Rose George | Longreads | March 2015 | 21 minutes (5,358 words)
She was a name on a plaque and a face on a wall. I ate beneath her portrait for three years and paid it little attention except to notice that the artist had made her look square. There were other portraits of women to hold my attention on the walls of Somerville, my Oxford college: Indira Gandhi, who left without a degree, and Dorothy Hodgkin, a Nobel prize-winner in chemistry. In a room where we had our French language classes, behind glass that was rumored to be bulletproof, there was also a bust of Margaret Thatcher, a former chemistry undergraduate. Somerville was one of only two women’s colleges of the University of Oxford while I was there, from 1988 to 1992, and the walls were crowded with strong, notable women. (The college has since gone co-ed.)
The plaque saying “Vaughan” was on the exterior wall of my first-year student residence, a building named after Vaughan, Dame Janet Maria, the woman in the portrait and principal of Somerville between 1945 and 1967. She was still alive when I was an undergraduate, and, according to her obituaries, was known for driving around Oxford in a yellow Mini; for always dressing in tweeds; and for going to the Bodleian Library even in her late eighties and inadvertently annoying other readers when her hearing aid hummed and whistled. But when I arrived at Somerville, and was assigned to Vaughan, I thought only with some relief that everyone would finally be able to spell my Welsh third name, usually a puzzle even to English speakers. I did not think back to my two surgeries, or to my birth, where bags of someone else’s blood and plasma would have hung from hooks and saved my life, and thank Janet Vaughan for her role in helping to make that standard medical practice. But I should have.
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Blood. We all have it, this liquid that is nearly half water, red in color, that “circulates in the arteries and veins, carrying oxygen to and carbon dioxide from the tissues of the body,” an Oxford Dictionary definition. Blood is common, ubiquitous, inevitable. But it is also so much more than its dictionary description. It is more expensive than oil. Every two seconds, someone needs some. Every day, millions of people receive blood from anonymous strangers in a wondrous procedure that has become banal.
In the United Kingdom, where I live, the system of widespread donation of blood by anonymous volunteers, and its transfusion into people who need it, dates back not even a century. The National Blood Service began as the Blood Transfusion Service in 1946; the National Health Service was founded in 1948. But humans have been curious about blood probably since the first human bled. The first date on the history timeline of the National Blood Service is 1628, when William Harvey demonstrated that blood circulates around the body, but the practice of blood-letting is usually dated back to Egyptians of 3,000 years ago. Letting out blood eased the imbalance of the four humors— blood, phlegm, black bile, yellow bile—that governed the body.
Transfusion—the transfer of blood from one creature to another—is also ancient. Romans, wrote Pliny the Elder, ran to drink the blood of dying or dead gladiators, to gain some of their strength and force. Blood was also thought to carry personality, so when Jean-Baptiste Denis, doctor to Louis XIV, treated a feverish 16-year-old patient with a blood transfusion in 1667, he thought the “mild and laudable” blood of a lamb his best bet. The patient recovered, though a madman treated with calf’s blood did not. Transfusion was largely avoided for 150 years. The Victorians tried, but humans given human blood kept dying, and only when Karl Landsteiner discovered blood types in 1909 (and that some mixed fatally) did transfusion become acceptable.
Transfusion is now unremarkable. A car accident victim can require 100 pints of blood. Coronary bypass surgery can require blood from 20 donors, while a premature baby can be saved with three teaspoonsful. 15.7 million pints of blood are donated every year in the U.S., and more than 100 million globally, according to the World Health Organization. But in 1920s Oxford, when Janet Vaughan was a medical sciences undergraduate at Somerville, the speedy transfer of blood from one human to another en masse was unthinkable.
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Vaughan was born to privilege. Her father was a headmaster of fine public schools such as Rugby. Her mother, Madge Symonds, was a beauty, though Vaughan described her as “a caged butterfly or hummingbird,” and the cage was her life as a headmaster’s wife in stuffy schools where she ate chicken bones with her fingers to shock the butler. Madge was great friends with Virginia Woolf, Janet Vaughan’s second cousin, and the character of Sally Seton in Mrs. Dalloway is based on her. The Vaughans were connected, but not wealthy. Janet was given indifferent schooling, including a headmistress who described her as “too stupid to be educated.” She ignored that, read voraciously, and after three attempts, was accepted at Somerville to study medical sciences. She arrived, she said, with nothing more than “a little ladylike botany,” yet graduated with a first class degree, and set about being a physician. For her obstetrics rotation at University College Hospital, London, she was sent into London’s slums. “Terrible poverty,” she told the journalist Polly Toynbee, when Vaughan was interviewed as one of six women chosen by the BBC to be “Women of Our Century.” She encountered “a woman with no bed except newspaper. A husband who said, ‘ain’t there no male doctors? I’d rather have a black man than you.’” She saw lines of children sitting up in bed with rheumatic hearts, who would die. She saw that poverty is deadly. “How anyone could do medicine in those days and not become a socialist I find hard to understand,” Vaughan wrote. “What I hated most was people’s acceptance: ‘Yes, I have had seven children and buried six, it was God’s will.’ I hated God’s will with a burning hatred.”
The slums introduced her to real poverty, but also to blood, her lifelong interest. Anemia was endemic, and by the time she qualified, she began to wonder why the standard cure for anemia was arsenic. She was a pathologist by now: her mother had died, and she thought her widowed father needed her. Pathology, with a more stable routine than doctoring, would make her available for him. But a pathologist can still read. She was trained at Oxford, and at Oxford you are trained to read ferociously. So she had read of the work of Dr. George Minot, an American physician who had been treating pernicious anemia with raw liver extract. Vaughan thought this made more sense than arsenic, so she approached her professor of medicine, a man who did not see a woman who was young and think both those things to be handicaps. “I went to the professor,” she told the BBC, “and said, can we test it on a patient?” He said no, but she could try it first on a dog, if she produced the extract herself. He gave her some money, and off she went to collect as many pails and mincing machines as she could. She did the rounds of her friends. She borrowed Virginia Woolf’s mincer, and minced and minced. It became a scene in Virginia Woolf’s “A Room of One’s Own,” Janet with her mincers, Minot’s paper propped on the kitchen table, a parody of expected domesticity.
The extract was fed to two dogs, who sickened. Janet said, no more dogs, and took the extract herself. “The next morning when I came back to the hospital there were all the professors of medicine, chemistry, surgery, waiting on the doorstep to see if I was still alive.” It was fed to a patient, “a nice old labouring man.” The patient survived, and of course a senior professor took all the credit for the miraculous new treatment. Janet didn’t much mind: she had other things to do. Her father had remarried, and she could travel, so she got a Rockefeller Scholarship to Harvard, where there were no women. She wasn’t allowed to work with patients and she wasn’t allowed to work with mice either, for when she ordered some Boston mice, a famous lab variety, she was told there were none to spare. No matter. She sourced some “excellent Philadelphian mice,” but Harvard didn’t allow them. She ended up with pigeons, using them to do groundbreaking research on vitamin B12 in blood that wasn’t fully acknowledged for 50 years. She called them her Bloody Pigeons.
How I love the brisk nervelessness of this woman. Some of it comes from privilege. But much of it is her own, as much as her fictional room was. She had the confidence to make fissures in patriarchal concrete, but also the confidence to get married, because she wanted to. With her husband, David Gourlay, she moved into Gordon Square in Bloomsbury, and Vaughan went to work at a hospital where no one spoke to her, and physicians asked for her advice—by then her reputation was significant—only by letter. She treated more anemic patients with liver, though the patients then said, “don’t give me any more of that medicine, doctor. It makes me hungry and I can’t afford [to eat].” She taught her patients to fight authorities to get extra milk, for the extra iron it would give them. She taught her students that to practice medicine, they must learn to deal with the public assistance board as well as the hospital dispensary. She had two daughters. She was busy, and happy.
But war was coming. First, it came to Spain. Her Bloomsbury friends went to fight, and Vanessa Bell’s son Julian was killed. Vaughan began to work with the Committee for Spanish Medical Aid and joined the Communist Party, though she soon lapsed. She said that no one seemed to notice. She sold possessions to raise money for Basque children; she spoke on soapboxes at street corners. She welcomed to London Dr. Duran Jorda, an exceptionally gifted Spanish hematologist who had worked out how to store large supplies of blood so it could be used in a war situation. By now, taking blood from one human and putting it in an another was understood: but storing that blood so it didn’t spoil was not. Vaughan read that Russians had also stored blood, taken from fatal road accidents and kept at low temperatures, then used for civilian needs. She noted all this, and she kept it safe until 1938, when the Munich Agreement was signed, allowing Nazi Germany to annex Sudetenland.
We think now, in our era of wars that only happen elsewhere, of 1938 as safely pre-war. But it can’t have felt like it. A bombing blitz on London was seriously expected to follow Munich. Someone came to Hammersmith and told the medical school to be ready for 57,000 casualties in London that weekend. And Vaughan realised, immediately, that casualties would need blood. They would need a lot of blood.
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In the Wellcome Library in London, I find a propaganda film published by the Ministry of Information in the 1940s, a time when neither “propaganda” nor “Ministry of Information” sounded sinister. The film is called “Blood Transfusion,” and is narrated by accents that now sound cut-glass and royal, but then were normal. It tells us that blood transfusion was widely used in the First World War on the Western Front, including by Dr. Oswald Robinson of Toronto. Donors were easily on hand, and by then it had been understood that adding sodium citrate to blood stopped coagulation and made blood easier to store.
The film moves to 1921, in Camberwell, where we meet Mr. Percy Oliver, leader of a local branch of the British Red Cross society. In 1921, there was no mass storage of blood, nor any organized recruitment of blood donors. Blood donation was done, but ad hoc. The technical term was “on the hoof.” Oliver’s actions helped to change that, when the telephone rang on an October evening in the south London suburb of Camberwell, and someone from King’s College hospital asked for urgent blood donors. Oliver volunteered, and so did all the nurses on the committee. From this one call in 1921, Oliver set up a network of blood donors, an office with donors’ details on index cards and a telephone that was always manned, and he called it the London Blood Service. Donors were sought and their blood used immediately. The service dealt with 737 calls in 1926, 2,442 in 1931 and by 1938 nearly 7,000. Oliver’s model was copied and spread, so that by the war, most parts of the country could reach a donor panel. It was an amazing achievement from a man who still worked full-time at the local council, and from each donor who gave some of their eight or nine pints of blood, freely and for no reward.
But in a war, it would not do.
By 1938, science knew how to transfuse blood and store it temporarily. But Janet Vaughan knew that on the hoof would not be possible in wartime. She needed to work out how to store large quantities of blood, safely, and transport it, safely. Blood supply needed to go from Mom and Pop to Walmart. Yet there was resistance. Douglas Starr, in Blood, quotes the British Secretary of War, asked in 1937 what the nation proposed to do about a mass blood supply. The secretary was dismissive. Blood could not be stored for long or in great quantities, he said. On the hoof was better. “It was more satisfactory to store our blood in our people.”
Janet Vaughan did not agree, and Janet Vaughan did something about it. Her medical director gave her £100, and she sent off her assistants in taxis to find all the tubing that London shops could provide. They made up crude transfusion sets, and set about bleeding. (I am struck by this word, which Vaughan and contemporary accounts use routinely. It has been retired in the modern blood supply service. Today, I receive letters asking me to “donate” or “give blood,” but not to be bled, or to sit on a “bleeding couch.” Is it too brutal? Does the word make us too animal? Now the emphasis is on altruism, not the baseness of a body fluid.)
The bombs did not fall, and Vaughan’s team diverted the blood collected at Hammersmith to hospital use. But war was going to come so Janet began planning. The minutes of the meetings of the Emergency Blood Transfusion Service exist in the archives of the Wellcome Library, and they are as rich as blood. The Service was actually a gathering of Vaughan’s peers from various hospitals, held in the Gourlays’ Bloomsbury flat. The meetings were always in the evening, after the day’s work was done, and they lasted hours. I picture these meetings. Janet Vaughan would be wearing a tweed suit. She would be kind but brisk. Later, someone described her as “down to earth but like air on a mountain.” The other doctors might have bow ties. They would smoke pipes. They would drink tea, or gin and tonics, and eat crumpets. They would do this while deciding on the size of bottles, or what kind of armrests to put on the “bleeding chairs,” and they would change modern medicine.
London needed blood depots. The committee decided on four, one for each quarter of the city; two north of the river, two south. They would be near hospitals, but safely out of the city center, in case it was bombed. The service needed money, so they worked on a budget, which was doubled on the advice of Vaughan’s boss. The precise methods of storing blood had to be decided upon: On April 5, 1939, the first meeting, the minutes record a suggestion that 50cc of 3.8% citrate containing 0.1% glucose should be added to every 450cc of blood. Donors, they thought at first, would be Group O only, the universal blood type that can be safely transfused into most people, and there should be 9,000 of them per depot. Other issues arose. Of course donors must be screened, as much as circumstances permitted. Syphilis was a worry, particularly as promiscuity always rises in wartime. The practicality of testing all donations for syphilis was one issue: whether or not to tell unwitting carriers that they had been infected by their spouses was another.
The bottles, though. Amongst all calculations detailed painstakingly in the committee minutes over the months—8 million Londoners, therefore 2 million people per depot, 65,000 estimated daily casualties therefore 10,000 per depot; and from wanting only O to accepting all blood types—the bottles were vital. Without the proper storage vessel, all the sodium citrate in the world wouldn’t keep blood safe, or make it portable. The choices were few but they were tricky: a Beattie waisted type? A whisky cap on a United Dairies bottle? A McCartney screw cap on a United Dairies bottle? Or a modified McCartney bottle of the L.C.C. type? “The children complained that the flat was littered with old bottles,” wrote Vaughan in her unpublished autobiography Jogging Along.
Through the summer the deliberations continued. The committee was an informal one, but then Vaughan sent a memorandum about their plans to Professor Topley of the London School of Hygiene, who was known to be organizing emergency services. Her boss heard of it and called her “a very naughty little girl.” As if that would stop her.
By the second week of June, they had decided to use Wall’s ice cream vans to transport blood. They would call up registered donors by using runner boys. The bottle would be a modified milk bottle with a narrow waist and an aluminum screw cap lined with a soft rubber disc. This became known as the MRC bottle, after the committee was taken over by the Medical Research Council.
Janet was to run the northern depot, in Slough. She set off alone to see the medical officer of Health (M.O.H.) to find premises. “How fortunate I was to go to Slough where everyone—mad as they thought me at the time—was more than willing to help me.” There was an unshackled energy about Slough that appealed to this child of boarding school, Oxford and Bloomsbury. She thought it “a frontier town,” grown up after the First World War around a vast trading estate, full of migrant workers “with no settled traditions and customs to be disturbed.” She was directed to Noel Mobbs, Chairman of the Great Trading Estate and of a social center. Mr Mobbs did not believe a war was coming, but he said the depot could move into the social center, that there was space for cold rooms to be built. There was also a bar.
Agreements were signed. Hitler prepared to invade Poland. Three days before Britain declared war, on September 3, 1939, Janet Vaughan received a telegram from the Medical Research Council. It read, “Start bleeding.”
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Slough Depot. Wartime. The place bustled with nurses, secretaries, telephonists, medical technicians, drivers. There were 100 staff, including two local girls to make all the sterile plasma and serum “and sterile they kept in spite of the really unsuitable dusty conditions in which they had to work.” And the drivers who must drive the Wall’s ice-cream vans full of blood. These drivers: I pictured them as forthright young women in heavy coats, like the forthright young women in heavy coats in Sarah Waters’s The Night Watch. But I was wrong, because in Slough, there was “Mrs. E. O. Franklin’s chauffeur Brady, a mad Irishman,” who kept the vans ticking over. There were voluntary drivers, and unexpected drivers who in times of dire need, such as when Liverpool was bombed and Liverpool had no blood, were recruited from the bar. Drinkers became drivers. Janet loved this bar, for what it meant to her staff: “My young drivers, girls, coming in late at night having driven through terrible weather and blackout, to be able to get some whisky in the war was very important.”
They were not all young girls. One regular driver was Lady Dunstan, “who must have been at least 70. She always wore a string of pearls and a toque rather like Queen Mary, but she was never daunted.” An elegant pensioner, driving an ice-cream van around bombed streets: I couldn’t have invented it. Another driver was “a remarkable old lady whose only interest in life before the war had been her string of ponies and her bridge. She came and said she wanted a job and we set her down amongst the young technicians to fix a singular nasty wire filter that was being used at that time for stored plasma.” When she was ill, as she was occasionally, “she used to send her chauffeur in the Rolls Royce to fetch her a supply of filters to fit at home in bed. One of her friends said she had never been so happy in her life before. She knew we depended on her work, as we did, and through us casualties all over the country.”
And who sat on the bleeding couches and gave their blood? Everyone. Some were recruited in factories or army units or offices, where large groups of people could be appealed to easily. “But the housewife in the country village and small town was often a most faithful and regular donor.” Many gave every three months throughout the war “feeling it the one personal contribution they could make to the war effort.” Richard Titmuss, in The Gift Relationship, reported the results of a survey into why people donate blood. One man wrote, “1941. War. Blood needed. I had some. Why not?”
The bleeding of donors was undertaken in the depot and by mobile teams sent out into the surrounding small towns and villages where they set up a temporary bleeding center in a town hall, factory restroom, church hall or village public house. Janet was very proud of the quality and sterility of “the bleed.” At first, blood was requested by telephone. But “they soon learnt that Slough could hear and see the bombs falling and would arrive.” The bombs began to drop in the fall of 1940. The ice-cream vans would get near the bomb sites, and deliver their blood to the hospital where the casualties were being taken. This experience created medical innovation: they wore electric lights on their foreheads, like miners, so that if lights were off and blackout was in operation, they could still see where to stick in their needles.
They changed the needle design because of one incident with a burned girl on the Great West Road. Vaughan arrived and found a little girl, horrifically burnt after she had taken alight from the house electric fire. She left the girl to die, because she had to see who she could save and who she couldn’t, but after saving who she could she returned to the girl and found her still alive. Her legs and arms were so burnt, she had no veins. And Janet again remembered something she had read, that you could give blood into bones. “That was the great thing about medicine in the war, you could take risks because people died so they were no worse off if they died because of what you did.” She took the biggest needle she could find and stuck it in the girl’s breastbone, and told a nurse to pump in blood. (When depot staff couldn’t find a vein, they called it “Digging for Victory.”) Two hours later, the nurse had got two pints in. The girl lived, and applied to Somerville years later, when Vaughan was principal. Harriet Proudfoot, that burned little girl, was given the choice of three Oxford colleges to choose from, but remembered Vaughan, who visited her and sucked blood out of her undamaged ear. And all the while “she explained what she was doing and spoke to me as if I was as interested and intelligent as she was.” When Harriet applied to Oxford, the only college she put on her form was Somerville. “So,” said Janet Vaughan of this, “nice things happen.”
The depots treated thousands of casualties, but the staff also did scientific research. They learned that theories about how to treat shock were wrong: rather than having the expected low blood pressure, shock victims had high blood pressure, and needed large volumes of blood. Each trauma victim received on average two and a half milk bottles of blood, with two bottles of blood used for one bottle of plasma. Sometimes, they quickly learned, dried serum and no blood was adequate treatment. This was essential for the mass evacuation of Dunkirk in the summer of 1940, when the depot sent all the blood it had to the coast. But the casualties kept coming, and the system could not cope, even though the Americans by now were sending over blood and plasma on ships, under the Blood Plasma for Great Britain program. Vaughan and her staff had also been working on using plasma, but the plasma looked cloudy and full of clots, so they hadn’t dared risk it until Dunkirk. “We knew men must die if we didn’t transfuse them, so we took a risk on our very odd-looking plasma.” It was another risk justified by war, and the plasma worked “like magic.”
By the spring of 1941, when the air raids stopped, they thought the demand for blood would drop, but it didn’t. “Surgeons and physicians had learnt to appreciate the value of transfusion as a therapeutic aid. Throughout the war there was a steady increase of transfusion practice throughout the country. In many cases no doubt the pendulum swung too far and unnecessary transfusions were given, but on the whole the educative value of the war time transfusion service was great.” The war, and the depots of London—along with army depots—taught us the value of blood.
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Through the war, then, delivering blood. Vaughan learned to say yes to any request, because “what men and women need in a desperate emergency is reassurance. They can hold on if help is coming, and—given the lead—other men and women will always be prepared to give that help.” Just before D-Day, Janet received a phone call from the head of Emergency Medical Services. “Janet, we have made no arrangements for the Ports, will you look after them?” She said, yes, of course, having no idea what looking after the Ports would entail. “As so often we heard no more, but I can only hope that the Ports received reassuring messages that Slough would come if needed.”
The war was ending, and although Vaughan had had five years of death and burns and bombs, when she was asked to go to the Nazi death camp Belsen to research how best to feed starving people, she said yes. She said yes, for science, because people who had been as starved and annihilated as the inmates of Belsen needed emergency nutrition, and the prevailing medical thought was that this should consist of hydrolysates, a strong protein in liquid form. She was driven over the Rhine on wooden pontoon bridges, and she waved to troops returning from the front. She saw hundreds of forced laborers in striped pajamas, spat out from their camps and wandering over the countryside. When she got home, she burned all her husband’s striped pajamas.
They knew before they got there that they were near Belsen, because of the stench of shit and dead bodies. The senior officer thought they were there to help, but they said no, they were there to do research. That sounds brutal now, but Vaughan writes about it with no shame. She believed in science, and they would soon need to save all the prisoners of war who would emerge from Japanese camps. The science must be done, even if she found herself having to inject hydrolysates into skeletal men who saw her approaching with a needle and screamed “nicht crematorium!” because the Nazis had sometimes injected the condemned with paraffin before sending them to the crematoria. Vaughan writes that this was so that they burned better. This was horror, but Vaughan kept on, though she had to pick the living from the dying in piles of bodies; though she was attacked by naked, desperate men (and could only wave a bedpan at them). She did enough research to show that small amounts of food were a more efficient treatment of starvation than hydrolysates. She wrote a letter home on a scrap of paper, that said, “I am here—trying to do science in hell.”
She did science in hell for a few weeks, then returned to England, and to a job as Principal of Somerville College for the next 22 years. It was academia, but it was no sinecure: of course she rose at dawn to dictate all the correspondence needed to run an Oxford college, before setting off every day to put a full day of work in at her lab nearby. If callers to the college wondered where the principal was, she responded, “Do they think I sit knitting?” She became an expert on radiation, researching the metabolism of nuclear fission on humans and on the rabbits who were her test animals. A fellow scientist called her “our radioactive Principal,” which was more accurate than he expected, because if there was any risk that radiation had leaked, Janet Vaughan would disappear to have a bone biopsy from her tibia. She did this work for decades, and once answered the politician Shirley Williams’s question as to why on earth she was handling plutonium at her age, with “what could be better than for someone in her seventies to do this work: I haven’t long to live anyway.” She fought to have women’s colleges accepted as full Oxford colleges, and she increased the intake of science and medical undergraduates at Somerville. She never stopped being a socialist.
She lived long after retiring in 1967. She still wrote academic papers in her eighties. She was a Dame, of course, a member of so many societies (my favorite: The Bone and Tooth Society), and loaded with honorary degrees. She was establishment, but yet not, to the end.
Polly Toynbee asked her in 1984 how she would like to be remembered. And this woman who was instrumental in setting up mass blood donation and transfusion; who dared to stick a large needle into the breastbone of a small burned girl; who did science in hell; who never stopped encouraging science in all ways, and women to do more of it, said, “As a scientist. That I have been able to solve, to throw light onto fascinating problems. But as a scientist who had a family. I don’t want to be thought of as a scientist who just sat thinking. It’s important you have a human life.”
Dame Janet Maria Vaughan died in January 1993, aged 92. She had only recently stopped driving her Mini. By then, the Blood Transfusion Service, later the National Blood Service then NHS Blood and Transplant, had existed for 47 years. Last year, it collected 1.9 million donations of blood. British hospitals use 8,000 units every day. Although some parts of blood still only last five days, it can now be separated, stored and widely transported, partly because of a woman named Janet.
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Rose George is the author of The Big Necessity: The Unmentionable World of Human Waste and Why it Matters (2008); and of Ninety Percent of Everything: Inside Shipping, the Invisible Industry that puts clothes on your back, gas in your car, and food on your plate (2013).
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