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Surgeon General's Office LIBRARY.

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HISTORY OF THE YELLOW FEVER, AS IT APPEARED IN THE CITY OF NEW YORK, IN 1795.

By ALEXANDER HOSACK, Jun. M. D. OF NEW YORK.

PHILADELPHIA; PRINTED BY THOMAS DOBSON, AT THE STONE-HOUSE, No 41, SOUTH SECOND-STREET. 1797.

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THE FOLLOWING PAGES ARE INSCR [...]D TO Doctor JOHN BARD, AS A TESTIMONY OF SINCERE RESPECT FOR A MEDICAL PRACTITIONER WHO UNITES THE CHARACTER OF A LEARNED PHYSICIAN AND AN ELEGANT SCHOLAR TO THAT OF AN ACCOMPLISHED GENTLEMAN; AND AS A TRIBUTE OF PERFECT ESTEEM, BY HIS VERY OBLIGED AND HUMBLE SERVANT, THE AUTHOR.

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PREFACE.

BEFORE the reader peruses the following dissertation, I must beg leave to inform him, that this is the first attempt of a young man, inexperienced in writing, and is done only in compliance with the regulations of this Col­lege for conferring the degree of Doctor of Medicine.

I have purposely avoided any inquiry as to the origin of the disease, or the chemical com­position of the matter or poison producing it; referring the reader for particulars upon these subjects to the more complete history of the disease, as published by Doctor BAYLEY, Mr. WEBSTER, and others; and have confined myself to a plain detail of the symptoms, causes, and cure of the disease, as far as fell under my own observation, in my attendance at the New York Hospital, and upon the private practice of Doctor SAMUEL BARD, and my brother Doctor DAVID HOSACK.

If a single fact, either new or useful, shall be communicated, I shall feel myself much gratified in having undertaken the task.

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THE following history of the Yellow Fever was published in New York as the inaugural dissertation of the author upon his receiving the degree of Doctor of Physic, May the 3d, 1797.

It contains, as appears by the preface, a de­tail of the symptoms, causes, and cure of the disease, as it occurred under his observation, in the New York Hospital, and in the course of his attendance upon the private practice of Doctor Samuel Bard and his brother Doctor David Hosack.

As it has acquired much reputation, and con­tains a mode of treating that disease, which is different from what is usually practised—the present republication of it requires no apology from

THE EDITOR.
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HISTORY OF THE YELLOW FEVER.

HISTORY.

THE Yellow Fever is known by a variety of names. By the French it has been deno­minated La Maladie de Siam, from a country of that name in the East-Indies, where it is supposed to have had its origin, and from thence to have been conveyed to distant parts of the world. Sometimes they call it La fiévre matelotte, from its attacking sea­faring people and foreigners more readily than the natives of the country in which it prevails. The Spaniards have given it the name of vomito préto, or the black vomit, which is one of its most malignant and cha­racteristic symptoms. Some have called it [Page 8]the malignant fever—others the putrid bilious, and bilious remitting fever, &c. This dis­ease first appeared in this city about the year 1740; and, as I am informed by Doctor JOHN BARD, who was at that time a prac­titioner, it manifested the same malignant symptoms which characterised the late mor­tal epidemic.—In some of the southern states it has been known to prevail at a much ear­lier period.* In 1791 it appeared again in New-York, and has been described in a dissertation published by Doctor ADDOMS.

THE epidemic I am now about to describe, and which has universally received the name of yellow fever, first appeared about the mid­dle of July, and continued until the weather became cold. The season, during its pre­valence, was very hot and moist. It raged with most violence in those parts of the town adjacent to the eastern shore, where the air is less pure, and the ground lower than in any other part of the city; which, consequently, must, in some degree, serve as a reservoir for the filth of the upper parts of [Page 9]the city. It attacked persons of all ages, adults more frequently than children, and males than females—foreigners more than the natives, or such of our inhabitants as had lived in warm climates.* Frenchmen and [Page 10]blacks who had lately arrived from the West-Indies, were rarely the subjects of this dis­ease, as they appeared to have been inured, and thence rendered insensible to the opera­tion of its cause; but their exemption is, no doubt, more particularly to the ascribed to their temperate mode of life, and espe­cially their freer use of vegetables; for it is certain, that those who most indulge in the [Page 11]use of animal food and spirituous drinks were most susceptible of the disease.

THE symptoms which marked the yellow fever in its first stage were, a general lan­gour and heaviness—depression of the spirits, sometimes approaching to stupor—disincli­nation to motion—a sense of cold, and shi­vering—acute pain in the head, especially above the eyes—pains in the back, and fre­quently extending down the extremities— the skin was hot, dry, and much flushed, not unlike the scarlet blush of an erysipelatous inflammation—the eyes were suffused with water, and the vessels of the tunica adnata much distended with blood: so constant were these last symptoms, that they may, in a certain degree, be considered as charac­teristic of the disease. The pulse was, for the most part, frequent, full, and hard—re­spiration was proportionably quickened, at­tended with much anxiety, stricture, sore­ness, and frequently intense heat about the precordia—the tongue was foul, the appe­tite depraved, with nausea, vomiting, and not unfrequently pain about the region of [Page 12]the stomach: these were among the first symptoms of the disease. The bowels were constipated, unless the patient laboured under a diarrhoea at the commencement of the fever —the urine, in this stage of the disease, ap­peared, for the most part, as in the first stage of the fevers in general, viz. high-colour­ed, and small in quantity; in the last stage, when the fever had continued for some days with violence, and the general mass of fluids became changed, this excretion manifested the same alterations, becoming sometimes turbid, and at others yellow, as if tinged with bile.—Such are the symptoms which generally appeared at the commencement of the disease, constituting what I would call the inflammatory stage, but differing from any inflammatory disease, inasmuch as in the former there was no particular part of the body which appeared to be exclusively the seat of inflammation. Where the disease terminated favourably, there was, for the most part, an evident abatement of the above symptoms in forty-eight hours; and in the course of five days the patients were gene­rally [Page 13]freed from fever, but were left greatly debilitated by the violent operation of the poison producing the disease, and the evacu­ations which became necessary for the re­moval of the fever: even in those instances where blood-letting, the most debilitating of all evacuations, was not employed, the pa­tient was so reduced as to require all the re­sources, both of nature and of art, for his support. This stage of the disease was ra­ther marked by symptoms of debility, yet accompanied with great irritability, so much so, that the least imprudence in diet, cloth­ing, bodily exertion, or indulgence in conver­sation and company, would frequently induce a return of fever. But where this abate­ment of the disease did not take place with­in the first three days, a very different and more malignant train of symptoms appeared, partaking more of the symptoms of the last stage of putrid fever, as described by HUX­HAM and CULLEN.

IN the last stage of the disease, the pulses sunk, became more frequent, irregular, and sometimes intermittent: the person would [Page 14]lie continually on the back, with the knees drawn up, and the body sinking toward the bottom or foot of the bed; the breathing became proportionably more difficult; and the crust which had formed on the tongue became of a black colour, which change also took place on the lips and teeth; the yellow­ness became more general over the body, attended with cold clammy sweats; the vo­miting now became more frequent and co­pious; in some instances patients have vo­mited incessantly, and in astonishing quan­tities; and what was brought up resembled the grounds of coffee: this, for the most part, was considered as a fatal symptom: there were, however, several instances of recovery after this had taken place to a consi­derable degree.* It is worthy of remark, [Page 15]that when the vomited liquor acquired this black colour, a diarrhoea sometimes follow­ed, in which there was a discharge of a simi­lar sort of black matter, but more resembling tar or molasses. The florid colour now left the eyes, and they became yellow and sunk. The functions of the brain and nervous sys­tem were also very much deranged: the patient was attacked with delirium, attended with subsultus tendinum, and sometimes a per­fect stupor, with a convulsive kind of sigh­ing. The speech began to faulter and trem­ble. The patient appeared very uneasy, and shewed a disposition to leave the bed. Some­times [Page 16]a deceitful tranquillity appeared, and by some was supposed to be a favourable symptom; but the patient, upon getting asleep, was much agitated. The stools and urine became black, very offensive, and dis­charged involuntarily: in some instances there was an entire suppression of urine: the extremities became cold, but the heat still continued about the stomach: blood was discharged from the mouth, nose, ears, and eyes, and from those parts of the skin where blisters had been applied. Sometimes blood was effused in the cellular membrane, ap­pearing in the form of mortification—pete­chiae appeared about the neck and breast— vibices, or livid spots, came out upon the body, particularly upon the abdomen—the perspiration became very foetid—the eyes shone like glass—hiccough and muttering came on, and were followed by death.

Doctor RUSH, in his history of the yellow fever as it prevailed in Philadelphia, has taken notice of buboes and carbuncles as among its symptoms. I do not now a single instance where these symptoms have occurred in this disease in New-York. In [Page 17]the West-Indies these symptoms are not un­common, as would appear from the follow­ing extract of the before-mentioned letter, which I have introduced, as it serves to establish the similarity of the yellow fever to the plague.—"We have had a return of the yellow fever during the months of July, August, and September, much more violent than I ever recollect seeing. The rainy sea­son set in very late, and the weather proved, during these three months, remarkably warm and sultry. The disease commenced early in July, and was not only contagious, but attended with pestilential symptoms. Bu­boes appeared in several patients, who, how­ever, recovered; and I have seen several instances of the anthrax and pestilential car­buncle. One patient evidently sunk from a carbuncle on his elbow, the haemorrhage from which could scarcely be suppressed by pledgits dipt in diluted vitriolic acid; and two others also appeared upon the foot and ankle of the same patient. I am at present attending a medical gentleman who has above fifty carbuncles upon his body. The [Page 18]discharge has reduced him, but he is recover­ing. The appearance was first a red une­qual erysipelatous appearance upon the skin; in the centre appeared an elevated spot, which gradually changed to black, burst, and discharged a blackish bloody ichor, and left behind it a deep pit. Upon other parts a white pustule appeared, which, after burst­ing, discharged pus and bloody serum, and pitted in the same manner. The back, loins, and upper part of the thighs were princi­pally affected."

PREDISPOSING CAUSE.

PREDISPOSITION is that state of the body not of itself capable of producing the disease, but rendering the body more suscep­tible of the exciting cause. In order to pro­duce yellow fever, it is necessary that the body should be in such a state as to receive the action of the exciting cause. This state appears to be a peculiar irritability in the [Page 19]system, by whatever means induced. Upon no other principle can we explain the rea­son why the contagion does not affect every person within its atmosphere, and why the attendants of the sick are not always at­tacked. The causes which produce predis­position in the body, for the most part, are,

1st. Fear, which possesses great power in debilitating the body, and hence rendering it more irritable. Upon this principle we may account for the good effects of the dif­ferent preventives which many were in the habit of using; such as the wearing a small quantity of camphor, vinegar, &c. con­stantly about the body, inspiring them with a certain degree of courage. The use of tobacco was supposed to have a good effect in counteracting the disease, probably from its possessing more stimulus than the matter of contagion.

2d. Heat. especially exposure to the di­rect rays of the sun, was a common cause, as it assisted the stimulus of contagion in bringing on indirect debility. Fire also ren­dered the contagion more active. To prove [Page 20]this we notice, that a great majority of those that were infected were such as, from the nature of their occupations, were much exposed to the heat of the sun and fire.

3d. Fatigue, whether induced upon the mind or body, and from whatever source.

4th. Grief. Persons who attended friends or relatives in this disease were not unfre­quently seized during their attendance.

5th. Excess in venery, and other evacua­tions, such as bleeding and purging, aided by fear, which caused some persons to adopt these means in order to prevent the opera­tion of contagion.

6th. Cold; accordingly such as had been previously much heated, upon getting them­selves wet, drinking largely of cold water, or exposing themselves to a stream of cool air, were readily attacked with the disease.

7th. Intemperance in eating or drink­ing: taking either too large or small quan­tity of improper food; or a scantity allow­ance of common diet.

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EXCITING CAUSE.

DISEASE is brought on by the action of the exciting cause, after the body is rendered capable of receiving the contagion by the action of the predisposing cause. The yel­low fever being a contagious disease, it must undoubtedly depend upon the action of a poison either generated or introduced into the body. This matter, or poison, is generally acknowledged to be exhaled from animal and vegetable substances in a state of putrefaction: but, as there is a great con­trariety of opinion upon this subject, I shall purposely pass it over, referring the reader to the works of LAVOISIER and others.— There are also many different opinions as to the mode in which this contagion acts upon the body in producing the disease. Some have supposed that it enters the sys­tem by the stomach—some that it enters by the lungs—and others, that the body re­ceives [Page 22]it by the pores of the skin. All these opinions have their advocates; but by which­ever passage it is communicated to the sys­tem, whether by the stomach, the lungs, or the pores of the skin, it is certain, that, in common with the matter of small-pox, measles, lues venerea, the venom of the rattle-snake, &c. it produces a violent irrita­tion throughout the whole system. Its first operation I consider to be upon the nervous system: hence the violent pains of the head, back, and extremities of the body—hence the sickness of stomach and vomiting— hence the sensation of cold and constriction upon the secreting and excreting vessels. Such an irritation upon the nervous system, with an interruption to the secretions and excretions, are necessarily followed with a quickened circulation. The irritating matter of itself is sufficient to produce this effect; but the suppression of perspiration, the con­fined state of the bowels, and especially the re­tention of bile of an uncommonly acrid qua­lity, must also unquestionably have a share in adding to this irritation and increased action.

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CURE.

HAVING stated the symptoms and causes of the disease, we are next to consider the indications of cure, which appear to be,

First, To prevent the further operation of the poison producing the disease.

Secondly, to procure a solution of the in­flammatory stage of the fever.

Thirdly, To counteract the putrescent state of the body, as described in the second stage of the disease. And,

Lastly, to restore the tone of the system when the preceding indications are accom­plished.

First, To prevent the further operation of the poison producing the disease. To this end it is necessary that the patient be remo­ved from the atmosphere in which he took the disease, and placed in a situation where he may enjoy a pure, free air: all articles capable of conveying the contagion should [Page 24]be immediately removed from the body, such as clothing, &c. in place of which there should be clean dry clothing, bedding, &c.

Secondly, To procure a solution of the in­flammatory stage of the fever. It is neces­sary to moderate the increased action of the system, and to remove, as far as possible, every other source of irritation. To evacu­ate immediately the poison from the body, when one introduced, is as impossible as to eradicate the matter of small-pox, measles, or any other disease produced by specific con­tagion. In the treatment of yellow fever, as in that of the small-pox, if the analogy be a just one, t [...]sness of the physician appears to be, to moderate the action of the poison producing the disease, and, at the same time, to remove every circumstance which can aggravate its operation upon the body. With a view to diminish the increased ac­tion of the system, evacuations of different kinds were employed. Some practitioners had recourse to blood-letting, followed by purging and sweating; and others trusted [Page 25]entirely to the two latter. With respect to blood-letting, my observation has been, that the promiscuous use of the lancet was very injurious and unsuccessful. In the New-York hospital it was frequently employed, but in the majority of cases the disease ter­minated fatally; yet, in some few instances, where the constitution was uncommonly ple­thoric, and the determination to the head more violent than usual, I have observed good effects follow the loss of a moderate quantity of blood. But, generally speaking, blood-letting was attended with pernicious consequences. The same has been confirm­ed by the observations of several of our most respectable practitioners. The more com­mon and successful practice was,

1. To procure a free evacuation from the bowels. The purgative medicines which were employed were many and various. By some, calomel and jalap were prescribed, and, in the beginning of the disease, with good effect. Others administered a mixture of rhubarb and magnesia with cinnamon or mint-water. This also answered well in [Page 26]many cases, where the stomach was irrita­ble, and rejected the former medicines. But the medicine which was the most success­ful, and acquired the greatest reputation, was the Glauber's salts, given in warm diluting drinks. The dose was generally from one to two ounces, dissolved in a pint of gruel made of Indian meal, and given in divided doses until it operated freely; the patient at the same time drinking freely of gruel or chicken water, to promote its operation. Salts, exhibited in this form, for the most part sat well on the stomach: they were ex­peditious in their operation, and, in many instances, possessed the additional advantage of relaxing the skin and inducing perspira­tion, especially where the patient drank large­ly during their operation. But when the sto­mach was so much irritated as immediately to reject every thing taken into it, recourse was then had to glysters, composed of vi­negar and water, quickened by the addi­tion of a small quantity of molasses: these scarcely ever failed to produce the intended effect.

[Page 27]2. Having procured copious and free eva­cuations from the bowels, the next object appeared to be to relax the surface of the body, and induce free perspiration. In some instances this salutary discharge came on im­mediately after the bowels had been empti­ed, and was readily continued by taking plentifully of warm drinks; but, for the most part the febrile symptoms continued violent, the skin remained hot and dry, the pains still distressing, and it became necessary to have recourse to more active means to induce sweating. For this purpose many su­dorific medicines were employed. Some practitioners used emetics, and others small doses of James's powders, and the different preparations of antimony. Vomiting, in this disease, I have generally observed to be of dangerous tendency. It may, perhaps, not be amiss, when the disease first discovers itself, and is attended with much sickness and vomiting, to empty the stomach freely, by means of an infusion of chamomile flow­ers: but the exhibition of emetics I consider to be highly dangerous and improper. I [Page 28]believe I have seen some cases in which the death of the patients could be ascribed to no other cause than the incessant vomiting brought on by an emetic given in the com­mencement of the disease. But the most certain and successful means were, to wash the whole surface of the body with cold vi­negar and water, and immediately after co­vering the patient with blankets—to admi­nister such medicines as possess the effect of bringing on sweating: of these the spiritus mindereri and saline draughts of RIVERIUS succeeded well, more especially if the warm drinks were continued, such as the infusion of snake-root, gruel, toast water, tamarind water, lemonade, &c. These were much aided by applying to the feet of the patient a warm brick, steeped in vinegar and cover­ed in a flannel cloth wet with vinegar or spirits: the steam, thus emitted and diffused through the bed, had a wonderful effect in softening the skin and exciting sweat, espe­cially where the cold washing had been pre­viously employed.—Some practitioners have preferred the practice of plunging the pa­tient [Page 29]several times in a cold bath, and vio­lently dashing the body with cold water. But simply washing the patient with cloths dipped in cold vinegar and water, was found much preferable to immersion, both because it more effectually diminished the heat of the system, and was less fatiguing to the patient. Experiments have proved, that re­peatedly wiping and washing with water, in the ordinary way in which the operation is performed, diminishes the heat seven or eight degrees more than simple immersion, or dashing it over the body with pails.

THE practice of cold bathing in fevers of this type is not a new one, but was very commonly employed at Breslaw, in Silesia;* and of late years has been very successfully applied in the West-Indies, as well as in different parts of Europe, where diseases of this type prevail.

PROFESSOR GREGORY, of Edinburgh, and Doctor CURRIE, an eminent physician [Page 30]at Liverpool, have also prescribed it with great advantage in the low typhus fevers of those cities. But its great success in the New-York hospital, as employed by Doctor SAMUEL BARD, and in the private practice of my brother, have fully convinced me of the propriety of its use. It is also proper to remark, that where the physician was not called to the patient in the first stage of the disease, and putrid symptoms had appeared, and the patient had become much debilita­ted, the cold bath was injurious; and from the abuse of cold bathing, by employing it in the last stage of the disease, it has fallen into disrepute with some practitioners. But as the abuse of a thing is no argument against its use, I repeat my observation, that in the first or inflammatory stage of the disease, it was one of the most useful remedies that was employed. When the cold bath had been thus made use of, and immediate­ly after followed by the spiritus mindereri or saline mixture, with plentiful dilution, it rarely failed to produce sweating in the course of fifteen minutes; and when once [Page 31]induced, it was easily continued by the re­petition of the sudorific medicines and drinks, until a solution of the fever was obtained. In some instances where the patient refused his drink and medicines, or, from the care­lessness of the nurses, they had not been sup­plied as frequently as was proper, and the perspiration had been suppressed, it became necessary to repeat the cold bathing, which seldom failed to procure a return of the sweating. By the continuance of this dis­charge an abatement of all the symptoms took place: it appeared to operate as a spe­cific in the disease; the pulse in a short time became moderate; the heat of the skin di­minished; the pain in the head and back, before so distressing, was also relieved; the sickness of stomach and vomiting were re­moved; and, in the course of two or three days from the attack, the patient had little else to contend with but mere debility.

Thirdly, In those cases where the physi­cian was not called in the early stage of the disease, where the bowels were not freely emptied, and perspiration had remained sup­pressed, [Page 32]with a continuance of the fever, a more distressing train of symptoms appear­ed, as described in the second stage of the disease, and required a different mode of practice: few patients, however, recovered from this stage of the disease.

WHERE the stomach was much disturb­ed with sickness and vomiting, which was one of the most dangerous symptoms, the saline draught was exhibited in the efferves­cing state; and, in some instances, yeast was employed with advantage, followed with nourishing antiseptic drinks, as milk-punch, lemonade, porter diluted with water, &c. Snake-root-tea, where it sat well upon the stomach, appeared to possess most advan­tages in this stage of the disease, inasmuch as it procured a free determination to the surface of the body, independent of its anti­septic properties; but where the stomach rejected every thing, recourse was had to blisters, applied immediately over the region of the stomach, and, in some instances, with the most happy effects. Spirituous fomen­tations, applied to the lower extremities, [Page 33]especially where they were followed with perspiration, in many instances gave relief to the stomach, and rendered it more re­tentive.

WHERE the bowels were in a costive state, purgative medicines were given to the patient; at the same time injections were employed, composed of vinegar and water, with the addition of molasses and repeated every hour until they produced the desired effect.

WHEN the functions of the brain and nervous system were much disturbed, as in­dicated by delirium, subsultus tendinum, rest­lessness, &c. sinapisms, composed of rye-meal, vinegar, and mustard, applied to the soles of the feet, blisters to the ankles, to the inside of the thighs, and to the head, in some few instances procured relief.—In this stage of the disease some practitioners had recourse to bark, wine, and the tonic treat­ment in general; but the plan I have ob­served to be attended with most success in addition to the medicines and treatment re­lated above, was to support the patient's [Page 34]strength, by the mildest nourishment, and such as was the least stimulating to the sys­tem, viz. soups, composed of a great pro­portion of vegetables, sago, milk punch, with a small quantity of spirits or brandy, merely sufficient to render it grateful to the sto­mach. In addition to this mode of treat­ment, great attention was paid to the re­moval of every external source of irritation, by frequent changes of linen and bedding, by frequently wiping the body with cloths dipped in spirits or vinegar, removing every offensive matter from the room, and by cor­recting the atmosphere around him, by the explosion of gun-powder, sprinkling vine­gar over his bed, and through the room, and procuring a free circulation of fresh air.

Fourthly, Having, by the means above enumerated, procured an entire solution of the fever, it remains to restore the strength of the system. In the stage of the disease alluded to under the last indication, while a degree of fever remained, an active tonic or stimulating plan of treatment was found in­jurious; but, when a perfect solution of the [Page 35]disease was obtained, and the patient labour­ed under mere debility of body, this mode of treatment was not only admissible, but, in many instances, the patient's strength was so completely exhausted, that the most re­storative medicines and diet became neces­sary. In this state of body recourse was had to the bark, serpentaria, the different bitters, mineral acids, and the usual medi­cines prescribed with this intention, viz. wine, porter, milk-punch, &c. The diet employed with most advantage consisted chiefly of vegetables: sago, tapioca, indian and oat-meal gruel, rendered palatable by the addition of wine, were, for the most part, grateful to the patients—were suffici­ly nourishing, and, being of a more antisep­tic quality, were found less hazardous than the use of animal food. When animal food was employed, it was in the form of soups, with a large proportion of vegetables, or calves-feet jelly, with the addition of wine: in this form it became less exceptionable. But solid animal food was very commonly injurious, retarding the recovery of the pa­tient, [Page 36]and in many instances producing a return of the disease; it was therefore very generally prohibited during the convalescent state of the patient.

THE drinks employed with most benefit, and which were found most grateful to the sick, were wine and water, milk-punch, porter, &c. Such was the disease, and such the mode of treatment, as far as has come within my knowledge.

THE END

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