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Public Health in UK

The history of public health in the United Kingdom is long and very rich. The idea of public health seeps into every corner of British history and forms the foundation of modern society.

What did public health look like in medieval times? What about in the early modern or modern period? We'll learn all of this before discussing the state of public health in the present day and its importance in society.

Public health

The health of the population; also refers to the branch of science that focuses on improving overall health

History of public health in the UK

As you can imagine, public health has changed a lot over time. Ideas surrounding health have changed, as have living conditions, government policies, and our ability to treat injury and disease.

Public health in the medieval period (c. 1000-1500)

In the medieval era, the modern-day idea that germs and bacteria caused disease was non-existent. In this period, people believed that illness was spread by miasma and could be a punishment from God.

Miasma

Essentially, miasma was bad air. It was believed that particles from rotting or decaying matter could travel through the air and cause disease. This is why medieval doctors used to always carry herbs and other strong-smelling ingredients with them - they thought it stopped them from being infected.

Theory of the Four Humours:

Another of the central theories about health in the medieval period was the Theory of the Four Humours. In this theory, popularised by the Ancient Greek scientist Galen who built on the work of Hippocrates, diseases were not caused by outside forces but by imbalances within the human body. It was believed that the body was made up of four 'humours':

  • Blood
  • Yellow Bile
  • Black Bile
  • Phlegm

What did this mean for public health? Physicians would treat patients by attempting to restore balance between the humours - this could be through recommendations of exercise or diet, or most famously in the case of excess blood, 'bleeding' via leeches. Importantly, this theory represented the first time physicians considered symptoms and attempted to cure them.

This theory was believed until the beginning of the early modern era.

four humors public health studysmarter16th-century illustration of the four humours. Image via Wikipedia.

The Medieval Environment

Medieval towns were often extremely unhygienic places. They did not have clean running water or any kind of sewage system. Rubbish and human waste were normally thrown out into the streets and rats, lice, and fleas flourished in this environment.

Cleanliness was not an alien concept to the people of medieval England but to keep properly clean was a luxury few could afford. Bathhouses existed in bigger cities, where people could go to have a hot bath; however, these cost money and were not affordable for every member of the population.

There were very few advances in public health during this era. Muck-rakers were employed by towns to clean the streets and public latrines (toilets) were built but much of this waste ended up going back into the rivers which were also used as a water source, allowing diseases to flourish.

Quarantine was enforced in cases of plague, and for those with particularly infectious diseases.

Lazar House:

A Lazar House, more commonly known as a Leper Colony, was a house in which people suffering from leprosy lived, kept away from the rest of society so as not to spread the disease.

Overall, public health was very bad in the medieval period. There was little knowledge of what caused diseases or how to treat them, the environment people lived in was unhygienic, and efforts made to clean up towns and cities had little effect. The result was a low life expectancy and high infant mortality rates.

Public health in the early modern period (c.1500-1800)

The early modern era saw the growth of new ideas about the human body and public health thanks to the Enlightenment. In addition, the country was becoming wealthier thanks to the growth of the British Empire. However, ideas of germ theory did not appear in this period and there was little government intervention in public health, as it was not seen as their responsibility.

The Enlightenment

An intellecutal and philosophical movement in the 17th and 18th centuries which emphasised reason over religious ideas and superstition.

17th Century

In the 17th century, people began to make links between dirt and the spread of disease, although the true link between the two was not established.

In 1665, London was struck by a plague epidemic, known as the Great Plague of London. This was the last major outbreak of the Bubonic Plague in England.

An unintentional improvement in public health came from the Great Fire of London in 1666. After the fire, the city was rebuilt to make the houses further apart and the streets wider. In addition to stopping the spread of fire, the new spaced out streets helped stopped the spread of disease as well, resulting in better public health.

Public Health in Britain the Great Fire of London StudySmarterThe Great Fire of London, Picryl

18th Century

The 18th Century brought the Enlightenment to England, which helped the growth of new ideas and theories about the body, disease, and health. There was an increase in the number of hospitals, changes in medical education, and the professionalisation of medicine.

Three main types of medical institutions came about in the 18th century; the hospital, the dispensary, and the operating theatre.

  • A hospital or infirmary was a place for people with long-term illnesses - there were many wards and many rooms. These were often set up through the charity of the wealthy.
  • A dispensary was more like a modern-day 'Walk-In Centre' - they catered for patients with minor illnesses and did not have beds. They would dispense medicines and give inoculations.
  • An operating theatre was where surgery would take place. As its name suggests, these operations would be watched, usually as a means for those in training to learn about the human body.

Inoculation

A method of giving immunity to a disease via injection, similar to vaccination

Public Health in Britain Engraving showing the second stage of building Guy's Hospital in Southwark StudySmarterEngraving showing the second stage of building Guy's Hospital in Southwark, Wellcome Collection

The different medical professions of this era can be nicely divided into three categories as well. They were:

  • Physicians: A physician's role was to diagnose illness and prescribe remedies. They did little physical work and did not do surgeries. This role was seen as the most senior in the medical profession.
  • Surgeons: Surgeons performed surgeries and attended to any work that needed to be done on the body. They did not diagnose illness or prescribe remedies. They were considered secondary in importance to physicians.
  • Apothecaries: An apothecary was someone who ran a shop that supplied medicines and remedies. This job required no training and was looked down upon by both physicians and surgeons. They did not diagnose illnesses or perform surgeries.

Conditions in towns and cities during the early modern period had improved but were far from hygienic. The government still did not take responsibility for public health as they considered health an individual responsibility. However, professional healthcare became more accessible and more advanced thanks to enlightened ideas about science and the body.

Public health in the modern period (c.1800-present day)

The 19th and 20th centuries saw rapid progress in the advancement of medical science and the growth of public healthcare. From the discovery that germs caused diseases to the creation of the National Health Service, the shift in medical knowledge and public health provision was huge.

19th Century

The 19th century was a period of great change in Britain as the Industrial Revolution accelerated advancements in science and technology whilst also expanding towns and cities all over the country.

However, due to this, public health worsened. Increased urbanisation thanks to people moving into cities to find work led to overcrowding and poor living conditions. Urban slums, combined with a lack of good diet and no access to clean drinking water meant diseases like Typhoid fever, Cholera, Dysentery, and Tuberculosis (TB) spread like wildfire through the population.

For the first half of the century, the government did little to help; they were still set in the idea that public health was not their responsibility. However, things changed in the second half of the century when it became evident just how appalling conditions were.

In 1842, Edwin Chadwick published a report entitled 'Report on the Sanitary Conditions of the Labouring Population'. In it, he made the link between poor living conditions and the spread of disease and suggested reforms to combat the issue.

The Cholera Epidemic of 1848 made the government realise they needed to take responsibility for public health. This led to important legislation like the 1848 Public Health Act, which set up local boards that were responsible for improving sanitation in their area. Later in the century, London's first sewage system was built and more legislation was passed to improve living conditions and public health.

The most significant advancement came in 1861 when the French chemist Louis Pasteur made the discovery that germs caused disease. This revolutionised the way people thought about diseases and allowed for huge improvements in public health.

louis pasteur germ theory health studysmarterLouis Pasteur, whose 1861 discovery of germ theory revolutionised public health. Image via Wikipedia.

20th Century

Despite the progress that had been made during the 19th century, it was evident that there were still issues concerning public health leading into the 20th century.

The Liberal Governments of the early 20th century introduced lots of legislation to support the population; a minimum wage, old-age pensions, free school meals, and school medical inspections all improved living conditions and therefore public health. Later on came the building of council houses, which had running water and electricity.

The most significant development in public health during the 20th century was the creation of the National Health Service (NHS) in 1948. This provided free healthcare to every member of the British population, as well as giving health advice, vaccinations, and campaigning to stop unhealthy habits like smoking. The NHS has continued to support the British public since its creation and is an incredibly important asset to public health.

In addition, legislation was passed during the 20th century to improve living conditions, such as the building of council housing, creating a system of benefits, and improving air quality.

The current changes in the UK's public health

Public health in the UK today is strictly maintained and is controlled by the government Department of Health and Social Care. The NHS provides healthcare to all permanent residents free of charge. There are strict regulations surrounding the conduct and training of medical professionals to ensure everyone gets the best care possible. The UK is also involved in international organisations like the World Health Organisation, to share medical knowledge and help improve public health all over the world.

The government is putting increasingly more focus on the environment - improving air quality and creating more green spaces to help stop climate change and improve public health. Programs of building adequate housing and ending poverty are also a top priority.

The National Health Service is one of the largest employers in Europe, with over 1.3 million people working there.

The importance of public health in the UK

Public Health is incredibly important - it is the basis of society in Britain. Through public health, millions of lives are saved from preventable diseases and epidemics. It allows us to live longer, accomplish more, and demonstrates how much we have achieved. Public health also helps reduce inequalities by ensuring that everyone has equal opportunities and that no one will be disadvantaged due to their socio-economic background.

Public Health in UK - Key takeaways

  • The history of public health in the UK is long and very rich.
  • In the medieval era, public health barely existed. There was no knowledge of what caused diseases or how to properly treat them and living conditions were very unhygienic. The key medical theories were miasma and the Theory of the Four Humours.
  • In the Early Modern world, some advancements were made. Links were made between dirt and disease. The Enlightenment brought new ideas about medicine and the body and new institutions made medical care more accessible.
  • The most significant improvements took place in the Modern era. Government legislation for public health, the discovery of germ theory, creation of the Welfare State and NHS are the main advancements.
  • Today, the UK's public health is controlled by the Government. It has many benefits, and good public health is the basis of modern society.

Frequently Asked Questions about Public Health in UK

The UK's public health system helps control the health of the entire population, by ensuring a good standard of health through free healthcare and the prevention of diseases.

The UK's public health is controlled by the government through the Department for Health and Social Care. The NHS also provides nationwide care for all permanent residents.

The UK's public health is controlled by the government through the Department for Health and Social Care.

There have been several Public Health Acts in British history. The first was in 1848 that created local boards to improve sanitation, with many more being created after to improve public health.

The UK's system of public health has changed a lot over the centuries. Most public health provisions occurred during the 19th and 20th centuries.

Final Public Health in UK Quiz

Question

Where was the Western Front?

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Answer

The Western Front was in northern France and Belgium.

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Which important development took place in 1901?

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Answer

Blood groups

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Question

Which body parts were normally amputated?

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Answer

Over half of the amputations were on arms and legs. The Carrel-Dakin method limited deaths from infection.

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What did soldiers use before gas masks to fight against poisonous gases?

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Answer

Urine-drenched cotton pads

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Which development occurred at the Battle of Cambrai in 1917?

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Answer

Creation of blood banks

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What was the Chain of Evacuation?

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Answer

The Chain of Evacuation was the method used by the RAMC and FANY to get injured soldiers away from the front line. It had four stages.

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Which of these illnesses would have caused other soldiers to call you a coward?

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Answer

Shell-shock

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How many men went back to the front line thanks to the RAMC?

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Answer

1,600,000 men recovered from their injuries and returned to the front line thanks to the RAMC.

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What was the primary role of the FANY?

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Answer

Transportation

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Who opened the first facial transplant hospital in London in 1917?

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Answer

Harold Gillies

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What was the name for the battlefield in between the trenches?

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Answer

No man's land

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Which body part was first transplanted in 1905?

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Answer

The cornea (outer eye)

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What were the symptoms of shell shock?

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Headaches, jitters and shakes, nightmares, inability to speak and panic attacks.

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What was the impact of the Carrel-Dakin method?

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The survival rate of people who were amputated greatly increased.

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What was the impact of blood banks?

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Blood transfusions could be administered quickly. 11/20 Canadians survived blood transplants in the Battle of Cambrai.

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Which pre-war development caused medical teams to try and promote aseptic practices and sterilisation?

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Answer

Louis Pasteur's 1861 germ theory

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Where were mobile x-rays used?

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In Casualty Cleaning Stations and Base Hospitals.

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What was miasma?

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The theory that diseases could be spread by bad air

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What were the four humours?

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Blood, Phlegm, Black Bile, Yellow Bile

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Which two physicians created and developed humoural theory?

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Hippocrates and Galen

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Question

Give three reasons why Medieval towns were unhygienic.

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Answer

- Contaminated Water

- Rubbish thrown into streets

- Human waste thrown onto streets

- Rotting food

- Tightly packed houses 

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Why did monasteries stand out from other medieval environments?

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Answer

Much more clean and hygienic.

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What linked religion and medicine?

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It was believed illnesses could be a punishment or test from God

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What was the name of a common herbal remedy that many people used and trusted?

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Theriac

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Who was responsible for the creation of herbal remedies?

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An apothecary or the woman of the house

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What did 'hospitals' NOT do in the medieval era?

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Treat people's illnesses!  They were places for people on pilgrimages to rest.

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What efforts were made to improve the environment?

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Waste disposal regulations

Introduction of quarantine

Bathhouses

Muck-rakers and gong-farmers

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What does RAMC stand for?

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Royal Army Medical Corps

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What does FANY stand for?

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First Aid Nursing Yeomanry

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Where did the RAMC first see battle?

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Africa

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Who founded the FANY?

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Edward Baker in 1907

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What was the Chain of Evacuation?

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The Chain of Evacuation was the four stages of medical care that helped treat soldiers in World War I.

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What was the primary role of the FANY in the Chain of Evacuation?

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Transport

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Which famous writer was a member of the British Red Cross in World War I?

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Agatha Christie was a member of the British Red Cross in World War I before publishing her first novel.

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What was the Special Operations Executive in World War II?

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Formed by Churchill, the Special Operations Executive was a clandestine war organisation that sought to destabilise Germany in Europe. They used members of the FANY.

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What was the biggest obstacle for the FANY's involvement in World War I?

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Initially, the British Army did not want to work with them.

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What were Blighty Wounds?

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Wounds or injuries serious enough to require treatment in Britain.

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Which member of the Royal Family became Commandant of the FANY in 1933?

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HRH Princess Alice

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When was Florence Nightingale born?

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1820

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Where was Florence Nightingale born?

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Florence, Italy

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Why were Florence Nightingale's family so opposed to her training as a nurse?

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Nursing was regarded as a very lowly and drunks profession. Nurses were seen as uneducated and unrespectable women. Nurses were portrayed in popular literature, such as Charles Dickens's novel, Martin Chuzzlewitz, as drunks. 


This was heightened by the fact that Florence Nightingale came from a wealthy and educated background.

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What vision did Florence Nightingale have when she was 17? And, how did this impact her work?

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Florence Nightingale had what she viewed as a religious vision that instructed her to help people.

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Where did Florence Nightingale train as a nurse?

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Germany, Alexandria, Egypt and Britain

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When did Florence Nightingale arrive at Scutari hospital?

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November 1854

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When did the mortality rate at Scutari hospital fall to 2.2%?

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Spring 1855

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What did Florence Nightingale do to improve the conditions at Scutari hospital?

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  1. Florence and her team of nurses scrubbed all the surfaces and the kitchen, washed all the bedding, sheets, equipment, towels and bandages. 
  2. Florence Nightingale pushed for the increase of airflow and clean air circulation.  
  3.  Florence Nightingale prioritised the importance of a good diet and hydration. This led her to source fresh vegetables and fruit.  

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What was another possible reason the conditions improved at Scutari hospital by 1855?

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In 1855 the government intervened and decided to invest in a clean water supply.  

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What was the name of Florence Nightingale's most famous work?

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Answer

Notes on Nursing

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In what year did Florence receive the royal red cross?

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Answer

1883

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In what year did Florence receive the Order of Merit for exceptional service to the crown 

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Answer

1907

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