USA > Ohio > Hancock County > Findlay > Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens > Part 72
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Mr. Fuller received a common school educa- tion in the public schools of Kalamazoo, and at that place attended and graduated from Kalamazoo College, completing his collegiate course in 1883, receiving the degree Ph.B., and having later the degree of Ph.M. con- ferred for post-graduate work. Immediately following his graduation in 1883 he received the appointment of assistant city engineer in the city of Kalamazoo, which position after about two years he resigned to take up the study of law as a profession. He was ad-
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656
HISTORY OF HANCOCK COUNTY
mitted to practice as a member of the bar of Michigan in September, 1885, by the Circuit Court of Kalamazoo County, with the distinc- tion of having covered the then ordinary two- year course of reading required by the univer- sity curriculum in seven months. Following his admission to the bar, Mr. Fuller engaged in active practice of his profession at Cadillac, Mich., where he held for one year the office of city attorney, and for one year that of county superintendent of schools in Wexford County. In August of 1889, drawn by the then growing fame of Findlay as the center of the oil and gas belt of Ohio, he removed to that city, becoming at the time a member of the law firm of Barber and Fuller, which con- tinued until 1896, since which time Mr. Ful- ler has continued his professional work as the successor of this firm, Mr. Barber having re- moved to Toledo.
Since taking up his residence in Findlay, Mr. Fuller has been thoroughly identified with the interests of the city as a property owner
and citizen, taking part in its movements for civic advancement, and serving it as a member of its Board of Health for many years, and holding the office of local registrar of vital statistics. Professionally he has been inter- ested in and taken part in very many of the cases of large importance that have passed throught the courts in his own and adjoining counties.
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He has been for many years prominent as an Odd Fellow, both among local lodge cir- cles, and in the State, having been representa- tive in the Grand Lodge of Ohio I. O. O. F.
Mr. Fuller was married, October 12, 1887, to Miss Mary A. Peck, of West Bloomfield, N. Y., to which union have been born eight children, of whom seven are living, being in the order of their birth, Henry C., Raymond M., Margaret A., Robert E., Edith N., Fran- ces F. and Ruth E. All were born at Findlay except the oldest son, whose birthplace was at Cadillac.
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BIO-MEDICAL LIBRARY
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THE .
JOHNS HOPKINS HOSPITAL
BULLETIN
VOLUME XXII
U
MINI
BALTIMORE THE JOHNS HOPKINS PRESS 1911
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Ele Lord Baltimore (press BALTIMORE, MD., U. S. A.
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THE 1
Vol. XXIII, -No. 2
Urinary Hyperacidity a Myalgia. By THOMAS R. 1 An Analysis of the Cor sentations. By CLARENCE B
Investigation into Sevel Benzol,
By CHARLES GL. The Viscosity of the B By CHARLES R.
URINA
The etiology of n been difficult to det types of cases vario in neuritis the only of cases is some poi out, or produced w organisms or to di recognize that man chemical constitutic peripheral nerves. poisoning or autoin cases the only symp upon the periphera may be mentioned :
bon monoxide, alco and sulphonal, and produced by fevers, and other infection:
affecting metabolisı cachexia, malnutrit the resistance of the When we conside: find very similar ft
BULLETIN
OF
.To
E JOHNS HOPKINS HOSPITAL
1
Entered as Second-Class Matter at the Baltimore, Maryland, Postoffice.
-No. 238.1
BALTIMORE, JANUARY, 1911.
[Price, 25 Cents
CONTENTS.
PAGE
PAGE
eracidity and its Relation to Neuritis, Neuralgia and
OMAS R. BROWN, M. D. . 1
of the Course of Labor in 100 Occiput Posterior Pre- 18.
ARENCE B. INGRAHAM, M. D. 5
into Several Cases of Poisoning by Vapors of "C. P."
In Memoriam. August Horn. (Portrait.) By MAX BRODEL 21
Notes and News
23
ARLES GLASER 8
y of the Blood in Health and Disease. (Illustrated.) IARLES R. AUSTRIAN, M. D. .
£
Notes on New Books .
24
Books Received
32
RINARY HYPERACIDITY AND ITS RELATION TO NEURITIS, NEURALGIA AND MYALGIA.
By THOMAS R. BROWN, M. D., Associate in Medicine, Johns Hopkins University.
ogy of neuritis, neuralgia and myalgia has always It to determine, although we recognize in certain ses various causative factors. Thus, for example, the only assignable origin in a certain proportion some poison, introduced into the body from with- duced within, either due to the action of micro- or to defective metabolism. We cannot fail to hat many poisons, very different in nature and nstitution, show a peculiar tendency to affect the nerves. In some of these cases other symptoms of r autointoxication are present, but in a group of ily symptoms seem to be the effect of these toxins eripheral nerves. Among the etiological factors itioned metallic poisons, as lead and arsenic, car- de, alcohol, various drugs, as aniline compounds al, and the ptomaines and leucomaines ; the toxins fevers, as scarlet fever, diphtheria, typhoid fever, fections and poisons in various diseases especially etabolism, as diabetes; affections associated with ilnutrition and anemia, where in all probability e of the nerve is lowered, and cold.
consider the etiology of neuralgia and myalgia we nilar factors-various toxins, exogenous or endo-
genous, conditions of malnutrition and anæmia, cold, organic diseases of the nervous system, some systemic diseases, espe- cially those of the circulatory apparatus, and direct trauma of the nerves. or muscles. We must not forget that certain cases, considered as neuralgia or myalgia, are probably in reality mild case of neuritis. There is unquestionably a dis- tinct hereditary predisposition in a certain proportion of all these cases. Certainly in myalgia, and possibly in neuralgia, the feeling is that in a certain number of cases there seems to be a peculiar susceptibility in members of rheumatic or gouty families.
It is not our purpose to discuss the etiology of neuritis, neuralgia and myalgia in toto, but simply to call attention to certain interesting features especially in regard to the chem- istry of the urine in that group which from lack of definite causative factors can be spoken of as idiopathic. In this dis- cussion while we recognize that these conditions shade im- perceptibly into each other; how, for example, many regard neuralgia as a mild neuritis, and others regard myalgia either as a neuritis or a neuralgia, we shall use the terms in the ordi- narily accepted sense, and define neuritis as a definite inflam- mation of the nerve with demonstrable signs of inflammation ; neuralgia as a pain strictly confined to a nerve or group of
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Sarcoma and Tuberculosis. - Report of a Case. By J. P. SIMONDS, M. D. . 17
Carcinoma of the Right Fallopian Tube Readily Palpable Through the Abdomen. (Illustrated.) By THOMAS S. CULLEN, M. B. . 20
2
JOHN LU
SPITAL BULLETIN.
[No. 23
nerves without demonstrable signs of inflammation; and my- algia as more diffuse pain affecting certain muscles, or groups of muscles, probably due to changes in their fibrous con- stituents.
We wish to present a group of cases of neuritis, neu- ralgia and myalgia, in which the examination of the urine showed a marked increase of acid; to suggest that this is prob- ably due to disturbances of metabolism, and that the pain represents a symptom of autointoxication; and to note that in certain of these cases the administration of alkalies with the consequent diminution of the acidity is associated with marked improvement in the symptoms.
While the acidity of the urine varies within quite consider- able limits in health, broadly speaking we may say that when expressed in terms of deci-normal sodium hydroxide solution it is 25, that is, it takes 25 cc. of deci-normal sodium hydrox- ide solution to neutralize 100 cc. of urine, phenolphthalein being used as the indicator. A number of years ago we made between 100 and 125 observations on normal human beings, and arrived at these figures, which subsequently have been confirmed by other investigators in this field (Hastings) ; in certain of the text-books of clinical diagnosis (Wood) as well, .25 is given as the average urinary acidity. Of course, this is markedly dependent upon the specific gravity of the urine, which, in turn, is influenced by the exercise taken, and the amount and character of the ingesta; it is lower, often markedly so, when the specific gravity is diminished, as after the ingestion of large amounts of water, and is higher when the specific gravity is increased by the ingestion of too little water, or by an augmented loss of water from the skin or bowels; but under normal conditions, the patient passing about 1500 cc. daily with an average specific gravity of 1.015, the usual acidity is 25 or thereabouts.
In making our observations we examined, as a rule, the early morning specimens, as these probably represent more closely the average urine of the 24 hours than specimens ob- tained at any other time of the day, and also because, by this means, we can more easily make our examinations shortly after the urine has been voided.
CONSIDERATION OF CASES.
The series we wish to report comprises 44 cases classified as follows: 5 cases of neuritis, 2 of sciatica, 8 of neuralgia, 11 of neuralgic headache, 5 of lumbago, 1 of torticollis, 23 of myalgia. There were 14 males and 30 females. The young- est case was 16, the oldest 55; no decade predominated.
As regards hereditary predisposition four gave a family history of gout, one of tuberculosis, one of diabetes, one of rheumatism, one of arterio-sclerosis and cerebral hæmorrhage, and one of myalgia and neuralgia. Two of the cases (17 and 19) were sisters, while one (28) was the daughter of two others (16 and 35). It would seem from a consideration of these figures that heredity played a very minor rôle in these conditions.
The digestion and the general habits were good in the great majority of cases; 10 complained of indigestion, either gastric
or intestinal, and 10 of constipation, while three used tobace extensively, six alcohol in considerable amount and five ad- mitted being careless and rapid eaters.
Whether the conditions may be regarded as an expression of a gouty or lithæmic tendency or diathesis is uncertain as si only of the 44 cases could be considered clinically in this category (11, 14, 20, 26, 39, 44).
The hæmoglobin was above 85 per cent in all the cases in which it was taken-a great majority of the 44-with the er- ception of three (31, 34, 40), in which it was 60, 74 and ;v per cent, respectively. All cases with facial neuralgia or neu- ralgic headache were especially questioned regarding the con- dition of their eyes. If there was any suggestion cof visual dis- turbance an oculist was consulted, but in almost all these cases, in fact, with only one or two exceptions, that possibility had already been considered by the patient, and the proper glasses obtained without relieving the symptoms. In the case of ull women the suffering was often increased at the menstrual period, at which time, of course, metabolic disturbances are likely to be increased, while in two of the cases the disease came on at the menopause.
It would seem, therefore, that the great majority of these cases developed neuritis, neuralgia and myalgia, not as a result of hereditary predisposition, or indiscretions in diet, exposure to cold or trauma, but from some indefinite cause, as far as we could determine. It, therefore, seems justifiable to regard these cases as idiopathic in origin, and due to a disturbance in metabolism, probably to some circulating toxin, manifest- ing itself clinically in the production of pain in the affected group of nerves or muscles, associated with an increase in the urinary acidity ..
THE URINARY ACIDITY IN THESE CASES.
The acidity was quantitatively determined in each exami- nation, as previously described, from fresh morning specimens. In this series 43 of the 44 cases gave readings, ranging from 35 to 138, and of these 36 had an acidity of 50 or above, 16 of 75 or above, six of over 100, and two of over 125. The average acidity of these 44 cases, which with recurrences furnished 52 readings, was 69.1, that is, nearly three times the normal, 25, as expressed in terms of deci-normal sodium hydroxide solution.
The inspection of our table of cases, however, will demon- strate that . the majority show an increase of the specific gravity, and, therefore, it will be fairer to reduce them to a basis of a specific gravity of 1.015, in other words, to deter- mine the acidity if the urine voided were of sufficient dilution to be of the normal degree of density. In 34 of the 44 cases the specific gravity was taken, and the correction made; that is, bringing them to a specific gravity of 1.015 gave an aver- age acidity of 51.5, which shows that although the tendency is to have a urine of higher specific gravity, there is, never- theless, a real and considerable increase in the acid, the aver- age being a little more than double the normal. In this connection we have assumed that the total amount of solids excreted is the same as under normal conditions, or, in other
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JANUARY, 1911.]
No.
1 1. | Neuritis: r. brac] lowed by disus
2 Neuritis: r. bracl Recurrence in '
3. Neuritis: 1. brach 1. Neuritis: severe 1
5. Neuritis: severe I
6. Myalgia : thigh.
7. |Neuralgia: facial. Recurrence in 4
8. Neuralgia: arms.
9. |Myalgia: diffuse .. 10. Myalgia: shoulder 11. Neuralgia : facial. Recurrence in 6 12. |Sciaties: left. Lt
13. Myalgia : diffuse.
14. Myalgia: diffuse ...
17. Neuralgie headache
18 Myalgia: diffuse. . 19. Lumbago ... 20. ..... Myalgia : severe, d Return of sympti 11. |Neuralgic headache
# |Myalgia: diffuse ... 13. Myalgia : back and 14 |Myalgis: severe, di 5. |Myalgis
24 |Myalgia: severe, di: Torticollis ....... ...
24. Sciatica.
Recurrence in 2 n 29. Myalgia: severe, dit Recurrence in 8 Ir Recurrence in 3 m Recurrence in 2 m Neuralgie headache.
Myalgia. Neuralgic
12. Neuralgia: face and a. Myalgia: diffuse .... Neuralgie headaches
Myalgia: diffuse ... W. |Neuralgic headaches. 17. Neuralgia: facial .. . 1. Neuralgie headaches.
19. Myalgia
...
Neuralgia: facial, se aches ...
41. Attacks of neuralgic disturbances ......
42. | Neuralgia: facial ....
1. |Lumbago. 4. Myalgia
..
-
15. Lumbago.
16. Myalgia and neurai
4
REPORT OF CASES.
No.
Diagnosis.
Urinary Acidity and Specific Gravity.
Urinary Acidity Corrected to Sp. Gr. of 1.015.
P. H. = Past History. F. H. = Family History.
1.
Neuritis: r. brachial and circumflex, severe type, fol- lowed by disuse and atrophy
2.
Neuritis : r. brachial. Recurrence in 7 months
50-1.020
$7.5
F. H .- Gout (maternal side)
Neuritis : 1. brachial
Neuritis : severe r. brachial, ulnar, and circumflex
69-1.017
60.9
P. H. - Very small eater.
Neuritis : severe r. brachial ..
75-1.015
75
.
.
Neuralgia : facial. Myalgia : back.
49-1.018
40.8
Neuralgia: arms
46-1.016
43.1
P. H. - Eczema, attacks of purpura bæmorrhagica.
Myalgia: diffuse Myalgia: shoulder and back
51-1.009
85
Neuralgia : facial. Myalgia. Recurrence in 6 weeks
65
....
Sciatica : left. Lumbago.
135
98-1.025
... 58.8
Lumbago.
Myalgia and neuralgic headache
57-1.015
57
P. H. - Constipated. Gout. Nervous strain. F. H. - Father had gout.
Neuralgic headache: severe myalgia of back
68
....
F. H. - Arterio-sclerosis.
P. H. - Careless eater, alcohol in considerable amounts. Constipated. Nervous.
Has epilepsy.
Menopausal nervousness.
F. H. - Father has diabetes.
138-1.027
76.6
Myalgia: diffuse.
85-1.025
51 45.8
P. H. - Chronic intestinal indigestion.
P. H. - Occasional attacks of acute epigastric pain.
Sciatica.
Recurrence in 2 months
66-1.018
55 48.5
F. H. - Father, Case 16. Mother, Case 35.
Myalgia : severe, diffuse. Recurrence in 8 months. Recurrence in 3 months ..
105-1.028
56.3
Recurrence in 2 months.
74
13-1.012
16.3
[yalgia. Neuralgic headaches
78-1.026
45
P. H. - Splanchnoptosis. Hemoglobin 60%. tion.
Indiges-
80-1.030
40
35-1.005
105
49-1.015
49
yalgia : diffuse
52-1.021
37.1
euralgia : facial
60
70-1.019
55.3
ralgia
73
....
uralgia: facial, severe repeated attacks of. Head- aches . . .
105
....
P. H. - Constipation. Hæmoglobin 65%.
uralgia: facial.
45-1.018
37.5
nbago algia
48-1.014
51.4
75
....
. .
. .
P. H. - Neuralgia and sciatica several years ago-severe one year ago. (Urinary acidity = 60).
69-1.017
60.9
P. H. - Hard worker, light eater, smokes and drinks in moderation.
Myalgia : thigh. Neuralgia : leg
59-1.022
40.0
61-1.017
53.8
P. H. - Much worry. Obesity. F. H. - Father died of tuberculosis. P. H .- Very small eater, very nervous. F. H. - Nervous.
51-1.015
51
F. H. - Mother bad gout.
P. H. - Always nervous, careless eater, drinks consid- erably at times.
P. H. - Very neurotic. Constipated.
Very nervous. Pain in lower back for years.
P. H. - Alcohol and tobacco in large amounts. Large eater. Constipated. Hard worker.
P. H. - Hard worker, careless eater. Has had attacks of epigastric pain and nausea.
Myalgia : diffuse. Lumbago .
49 49-1.018 88
40.8
Myalgia : severe, diffuse. Return of symptoms one year later. Neuralgic headache. Myalgia: diffuse.
101-1.028
54.1
P. H. - Scarlet fever twice. Large, rapid eater.
P. H. - Scarlet fever once.
Constipated. Considera- ble indigestion. Neurasthenia and psychasthenia. P. H. - Neurasthenia.
Myalgia : severe, diffuse.
55-1.018
Myalgia
75-1.028
40.2
Myalgia : severe, diffuse
79-1.029
40.9
Torticollis
99-1.027 70
55
P. H. - Menopausal nervousness. Obesity.
P. H. - Tonsillitis as a child. Malaria one year before. Considerable nervous strain.
F. H .- Gout on both sides.
75
....
Teuralgic headache.
...
F. H. - Mother had rheumatism.
P. H. - Neurasthenia and nervous dyspepsia.
euralgia : face and arms. yalgia: diffuse ..
P. H. - Repeated attacks of tonsillitis.
P. H. - Indigestion (hyperchlorhydric). Constipation. Hæmoglobin 74%.
euralgic headaches. Lumbago
60
....
euralgic headaches
P. H. - Constipation. Nervousness. P. H. - Nervous. Constipated. Hard brain worker.
P. H. - Very hard worker, physically and mentally. Splanchnoptosis.
P. H. - Eats carelessly. Drinks moderately. Hyper- trophied heart, and anginoid attacks.
tacks of neuralgic headache, followed by digestive disturbances ..
51-1.024
30.5
P. H. - Digestion poor. Used tobacco immoderately, and alcohol moderately.
P. H. - Constipated. Some indigestion. Previously operated on for appendicitis.
P. H. - Neurasthenia. Pruritus.
P. H. - Eczema and pruritus.
Digitized by
50
51
Myalgia : diffuse. Neuralgic headache
Myalgia: diffuse.
54
91-1.026
53.5
...
Myalgia : back and legs
P. H .- Nervous indigestion. Constipation.
55-1.017 75
P. H. - Double ovariotomy 2 years ago. Has distinct beginning gouty deposits in fingers.
euralgic headaches : severe for many years.
P. H. - Considerable exposure to cold.
Recurrence in 4 months ..
115
4
JOHNS HOPKINS HOSPITAL BULLETIN.
[No. 238
words, that the quantity varies inversely with the specific gravity, but more than likely this is not the case, as the solids are probably increased in this group of cases, and, therefore, the total acidity is doubtless higher than the figure given, 51.5.
Increased acidity of the urine is met with in other condi- tions, and we have described 20 or more cases (Philadelphia Medical Journal, March 2, 1901, New York Medical Journal, March 14, 1903) where the effect of this was to produce symp- toms very suggestive of cystitis, notably pain in the bladder and on urination, conditions entirely absent in the present group of cases.
Just why in some instances the brachial nerve, in others certain muscles, and in still others the nerves of the bladder should be selected by the circulating poison or toxin as the source of the signs and symptoms of the individual case we find it impossible to say, but in all probability there have been certain causes in the past history of the patient, which have lowered the resistance of that portion of the body affected.
.
THE RELATION OF URINARY TO GASTRIC ACIDITY.
The question may well be asked what is the cause of this increase in the urinary acidity ; and does it bear any relation to the acidity of the gastric juice, or is it due to errors in metabolism arising elsewhere? In our series of 44 cases we took test meals in nine, comparing the analysis of the test meal with the specimen of urine obtained at the same time. A study of these cases would seem to show that there is no definite relationship here between the urinary and gastric acidity.
Case
Urinary Acidity.
Corrected to
Test Meal
sp. gr. 1.015 Free HCI-Total Acid
16
91-1.026
52.5
59-75
19
49-1.018
40.8
0 -..
21
138-1.027
76.6
35-50
24
75-1.028
40.2
20-52
25
79-1.029
40.9
43-76
32
80-1.030
40.0
0-22
34
49-1.015
49.0
52-72
41
51-1.024
31.9
0-15
42
45-1.018
37.5
39-63
.
In nine instances the urinary acidity varied from 45 to 138 or (corrected to a specific gravity of 1.015) from 31.9 to 76.6; the free HCI from 0 to 59, the total acid from 15 to 76, these figures also being expressed in terms of deci-normal sodium hydroxide solution. Of these nine, three had no free HCI; in three the free HCI was between 20 and 40; and in three between 40 and 60. While these are, of course, far too few in number to furnish definite and final conclusions, nevertheless, they suggest that there is little or no relationship between urinary and gastric acidity. It, therefore, seems probable that the urinary hyperacidity met with in these cases is due to metabolic disturbances arising elsewhere, possibly to de- rangement in the functions of certain of the ferments in the liver or intestines.
It is, of course, quite possible that these cases simply repre- sent a form of atypical gouty manifestation, or a lithæmic tendency. It is worth remembering that in gout and dia-
betes, with their deranged metabolism, where neuritis and neu- ralgia are frequent, there is a distinct tendency towards in- creased acid production, or acid elimination. This naturally suggests that any condition which has as its especial char- acteristic an increase in the amount of acid produced would seem to possess a peculiar tendency to show symptoms in the nervous tissues, which in turn seem to be peculiarly vulnerable to acids, whatever their chemistry or source of origin.
TREATMENT.
The treatment of these cases was extremely suggestive along certain lines. In all the cases, believing we were dealing with disturbances of metabolism and that as a consequence toxins were being formed, which in their circulation produced defi- nite lesions or disturbances in certain nerves or muscles, we insisted upon a simple dietary and the drinking of water in considerable amounts ; and basing our treatment purely on the urinary findings, we administered alkalies to all in sufficient amount to reduce the urinary acidity to or below normal. It might be well to mention in this connection that in some patients enormous quantities were necessary to bring about this result; thus in a case of very stubborn sciatica of many years' duration, the administration of one ounce of alkali daily for four weeks reduced the acidity of the urine from 138 to only 89, while in many it was necessary to give from half an ounce to an ounce of alkali daily for two or three weeks before the acidity reached rormal.
The alkalies given were usually bicarbonate or citrate of soda, carbonate of lithium, and bicarbonate of potash, while if constipation were present calcined magnesia was frequently added.
In some instances the administration of sufficient alkali with the simple dietary and the drinking of large amounts of water was the entire treatment; and in 17 of the 44 cases (1. 2, 3, 7, 9, 10, 14, 16, 22, 24, 25, 26, 28, 31, 34, 37, 39) the cure was effected by this means with little or no additional treatment, but. in some other cases it was found necessary to use different therapeutic agents, such as aspirin, coal-tar derivatives, the salicylates, or even opiates occasionally, the paquelin cautery, and the application of heat or cold.
It seems worth while to mention a few of the cases in detail. Three of the five cases of neuritis obtained almost entire relief in a comparatively short time under this treatment, and one of these (1) had previously been obliged, for between three and four weeks, to take from $ to 1 grain of morphia daily: the other two cases of neuritis, however, needed sedatives of some kind. One patient (7) with neuralgia and myalgia had noted before he came that his attacks could be stopped by taking large quantities of bicarbonate of soda, while in several of the milder cases (9, 10, 14, 15, etc.) almost complete relief was obtained in a few days' time. In some (14, 20, etc.) it seemed that the regulation of the diet, and the general regimen was really of much greater importance than the ad- ministration of alkalies.
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