DE PONDERE INFANTUM RECENS NATORUM
The
History
of Weighing
the Newborn
Infant
Thomas E. Cone, Jr., M.D., Captain (MC) USN
Department of Pediatrics, United States Naval Hospital
I have reckoned upon a medium that a child
just born will weigh twelve pounds, and in a solar
year, if tolerably nursed, will increase to
twenty-eight pounds.
The opinions or assertions contained herein are the private ones of the writer and are not to be con-strued as official or reflecting the views of the Navy Department or the Naval Service at large.
ADDRESS: Bethesda 14, Maryland.
PEDIATRIC HISTORY
PEDIATRICS, September 1961
Jonathan Swift-1729’
T
HE II(ASCIBLE Dean Swift may havebeen a moody, self-tortured and often despondent man, but inexactness with the available facts was not one of his weak-nesses. That Swift should give an erro-neously high figure for the birth weight of the newborn infant led me to delve into the medical writings of the great physicians
who lived not only before but also contem-poraneously with Swift, to search for their values for the newborn infant’s birth weight. It was difficult to believe that the leaders of medicine up to Swift’s time would have
caused him to be so egregiously in error in
recording the infant’s weight at birth,
be-cause this measurement has really been the cornerstone of pediatrics as we know it.
The only reference to an infant’s birth weight that I could locate until almost the end of the seventeenth century was a state-ment that in Talmudic times the infant was weighed and its body weight in coins was given to the poor.2
Strangely enough, there is no mention of
the birth weight of a child in the Bible or in the writings of the ancient Greek and
Roman physicians. The medical authors of
the Arabic School appeared equally disin-terested in the newborn infant’s measure-ments.
But, if physicians were so unconcerned,
one questions why the great artists and
sculptors, whose masterpieces depended so much on an accurate knowledge of the
pro-portions of tile human body, made no effort to measure infants. This disinterest also bothered the Belgian astronomer and
sta-tistician Quetelet, to wilom all who are in-terested in Ilumall growth owe an intense debt for his brilliant original studies of
growth and for his provocative hypotheses concerning the laws of human growth.
Q
uetelet made an exhaustive search of all the studies dealing with the bodily propor-tions of man by every European scientist and artist. He stated that he was astonishedby the paucity of measurements made on human adult models but ever more puzzled
by the total absence of information con-cerning the proportions and measurements of the infant.
EARLIEST MENTION OF BIRTH WEIGHT
The first author to consider the propor-tions and weights of the fetus and the new-born infant to be worthy of publication was Fran#{231}ois Mauniceau, the great French oh-stetnician of the seventeenth century (Fig.
1, left). He waited, however, until the fourth
edition of his Trait#{233}des Maladies des Femmes Grosses (1694) to include any in-formation concerning the physical measure-ments of the infant
(
Fig. 1, right). Mauni-ceau4 wrote:One will find that one (fetus) of nine months
ordinarily weighs about thirteen pounds each; I
have even seen some to weigh as much as fourteen
pounds.
-‘
.
.
S:
I L
l:-:
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FIG. 1. (Left): Frali#{231}OiS \Iauriceau (from a contemporary engravings). (Rig/it): a page from \Iauricciti
Traite des Maladies des Femnies Grosses (Paris, 1694). This is the earliest illustration of the proportions
of the fetus.
pound (livre) of Mauriceau’s day was dif-ferent from our present pound avoirdupois. But this is not so, because the French livre used by Mauriceau is heavier than the United States pound avoirdupois by about
1.7 ounces.5 If Mauriceau’s weights \‘erc
converted to our present unit of weight, it would add about an additional pound to the figures given in the above quotation. Mann-ceau, therefore, stated without equivocation that the newborn infant weighed 14 to 15 pounds at birth. Why he blundered so be-comes more of an enigma when one re-members that Mauriceau was the greatest obstetrician of his time, with an enormous
practice that covered the span of several decades. His celebrated textbook went through many editions and was translated into English, German, Dutch and Italian.
Of further interest was the fact that he con-sidered the information concerning the size of the fetus at varying periods of
preg-Des Maladies ties Femmes pofes. LI Va a I. Si
CHAPITRE V.
Des hffi’rcntes proportions Is corps de lenfsstfiIonles d:ferriu temps de l4,rOfeJfr.
J
Epeux facilemcnt prouver par&moftration, que Ics ditfirentes proportions des cnfansqticl’on volt en cctcc plancbe ,touchaat irs ,iiifcrens temps dcIagro1fc1t,font trcs-juftcs, commckscxpc-riences journalicres nous
Icfont tres-bien
connoi-ftrc. Cu IiIon conGdcrc
‘‘‘
toutcslcs proportions du
corpstfun fort cnfmz du
‘relIne
dencufinoiscom-plets, parr.ipporc #{224}Ii
pro-0T000 din frz,i, qul
ncftquc de trots mois,on
trouvera quc ccluy dc
nevfmcns pcl#{232}
orchn.aire-mencrnvarondouzelivrcs
tic (rise onces chacuac,
en sy mc4nc veiS pefer
yufques #{224}quacorzelivrei. Maalefst*vdc croismois nepefera pas an plustrois
oaces. C’eft-I-dirc qui1
pc(era foixante -quatre
rois moiris qu’un enf:int
Ic neuf mon qul pete
douze Ifyres. Orcoasme
Ic reline sic trois mois
ri’eft pie Ie#{252}ersdeccluy
,‘
) i S ste neufmois, & que cc. .1t2yd’un mois eli aufli Ic
tIers de celuy de trois mini ,noti* trouverons parcillement que.
Liproportion do corps desfsr:sic sic cc, deu tcrmes pr#{233}maturcz.
repond.rnt acette premiere demoaftration ,le fwttii dun usois
sicpefcra pasu.nc dems draclune. C’cft-i-darc quO pefera ca.
1 tj
nancy, as well as the weight of the newborn
infant, of so little importance that he omit-ted this section in all but one of his book’s many editions.
Mauniceau’s excessively high birth weight figure was topped by that quoted by The-ophilus Lobb6 in 1747 (Fig. 2, left). Lobb, a
member of the College of Physicians, and a Fellow of the Royal Society of London, wrote his compendium so that those who were unable to attend his lectures might have the advantages granted to his listen-ens.
4:tg. 8 i”4.:’ I .c;iij;: &c.
John Phulh1)IOn. 492
A
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PRACTICAL
PHYSICIc,
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Of
Dijeafes peculiar to Women. Le&.XXIV
the Weight of the Ouantity of the Blood ufually ciracuated from the Mother in ten lumir Months.
The Truth of this Obfervation is confirmed by the Account
I
received in the following Letter from Mr. Pbillipfon, an ingenious Surgeon, andMan-midwife,
whom I had defired to get me the Weight of fome w born Children, andof
thePlacenta,
&c.
%Dr.
LOBB.
.5
1 R,
‘C have according to your Define weighed a
“ Child, and Placenta foon after Delivery : the ‘C Child weighed /ixtcen Pounds, and feven Ounces, ‘C which is a large Child, but have ken forne
I’ larger ; arid the Pku’e;zta weighed one Pound,
a’ feur Ounccs with the umbilical Cluyrd.”
FIG. 2. (Left): The frontispiece of Lobb’s A Compendium of the Practice of Physick (London, 1747).’
(Right): A page from Lobb’s text containing Mr. Phillipson’s letter of August 8, 1747.
I have according to your desire weighed a child, and placenta soon after delivery: the child weighed
sixteen pounds, and seven ounces, which is a large
child, but have seen some larger; and the placenta
weighed one pound, four ounces with the umbilical cord.
Lobb’s compendium was widely read by
physicians during the mid-eighteenth
cen-tury. The exaggerated birth weight
men-tioned in the above letter went completely
unchallenged. Why was so simple a meas-urement not of greater interest to the great practioners of the period? Perhaps each
writer was servilely copying authors such
as Mauniceau and Lobb without resorting
to the simplest of experiments-placing a
baby on a pair of scales and observing the
true weight.
William Smellie, one of the greatest fig-ures in English obstetrics, published his superb book in 1752. This book became the standard and best reference in
obstet-nics for many years. What did Smellie give as the birth weight of the newborn infant? He wrote7 that “at nine months [the infant would weigh] from ten to twelve, and
sometimes sixteen pounds.”
One wonders why Smellie, who was per-haps the greatest of English obstetricians, could have been so mistaken. According to Fisher8 Smellie gave 280 courses of lec-tures, which were attended by thousands of pupils. That none of the thousands of stu-dents who attended his lectures questioned his figures for an infant’s birth weight would point to a widespread indifference concern-ing human growth during the eighteenth
century.
EARLIEST CORRECT REPORTS
OF BIRTH WEIGHT
in-FIG. 3. The first page of Roederer’s paper to the Royal Society of G#{246}ttingen, December 1, 1753.
fants than their English contemporaries, for witilin a period of 5 years (1753-1757) two reports were published in Gottingen,
vhich gave for the first tinie the correct measurements of the human newborn in-fant. The first was a brilliant, albeit
sancas-tic, paper read on December 1, 1753, to the Royal Society of G#{246}ttingen by Dr.
J.
G. Roederer, the outstanding German obste-tnician of his age (Fig. 3).Roedener came directly to tile point by
starting his paper with the comment that past writers in determining the weight of the newborn infants were hallucinating.#{176} He further told 11i5 audience that he meas-ured 27 full-term children, 18 males and 9 females. The average weight of the male
infants was 6 lb 9 oz; that of the female in-fants was 6 lb 23 oz. Roederer also had tile distinction of being tile first to record the length of the newborn infant. His values
were 20 1/3 inches for the male and
19 17/18 inciles for the female.
In a discussion of this sort the question
of the comparison of the units of weight
used in relation to tile Anglo-Saxon stand-ard pound avoirdupois is of tile utmost im-portance. Roederer stated that lie used the civil pound of Gottingen, which consisted of 16 oz. The most accurate information I could obtain concerning the G#{246}ttingen civil pound of the mid-eighteened century
would indicate that it was about 3% heavier than the United States or English
avoirdu-pois pounds.1#{176}
This would mean that the average weight of the males weighed by Roederer would be 6 lb 12 oz, and that of the females 6 lb 5 oz, in pounds avoirdupois. Such weights
are, of course, more in keeping with our present figures than the erroneously high
values previously described.
One of Roederer’s students was
J.
F. G. Dietz, \VilO in 1757 in his doctoral thesisaccurately recorded not only the birth
weight and length of 113 newborn infants
but also the week and day before delivery when fetal motion was first noted. The
lat-ten data ilad never been published previ-ously, to my knowledge. Dietz did not give the sex of the infants included in his study,
but he found the average birth weight of these infants to be about 63 lb.11 These fig-ures agree vith those of Roedener.
Unfortunately, Dietz’s doctoral thesis thesis must have received scant attention;
no writer interested in the growth and de-velopment of infants mentioned his thesis
until Scammon12 included it in one of his papers 170 years after Dietz had published his carefully documented study.
Albrecht von Hailer (1709-1777), one of the greatest intellectual geniuses of the eighteenth century, was unquestionably among the most famous men of his period both for the profundity and extent of his knowledge and for his versatility in many fields. I was surprised to find not only that von Hailer was intensely interested in the weight of the newborn infant but even more that this fact escaped the encyclopedic minds of the great German pediatricians of
\?an Hailer’s Disputaticnmes Anatom icae
Selectae, published in 1752, contained the
following paragraph :
The weight of a healthy cow is 250 to 300
1)OUfldS or above, iiitl that of the calf 20 pounds,
which is one-twelfth to one-fifteenth of the
mother’s weight; the s’eight of the lamb is 25 to 30 pounds, which is a third to a fourth of the mother’s weight; tlw weight of the healthy adult niale is from 150 to 200 pounds; the weight of the
newborn infant is approximately 6 pounds, which
is one-twentieth to one thirty-third of the mother’s
weight.
Von Hailer again referred to the birth-weight of the newborn infant 111 his great
Elementa Physiologiae Corporis humani (8 vols, 1757-66). In this superb book, which
may truly be considered the basis for all
future works of scientific physiology, von
Hailer stated that the human infant would
weigh 6 lb 10 oz at 1)intiil4 He apparently
arrived at this figure by deductive
reason-ing; he does not cite any actual
measure-ment that he performed himself.
Unhappily, von Hailer’s statistic went unheeded and apparently unread, because I can not find a single reference to his birth weight figure in the vast literature dealing
with the physical growth of the infant.
The first correct report of the birth
weight of the newborn infant in English
did not appear until 1786 when Dr. Joseph
Clarke addressed a letter to the Reverend Doctor Price, dated Dublin, October 22,
1785, and published the next year in the
Philosophical Transactions of the Royal
Society of London. Clanke’ complimented
Roederer by writing:
In this paper he (Roederer) proves, in the
clear-est manner, by incontestable experiments, the
ab-surdity of the ideas of obstetric writers with regard
to the progress of the ovum during gestation, and the weight of the foetus after birth. He shews (sic), although they state the weight of the foetus, come to the full time, to be from 12 to 14 or 16
pounds, that it is more generally 6 to 7, and very rarily (sic) exceeds eight pounds. This iiipet
(Roederer’s) has been overlooked by some of the
most celebrated writers and teachers of midwifery
now living. What idea are we to form of the
ae-curacy of one of our latest systematic writers who
( telling us that he has been a practitioner of mid-wifery, in a capital city, for twenty years, and a
teacher for more than twelve) states that at full
time (the infant) weighs from twelve to fourteen
I)1fl(lS?
Clarke did not name this practitioner of midwifery who erroneously affirmed that
the full-term infant weighed from twelve
to fourteen
pounds. But I am certain that lie was referring to Doctor Alexander Ham-ilton, the professor of midwifery at theUniversity of Edinburgh. Hamilton’s text’
contains a page (Fig. 4) which proves Clarke’s opinion that Hamilton’s knowledge of birth weights left mucil to be desired.
In his letter to the Reverend Dr. Price,
FIG. 4. A page from Hamilton’s Treatise of
Mid-wifery, citing an erroneously high birth weight for
!)afr
TABLE I
MEAN VALUES FOIl BIRTH WEIGHT AND FOR CIRCUMFERENCE OF HEAD OF NEWBORN INFANTS*
Males Females
Number
ifea.uLred
Sum of
Birth ii’eigh1.
(ib)
um of
Circumference
(in.)
.Vumber
.lfearured
Sum of
!lirthweights
(Ib)
Sum of
Circumference
(in.)
his-, 1785 O 1494 ‘282 0 1371
August, 1785 O 144} 77 O 185
eptemher, 17H.5 O 148 80 O 13 73
Average Values 7 lb .5oz 7dr 14 6 lb I 1 oz 6 dr 13l
* Values are from (‘lark,” whose report of the newborn infants’ weight and head circumference was the first to
appear iii English.
Clarke gave the birth weight in pounds and the head circumference in inches of 20 selected male and an equal number of fe-male infants delivered at the
Lying-in-Hos-pital, Dublin (Rotunda) for the months of July, August and September, 1785, as shown in Table I. This Table shows that
the males averaged about 7 lb 5% oz at birth and had a head circumference of 14 in.; tue average weight of the female infants was about 6 lb 11% oz and their head
cincumfen-erice averaged 13% in.
Clarke was also concerned with the differ-ence in the units of weights used by Roed-ener and by himself. He wrote that he did not know whether Roederer and he had used the same weights. Clarke further
as-sented that he had no data to tell whether Roederer’s civil pound of Gottingen was equal to the standard English pound.’
As mentioned previously the civil pound of Gottingen in the second half of the
eighteenth century was about 3% heavier than tile United States or English avoirdu-pois pound. Clarke had the prescience to question the possibility that the German pound might differ from that used in Eng-land. He did not mention the history of standard units of weight of the United Kingdom. A brief discussion of this subject might be of interest to those who may wonder about the history of the
standardi-zation of the English pound as a measure of weight.
STANDARD WEIGHTS IN THE
UNITED KINGDOM
Tile English standard pound has come down from the Saxons; no change was
made by the Nonmans in the Saxon system of weights and measures established in Eng-land. A statute of William the Conqueror ordained that “the measures and weights shall be true and stamped in all parts of the country.” The English standards of weight and measure were deposited by the king’s order in a consecrated building just as the standards of ancient countries were
placed in their temples.
As regards the actual standards of
avoir-(lupois weight, Chisholml7 stated that the official records show that the series of stand-and avoirdupois weights constructed during tile reign of Elizabeth I, by which all the commercial weights of the United Kingdom were regulated up to the reign of George IV, were derived from a 56-lb avoirdupois standard of Edward III.
The complete set of standard weights, constructed in 1588 under the first Queen Elizabeth’s orders, are still in good condi-tion. They were made of bell-metal and were used to regulate all the weights in the kingdom until 1824.
The larger set, from 56 pounds to 1 pound, is bell-shaped. The avoirdupois bell-shaped
Meas-496 WEIGHING INFANTS
FIG. 5. The newborn infant being weighed (I)aniel Chodowiecki, 1789).1s ures Committee reported it to weigh 7,000.5
troy grains. One hundred fifteen years later, in 1873, it weighed 6,999 grains. It thus
appears to have lost only 3 grains in weight, though used continually as a standard from 1588 to 1825-a period of 237 years.
The smaller set of Elizabethan avoirdu-pois standards, from 8 pounds to 1 dram in
a continued binary series, consists of flat circular weights. The flat disk-shaped
avoir-dupois pound was found to weigh 6,997.5
troy grains in 1758; in 1873, 115 years later, it weighed 6,996.4 grains, having lost a mere 1.1 grains during this period of more
than 100 years.
From this, we see that the English
avoir-dupois pound has been standardized for many centuries; it is the oldest standard
unit of weigilt in the western world.
RECOGNITION OF IMPORTANCE OF BIRTH WEIGHT
The studies cited so far dealing with the weight of the infant at birth made little or no impression on the major medical writers during the remaining years of tile
eight-eenth century. But infants were weighed
at birth during this period, because in 1789 Chowdowiecki,’8 the famous German genre
painter and engraver of Polish descent, en-graved a vignette depicting a newborn
in-fant being placed on a scale (Fig. 5). Pen-haps the laity considered tue birth weight of the child of value despite the disinterest
of the physician in such a statistic. None of the standard pediatric texts of this period contained a single statement concerning the
proportions or measurements of the new-born infant. Underwood,19 for example, in his famous treatise of 1784 did not refer
at all to the weight of the infant or child
during the period of his growth.
Under-wood’s text, it will be remembered, occu-pied an important position in the history of
pediatrics, because his book bridges oven the time between the empiric period of the eighteenth century and the anatomicopath-ologic era of the nineteenth century.
It was not until 1815 that the first large-scale, accurate report of the newborn in-fant’s birth weight was published. These
aAverage for male and female equals S,5O gm.
newborn infants at the L’Hospice de la
Maternit#{233} in Paris, by Friedlaender.2#{176} Fniediaender’s values were published in
ta-bie form by many European medical au-thons and in the United States by DeWees2’
in his widely used textbook. By publishing
these data of an infant’s birth weight,
De-\Vees for the first time brought to the
at-tention of the American physician an ac-curate study of the variation in infants’ birth weights.
The first earnest and continued series of anthropologic measurements made on the
infant from birth throughout the period of growth were those of Quetelet,22 who may truly be called the founder and inspiration for our modern interest in the physical
growth and development of the infant and child. It is of interest that Quetelet’s
train-ing was not in medicine at all, but rather in astronomy, meteorology and statistics. While serving as the director of the Royal
Observatory in Brussels, he published his most important work, Sur l’hornme et le
de’ueloppement de ses facult#{233}s, in 1835. This book paved the way for others interested in the newborn’s growth and development.
Q uetelet,
along
with
Chaussier2
was
the
first to establish the fact that the newborn baby normally loses weight during the first
days of life.
However neither Quetelet or Chaussier was apparently concerned with the value of regular weighing of the infant as a means of evaluating his state of health. They were more absorbed in the objective obser-vations per se than in their clinical
signifi-cance.
Guillot2 in 1852 advocated for the first time the advisability of regular weighing of infants as an adjunct in the evaluation of their optimal physical and nutritional devel-opment. In addition, Guillot pointed out that periodic weighing of the infant was an invaluable guide in estimating the ade-quacy of the quantity of breast milk. His study appeared at the crest of the clinician’s awareness of the great contributions of the
organic and physiologic chemist to clinical medicine. Chemists such as Liebing and
Hoppe-Seyler re-oriented medical thought away from past concepts of considering disease as rooted only in the anatomic
le-sion; they speculated that diseases were the result of a long series of chemical changes within the body.
The application of biochemical studies to
clinical pediatrics became irrevocably es-tablished in Germany during the second half of the nineteenth century. The
nutri-tional needs of the newborn as well as the biochemical studies indicative of optimal nutrition became the guiding theme of those interested in the care of the newborn child. As a means of establishing basic data in estimating the nutritive needs of the
in-fant, Ahlfeld25 in 1878 stressed that Guil-lot’s suggestion of weighing newborn
in-fants before and after breast feeding should be a cardinal item in estimating the caloric and nutritive needs of the nursing child.
Now for the first time the importance of
periodic measurement of weight as an in-dex of satisfactory growth and development
of the child became an established fact. Many reports of the newborn infants weight at birth, with consideration of the
wide variability of this figure in both sexes, appeared during the period 1849-1882. The values for the birth weight cited in these reports are shown in Table II. Present
val-ues26 compare almost exactly with those given in this Table.
TABLE II
BIRTH WEIGHT VALUES OBTAINED IN STUDIES
FROM 1835 TO 1871
Year Author Weigli (gm) Male Female Place 1835 1840 1849 1855 1860 1867 1871 Quetelet’ Quetelet3 Scanzoni27 Hartmann28 von Siebold29 Martin#{176} Gregory3’ 3, 00 3,000 3,530
3,545
.. 8,386 ,900 3,000 3,430 3 ,440
S
,
250WEIGHING INFANTS
SUMMARY
It appears that a biologic measurement
so mundane as the birth weight of the newly born infant was of little interest to physicians throughout almost the entire
history of western medicine. Roederer, in 1753, slightly more than 200 years ago,
pub-lished the first accurate value for an in-fant’s weight at birth. In reviewing the course of obtaining so elementary a statistic
as a newborn infants birth weight, two findings still remain enigmatic. The first is why so many distinguished physicians of the past lacked the curiosity to weigh a
newborn accurately; the second, and
pen-haps, the more disturbing, is why such cele-brated physicians were content to copy
servilely the erroneous values of others.
REFERENCES
1. Swift, J.: A Modest Proposal, in Woods, C. B.,
et al.: The Literature of England, Vol. I,
Ed. 3. Chicago, Scott Foresman, 1947, p.
963.
2. Garrison, F. H.: History of pediatrics, in Alit, I. A., et al.: Pediatrics, Vol. 1. Philadelphia, Saunders, 1923, p. 29.
3. Quetelet, L. A. J.: Anthropom#{233}trie ou mesure
des diff#{233}rentesfacult#{233}sde l’homme. Brussels,
1871, pp. 346, 412.
4. Mauriceau, F.: Trait#{233} des Maladies des
Fem-mes Grosses, Vol. 1, Ed. 4. Paris, 1694, p. 85.
5. Judson, L. V. : Measures and Weights in
En-cyclopaedia Britannica, Vol. 15. 1947, p.
140.
6. Lobb, T. : A Compendium of the Practice of
Physick. London, 1747, p. 90.
7. Smellie, W. : A Treatise on the Theory and Practice of Midwifery, Vol. 1. London,
1766, p. 122.
8. Fisher: Cited by Garrison.’
9. Roederer, J. C. : De pondere et longitudine
in-fantum recens natorum, in Commentaries of the Royal Society of C#{246}ttingen,1753, p. 410. 10. Judson, L. V.: Personal communication to the
author.
1 1. Dietz, J. F. C. : Dc temporum in graviditate
et paths aestimatione (Dissertation). Got-tingen, p. 61.
12. Scammon, R. E. : First seriatim study of human
growth. Amer. J. Phys. Anthrop., 10:329,
1927.
1:3. von Hailer, A. : Disputationes Anatomicae
Se-lectae, Vol. 6. G#{246}ttingen, 1752, p. 785.
14. von Hailer, A. : Elementa Physiologiae
Cor-poris Humani, Vol. 8. Bern, 1766. p. 295.
15. Clarke, J.: Observations on some causes of the excess of mortality of males above that of
females. Phil. Trans. Roy. Soc., London, 76:
358, 1786.
16. Hamilton, A. : A Treatise of Midwifery, Ed. 8. London, 1781.
17. Chisholm, H. W. : On the science of weighing
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