The prehistoric man, motivated by feelings of sympathy and kindness, was always at the behest of his kindred, trying to provide relief, in times of sickness and suffering. Since his knowledge was limited, the primitive man attributed Man and Medicine: Towards Health For All disease and in fact all human suffering and other calamities to the wrath of gods, the invasion of body by "evil spirits" and the malevolent influence of stars and planets.
The concept of disease in which the ancient man believed is known as the "supernatural theory of disease". As a logical sequence, the medicine he practiced consisted in appeasing gods by prayers, rituals and sacrifices, driving out "evil spirits" from the human body by witchcraft and other crude means and using charms and amulets to protect him against the influence of evil spirits.
The administration of certain herbs or drugs whose effect is doubtful or nil but hopefully harmless may also be likened to a kind of magic ritual associated with the need to "do something". There is also evidence that prehistoric man improvised stone and flint instruments with which he performed circumcisions, amputations and trephining of skulls. It is thus obvious that medicine in the prehistoric times (about 5000 BC) was intermingled with superstition, religion, magic and witchcraft.
Primitive medicine is timeless. If we look around the world, we find the rudiments of primitive medicine still persist in many parts of the world - in Asia, Africa, South America, Australia and the Pacific islands. The supernatural theory of disease in which the primitive man believed is as new as today. For example, in India, one may still hear of talk of curing snake bites by "mantras".
Diseases such as leprosy are interpreted as being punishment for one's past sins in some cultures. Although primitive man may be extinct, his progeny - the so-called "traditional healers" are found everywhere. They live close to the people and their treatments are based on various combinations of religion, magic and empiricism. Indian medicine The medical systems that are truly Indian in origin and development are the Ayurveda and the Siddha systems. Ayurveda is practiced throughout India, but the Siddha system is practiced in the Tamil-speaking areas of South India. This system differs very little both in theory and practice. Ayurveda by definition implies the "knowledge of life" or the knowledge by which life may be prolonged. Its origin is traced far back to the Vedic times, about 5000 BC. During this period, medical history was associated with mythological figures, sages and seers. Dhanvantri, the Hindu god of medicine is said to have been born as a result of the churning of the oceans during a 'tug of war' between gods and demons.
According to some authorities, the medical knowledge in the Atharvaveda (one of the four Vedas) gradually developed into the science ofAyurveda. In ancient India, the celebrated authorities in Ayurvedic medicine were Atreya, Charaka, Susruta and Vaghbhata. Atreya (about 800 BC) is acknowledged the first great Indian physician and teacher. He lived in the ancient university of Taxila, about 20 miles west of modern Rawalpindi. Ayurveda witnessed tremendous growth and development during the Buddhist times. King Ashoka (226 BC) and the other Buddhist kings patronized Ayurveda as State medicine and established schools of medicine and public hospitals. Charaka - the most popular name in Ayurvedic medicine, was a court physician to the Buddhist king, Kaniska.
Based on the teachings of Atreya, Charaka compiled his famous treatise on medicine, the "Charaka Sarnhita". Charaka mentions some 500 drugs. The Indian snakeroot (rauwolfia) was employed for centuries by the Indian physicians, before reserpine was extracted from the root and found spectacularly effective in the treatment of hypertension. Among the many distinguished names in Hindu medicine, that of Susruta, the "father of Indian surgery" stands out in prominence. He compiled the surgical knowledge of his time in his classic "Susruta Sarnhita". It is believed that this classic was compiled between 800 BC and 400 AD. Though this work is mainly devoted to surgery, it also includes medicine, pathology, anatomy, midwifery, ophthalmology, hygiene and bedside manners. The early Indians set fractures, performed amputations, excised tumors, repaired hernias and excelled in cataract operations and plastic surgery (6).
It is stated that the British physicians learned the art of rhinoplasty from Indian surgeons in the days of East India Company. However, during Buddhist times, Indian surgery suffered a setback because of the doctrine of ahimsa (non-violence). Of significance in Ayurveda is the "tridosha theory of disease". The doshas or humors are: vata (wind), pitta (gall) and kapha (mucus). Disease was explained as a disturbance in the equilibrium of the three humors; when these were in perfect balance and harmony, a person is said to be healthy (8). This theory of disease is strikingly similar to the "theory of four humors" in Greek medicine. Medical historians admit that there was free exchange of thought and experience between the Hindu, Arab, Persian, Greek and Jewish scholars. The Samhitas of Charaka and Susruta were translated into Persian and Arabic about 800 AD. Hygiene was given an important place in ancient Indian medicine. The laws of Manu were a code of personal hygiene. Archaeological excavations at Mohenjo-dara and Harappa in the Indus valley uncovered cities of over two thousand years old which revealed rather advanced knowledge of sanitation, water supply and engineering. The golden age of Indian medicine was between 800 BC and 600 AD. During the Moghul period and subsequent years, Ayurveda declined due to lack of State support.
Medical historians admit that Indian medicine has played in Asia the same role as the Greek medicine in the west, for it has spread in Indochina, Indonesia, Tibet, Central Asia, and as far as Japan, exactly as the Greek medicine has done in Europe and Arab countries. Mention must be made of the other indigenous systems of medicine namely Unani-Tibb and Homoeopathy, which are not of Indian origin. The Unani-Tibb system of medicine, whose origin is traced to the ancient Greek medicine, was introduced into India by the Muslim rulers about the 6th Century AD. By the 13th Century, the Unani system of medicine was firmly entrenched in certain towns and cities notably Delhi, Aligarh, Lucknow and Hyderabad (5). It enjoyed the State support under successive Muslim rulers in India, till the advent of the British in the 18th Century.
Homoeopathy, - which was propounded by Samuel Hahnemann (1755-1843) of Germany gained foothold in India during 1810 and 1839 (9). It is a system of pharmaco-dynamics based on "treatment of disease by the use of small amounts of a drug that, in healthy persons, produces symptoms similar to those of the disease being treated" (10).
Homoeopathy is practiced in several countries, but India claims to have the largest number of practitioners of this system in the world (9). The Indian systems of medicine including Unani-Tibb and Homoeopatily are very much alive in India even today. In fact, they have become part of Indian culture, and they continue to be an important source of medical relief to the rural population. Chinese medicine Chinese medicine claims to be the world's first organized body of medical knowledge dating back to 2700 BC (11). It is based on two principles - the yang and the yin. The yang is believed-to be an active masculine principle and the yin a negative feminine principle. The balance of these two opposing forces meant good health. Hygiene, dietetics, hydro-therapy, massage, drugs were all used by the Chinese physicians.
The Chinese were early pioneers of immunization. They practised variolation to prevent smallpox. To a Chinese, "the great doctor is one who treats not someone who is already ill but someone not yet ill". The Chinese have great faith in their traditional medicine, which is fully integrated with modern medicine. The Chinese system of "bare-foot doctors" and acupuncture has attracted world-wide attention in recent years (12). Egyptian medicine Egypt had one of the oldest civilizations about 2000 BC. A lot is known about ancient Egypt because they invented picture writing and recorded their doings on papyrus.
In Egyptian times, the art of medicine was mingled with religion. Egyptian physicians were co- equals of priests, trained in schools within the temples. They often helped priests care for the sick who were brought to the temples for treatment.
There were no practical demonstrations in anatomy, for Egyptian religion enjoined strict preservation of the human body. Egyptian medicine reached its peak in the days of Imhotep (2800 BC) who was famous as a statesman, architect, builder of the step pyramid at Saqqarah and physician. The Egyptians worshipped many gods. Imhotep was considered both a doctor and divinity. Specialization prevailed in Egyptian times. There were eye doctors, head doctors and tooth doctors. All these doctors were officials paid by the State. Homer speaking of the doctors of the ancient world considered the Egyptians to be the "the best of all" (13). Egyptian medicine was far from primitive. They believed that disease was due to absorption from the intestine of harmful substances which gave rise to putrefaction of blood and formation of pus.
They believed that the pulse was "the speech of the heart". Diseases were treated with cathartics, enema, blood-letting and a wide range of drugs. The best known medical•manuscripts belonging to the Egyptian times are the Edwin Smith papyrus (3000-2500 BC), and the Ebers papyrus (1150 BC). The Edwin Smith papyrus, the oldest treatise on surgery, accurately describes partial paralysis following cerebral lesions in skull fractures. The Ebers papyrus which was found with a mummy on the banks of the Nile, is a unique record of some 800 prescriptions based on some 700 drugs. Castor oil, tannic acid, opium, turpentine, gentian, senna, minerals and root drugs were all used by the Egyptian physicians. A great number of diseases are reported in the papyri such as worms, eye diseases, diabetes, rheumatism, polio and schistosomiasis. Unfortunately, these ailments are still present in modern Egypt (7).
In the realm of public health also, the Egyptians excelled. They built planned cities, public baths and underground drains which even the modern might envy. They had also some knowledge of inoculation against smallpox, the value of mosquito nets and the association of plague with rats. Their god of health was Horus. Egyptian medicine occupied a dominant place in the ancient world for about 2500 years when it was replaced by Greek medicine. Mesopotamian medicine Contemporary with ancient Egyptian civilization, there existed another civilization in the land which lies between the Euphrates and Tigris rivers, Mesopotamia (now part of Iraq), often called the "Cradle of Civilization", as long as 6000 years ago.
In ancient Mesopotamia, the basic concepts of medicine were religious, and taught and practised by herb doctors, knife doctors and spell doctors - a classification that roughly parallels our own internists, surgeons and psychiatrists. Mesopotamia was the cradle of magic and necromancy. Medical students were busy in classifying "demons", the causes of disease. Geomancy, the interpretation of dreams, and hepatoscopic divination (the liver was considered the seat of life) are characteristic of their medical lore. Sumerians, Babylonians and Assyrians were the authors of a medical astrology which flourished in the whole of Eurasia.
Prescriptions were written on tablets, in cuneiform writing. The oldest medical prescription comes to us from Mesopotamia, dating back to 2100 BC. Hammurabi, a great king of Babylon who lived around 2000 BC formulated a set of drastic laws known as the Code of Hammurabi that governed the conduct of physicians and provided for health practices (14). Doctors wnose proposed therapy proved wrong ran the risk of being killed. Laws relating to medical practice, including fees payable to physicians for satisfactory services and penalties for harmful therapy are contained in the Babylonian Code of Hammurabi, the very first codification of medical practice. While the code of Hammurabi reflected a high degree of social organization, the medicine of his time was devoid of any scientific foundation. Greek medicine The classic period of Greek medicine was the years 460-136 BC. The Greeks enjoyed the reputation - the civilizers of the ancient world. They taught men to think in terms of 'why' and 'how'. An early leader in Greek medicine was Aesculapius (1200 BC). Aesculapius bore two daughters - Hygiea and Panacea.
The medical historian, Douglas Guthrie (17) has reminded us of the legend that Hygiea was worshipped as the goddess of health and Panacea as the goddess of medicine. Panacea and Hygiea gave rise to dynasties of healers (curative medicine) and hygienists (preventive medicine) with different philosophies. Thus the dichotomy between curative medicine and preventive medicine began early and we know it remains true today. Hygiea (prevention) is at present fashionable among the intellectuals; but Panacea (cure) gets the cash. Aesculapius is still cherished in medical circles - his staff, entwined by a serpent continues to be the symbol of medicine. By far the greatest physician in Greek medicine was Hippocrates (460-370 BC) who is often called the "Father of Medicine". He was born on the little island of Cos, in the Aegean sea, about 460 BC. He studied and classified diseases based on observation and reasoning. He challenged the tradition of magic in medicine, and initiated a radically new approach to medicine i.e., application of clinical methods in medicine. Hippocrates' lectures and writings, as compiled later by Alexandrain scholars into the "Corpus Hippocraticum", encompassed all branches of medicine. This 72-volume work contains the first scientific clinical case histories. Some of the sayings of Hippocrates later became favourites with physicians, such as "Life is short, the art (of medicine) long, opportunity fleeting, experience treacherous and judgement difficult", and "where there is love for mankind, there is love for the art of healing". His famous oath, the "Hippocratic oath" has become the keystone of medical ethics. It sets a high moral standard for the medical profession and demands absolute integrity of doctors.
Hippocrates will always be regarded as one of the masters of the medical art. Hippocrates was also an epidemiologist. Since he distinguished between diseases which were epidemic and those which were endemic, he was, in fact, the first true epidemiologist. He was constantly seeking the causes of disease. He studied such things as climate, water, clothing, diet, habits of eating and drinking and the effect they had in producing disease. His book "Airs, Water and Places" is considered a treatise on social medicine and hygiene. The Hippocratic concept of health and disease stressed the relation between man and his environment. In short, the Greeks gave a new direction to medical thought. They rejected the supernatural theory of disease and looked upon disease as a natural process, not a visitation from a god of immolation. The Greeks believed that matter was made up of four elements - earth, air, fire and water, These elements had the corresponding qualities of being cold, dry, hot and moist and were represented in the body by the four humors - phlegm, yellow bile, blood and black bile - similar to the "tridosha theory" in Ayurveda.
The Greeks postulated that health prevailed when the four humors were in equilibrium and when the MEDICINE IN ANCIENT TIMES 3 balance was disturbed, disease was the result. The human body was assumed to have powers of restoration of humeral equilibrium, and it was the physician's primary role to assist in this healing process. While the humeral theory of Hippocrates was based on incorrect foundations, the concept of the innate capacity of the body of responding to disturbances in the equilibrium that constitutes health is highly relevant to modern medicine (15). Outstanding amongst post-Hippocratic medical centers was Alexandria's huge museum, the first University in the world which sheltered a library containing over 70,000 books. To this house of learning came eminent men. Between 300 BC and 30 BC, thousands of pupils matriculated in the school of Alexandria, which replaced Athens as the world's center of learning. In short, the Hippocratic School inspired in-turn the Alexandria school and the Arabo-Persian medicine. The Hippocratic School changed the destiny of medicine by separating it from magic and raising it to the status of a science.
They had scientific method, although not scientific knowledge. The glorious Greek civilization fell into decay and was succeeded by the Roman civilization. Roman medicine By the first Century BC, the center of civilization shifted to Rome. The Romans borrowed their medicine largely from the Greeks whom they had conquered. While the politics of the world became Roman, medicine remained Greek. In the political philosophy of the Romans, the State and not the individual were supreme. The Romans were a more practical-minded people than the Greeks. They had a keen sense of sanitation. Public health was born in Rome with the development of baths, sewers and aqueducts. The Romans made fine roads throughout their empire, brought pure water to all their cities through aqueducts, drained marshes to combat malaria, built sewerage systems and established hospitals for the sick. An outstanding figure among Roman medical teachers was Galen (130-205 AD) who was born in the Greek city of Pergamon in Asia Minor (now Turkey). He was physician to the Roman emperor, Marcus Aurelius. His important contributions were in the field of comparative anatomy and experimental physiology. Galen was far ahead of his time in his views about health and disease. About health he stated: "Since both in importance and in time, health precedes disease, sowe ought to consider first how health may be preserved, and then how one may best cure disease" (16). About disease, Galen observed that disease is due to three factors - predisposing, exciting and environmental factors, a truly modern idea. The doctrines of Hippocrates and Galen were often in conflict since their approaches were so different - one is synthetic, the other analytic.
An author of some 500 treatises on medical subjects, Galen was literally a "medical dictator" in his time, and also for a long time there-after. His writings influenced European medicine. They were accepted as standard textbooks in medicine for 14 Centuries, till his teachings and views were challenged by the anatomist, Vesalius in 1543, and the physiologist, William Harvey in 1628, almost 1500 years after his death. Middle ages the period between 500 and 1500 AD is generally known as "Middle Ages". With the fall of the Roman empire, the medical schools established in Roman times also disappeared. Europe was ravaged by disease and pestilence: plague, smallpox, leprosy and tuberculosis. The practice of medicine reverted back to primitive medicine dominated by superstition and dogma. Rejection of the body and glorification of the spirit became the accepted pattern of behaviour. It was regarded as immoral to see one's body; consequently, people seldom bathed. Dissection of the human body was prohibited. Consequently there was no progress of medicine. The midaeval period is therefore called the "Dark Ages of Medicine" - a time of great strife, of socio-political chanqe, of regression and progression. When Europe was passing through the Dark Ages, the Arabs stole a march over the rest of the civilization.
They translated the Graeco- Roman medical literature into Arabic and helped preserve the ancient knowledge. Borrowing largely from the Greeks and Romans, they developed their own system of medicine known as the Unani system of medicine. They founded schools of medicine and hospitals in Baghdad, Damascus, Cairo and other Muslim capitals. The Arabs lit a brilliant torch from Greecian lamps said Osler. Leaders in Arabic medicine were the Persians, Abu Becr (865-925) also known as Rhazes; and Ibn Sina (980-1037) known as Avicenna to the western world. Hhazes was a director of a large hospital in Baghdad and a court physician as well. Noted for keen observation and inventiveness, he was the first to observe pupillary reaction to light; to use mercurial purgatives; and to publish the first known book on Children's diseases.
However, the work most highiy regarded today is his book on smallpox and measles which he distinguished clinically, Avicenna was an intellectual prodigy, He compiled a 21-volume encyclopaedia, the "Canon of Medicine", which was to leave its mark on medical theory and practice. He was responsible for elevating Islamic medicine to its zenith in the middle ages, the greatest contribution of Arabs, in general, was in the field of pharmacology. Seeking the "elixir of life", they developed pharmaceutical chemistry, introducing a large number of . drugs, herbal and chemical. Pioneers in pharmacology, they invented the art of writing prescriptions, an art inherited by our modern pharmacists, They introduced a wide range of syrups, oils, poultices, plasters, pills, powders, alcoholates and aromatic waters.' The words drug, alcohol, syrup and sugar are all Arabian (17).
The golden age of Arabic medicine was between 800 - 1300 AD. During the turbulent middle ages, Christianity exerted a wholesome influence, The spread of Christianity led to the establishment of hospitals, Early midaeval hospitals rarely specialized in treatment of the sick. Usually the sick were received for the purpose of supplying their bodily wants and catering to their spiritual needs, the first hospital on record in England was built in York in 937 AD, With the growth of medicine, a chain of hospitals sprang up from Persia to Spain - there were more than 60 in Baghdad and 33 in Cairo. Some hospitals, like Cairo's AI Mansur had separate departments for various diseases, wards for both sexes, fountains to cool fever patients, libraries, musicians and story tellers for the sleepless, During the middle ages, religious institutions known as "monasteries" headed by monks, saints and abbots also came up.
These monasteries admitted men and women from all ranks including kings and queens, They not only helped preserve the ancient knowledge but also rendered active medical and nursing care to the sick. The period following 1500 AD was marked by revolutions political, industrial, religious and medical. Political revolutions took place in France .and America, people claiming their just rights. The industrial revolution in the West brought great benefits leading to an improvement 'in the standard of living among people. With advancing degrees of civilization, medicine also evolved. Revival of medicine for many historians, the revival of medicine encompasses the period from 1453-1600 AD. It was an age of individual scientific endeavor, The distinguished personalities during this period were: Paracelsus (1493-1541) who revived medicine, He was born at a time "when Europe stretched her limbs after a sleep of a thousand years in a bed of darkness", Labelled genius by some and quack by others, Swiss-born Paracelsus publicly burnt the works of Galen and Avicenna and attacked superstition and dogma and helped turn medicine towards rational research.
Fracastorius (1483-1553), an Italian physician enunciated the "theory of contagion". He envisaged the transfer of infection via minute invisible particles and explained the cause of epidemics, Fracastorius recognized that syphilis was transmitted from person to person during sexual relations. He became the founder of epidemiology, Andreas Vasalius (1514-1564) of Brussels did lot of dissections on the human body and demonstrated some of Galen's errors, He raised the study of anatomy to a science, and has been called "the first man of modern science". Vesalus' great work Fabrica became a classic text in medical education. What Vesalius did for anatomy, Ambroise Pare (151 0-1590), a Fench Army surgeon did for surgery and earned the title, "father of surgery". Pare advanced the art of surgery, but John Hunter (1728-1793) taught the science of it. In 1540, the United Company of Barber Surgeons was established in England, which later became the Royal College of Surgeons, Another great name in clinical medicine is that of Thomas Sydenham (1624-1689), the English Hippocrates who set the example of the true clinical method, He made a differential diagnosis of scarlet fever, malaria, dysentery and cholera, Sydenham is also regarded as the first distinguished epidemiologist, The 17th and 18th Centuries were full of even more exciting discoveries, e.q, Harvey's discovery of the circulation of blood (1628), Leeuwenhoek's microscope (1670) and Jenner's vaccination against smallpox (1796), However, the progress in medicine as well as surgery, during the 19th Century would not have been possible but for Morgagni (1682-1771) who founded a new branch of medical science, pathologic anatomy. Sanitary awakening another historic milestone in the evolution of medicine is the "great sanitary awakening" which took place in England in the mid- nineteenth Century and gradually spread to other countries.
It had a tremendous impact in modifying the behavior of people and ushering an era of public health, The industrial revolution of the 18th Century sparked off numerous problems - creation of slums, overcrowding with all its ill-effects, accumulation of filth in cities and towns, high sickness and death rates especially among women and children, infectious diseases like tuberculosis, industrial and social problems- which deteriorated the health of the people to the lowest ebb, The mean age at death in London was reported to be 44 years for the gentry and professionals, and 22 years for the working class, in 1842 (14). Add to this, the frequent visitations of cholera compounded the misery of the people. The great cholera epidemic of 1832 led Edwin Chadwick (1800-1890), a lawyer in England to investigate the health of the inhabitants of the large towns with a view to improve the conditions under which they lived (18). Chadwick's report on "The Sanitary Conditions of the Labouring Population" in Great Britain, a landmark in the history of public health, set London and other cities slowly on the way to improve housing and working conditions, Chadwick's report focussed the attention of the people and government on the urgent need to improve public health. Filth was recognized as man's greatest enemy and with this began an anti-filth crusade, the "great sanitary awakening" which led to the enactment of the Public Health Act of 1848 in England, A new concept began to take shape, i.e., the State has a direct responsibility for the health of the people, The rise of public health The above events led to the birth of public health in England around i 840, Earlier, Johanna Peter Frank (1745-1821) a health philosopher of his time, conceived public health as good health laws enforced by the police and enunciated the principle that the State is responsible for the health of its people, The Public Health Act of 1848 was a fulfillment of his dream about the State's responsibility for the health of its people.
Cholera which is often called the "father of public health" appeared time and again in the western world during the 19th Century. An English epidemiologist, John Snow, studied the epidemiology of cholera in London from 1848 to 1854 andestablished the role of polluted drinking water in the spread of cholera. In 1856, William Budd, another pioneer by careful observations of an outbreak of typhoid fever in the rural north of England concluded that the spread was by drinking water, not by miasma and sewer gas. These two discoveries were all the more remarkable when one considers that the causative agents of cholera and typhoid fever were not identified. Then came the demand from people for clean water. At that time the Thames was both a source of drinking water and the depository for sewage. A comprehensive piece of legislation was brought into force in England, the Public Health Act of 1875 for the control of man's physical environment.
The torch was already lit by Chadwick, but the man who was actually responsible more than any other for sanitary reforms was Sir John Simon (1816-1904), the first medical officer of health of London. He built up a system of public health in England which became the admiration of the rest of the world (18). This early phase of public health (1880-1920) is often called the "disease control phase". Efforts were directed entirely towards general cleanliness, garbage and refuse disposal. Quarantine conventions were held to contain disease. The development of the public health movement in America follows closely the English pattern. In 1850, Lemuel Shattuck (1793- 1859), a bookseller and publisher, published his report on the health conditions in Massachusetts. Like Chadwick's report it stirred the conscience of the American people to the improvement of public health. France, Spain, Austria, Germany, Italy, Belgium and the Scandinavian countries all developed their public health. By the beginning of the 20th Century, the broad foundations of public health - clean water, clean surroundings, wholesome condition of houses, control of offensive trades, etc were laid in all the countries of the western world.
After the First World War, there were three particular new comers to the public health scene - Yugolsavia, Turkey and Russia (19). These three countries in 1920 presented the typical picture of the underdeveloped world. Today they are quite advanced in public health. While public health made rapid strides in the western world, its progress has been slow in the developing countries such as India where the main health problems continue to be those faced by the western world 100 years ago. The establishment of the WHO providing a Health Charter for all people provided a great fillip to the public health movement in these countries. Germ theory of disease For long, man was groping in darkness about the causation of disease. Several theories were advanced from time to time to explain disease causation such as the supernatural theory of disease, the theory of humors by Greeks and Indians, the theory of contagion, the miasmatic theory which attributed disease to noxious air and vapours, the theory of spontaneous generation, etc.
The breakthrough came in 1860, when the French bacteriologist Louis Pasteur (1822-1895) demonstrated the presence of bacteria in air. He disproved the theory of "spontaneous generation". In 1873, Pasteur advanced the "germ theory of disease".
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