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of the other; and the type, it is often serviceable to the general health, two sets evincing a and carries off many disorders of other kinds difference of duration Dr. Fordyce affirms (On Fever, Diss. ii., p. 16),

or of violence. that he has seen it of considerable use in curing 8 Tertianus triplex. A double tertian, taking or alleviating chronic rheumatism, habitual in Triple tertian. place as above ; but digestion, cutaneous eruptions, protracted it

one of the sets having flammations, epilepsies, and hysteria. And his regularly two parox- | assertion is corroborated by other authorities.ysms on the day of (Salmuth, cent. ii., obs. 14; Ephem. Nat. Cur, its return, and the dec. iii., ann. iii., obs. 30.) It is to this kind

other one alone. of remedial fever that Professor Frank gives the y Tertianus impar. The one set evincing a name of depurátory.(Op. cit., tom. i., p. 48.) Double unequal ter- more perfect, the other The duration of intermittents is of great

a less perfect inter | uncertainty. The vernal agues generally dismission.

appear with the advance of summer; the au• Tertianus duplicatus. A single tertian with two tumnal are more obstinate, and especially the Duplicate tertian. paroxysms on the reg-quartan. Where they have remained long, and

ular day of attack, the have become habitual, even their removal must intervals being of or- be attempted with great caution ; for, when

dinary duration abruptly suppressed, they have been known to Quartani

The paroxysms of the lay a foundation for a host of other maladies, Double quartan. one set occurring in often of a more fatal description, as paralysis,

the intermissions of various visceral affections, and even sphacelus. the other, and evin-1 Ludolf gives an instance of an eight-day ague cing a difference of (anetus erraticus octanus)continuing for eighteen duration or of vio- years; yet this was probably a double quartan; lence : with an inter- while we have abundant examples of a conval on the third day tinuance of the regular quartan for nine (Eph. alone.

Nat. Cur., dec. i., ann. viii., obs. 45), twelve s Quartanus triplex. Consisting of a single (Avicenna, canonum i., lib. iv., tr. ü., cap. vi.) Triple quartan. quartan with regularly-eighteen (Madai, Von Weckselfiebern, sect. 144),

returning paroxysms ; | twenty (Eph. Nat. Cur., dec. ii., ann. is, and while each of them., obs. 51), twenty-four (Marcellus Donatus, intervening days is | lib. üi., cap. xiv., p. 291 ; Pontanus, De Febr. marked with a slighter Conel., lib. viii.), and thirty years (Binninger

or separate attack. obs. cent. V., N. 64; Wierius, obs., p. 37), and Quartanus duplicatus. Consisting of a single one instance of its lasting for not less than forty: Duplicate quartan. quartan with two par eight years.—(Gabelchover, cent. vi., obs. 74.) II

oxysms on the regular is in this species, therefore, that we chiefly meer day of attack: the in- with those congestions in the spleen which are tervals being of ordi- called ague-cakes, as also with scirrhosities nary duration.

the liver, pancreas, and other abdominal organs, « Quartanus triplicatus. Consisting of a single which by Bonet, Swalwe, Senac, and other Triplicate quartan. quartan with three par-writers, have been regarded as causes ol!

oxysms on the regular disease, but by Van Hoven, and most patbor
day of attack: the in-ogists of the present day, excepting, perhaps
tervals being undis-Cruveilhier, are more correctly resolved
turbed, and of ordi- | effects.
nary duration.

Schenck gives a case of congenital quartan,

| or in which it appeared in an infant immediatel Having thus distinctly noticed the several after birth (Obs., lib. vi., N. 36); and P species and chief varieties of intermittent fever, another, in which though not strictly congeni I shall proceed to offer a few remarks upon its it appeared in very early infancy. -10 general history and medical treatment.

obs. 94.) But such examples are rare. A

Among Whenever the accession of an intermittent is other singularities, I may observe, that the violent, be its type what it may, it is sometimes cession has sometimes been so violent a attended with very alarming symptoms, as syn- destroy the patient in the course of the cope, apoplexy, vehement spasms over the whole paroxysm, of which an instance will be on system, or a coldness or torpor which threatens in Senac (Von Weekselfiebern, b. 11., cap. death.* Yet, when not violent, nor of very while, at other times, it has been so slig long duration, especially when of the tertian rapid, that the entire paroxysm has run thi

# It once occurred to Dr. Joseph Brown to see ing very feebly, for eighteen hours, at the a person die in what appeared to be the cold stage which he expired, his intellect having be of a first fit of ague. Heat applied in various clouded till within a few minutes of his modes, ammonia, ardent spirits, ether, and other tion. The principal morbid appearance stimulants, failed to bring on reaction. The pa was in the liver, which was very much tient lay as cold as marble, and shivering violently, had a lobulated appearance, and was gors without any pulse at the wrist, and his heart act. I blood.-Cyclop. of Pract. Med., art. FEVE

as to e first


end of

been un inutes of his dissolu. Od appearance discovered ch was very much enlarged,

nd was gorged with ed., art. FEVER.-En.

its course in a minute.-(Reil, Memorab. Clin., | to particular cases, and, in the other, to the genvol ii., Fasc.)

eral disease. In plethoric habits, the head was The character of the intermittent seems in a greatly oppressed with a tendency to delirium considerable degree to depend upon the age or in those of a nervous and irritable disposition, idiosyncrasy of the individual, and the tempera- the intermittent was connected with spasms and ment of the atmosphere. We find, also, that twitchings of the tendons. And those disposed variations more usually take place in the quo- to rheumatism, had acute arthritic pains. The tidian than in any other type, which we should, state of the atmosphere, and the general charperhaps, ascribe to its occurring more frequently acter of the season, Dr. Reynolds has forgotten in early life, when the frame is more irritable ; l to notice ; but we see evidently, and indeed he and to the debility which the constitution suf- himself allows, that they give a typhous imfers from this type, above that of any other, in pression to the epidemic ; which, from the same, consequence of the greater length of its par- or from other causes, is also peculiarly distinoxysms, and the greater brevity of its intervals, guished by the easy victory it yielded to the use by which means the prostrated strength of the of the bark, as that of the preceding year was system has no time to rally.

distinguished by its obstinate resistance to this In this metropolis, from causes which have medicine. not been handed down to us, and which, in- ! If we ascend a year higher, or to 1780–1, we deed, do not appear to have been traced at the shall meet with an equal diversity of symptoms. time, intermittent fevers were more than ordi- “ These fevers" (intermittents), says Sir George narily frequent from the year 1781 to 1785 : Baker, “ were in general no other than the and the remarks I have just made apply in an common ague ; but in the more inland counespecial manner to all these. As a single ex-tries of England, they were often attended with ample, let us select those of 1782, as described peculiarities extraordinary and alarming. For by Sir George Baker and Dr. Reynolds, in an the cold fit was accompanied by spasm and article drawn up by the former, with an admira- stiffness of the whole body; the jaws being ble combination of learning and liberality, sound fixed, the eyes staring, and the pulse very small critical judgment, and inquisitive research. and weak. In many cases, delirium was added

“ The type of the sever of 1781-2," says Sir to spasm, under both which symptoms the paGeorge, “was either tertian or quotidian; the tieni laboured quite to the end of the paroxysm. former being more common in the first part of And though the senses returned when the fever the winter; the latter, from the middle of Feb- subsided, yet a convulsive twitching of the exruary to the end of June. With respect to the tremities continued, even in the intermissions, former, NOTHING OCCURRED to my observation to such a degree, that it was not possible to which is worthy of notice"—(Med. Trans., vol. distinguish the motion of the artery at the ui., art. xiii.) On the latter, Dr. Reynolds com- wrist. municated to him the following information :- “ This fever had every kind of variety : and,

The quotidian fevers were irregular in their whether at its first accession it were a quotidian, invasion, and uncommon in their appearance; a tertian, or a quartan, it was very apt to change and no cases resembled each other, except in from one type to another. Sometimes it revery few circumstances. The first attack gen- turned two days successively, and missed the erally commenced with a horror ; but the subse- third, and sometimes it became continual. I am quent paroxysms, though often beginning with not informed that any died of this fever while a sense of cold, were chiefly without horror. it intermitted. It is certain, however, that many The intermission was short, and seldom perfect. country people, whose illness had, at its begin The symptoms were very severe, and in many ning, put on the appearance of intermission, cases dangerous, and leaned strikingly to a ty- becoming delirious, sunk under it in four or five phous form. Great and sudden oppression of the days. It is a remarkable fact, and very well head, anxiety, depression of spirits, a dry, attested, that in many places, while THE INparched tongue, yet less covered with hardened HABITANTS OF THE HIGH GROUNDS WERE HARmucus than might be expected ; a pulse low, ASSED BY THIS FEVER IN ITS WORST FORM, quick, and intermitting ; bowels variable; urine THOSE OF THE SUBJACENT VALLEYS WERE NOT dark-red and clear, without any sediment, con- AFFECTED BY IT. The people of Boston and stituted the ordinary signs. Many had a low of the neighbouring villages, in the midst of the muttering delirium; two or three a laborious Fens, were in general healthy, at a time when respiration ; a few spasms and twitchings of the this sever was epidemic in the more elevated tendons : aphthæ appeared occasionally : and situations of Lincolnshire : and other examples one patient exhibited symptoms of violently acute of a like kind have already been noticed. It is rheumatism. The bark was universally successful; and, "I was as much pleased," says * Sir Gilbert Blane, Select Dissertations, p. 111, Dr. Reynolds, " with its present efficacy, as I 8vo., Lond., 1822. In order to form a correct judg. was in the year 1781 mortified by its extraordi ment of this part of the subject, we should have nary want of power. Half the quantity of it been informed of the state of the weather, not which I used on that occasion was sufficient ou

merely in respect to temperature, but quantity of rain that fell in the different places alluded to.

The occurrence of ague sometimes in high situ. In other words, idiosyncrasy and atmospherica

erisations, while it ceases in lower ones, will admit of temperament were both peculiarly visible, and

explanation on principles already noticed in a gave a peculiar character, in the one instance, preceding note.-ED.

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likewise singular, and worthy of notice, that, in or four times in succession. And he saires many families, the female servants were nearly us that he has very frequently seen obetuate exempted from a disease which very few male intermittents removed by this powder, and the servants, especially the labourers in the open out any relapse. air, escaped.' But the distinguishing character. The practice, however, has not been evaly of this fever was its obstinate resistance to the successful in other hands; not even when Peruvian bark ; nor, indeed, was the prevalence sicum has been given in a much larger quants of the disease more observable, than the ineffi- ty, or exchanged for ammonia, treacle-muster cacy of the remedy. Though the quantities of (clypoela jonthlapsi), or black or white pero the bark usually given were exceeded, the fit the latter of which is only the former dendal was apt to return, rarely altered, either with of its outward tunic, mixed up with brandy a respect to the time of invasion, or the intense- Hollands. They have all, indeed, soedas ness of the symptoms; and just as if no means answered, but the result is uncertain ; and a had been used to prevent it. A drachm of the / was long ago observed hy Van Swieten, des bark in powder was frequently administered medicine do not succeed upon a full dose, el every second hour, without averting the fit." especially when combined with ardent set

In casting our eyes over the great diversity of will often extend its influence to the hot flat medicines that have been employed for the cure greatly exacerbate it ; and not unfrequestlyet of intermittents, * we shall find that, innumer- vert an intermittent into a continued Ime able as they are, they may be arranged under Upon the whole, therefore, this plan is not ok two general heads, tonics and antispasmodics ; recommended, however varied. The leasie as though, long before the time of Dr. Cullen, nicious material is the ammonia ; but then ta his two principles of the disease, debility and also the least effective. spasm, had been uniformly admitted and acted A large draught of cold water has been upon.

unfrequently had recourse to for the same pet * The antispasmodics, consisting chiefly of pose, and also, in a few instances, with surtes stimulants, sedatives, and relaxants, have been The object is, by taking it about half u3 confined to the term of the paroxysm, with a before the cold fit is expected, to excite a set view to weaken and shorten it ; and the tonics, reaction and powerful glow over the entire ** consisting principally of bitters and astringents, tem against the time when the cold fit redem have been employed throughout the intervals, and thus to preoccupy the ground; and, by e with a view of fortifying the system against a turbing the regularity of the type, to satész a recurrence of the attack.

intermittent altogether. But this plan wat je In discussing the medical treatment of inter-haps, more frequently failed than the precedy mittent fevers, it will be sufficient to limit our and when the shivering or horripilation proper selves to these two indications.

by the cold water has not been followed It was a favourite practice with Bergius to stimulant effect, as in delicate habits nous anticipate the cold fit, constituting the accession cially, it has often continued so long as ** of the paroxysm, by pungent stimulants, in the into the term of the febrile cold fit, and me hope that, if he could successfully combat this considerably to increase its power Bes first stage, he should gain a complete victory, relates a case in which it proved fatal." not only over the individual paroxysm, but over The next division of antispasmods. all future incursions. His favourite medicines have been directed against the parores for this purpose were garlic, mustard-seed, especially against the rigour with each and capsicum. And he boasts of having, in nu-its onset, is sedatives and of the merous instances, completely succeeded, with have been opiates, which, when each of these ; though he admits that the mus- form of laudanum, in a dose of the Lard-seed answered best in vernal intermittents, forty drops at the commencement of a but did not, in general, prove sufficient for the has, in many cases of intermittents, bien bak autumnal quartans. The Indian practitioners, I beneficial ; diminishing the duration of these may here observe, employ chakka or ginger, and and moderating its symptoms. I sometimes the sison ammi for the same pur-says, that he practised this plan with pose, and Dr. Chisholm has occasionally suc- | advantage in an epidemic intermitent ceeded with scallions.-(Clim. and Dis. of Trop. tacked the Vengeance, one of the Chan Coun., &c., 1822, p. 53.) Bergius, however, | under Lord Howe ; and adds, thal," placed his chief reliance on the capsicum, six dose of opium did not produce a se grains of which he was in the habit of giving, combined with two scruples of bay-berries in

* Op., tom. i., p. 193. Venesectia la powder, “ incipiente primo rigore ;' and of re

recommended as a means of shortion

stage, and of preventing the hot stsee peating it every day, at the same hour, for three its duration and violence. Dr. Mack

work on the Practice of Physic, ist * Intermittents are sometimes cured merely by such treatment. On the other hant diet and regimen of twenty-three patients sent rather disapproves of venesection in the to the hospital la Charité, for the purpose of test. though he admits that it is benrbcial ing the efficacy of the misletoe (Ilex aquifolium). ( the symptoms of congestion about Lob M. Chomel states that the disease ceased immedi | abdomen.-(Edinb. Med. and Surg JOTEN ately in seven of them, although no medicine was | Dr. Elliotson has never seen a cam p us administered.-See Mem. de l'Acad. Royale de required venestetion in the cold stan Med., vol. i.-D.

Lond. Univ., Med. Gaz, 1809, 2

and exhilaration of spirits in half an hour, he re- , usual practice, so as not to regulate the hot and peated it, and never found it necessary to go sweating stages, but to anticipate the cold fit. beyond a second dose."* Sir Gilbert Blane ad. And we may still farther add to the ingredients verts to the same plan, as pursued at Walcheren of the medicine a full dose of ammonia with great during the English expedition to that island, and advantage; for, it is in this form, if in any, that with an equal success.

we can employ stimulants with a certainty of We have already seen, however, that there is doing little mischief, and very nearly a certainty some cause or other, probably the peculiar tem- of considerable benefit. In the case of a quartan perament of the atmosphere at the time, that in St. Thomas's Hospital which had lasted two baffles or one occasion the remedy that has best years, Dr. Fordyce determined upon this plan; succeeded on another. And hence opium has and prescribed a full dose of Dover's powder, with often failed in other intermittents in every form, a sweating draught of carbonate of ammonia, two bat especially when given in the cold fit. And hours before the paroxysm was expected. It owing io this diversity of effect, Dr. Lind thought succeeded perfectly. A profuse perspiration anit most useful in the hot fit; and asserts that, ticipated the period of the cold fit, and hereby if administered to the extent of twenty or five- entirely prevented it; bark was next given and-twenty drops of laudanum half an hour after freely, and this obstinate ague was cured in a the beginning of the hot fit, it produced the ad- few days.-(Edinb. Med. Comm., vol. vi., p. 359.) vantage of shortening and moderating the heat, Whatever be the relaxant or sudorific emcalmed the anxiety and headache, which are ployed, it should be assisted by plentiful potausual concomitants, expedited the sweating stage, tions of warm diluents, and by placing the pamade the paroxysms more regular, and some- tient between the blankets instead of in the times stopped the fever altogether.

sheets of his bed : for, I have already had occaOther physicians have commenced with re- sion to observe, that upon these auxiliary means larants; and where these are selected, the anti-depend, in many instances, the accomplishment monial preparations are to be preferred to ipe- of the object we have in view, without which cacuanha. They tend more directly towards the the most urgent diaphoretic exerts itself to no surface, and, where it is useful to excite vom- purpose. iting, which is often the case, they act sooner, The most important season, nevertheless, for and maintain the action longer, and hence make medical operation, is in the intermission of the a double effort to accelerate the sweating stage. paroxysms: since, however successful we may The antimonial preparations differ chiefly from be in moderating the febrile attack, it is rarely each other by having the reguline part of the that we can depend upon any plan which may antimony they contain in a more or less fusible then be adopted to prevent a recurrence of the fit. state ; and their operation will very often vary. The opinion of mankind seems to have conaccording to the quantity or quality of the acid curred in most ages, in regarding debility as they meet with in the stomach ; and hence the either the proximate or predisponent cause of different effect of the same preparation in dif- intermittents, since almost the only medicines ferent persons, and even in the same person at that have been brought forward to guard against different times.

the recurrence of their periodic attacks have The most efficacious practice which I have been TONICS, with the sensible qualities of bitterwitnessed, consists in uniting relaxants with ness or astringency, or of both. opiates; and, where this joint effort is pursued, | In what way these act upon the moving fibre ipecacuanha may answer as well as any of the at any time, and particularly in the diseases bepreparations of antimony. We cannot have, fore us, we cannot say with any degree of precis. for this purpose, a more useful medicine than ion. The tone of the moving fibre depends unDover's powder; and it should be commenced questionably in some degree upon the state of with much earlier than is consistent with the the fibrous material itself, but perhaps in a

much greater degree upon the state of the + The administration of opium to arrest the in

nervous influence. We have great reason for

believing, that astringents, in producing tone, vasion of intermittents, is one of long and extensive use in the United States. It is largely in- act upon the fibrous material itself, for we find debted for its popularity to the authority of Sir them operating in like manner upon animal fibres Gilbert Blane. Sixty or eighty drops of laudanum, both in a living and a dead condition. But blended with a few drops of sulphuric ether, or of whether, as Dr. Cullen conjectures, it be the aqua armonia, are often administered a short time previous to the invasion of the cold chill. Many # Dr. Elliotson conceives, that in the cold stage, physicians will testify to the efficacy of this treat the plan of surrounding the patient with hot air ment, and few be disposed to question its efficacy, would be better than putting him into the warm even in plethoric subjects. Plethora and local con- bath, as is sometimes done. Air in any quantity, gestion however should always be considered, and and of any temperature, may be conveyed under blood letting may sometimes be found an important the bedclothes by means of something like an inpreliminary measure. Dr. Gallup (Epidemic Dis. verted funnel, a tube, and a spirit-lamp. Dr. Ellitases of Vermont) strongly condemns the use of otson has also a favourable opinion of the usefulopium in every form of intermittent fevers.-D. ness of friction. The warm drinks which are given,

** Select Dissertations, &c., p. 105, Lond., 8vo., he thinks, should not contain wine or brandy, as 1822. Dr. Elliotson has given opium with very such stimuli would be likely to increase the sub. great success; yet, says he, "if I found great consequent hot stage, bring on delirium, and cause gestion of the head or other parts, I would order congestion and inflammation of the head and interbleeding in preference to oprum."

nal organs.-ED.

part of bitters alone to act upon the nervous . sician to his holiness, pointed out, in express power or living principle, and especially in the terms, the time and proportion in which the very singular manner in which he represents bark was to be taken. Unfortunately, the time them as acting, is a different question ; and the stated was frigore febrili incipiente, “at the present is not the place for entering upon it. commencement of the cold fit;" and it being

If we contemplate the brain and spinal mar- administered in this manner, with only temporow as the sources of nervous energy, we can rary benefit, to the Archduke Leopold of Austria, readily conceive that the component parts of a year or two afterward, it immediately fell into these organs, as well as of any other, may be great discredit with a very large and learned invigorated by medicines that have a peculiar part of the medical community of Europe ; and influence on their structure.; and that conse a most acrimonious warfare was instantly waged quently, such organs may be rendered capable in every quarter on the subject, in which the of distributing the nervous power in greater combatants on both sides seemed more des abundance, or of producing it in a more elabo | rous of victory than of truth. rate perfection. And we can also readily con In our own country, the bark began to be ceive, that such effects may be produced by both come popular about 1655. In 1658, Mr. Unbitters and astringents, as well as by medicines derwood, an alderman of the city of London, that possess some other sensible qualities, though died while using it, and was instantly reported these are the most obvious in their operation to have fallen a sacrifice to its power; and so But should we, with Dr. Cullen, affirm that the prejudicial was the effect of this rumour, that same bitter, employed in the same proportion, Cromwell, who was attacked with an ague in produces both tone and atony, energy and de- the same year, was suffered to languish and ar bility ; that it both cures the gout and occa- length to die without an exhibition of the bark, sions it ; that, employed for a certain time it his physicians being afraid to make a trial of it, effects the former, and, after such time, the lat- in consequence of the fatal accidents that had ter; and should we beyond this affirm, with so lately accompanied its use : in the words of him also, that the nervous energy is not the pro- Morton (Pyretolog., p. 17), “nondum vires corduction, but an inherent power, of the brain; ticis in hoc veneno subigendo, salter hic locie that it admits neither of increase nor diminu- comprobatæ erant." tion; is changeable in its state, but unchange- In England, therefore, as well as on the conable in its essence; becomes excited and tinent, there was a great conflict of opinjon. collapsed, or rises and falls in its energy, but Dr. Prejean, who both preceded and succeeded experiences nothing of the decomposition or Dr. Harvey as president of the College of Phyrecruit of every other part of the living frame sicians, appears openly to have advocated its around it; we should travel into a labyrinth employment in 1658, according to facts adverted of incongruities, and only enlighten ourselves to by Sir George Baker in his admirable article with a will-o'-the-wisp. Dr. Cullen's system, on intermittent fevers (Med. Trans., vol. 11., like himself, is a work of no ordinary stamp; art. xiii.), from which these hints are chicfly it is full of immortality, but mixed up with drawn up. Dr. Brady, professor of physic at weak and perishable materials.

Cambridge, appears equally to have counteOf the remedies appertaining to the one or nanced it ; as does Dr. Willis, according to his the other of the two divisions we are now con- own statement : while Dr. Morton professed sidering, those of astringents and bitters, the himself inexperienced upon its virtues, and Dr. cinchona, or Peruvian bark, which unites both Sydenham was decidedly adverse to its use. qualities in itself, is on every account entitled to Sydenham, however, was a man of reason and our first attention.

| liberality. His prejudices, and especially those This valuable medicine, which some practi-derived from the hypothesis, that a fever is a tioners are apt to despise or think lightly of in fermentation in the blood, raised by nature to the present day, has never been altogether with throw off some peccant matter at the surface, out its opponents; and there are many facts and which ought not therefore to be checked in respecting its operation, which, if not altogether its course, however wise it may be to moderate anomalous, are of very difficult solution. it in its violence, were all at arms against the

Peruvian bark, according to the authority of use of the bark under any circumstances : and Don Joseph Villerobel, a Spanish physician no- the mischievous effects to which he had been ticed by Badus, was first brought to Spain in an eyewitness in some instances, and its total the year 1632; but here, as in every other inertness in more, gave a sanction to suspicion, country, it had for a long series of years to en- if it did not justify hostility. But he was decounter the prejudices of the medical profes-termined to watch it for a still longer period, sion ; and consequently was very rarely made through all its variable effects, and to abide by use of, and unquestionably would have sunk into the result when fairly cast up. He soon became oblivion but for the activity of the Spanish jes- sensible that it was, in most cases, a powerful uits, who continued zealously to recommend it, engine ; that in many instances, it was highly and to import large quantities of it from their serviceable ; and that, in those in which it failed, brethren in South America. Through these the miscarriage was rather to be ascribed to means, it was at last recommended by Pope some error in handling it, than to a want of Innocent X., in 1661, as a medicine perfectly power in the drug itself. innocuous and salutary ; and a Schedula Ro- I Sydenham had sufficient ground for this last mana, drawn up under the sanction of the phy- conclusion. The mode in which it was, at this

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