pus, and begins to drain. During week two the second week, the blister begins to dry up and a scab forms. The scab falls off in the third week, leaving a small scar.

I haven't checked whether the source has a Wikipedia-compatible license, but at the very least the source should have been cited. I've little time to follow this up now... Just a heads-up for contributors and future FA reviewers. Adrian J. Hunter^{(talk•contribs)} 12:46, 28 December 2010 (UTC)

I believe CDC content is in the public domain.--Garrondo (talk) 15:15, 31 December 2010 (UTC)

By law, all works of the federal government of the United States of America are in the public domain. No license is required. A citation may be appropriate, but there is no copyright issue.71.109.153.121 (talk) 18:58, 10 June 2012 (UTC)

Past tense

Opening sentence, shouldn't it be Smallpox was?

Also, an indefinite semiprotection seems unwarranted for the level of vandalism that it was attracting and given good IP contributions at the time. Can we give it another shot please? 220.210.184.229 (talk) 12:09, 29 May 2011 (UTC)

Ditto as per above. Cooltrainer Hugh (talk) 00:24, 29 June 2011 (UTC)

The article alternates back and forth between past and present. SelectSplat (talk) 05:56, 13 August 2012 (UTC)

Recreation of the virus, from scratch, using its genome

I wonder if someone with expertise in the field could comment on the possibility that the virus could be recreated, even if it was globally extinct (all stockpiles destroyed), using knowledge of the genome.

A Wikipedia search shows that the viruses genome consists of only 186000 base pairs. I presume it's been sequenced on more then one occasion, and that sequence is in the public domain.

Doesn't this mean that, knowing the genome, anyone with the right equipment could re-create smallpox from scratch? I know the technology exists to generate custom DNA sequences and the 186000 base pairs would easily fit on an old floppy-disk. If you insert the custom DNA into an appropriate host cell, it would start spitting out smallpox. Right?

Am I missing something that makes the above scenario implausible? — Preceding unsigned comment added by JefeMixtli (talk • contribs) 01:01, 29 June 2011 (UTC)

In theory, yes, one COULD build it from the sequenced data. However, you have to consider, "from scratch", you're putting together 186000 base pairs. Individually. "Letter" by "letter".Wzrd1 (talk) 05:02, 30 November 2012 (UTC)

Smallpox no longer in PinkBook

It would seem that Smallpox or Variola are no longer in the latest edition (12) of the Pink Book Epidemiology and Prevention of Vaccine-Preventable Diseases. [CDC Pink Book] The references to PinkBook are no longer valid. Any suggestion as to references? Jim1138 (talk) 05:07, 7 July 2011 (UTC)

Arrg, darn CDC, I do not know why they insist on perpetuating linkrot. Added an archived link of the previous version, as it would seem that they are not planning on updating the information anyway.--DO11.10 (talk) 16:43, 7 July 2011 (UTC)

smallpox vaccine scar, how about a pic?

These dates must be wrong

From the article.... "Human history The earliest credible clinical evidence of smallpox is found in the Egyptian mummies of persons who died some 3000 years ago. Historical records from Asia describe evidence of smallpox-like disease in medical writings from ancient India (as early as 1500 BC) and China (1122 BC).[43] Small pox inoculation was first used by Hindu physicians since 1500 BCE.[44] As with other medical customs, the inoculation was associated with a Hindu.... "

First.... should be consistent.... has BC, and BCE... which are the same but mean different things to different people.... Second.... 3,000 years ago was 900 BCE, so the first sentence sets a date of discovery in Egypt after the reputed development of the Indian vaccine in 1500BC or BCE, which is 3600 years ago.... someone who knows what the dates should be should fix this confusion....I suspect that the 3000 years ago really means 3000 BCE (my preferred notation). Avram Primack (talk) 14:00, 7 October 2011 (UTC)

I have fixed the BC/BCE issue for now, but I am sure many editors with drive by to change to these back and forth (thus the rampant inconsistency). As for the other issue, while there are other earlier written descriptions of a smallpox-like disease (India 3600 years ago and China ~3200 years ago), we can only speculate that these are actually smallpox cases. The mummy smallpox case (from ~3100 years ago, he died in 1145 BCE) is the first case that is clinically evident (i.e. we can still see the disease on the mummy and identify it as definitely smallpox today). I hope that helps clarify things. If you have suggestions as to wording that will more clearly describe this in the article, then by all means add it in --DO11.10 (talk) 20:09, 12 October 2011 (UTC)

This paragraph is confusing or contradictory

"The earliest procedure used to prevent smallpox was inoculation (also known as variolation). Inoculation was possibly practiced in India as early as 1000 BC,[31] and involved either nasal insufflation of powdered smallpox scabs, or scratching material from a smallpox lesion into the skin. However, this idea has been challenged as few of the ancient Sanskrit medical texts of India described the process of inoculation.[32] "

Does this mean that the fact of inoculation for smallpox may be in error, or the methods used to inoculate may be in error, or the description of the methods may be in error. This paragraph is a good poster child for the need to reread and rewrite submissions before they are submitted...

Avram Primack (talk) 14:21, 7 October 2011 (UTC)

Hilda Whitcomb

It appears Hilda Whitcomb was the last person to be infected with smallpox. She was Janet Parker's mother, and contracted the disease after Janet, but Hilda survived. Janet's father died of a heart attack while watching Janet die, and never developed any signs of infection before he died. I don't know of any other publicly documented cases of smallpox after Janet Parker.

I'm not sure accidents with the military stocks in the USA or Russia would necessarily be made public, especially if they were the result of illegal bio-weapons research, like what happened in the Sverdlovsk anthrax leak. So, there may be others who have contracted it, but for now, the last known documented victim was Hilda Whitcomb, who survived.

Badon (talk) 09:45, 23 October 2011 (UTC)

The disease is HIGHLY contagious. So, if there were some accidental release from the secure labs, it would quickly be apparent, as it would rapidly escape any containment attempts easily. It comes down to ease of transmission (quite easy) and length of time for incubation before becoming both ill AND contagious (a contagious person who is not feeling ill successfully spreads the disease far further than a person who is ill and contagious). The last biowarfare estimate for smallpox was on the order of it breaking out of a "sealed" state/province in two weeks at a maximum, with nine days being a mean anticipated breach of quarantined region, but that data is a bit old.Wzrd1 (talk) 05:07, 30 November 2012 (UTC)

Smallpox

How Did all of this affect the peop;e who had smallpox? — Preceding unsigned comment added by 216.129.253.102 (talk) 17:22, 29 March 2012 (UTC)

Biological warfare

The article cautiously indicates that "the British at least considered using smallpox" when literature about the French and Indian War asserts that Jeffery Amherst consciously and wilfully transmitted smallpox to Indians. I am no specialist of the subject, is there a debate on the issue? 62.62.170.136 (talk) 07:07, 2 April 2012 (UTC)

The quote given in the article is a little out of context. The parley with the Delawares were to end the siege of Fort Pitt. The talks ended with the Delawares reaffirming their friendship with the British, there was no reason to infect them. Why would they try and infect a group they have peaceful relations with? The correspondence these claims are based on is extremely vague and there is no concrete evidence that they actually did intentionally infect the native population. The only concrete thing we know is that some commanders discussed doing it.

--24.202.0.118 (talk) 00:34, 10 November 2012 (UTC)

Information on Life cycle

I was looking for information on the life cycle of this disease. I remember from school (a long time ago) that humans were part of the life cycle of the disease it is briefly mentioned but not explictly described ```` — Preceding unsigned comment added by 71.222.74.105 (talk) 09:46, 1 May 2012 (UTC)

The disease is a human specific pathogen. While other mammals, especially primates may contract the disease after being inoculated in the lab, "in the wild", the disease was 100% human specific. No secondary hosts, no secondary infectious path. Strictly human to human, either directly, respiratory aerosol or fomite.Wzrd1 (talk) 05:11, 30 November 2012 (UTC)

Presence in Europe

The assertion that "the arrival of smallpox in Europe and south-western Asia is less clear. Smallpox is not described in either the Old or New Testaments of the Bible, or in literature of the Greeks and Romans" seems contradicted by the consensus that both the [[3]] and [[4]] plagues were smallpox, unless these were of the 'isolated incursion' type ascribed in the article to having occured during the "middle ages." Is it likely that the disease was well-established in Europe by late antiquity, but with less historical evidence corroborating such than in the more thoroughly-documented outbreaks of the middle ages? If so, should the history section of the article reflect this? — Preceding unsigned comment added by 70.65.251.247 (talk) 06:26, 15 May 2012 (UTC)

Edit request on 9 June 2012

Among the list of U.S. presidents who suffered from smallpox, it might be interesting to include the fact that John Adams, as a young man in 1764, was inoculated against smallpox in Boston. He wrote a series of fascinating letters about the experience to his future wife, Abigail Smith:

http://www.masshist.org/digitaladams/aea/cfm/doc.cfm?id=L17640407aa

http://www.masshist.org/digitaladams/aea/cfm/doc.cfm?id=L17640407ja&archive=&hi=&mode=&noimages=&numrecs=&query=&queryid=&rec=&start=1&tag=

http://www.masshist.org/digitaladams/aea/cfm/doc.cfm?id=L17640413ja&archive=&hi=&mode=&noimages=&numrecs=&query=&queryid=&rec=&start=1&tag=

http://www.masshist.org/digitaladams/aea/cfm/doc.cfm?id=L17640417ja&archive=&hi=&mode=&noimages=&numrecs=&query=&queryid=&rec=&start=1&tag=

76.102.66.215 (talk) 21:45, 9 June 2012 (UTC) Not done: That section is for deaths, not for anything else. Mdann52 (talk) 11:57, 10 June 2012 (UTC)

Edit Request on 22 October: simple grammatical error

In the Religion and mythology section, I believe that the 'too' of the sentence 'These shrines were worshipped and made offerings too while the victim was sick' should be 'to'. Thanks! — Preceding unsigned comment added by 2001:470:7:A2D:0:0:0:2 (talk • contribs)

Edit made by User talk:GrahamColm Jim1138 (talk) 01:05, 23 October 2012 (UTC)

Error Correction Please, Date of Introduction to New World

In the history section, the date of introduction from West Africa to South America is erroneously given as 19th century. Actually, it arrived in Mexico in 1520 or so, which is the 16th century. 2001:470:7:A2D:0:0:0:2 (talk) 16:15, 30 August 2012 (UTC)

Are you referring to the last sentence in this section Smallpox#History? The variola virus was transferred from West Africa to South America in the 19th century. Might be a specific strain. I requested clarification at the end of the sentence. Jim1138 (talk) 18:43, 30 August 2012 (UTC)

Yes, exactly. I think it's a typo or transposition. The rest of the article details the introduction as 16th century. 2001:470:7:A2D:0:0:0:2 (talk) 18:35, 30 September 2012 (UTC)

Redundant articles on variolation/inoculation

This article (especially the Prevention section) may contain content identical or similar to another topic. Please see Talk:History of smallpox
Mathglot (talk) 22:57, 24 March 2013 (UTC)

I don't see a problem. This is not a paper encyclopedia and there is no shortage of space. Content is duplicated across many articles. One of the advantages of Wikipedia is that, to some extent, we can avoid cross-referencing. I like to see different approaches to the same subject. Clearly, some stubs should be merged with more established articles, but this is not the case here. Graham Colm (talk) 23:17, 24 March 2013 (UTC)

Smallpox still exists and why it should

I think it would be worthwhile to mention in the main paragraph of this article that smallpox has not been completely eradicated, and that it still exists in laboratories. The reason smallpox is kept is mainly study- and research related. People reading the main paragraph will end up feeling that humanity has completely "wiped out" this virus. — Preceding unsigned comment added by 88.112.82.155 (talk) 17:08, 10 April 2013 (UTC)

Post-eradication New Mexico discovery of scabs

The article says the scabs were discovered in March 2004. However, the footnoted source, a "USA Today" story, says the date was December 2003. — Preceding unsigned comment added by 76.94.241.240 (talk) 18:40, 10 April 2013 (UTC)

A similar incident occurred in 2011 when the CDC recovered a scab on public display at the Virginia Historical Society: http://online.wsj.com/article/SB10001424052748704681904576319723384755958.html — Preceding unsigned comment added by 76.94.241.240 (talk) 18:54, 10 April 2013 (UTC)

Info boxes and Sick Child image

I moved the info boxes to the beginning of the article per WP:IBX. The boxes are a good summary for the reader at the beginning of the article, which helps with understanding for non-medical readers. Also, it helps to keep the medical articles on infectious diseases consistent. Thanks. Malke 2010 (talk) 20:48, 17 April 2013 (UTC)

I noticed [5] this discussion higher up on the talk page about the sick child image. I think the image should stay in the article in that it clearly shows the lesions with the classic dimple. But it apparently, by the comments above, does upset some editors/readers. This seems a good reason to keep the info boxes at the beginning of the article where they are meant to be anyway. In this way, readers learn something from the info boxes and see other images first. This allows them to gradually come to the more graphic image. If a reader then decides the image is upsetting and leaves the article, he/she will have at least gained some information about smallpox before leaving. Malke 2010 (talk) 23:12, 17 April 2013 (UTC)

This article is about the disease. Thus the disease info box should go first. I oppose attempts to hide the pictures of this disease. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:44, 17 April 2013 (UTC)

It's not an attempt to hide the pictures. I made it clear when I moved the infobox the first time. The infoboxes serve a purpose. Also, it might be that some readers are upset by the image because it depicts a child. It does seem to upset some readers. I think it's reasonable to put the image further down and put the infoboxes at the beginning where they are meant to be. Malke 2010 (talk) 00:11, 18 April 2013 (UTC)

I agree that {{Infobox disease}} serves a purpose. I also agree that an article about a disease ought to have {{Infobox disease}} first (and that an article primarily about a virus ought to have {{Infobox virus}} first).

When you moved {{Infobox disease}} to a lower position on the page, why did you remove the image from it? Why not leave the image in the infobox that you moved to a lower position? WhatamIdoing (talk) 00:45, 18 April 2013 (UTC)

Moving the image of smallpox so that it does not appear in the first screen is an attempt to suppress the image and is not something I support. There have been many attempts to suppress this image because it is disturbing. Smallpox is a disturbing disease. While it may not have existed in the wild for more than 30 years there are still at least two countries that have weaponized versions sitting in laboratories. These could get out either via terrorize, accident or incompetence so people still need to know what it looks like. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:53, 18 April 2013 (UTC)

I came by, moved the infoboxes per WP:IBX, kept the image in the article, and left. You reverted. I then went to the talk page and left a note and put the edit back. Then I looked over the talk page and saw the concerns of other editors that the image might be disturbing. This prompted me to mention that I had no problem with the image but that keeping my edit, which put the image further down, might solve the problem. I don't see any editors trying to suppress anything other than an edit that is more in keeping with the MOS which other medical articles follow. And as for the claim that the article must have the image in the lead in case there is a BSL-4 event, that's not the policy at Wikipedia. And note, a Google image search solves the question of what smallpox looks like, since the image in question is readily available there. Malke 2010 (talk) 18:02, 18 April 2013 (UTC)

Yes agree many people have concerns about this image. I guess we should have a RfC regarding if and where we place it. I am happy to abide by whatever is community consensus. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:58, 24 June 2013 (UTC)

RfC: Should we have the photo of the girl with smallpox in the lead (or in the article at all)

The photo in question is this one. As there is ongoing concerns about the image I think a wider community consensus would be useful. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:07, 24 June 2013 (UTC)

Support

• Support in the infobox Smallpox still exists in a few laboratories around the world. It is a horrible disease and this is a featured picture showing it. The image is both educational and would be very important if the infection was ever to occur again (thus important from a public health perspective). The dimple in the middle of the bumps are an important part of the diagnosis and this image is the only one that shows it clearly. I prefer the non cropped image but I am also happy with the image with the eyes blacked out or the cropped one just showing the shoulder. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:07, 24 June 2013 (UTC)

Would additionally be happy with the image suggested by Axl, however fell this image should still stay in the article however to be placed lower. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:29, 26 June 2013 (UTC)

• Support somewhere in the article, but see possible option in the discussion section. Sasata (talk) 18:59, 24 June 2013 (UTC)
• Support in the article (and quite frankly don't have an issue with the infobox). Prefer no crop. Victoria (talk) 01:33, 25 June 2013 (UTC)
• Support as is in the infobox, no crop. Smallpox is a horrific disease and mere words can not underscore what the image does. IMO, the image is ghastly, but its removal would extenuate the disease. Jim1138 (talk) 07:31, 25 June 2013 (UTC)
• Support - in the infobox with no cropping, as per my comments last year. (See above). Graham Colm (talk) 08:29, 25 June 2013 (UTC) Changed my mind, see below. Graham Colm (talk) 21:37, 25 June 2013 (UTC)
• Support, preferably in the lead. This is a terrible image for a terrible disease. I don't think it is disproportionate, based on Graham's earlier comments. It is worth noting that the great majority of other-language versions of this article also use this image (37 in total, with 29 having it as the lead image). The picture of the boy is next most common but I think its encyclopaedic value is lower. I'm not keen on the crop and hate the one with the black bars on the eyes. This is a Featured Picture on Commons as well as on three Wikipedia's including the English Wikipedia where its "encyclopaedic value" to the article determines its featured status. Colin°^Talk 19:43, 26 June 2013 (UTC)
• Support as is in the infobox, no crop. Kjetil_r 17:52, 29 June 2013 (UTC)
• Support in the infobox, no crop. It is a horrible infectious disease of historic significance. Shocking or not, it is a textbook example of the visible aspects of the disease.Wzrd1 (talk) 03:15, 2 July 2013 (UTC)
• Support in the infobox, no crop. No removal unless there is a more horrifying picture, more realistic, more diagnostically informative, more typical of the disease, more evocative and of greater impact. Complaints along the lines of "It's the child's distress that is so disturbing" are far more disturbing; its OK is it, as long as we don't disturb anyone? As long as the child's distress is invisible to us we can sweep her under the carpet? As long as we do not have to believe that the child and her family don't enjoy it? How clinical! If you don't like to see suffering and disfigurement, don't consult medical articles. Such are the things that medical topics deal with. And as for blacking out her eyes, that is still worse; why not draw a nice black moustache on her and add a few giggles to an otherwise stolid and tedious article? If some of our more delicate readers can't stand the sight of her, let them follow the example of the prissy spirits who nagged for removal of pictures dealing with pregnancy, finally compromising on having them moved off the lede in favour of less informative pictures. JonRichfield (talk) 06:49, 11 July 2013 (UTC)
• Support in the infobox, as is (uncropped). -- Brangifer (talk) 02:15, 17 July 2013 (UTC)

Support cropping image

• Support. It's the child's distress that is so disturbing. Previous talk page comments should be considered here:[6]; here: [7]; here: [8]; and here: [9] Malke 2010 (talk) 19:08, 24 June 2013 (UTC)
• Support for the infobox either of the two images cropped to show just the arm, either File:Child with Smallpox BangladeshCropped.jpg or File:Child_with_Smallpox_Bangladesh_-_arm_detail.jpg. The important diagnostic detail of the dimpled bumps is preserved (even highlighted) without having the distracting emotional distress visible in the full image, which is an appropriate consideration for the infobox image, especially when we're at GA or better. The image descriptions themselves can be linked to the full original image. I think either of these images is better than the black-bar image. Zad68 19:48, 24 June 2013 (UTC)

I support using the cropped image. There is no loss of educational value and it is considerably more neutral. The afflicted ones age, ethnicity, and gender are superfluous distractions. "A picture is worth 1000 words", but the 1000 words need to be relevant prose. Our focus ought to be the unique characteristics of the disease and its impact on an infected person. Instead, we see a little girl—a child from Bangladesh. There's much more "educational value" in showing these blisters on someone's palm, or sole—although much less shock value. When I see an image like this, I assume the author meant to invoke emotional stress. It's misguided artistic liberty—I do not recommend or condone. :) John Cline (talk) 01:36, 28 June 2013 (UTC)

Oppose

• Oppose. Although I am too young to have ever seen a case, I don't think that the picture is representative of smallpox. The vesicles are more confluent with very little normal skin between, especially on the face—more suggestive of "malignant" smallpox, or the confluent variant of ordinary smallpox.

This image (right) is a better representation of smallpox. Regarding the child's distress in the original image: that is a common (and unfortunate) feature of smallpox. As such, that feature is representative of the disease. WP:LEADIMAGE states "Lead images should be selected to be of least shock value; if an alternative image exists that still is an accurate representation of the topic but without shock value, it should always be preferred.... Sometimes it is impossible to avoid the use of a lead image with perceived shock value if the topic itself is of that nature." I think that my suggestion has an appropriate level of "shock value", lower than that of the original picture. Axl ¤ [Talk] 09:35, 25 June 2013 (UTC)

• Oppose: I must agree with Axl here. He's raised an important question. The image of the little girl might well be malignant smallpox. That was my impression when I first saw the image and compared it to others. Her lesions seem to be merging which is a feature of malignant smallpox. Also, I noticed that the image of the little boy does seem far less disturbing and has previously been in the article. I'd support putting that as the lead image and placing a smaller image of the girl into the malignant subsection. Malke 2010 (talk) 19:12, 25 June 2013 (UTC)

• Oppose and agree with Axl's alternative image and rationale. Excellent points. -- Scray (talk) 20:46, 25 June 2013 (UTC)

Yes, Axl's rationale is strong. I am old enough to have seen cases of smallpox – the last one I saw was Janet Parker. I would not contest the use of this other image; it's a good example of the lesions as I remember them, and, more importantly, the context is not lost. But I would object to the use of the original image as a example of malignant smallpox because this would be speculation on our part. If you check the source and history of the original image you will see that at some stage it has been changed by editing software which has made the girl's eyes much darker. This has made the image, in my humble opinion, more disturbing to those who perceive it as such. Here is a lesson - we should be careful when "improving" images. Graham Colm (talk) 21:34, 25 June 2013 (UTC)

• Comment This girl does not appear to have Malignant Smallpox. The geometry of the lesions does not appear to fit the description. medscape.com "A severe variety of smallpox in which lesions do not project above the skin surface". Also WHO pg 272: "Malignant smallpox is characterized by lesions that do not develop to the pustular stage but remain soft and flat." ndif.org A synonym of "malignant smallpox" is "flat smallpox". A search of CDC Public Health Image Library of "malignant smallpox" returns five images of three patients. The lesions, imo, bear no resemblance to the girl above. While her lesions appear more severe than most, they do not appear to be those of malignant smallpox. Another note: the three CDC malignant smallpox patients are laying down as if incapacitated, the girl is sitting up. Appearance of the lesions seems to depend heavily on the stage and severity of the disease. Jim1138 (talk) 00:46, 26 June 2013 (UTC)

• Comment: The flat appearance could also be due to the available lighting. These are old photos taken with film SLR's. The lesions do become this marked at around 7 to 10 days with periorbital swelling as she appears to have. The thing is most editors here are too young to have seen a real case. There hasn't been a case in the U.S. since 1949, and the last case in the world was Somalia in October, 1977. What we could really use is a series of photos that show the various stages from day 1 to around day 25. Also, I just noticed Graham Colm's comment. He's actually seen smallpox so his assessment of the photos will be more accurate. He's correct, we can't guess about them. I agree with him, I'd support the use of the other child's photo for the lead. Malke 2010 (talk) 06:11, 26 June 2013 (UTC)

  While I have great respect for GrahamColm, I don't think we should be using personal experience as a guide here (we've got to live by our own standards). I'm not disagreeing with the conclusion - just the reliance on an editor's reported RL experience. (retracted per Colin's correction following) -- Scray (talk) 06:52, 26 June 2013 (UTC)

I'm sorry If I gave that impression. It was not intentional. We have to go by the provenance of the photographs alone. That's why we cannot use our judgement to decide whether a case is the maligant form or not. That was my only point. Graham Colm (talk) 10:28, 26 June 2013 (UTC)

Actually, Scray, I think you are wrong wrt policy on personal experience and editor judgement. For original images, we utterly rely on the uploader (and anyone else who offers to help) in identifying and describing the subject. Think of all the birds and butterflies we have. For non-original images, we'd need of course to be careful about disagreeing with what was published with the image, but there's still a level where we need and accept Wikipedian help in identifying things. For example, if Graham had taken and uploaded this photo and attached a detailed description of the case, we'd trust him. We are right, of course, to not present speculation as fact. Colin°^Talk 19:27, 26 June 2013 (UTC)

Thanks for setting me straight. I see that is the reality in which we must work on images. Pictures are so powerful, and this is so far from the way we source text, that it really has the potential to undermine our work - but this is not the forum to address that issue. -- Scray (talk) 01:10, 27 June 2013 (UTC)

It might be nice to have a display of photos that show the various phases like the Dept of Health, State of Illinois has here: [10]. Comparison of it with chickenpox might be a good idea too. If the argument is that the photos are necessary to help readers with recognition, then we ought to have really functional ones. Don't know if we can get permission for these, but it's worth a try. They might already be in the public domain. Malke 2010 (talk) 20:39, 26 June 2013 (UTC)

Malignant smallpox is notable by its subcutaneous nature, whereas non-malignant smallpox is essentially cutaneous in nature. In short, the virus spreads beyond the skin and into the deeper structures of the body in an eventual systemic infection that is typically lethal.Wzrd1 (talk) 02:53, 2 August 2013 (UTC)

• Oppose per all above. PumpkinSky talk 22:40, 26 June 2013 (UTC)
• Weak Oppose - After scanning through the arguments, the main OPPOSE argument appears to be "Picture not representative of typical smallpox cases". Granted I'm no medical expert, and have little background in virology/pathology, but after glancing at a couple dozen other images of smallpox cases, my impression is that the "not representative" position seems accurate. NickCT (talk) 13:50, 9 July 2013 (UTC)
• Oppose - As per Axl, Malke 2010, and NickCT. --JustBerry (talk) 20:52, 16 July 2013 (UTC)
• Oppose While I wouldn't outright oppose the use of this photo, there does seem to be a better alternative. The girl seems to have an extreme case. Given that her situation may be an outlier, and that WP:LEADIMAGE suggests a photo with less shock value if possible, the photo of the boy is probably more appropriate . But whatever the case, please do not use one of those censored versions... --SubSeven (talk) 17:14, 19 July 2013 (UTC)
• Weak Oppose An informative photo demonstrating the effects of the disease is certainly an asset to the article and should be placed prominently, so the infobox is as good a place as any. However, the image in question does seem to have a severity and dermatopathological expression that is at least a little atypical. I think the alternative image proposed by Axl may therefore be the better option for a lead or infobox image, though the image of the girl, with its great detail and effective representation of an advanced case should certainly be retained somewhere in the article. Snow (talk) 07:29, 20 July 2013 (UTC)
• Comment: I agree with Snow, it might be a good compromise to have the little girl's photo somewhere in the article, perhaps create a photo gallery or add in a section that discusses progression of the lesions from first outbreak to resolution. Malke 2010 (talk) 01:45, 26 July 2013 (UTC)

Proposed alternatives

Proposed images to use in infobox

• 
  File:Child_with_Smallpox_Bangladesh_-_arm_detail.jpg
• 
  File:Child with Smallpox BangladeshCropped.jpg
• 
  File:Child with Smallpox Bangladesheyesblacked.jpg

Discussion

• One option to perhaps alleviate the concerns of people who find the photo too disturbing would be to crop off the top two-thirds, leaving only the shoulders and arms visible. This way, the characteristic pustule morphology will be still be seen clearly (even more so, as they will be somewhat larger in a cropped version. Sasata (talk) 18:58, 24 June 2013 (UTC)
• Yes, agree with Sasata. Cropping would solve it. It's the child's obvious distress that is so disturbing to others. We are talking about lay editors and readers and this is something that even medical professionals find hard to see. Malke 2010 (talk) 19:06, 24 June 2013 (UTC)

The greater area shows more of the distribution of lesions which is important when distinguishing between chickenpoxs, it however is a reasonable compromise..Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:15, 24 June 2013 (UTC)

Another option: a black bar over the eyes, like used in many medical textbooks. Sasata (talk) 19:18, 24 June 2013 (UTC)

Yes would be supportive of that. The eyes in this condition add no useful information. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:20, 24 June 2013 (UTC)

Strongly oppose the version with black bars over the eyes. This was done in the past in the mistaken belief that it protected identity. Such images have no place in 2013. Colin°^Talk 10:18, 25 June 2013 (UTC)

• I have uploaded a cropped image showing just the detail of the dimpled arm bumps. This should address the issue of how disturbing the original image is without losing the valuable information regarding the dimpled bumps. Zad68 19:26, 24 June 2013 (UTC)

You beat me to it. Have uploaded another cropped version and one with the eyes black out.Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:27, 24 June 2013 (UTC)

The second image seems to work the best. They can always click on it to enlarge it. Best to remember the lay readers and editors and not overwhelm. Malke 2010 (talk) 19:33, 24 June 2013 (UTC)

Argh so many edit conflicts... thanks for that final fix Doc, I think we're on the path to a good consensus now. Zad68 19:42, 24 June 2013 (UTC)

The second one does best at defining the arm, so the readers know what part of the body they're looking at straight away. Might lessen the shock. Well done Zad68 and Doc James. Malke 2010 (talk) 19:48, 24 June 2013 (UTC)

Have switched the lead image as per the discussion/consensus above. Have moved the full image lower. I guess the question is should we have it at all? I have no strong feelings either way and if someone wishes to remove it altogether I would have no concerns. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:38, 24 June 2013 (UTC)

I'd leave it off. The prior discussions regarding it seem to support eliminating it. And since the image does show the lesions well, the poor kid can be put to rest. Malke 2010 (talk) 21:28, 24 June 2013 (UTC)

Unless the reader has followed this discussion, it is not possible to tell what part of the body is shown in the cropped image. To some, it might not look human. The sense of scale has been lost and the size of the lesions is no longer discernible. Take another look, and try to forget what the original image looks like. Graham Colm (talk) 21:36, 24 June 2013 (UTC)

The second image makes it clear that it's an arm. That's the image in the article now. Malke 2010 (talk) 21:46, 24 June 2013 (UTC)

Looking at the lead image alone, it could be finger. Graham Colm (talk) 21:53, 24 June 2013 (UTC)

Have added what body part this is to the caption but yes good point one does sort of lose the context a bit. Maybe the image with the eyes blackout would be better? Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:53, 24 June 2013 (UTC)

How about a wikilink in the caption to the larger image with torso and face, with a warning that some people may find the full image disturbing? This seems far better to me that duplicating the full image farther down the page. -- Scray (talk) 00:01, 25 June 2013 (UTC)

The image with the eyes blacked out is not a good idea. And a smaller version of the photo is still in the article in the photo gallery. Malke 2010 (talk) 01:05, 25 June 2013 (UTC)

@Scary, if you find the full photo disturbing, we could delete it from the page. It's not needed any longer as the point is to show the lesions which the current cropped photo does very well. Malke 2010 (talk) 01:11, 25 June 2013 (UTC)

Sorry I was unclear. I don't find the original version to be disturbing in the least, and also feel that the cropped version loses important context. In that context, perhaps my prior comment will make more sense - a link in the caption of the cropped version providing access to the original with a warning, would serve all stated purposes without duplication on the page. (btw, I agree that blacking out eyes is not helpful - it just looks like an inadequate attempt at de-identification, and is widely viewed as inadequate for that purpose) -- Scray (talk) 01:18, 25 June 2013 (UTC)

• I've been seeing this on my watchlist all day and finally looking in at the discussion I have to agree with GrahamColm. It's hard to discern the anatomy of the crop. More importantly, however, this is a horrific disease, a disease that was all too common not that long ago, and in my view it's important to show the image. Victoria (talk) 01:37, 25 June 2013 (UTC)

Yes we can let this run for a couple of weeks and after that point in time switch to whichever the majority of the community feels is best.Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:42, 25 June 2013 (UTC)

Discussion II

As it stands the comments show a need for a compromise here. I don't think it wise to simply decide this on one's own and put the old photo back. It would likely be best to add the little girl's photo farther down in the article perhaps in a photo gallery. But the cropped image in the info box shows the lesions well. And as I suggested earlier, showing the progression of the lesions would be more informative for the reader. Malke 2010 (talk) 00:51, 2 August 2013 (UTC)

I rather disagree as to the tight cropping, as it neglects the generality of the lesions over the entire body. That said, there are other images that are equally usable:

http://www.bt.cdc.gov/agent/smallpox/images/PHIL_131_lores.jpg

http://www.who.int/emc/diseases/smallpox/slideset/images/spox_009.jpg

http://www.who.int/emc/diseases/smallpox/slideset/images/spox_015.jpg

http://www.who.int/emc/diseases/smallpox/slideset/images/spox_032.jpg

I included the URL rather than uploading the imagery to provide the source of the imagery. I suspect that the last image would be considered objectionable due to it showing a child's genitalia, the first being "too shocking", but shock value aside, the disease was indeed a terror of nature. It should be reflected as such, lest a reader not comprehend the severity of the disease and the disfigurement of surviving victims.Wzrd1 (talk) 02:58, 2 August 2013 (UTC)

I think the second image is a good one and could be cropped a bit more. Well done finding them. Malke 2010 (talk) 19:15, 2 August 2013 (UTC)

There was no consensus for my change of the image which is why I changed it back. Usually one needs a consensus to make a change. Will leave this to others. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:52, 2 August 2013 (UTC)

I would say that most of us are 'voting' based on very little information. Most of the opinions seem to be more on how one feels (myself included) about the picture rather than the statistics. How should one select a photo for the lede? Should it portray what smallpox is in terms of appearance or emotional impact on the infected? On one hand the severity of the symptoms that the Bangladesh child appears to be a extreme. The other photos, imo, do not convey the severity of the disease. The emotional impact of viewing the Bangladesh child image would not begin to compare to the emotional impact that of one familiar with the disease seeing family members and friends with smallpox.

Is there any data on the appearance of the size, shape, quantity, and distribution of the blisters on cases from mild to severe? What would be considered 'average'. What should the lede photo present? Jim1138 (talk) 09:31, 2 August 2013 (UTC)

Looking at google images there appears to be some cases worse than this one and some that are not as bad. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:14, 2 August 2013 (UTC)

Editors suggesting changing the image, cropping it or changing to another image, are well-informed on this topic and make cogent points about the real utility of the image. Clearly, there is concern about this image and a compromise is needed as I've suggested. The little girl's image can be farther down in the article and as I've said, if the goal is to present a clear picture of the lesions, then a gallery with the stages would be in order. The cropped image in the infobox does show the full bloom of lesions that appear somewhere around days 7 to 10, depending on incubation period. It's not necessary for the full image of the child to be in the infobox to convey that. As a physician, Doc James, you are aware of that. And as an admin, you are also aware that concerns by editors, especially this amount of opposition, must be addressed. As I said, compromise is in order here. This is an encyclopedia, not a medical journal. Malke 2010 (talk) 19:13, 2 August 2013 (UTC)

Usually one need a consensus to make a change. I made a change to the article without consensus and thus changed it back to how it was before when the fact that their is no consensus become clear. This is my understanding of Wikipedia policy. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:22, 3 August 2013 (UTC)

So whoever makes the first edit always has first mover advantage? Whomever disagrees with Doc J is wrong? I see no consensus here at all, it's roughly a 50/50 split. As to the issue at hand, find a pic more people agree on.PumpkinSky talk 02:45, 3 August 2013 (UTC)

Yes so the original version dose have the advantage. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:39, 3 August 2013 (UTC)

I've never heard that before. That the image that is there has an advantage? If anything it is problematic because it's drawing this much comment against it. As I said, a compromise is indicated and as an administrator you should recognize that. I've always understood that serious concerns must be taken into consideration, not dismissed. The compromise solution is needed here. Malke 2010 (talk) 03:45, 3 August 2013 (UTC)

Have dealt with some fairly controversial image discussions including those at Rorschach test and Pregnancy. For the image to change at pregnancy a super majority was required as was gained here [11]. The image was not changed until a super majority was obtained. Pumpkinsky was part of that discussion so I image is aware of this general requirement. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:52, 3 August 2013 (UTC)

Doc, as an admin should know wiki works on consensus model, not super majority. There is no consensus to keep this image so it should be changed. The real problem here is that you want to keep it and you expect everyone to go along with you come hell or high water.PumpkinSky talk 10:44, 3 August 2013 (UTC)

Strange because that was not how people felt it worked on the pregnancy article. Anyway I assume that we will have to agree to disagree regarding this one. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:58, 3 August 2013 (UTC)

Show me one official policy where "super majority" is used. Even better, where it's defined.PumpkinSky talk 11:23, 3 August 2013 (UTC)

How often do we have consensus and then a month later, a dispute arises? A case in point is a dispute that is currently ongoing on the second amendment article. Consensus was arrived at three times, now it's up on the dispute resolution noticeboard. I suspect that is why Doc James wishes for a supermajority, to avoid subsequent rehashing of the same tired subject.Wzrd1 (talk) 17:43, 3 August 2013 (UTC)

This article, nor any article for that matter, is up to "what Doc J wishes for". THANK YOU FOR CONFIRMING DOC J THINKS AND ACTS LIKE HE WP:OWNS medical article. What Doc wants is not the issue here.PumpkinSky talk 20:13, 3 August 2013 (UTC)

@Wzrd1: that's the nature of Wikipedia. Content and images can change at any time. A supermajority can't prevent that. And in this case, there is genuine concern and it should be addressed. There is no Wikipedia policy that requires a 'supermajority.' And note well, in the past, Doc James changed the image when just one person complained. Now he's got 10 editors saying no, and a talk page history with lots of others commenting about it. What's the problem? Why not address the concerns of others and strike a compromise? The image of the girl moved farther down into the article, perhaps a gallery, while the cropped image is in the infobox. That solution adequately addresses all concerns. The image could include a caption that explains it is an arm and shoulder. Malke 2010 (talk) 21:57, 3 August 2013 (UTC)

@PumpkinSky : You are welcome. Though, I never implied any such thing. I simply suggested a reason that Doc James wanted a larger majority over a smaller majority, such as a 51% majority. It's been a pleasure discussing how to improve this article with you! @Malke, I seem to recall Doc James mentioning that he changed the image, then reverted it when called on it, as is proper. That said, I've read comments from readers and editors who wanted all illustrations removed because they were emotionally distressing. What is germane now is what is the current count for and against? I honestly didn't count, as things have been hectic here. To be honest, I fail to see what the problem is with a picture of a smallpox victim. This disease is ugly and horrific, it's extremely difficult to find images of the lesions that are not upsetting to people unacquainted with the disease. That said, I gave a few other image links above that illustrate the disease and its lesions global nature, though I mentioned that some would be upset at seeing a baby's genitals in the one image that was quite representative. What we do need is consensus, flinging scat about ownership is not conducive to consensus, nor is bringing up one change from the past at this time. So, what is the current vote for each view? I do believe that an image is useful for the infobox that gives the viewer insight into the disease.Wzrd1 (talk) 22:15, 3 August 2013 (UTC)

@Wzrd1, yes, those are good points. As for consensus, I believe the count is 10 for change, 9 for no change. As for an image that gives insight into the disease, a cropped image showing the lesions is fine. And with that, it might also be possible to remove the protection level as currently it's at indefinite. The cause of vandalism may well have been this image. Remember, this is an encyclopedia and not a medical journal. When editors, over time especially, voice distress at the image, it really is a concern that must be addressed. The other images are fine, demonstrate the lesions more than adequately and are far less upsetting. Malke 2010 (talk) 22:53, 3 August 2013 (UTC)

I simply reverted my change to the lead image as I do not see a consensus for it. We could try another RfC with possibly more option. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:28, 3 August 2013 (UTC)

We could also just drop it and move onto other things. Jim1138 (talk) 01:30, 4 August 2013 (UTC)

Malke 2010, you have repeatedly tried to change the lead image on this article over the last few months. Please don't change it again. You are not an impartial editor wrt that change and compromises need to be agreed not imposed by one side. PumpkinSky, please do not post any more personal attacks here, as I will remove them and report your behaviour. You are experienced enough to know that when you use UPPERCASE to make your point, you have lost bigtime and should go find something else to do. If there is still a desire to change the image then some kind of mediation seems necessary. In the mean time, I suggest nobody edits the lead image or else page protection will be required. Colin°^Talk 11:29, 4 August 2013 (UTC)

I'll say whatever I want. I'm not afraid of you, anyone else, nor anything else.PumpkinSky talk 12:07, 4 August 2013 (UTC)

It is always a pleasure to deal with people who discuss things in a calm, rational and adult manner and do not consider chiding a threat that requires a defiant response.Wzrd1 (talk) 19:49, 4 August 2013 (UTC)

It's always a pleasure to deal with people who have backhanded condescending, holier-than-thou attitudes towards others. What I said before wasn't a PA anyway, it is the truth, so the whole "chiding" as you call it is baseless. And yes, that was a threat from Colin. With that, I'm leaving this. You all have fun here.PumpkinSky talk 20:37, 4 August 2013 (UTC)

The chiding was from Colin regarding personal attacks and use of caps. From what I read, it was far from baseless and quite on point, as well as rather mild when one considers your length of experience on Wikipedia. Please feel free to rejoin the discussion when you can discuss the matter rationally, without interjecting emotional baggage that ill suits discussion on improving the article. Now, on to the article, perhaps an RfC on which image is preferred for the infobox, with a group of images suggested? Anyone who could help get that together would find great appreciation, as I've little time to devote to it due to my father's sudden hospitalization.Wzrd1 (talk) 22:14, 4 August 2013 (UTC)

Conspiracy theory

Do we mention the conspiracy theory about how smallpox is a lie made by the pro-vaccination group here, or do you think that there should be a new page for it? 180.200.150.41 (talk) 02:28, 11 August 2013 (UTC)

I'm not quite certain that such a wild conspiracy theory, that would believe that three thousand years of history was falsified in the recent past just to sell smallpox vaccines that are no longer in common use would qualify as WP:notable.Wzrd1 (talk) 02:38, 11 August 2013 (UTC)

Case fatality rate

The claim "over 80% of infected children—died from the disease" is a vast overstatement. The paper cited is referring to a specific time and place. The true case fatality rate among children has been estimated at 20-30%

Bernoulli, D. and Blower, S. (2004), An attempt at a new analysis of the mortality caused by smallpox and of the advantages of inoculation to prevent it. Rev. Med. Virol., 14: 275–288. doi: 10.1002/rmv.443 — Preceding unsigned comment added by 130.56.79.153 (talk) 08:21, 26 August 2013 (UTC)

Picture again

The leading picture is absolutely inappropriate! I liking watching horror movies and blood doesn't creep me out, but I am trypophobic and I'm still shivering after looking at that picture. If you read this today, go to the front page of the Turkish Wikipedia. They have it as "today's picture"! They have gone way too far. Sorry for my bad English. --77.0.104.38 (talk) 19:53, 26 August 2013 (UTC)

File:Child with Smallpox Bangladesh.jpg to appear as POTD soon

Hello! This is a note to let the editors of this article know that File:Child with Smallpox Bangladesh.jpg will be appearing as picture of the day on October 26, 2013. You can view and edit the POTD blurb at Template:POTD/2013-10-26. If this article needs any attention or maintenance, it would be preferable if that could be done before its appearance on the Main Page. Thanks! — Crisco 1492 (talk) 23:36, 11 October 2013 (UTC)

Picture of the day

A Bangladeshi child infected with smallpox, 1973. In ordinary type smallpox the bumps are filled with a thick, opaque fluid and often have a depression or dimple in the center. This is a major distinguishing characteristic of smallpox. The last naturally occurring case of smallpox was diagnosed on 26 October 1977, and in 1979 the World Health Organization declared the disease eradicated.Photo: Centers for Disease Control and Prevention

• Please note previous discussion here. — Crisco 1492 (talk) 23:43, 11 October 2013 (UTC)
• Who is the girl? Did she live? --SmokeyJoe (talk) 07:01, 26 October 2013 (UTC)

• The source offers nothing on the subject's fate or identity. — Crisco 1492 (talk) 07:12, 26 October 2013 (UTC)

An amazing picture of a horrible disease. It was also the leading cause of death globally for a while if I remember correctly. National Geo says 300 million in the 20th century alone [12] Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:28, 21 November 2013 (UTC)

Smallpox and bodysnatchers

I read somewhere that one fear is that a 'sealed coffin' (whether or not against bodysnatchers) cracking and letting the virus 'escape.'

How feasible is this? 80.254.147.68 (talk) 13:38, 21 November 2013 (UTC)

Very low. More likely is that some of the stuff in vats in the former soviet union of the USA gets out. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:29, 21 November 2013 (UTC)

There are various stories about 'viruses' and 'corn etc seeds' found in sealed tombs being grown on in modern times (along with Grauniad Island). Are there any 'diseases' which could survive and be revived from such conditions (even discounting the SF/horror fiction staple) - assuming due precautions are taken with plague pits etc (regardless of known survival time of the disease causing organism). 80.254.147.68 (talk) 15:51, 21 November 2013 (UTC)

The fear that 'whatever killed them buried here might also kill me (so keep away)' is both rational and irrational. 80.254.147.68 (talk) 13:03, 5 December 2013 (UTC)

Smallpox picture

Are all authors who upload such pictures driven by psychic labil narzism? There is also a way to present an infection with Smallpox over a not such disturbing way, especially not showing children with it. — Preceding unsigned comment added by 46.115.54.171 (talk) 17:24, 30 January 2014 (UTC)

What do you mean by 'psychic labil narzism'?

The disease is extinct in the wild and the image would be disturbing whoever was shown.

Is there anybody still alive who had 'wild/non-laboratory originated' smallpox? 80.254.147.68 (talk) 18:01, 30 January 2014 (UTC)

Seeing the picture is absolutely nothing compared to the disease. IMO it is best not to make the article sterile; it should have some impact.

The last known case was in 1977. No reason people can not live to a ripe old age if they survive in reasonable shape. Jim1138 (talk) 19:11, 30 January 2014 (UTC)

Damned right about seeing the picture! Anyone who doesn't want to know about what the disease meant, needn't read about what it meant, and decidedly need not insist on other people being spared the sight of it, or being spared the facts. I commented along similar lines elsewhere on this page. Yo no lik'? Yo no look! JonRichfield (talk) 12:48, 3 April 2014 (UTC)

BBC article

A researcher is quoted in a BBC article about a 30,000 year-old amoeba-attacking virus becoming re-activated out of permafrost. He/she says that there is a risk of an old smallpox virus being frozen somewhere. If this view is not a fringe one, I imagine we could source it somewhere in the article. Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 19:40, 4 March 2014 (UTC)

Hmmm... A reasonable question concerning an important point, but the article cited is a bit simplistic, no matter whom it quotes. There are many poxviruses in nature, and it is likely that in the past smallpox started out as a zoonosis that adapted to humans, effectively generating a new species. If so, the likelihood of any frozen and newly-thawed virus amounting to a human-virulent strain is very low. Now, I am not about to debate the facts of such prospects, but I do suggest at the very least that before we add anything so hand-waving to a WP article, we find someone who can contribute something both non-trivial and properly cited. JonRichfield (talk) 12:58, 3 April 2014 (UTC)

RIP?

I am not comfortable with omitting the name of the researcher in question. Is it not supposed to be notable? Is it even considerate to consign him to oblivion? Has anyone objected to his name being mentioned? I'm not about to start an edit war, but it seems to me that to omit factual material out of squeamishness is a betrayal. Ask Herostratus. JonRichfield (talk) 19:08, 18 March 2014 (UTC)

I agree. The name should go back. Incidently, Bedson's father was famous for discovering Chlamydia, (once called "Bedsonia"). Henry Bedson, whose name was removed from the article, was the subject of a newspaper story as recently as 2011 [13]. As for "RIP", we can't anonymise dead people on Wikipedia -that would be daft. Graham Colm (talk) 19:29, 18 March 2014 (UTC)

I agree as well. Mind you, I think it's possible he may very well have prefered to be forgotten in this respect, given that he was apparently a dedicated researcher and it was the fallout from the infection of Ms. Parker (notable as the last known person to be infected with the disease and the last to die from it), which drove him to suicide, but it remains pertinent (in ancillary) information, all the same. Snow (talk) 22:18, 30 March 2014 (UTC)

Thanks folks. As no one has actually done any editing, I did it and added a ref to the actual report mandated by the British house of commons. JonRichfield (talk) 14:15, 3 April 2014 (UTC)

Possible copyright problem

This article has been revised as part of a large-scale clean-up project of multiple article copyright infringement. (See the investigation subpage) Earlier text must not be restored, unless it can be verified to be free of infringement. For legal reasons, Wikipedia cannot accept copyrighted text or images borrowed from other web sites or printed material; such additions must be deleted. Contributors may use sources as a source of information, but not as a source of sentences or phrases. Accordingly, the material may be rewritten, but only if it does not infringe on the copyright of the original or plagiarize from that source. Please see our guideline on non-free text for how to properly implement limited quotations of copyrighted text. Wikipedia takes copyright violations very seriously. Diannaa (talk) 22:53, 29 March 2014 (UTC)

Does anyone know what material in specific this was in regards to? Less than useful notice without context.... Snow talk 02:32, 9 May 2014 (UTC)

status as now one of 3 eradicated

polio has now been eradicated. - Sireditprofusely (talk) 20:41, 2 April 2014 (UTC)

If only! Polio has been eradicated from India, but is still endemic in three coutries. Hopefully within our lifetimes... Adrian J. Hunter^{(talk•contribs)} 10:28, 3 April 2014 (UTC)

Dead WHO Factsheet link

The link http://www.who.int/mediacentre/factsheets/smallpox/en/ was retrieved in 2007 and is now (as of April 2014) dead. The article relies on this link for five citations. The nearest links on the who web site are:

• http://www.who.int/topics/smallpox/en/ and
• http://www.who.int/csr/disease/smallpox/faq/en/

Neither of these links directly contain the information referred to in the article.

The information from the article can be found in various documents on the WHO site, but some of these could be considered primary sources so I don't know quite how to handle them in the context of this article:

• http://whqlibdoc.who.int/smallpox/WHO_SE_78.106.pdf "The Certification of Smallpox Eradication in Countries Without Recent Reported Endemic Transmission" aka WHO/SE/78.106 says that the last case of smallpox was the Variola minor strain(variant? I haven't verified the wording here), on 26 October 1977 as claimed in the article. Aside: The wording in the article could be understood to equate Variola minor with smallpox, whereas I understand major and minor are two variant of the smallpox virus. The source here says the final case of Variola major was two years earlier.
• http://www.who.int/about/bugs_drugs_smoke_chapter_1_smallpox.pdf "Smallpox, Eradicating an Ancient Scourge" partially supports the article content for its 1967 figures but instead of saying 15 million cases in 1967 it says "In 1967, there were around 10-15 million cases of smallpox in the world each year, a figure which had dropped from around 50 million cases a year in the 1950s.". I haven't found a good source for the claim that "two million died in that year" as yet.
• http://www.who.int/immunization/sage/nov2010_global_technical_consult_measles_eradication_durrheim.pdf and http://www.who.int/csr/resources/publications/PED_SmallpoxACVVR_report2013.pdf both make passing mention of the eradication of rinderpest, supporting the article... but I didn't find a great source on who.int for that claim.
• http://www.who.int/csr/disease/smallpox/en/ "Global Alert and Response (GAR), Smallpox" supports the article's claim that Smallpox was officially declared eradicated in 1979. The FAQ http://www.who.int/csr/disease/smallpox/faq/en/ says this occurred in December 1979.
• The article claims that "routine childhood vaccination was discontinued in the United States in 1972, and was abandoned in most European countries in the early 1970s". http://www.who.int/bulletin/volumes/84/2/editorial10206html/en/ "Bulliten of the World Health Organisation, Control, elimination, eradication and re-emergence of infections diseases: getting the message right" says that in 1980 routine smallpox vaccination was discontinued in all countries. http://apps.who.int/vaccine_safety/topics/smallpox/smallpox_aefi_cdc.pdf (a slideshow presentation) agrees that in 1972 US Routine childhood vaccination stopped, with routine health care worker vaccination stopping in 1976 and a halt to US vaccine production in 1982. http://whqlibdoc.who.int/smallpox/WHO_SE_73.58.pdf is something of an original source from 1973 I think that argues against the 1971 US Public Health Service Recommendation on Smallpox Vaccination, but I don't think clearly states a date when routine vaccination was discontinued.
• http://whqlibdoc.who.int/publications/a41438.pdf "The Global Eradication of Smallpox, Final Report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979" in its Foreward supports the article's claim that the eradication was certified on 8 May 1980.

 Fixed thanks to the miracle of the Wayback Machine. You're welcome to substitute in more recent sources and tweak the wording as required. Thanks, Adrian J. Hunter^{(talk•contribs)} 17:00, 8 April 2014 (UTC)

Hopefully I have put enough links and information here that someone a touch more competent could use them to replace the dead link and amend any text needing to change. Any takers? FuzzyBSc (talk) 15:56, 8 April 2014 (UTC)

Question

Is there anyone still alive who had 'wild' (as distinct from 'laboratory accident and similar') smallpox? 80.254.147.68 (talk) 16:32, 15 April 2014 (UTC) (Corrections due to usual computer snarly-ups) 80.254.147.68 (talk) 16:34, 15 April 2014 (UTC)

Presumably yes, particularly in Africa, Asia, and east Europe. But it is not clear how you could locate anyone. Wilcannia (talk) 02:52, 18 April 2014 (UTC)

Original resaerch for 'the proverbial someone' (when they have caught up with everything else). 80.254.147.68 (talk) 15:50, 13 May 2014 (UTC)

VARV Pathogenesis image from Plosone (macaque)

"Viremic blood is filtered through the spleen and liver following inoculation. Within 24 hours marginal zone macrophages and Kupffer cells begin expressing viral antigen indicating likely uptake and processing of the pathogen. When the immune response is effective these antigen presenting cells then traffic via the lymphatics to the lymph nodes where a hyperplastic response develops. Concurrently, trafficking to other preferred sites such as skin occurs, and lesions progress and regress as the ongoing adaptive immune response controls and clears the pathogen. In the face of an ineffective immune response, trafficking via macrophages also occurs, however, lymphoid necrosis rather than hyperplasia occurs, allowing unabated trafficking of the virus to other tissues. Infected cells undergo necrosis, pyroptosis, and/or apoptosis which, given the widespread state of infection, results in inflammation, hemorrhage and death.doi:10.1371/journal.pone.0024832.g007"

Uploaded this image to commons, if you wish to use it go ahead and add it to the article. CFCF (talk · contribs · email) 12:59, 6 June 2014 (UTC)

Edit Request: ordinary type and major/minor classification.

In lead picture "In ordinary type smallpox the bumps are filled with a thick, opaque fluid and often have a depression or dimple in the center."

It should say whether the type is major or minor.

Also the other picture

"Child showing rash due to ordinary-type smallpox (variola major)"

Does this mean that 'ordinary-type' = 'variola major' or that these are distinct classifications. This is somewhat confusing in the article

Macgroover (talk) 02:33, 17 July 2014 (UTC)

edit request

Regarding the sentence: "Fatality rates during outbreaks in Native American populations ere as high as 80–90%." This should be "Case fatality rates." As it stands, it sounds like 80-90% of the populations died.