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OBSERVATIONS On a particular Kind of SCARLET FEVER, That lately prevailed in and about ST. ALBAN's. In a LETTER to Dr. MEAD.

By NATHANAEL COTTON, M.D.

LONDON, Printed for R. MANBY and H.S. Cox, on Ludgate-Hill. MDCCXLIX.

OBSERVATIONS, &c.

[3]
SIR,

I Take the liberty to ſend you a few obſervations on a particular kind of Scarlet Fever, that hath lately obtained in this place, and ſome towns adjacent. The only circumſtances, which can entitle this ſheet to the trouble of your peruſal, are the novelty of the ſubject, and a careful repreſentation of facts. Nor ſhall I obtrude upon you any vague conjectures, or precarious hypotheſes, relating to the cauſes of this diſeaſe; much leſs take up your valuable moments in the purſuit of uſeleſs, unmeaning quotations from other authors.

About the latter end of Sept. 1748. a Scarlet Fever began to appear in this town. At firſt children only were ſeized with it; but afterwards it attacked adults. The manner of ſeizure was not always one and the ſame. There was ſome diverſity [4]herein; as likewiſe in the ſymptoms, and ſtages of the diſeaſe. Its period alſo was ſometimes various in various patients. And as there was a difference in the time, ſo likewiſe there was in the manner of its terminating.

In general, the firſt ſymptoms were ſickneſs, vomiting and purging. But theſe ſymptoms ſeemed pretty much confined to children. A ſore throat either attended theſe diſcharges of the inteſtinal tube, or immediately followed. The Tonſils, Parotids, and maxillary glands haſtily ſwelled to a conſiderable degree. In ſome, the Tonſils only were inflamed and ſwelled; in ſome a ſwelling of the Parotids accompanied the inflammatory tumours of the Tonſils; in ſome, all the glands abovementioned tumefied at the ſame time. Upon looking into the mouth, there were frequently ſeen, eſpecially after the diſeaſe was a little advanced, ulcuſcula, ſcattered up and down the fauces, which were pretty broad upon, and about the Tonſils, ſuperficial, (at leaſt all, that I ſaw, were ſuperficial) and covered with a whitiſh ſlough. The eyes appeared watry, and the countenance, particularly the eye-lids [5]were puffed up, as in the Meaſles. In many, the neck, arms, and hands were puffed up, and ſwelled likewiſe. And it is not improbable, that the trunk of the body was alſo ſwelled, if we could as eaſily have diſcerned ſuch a general enlargement, as we could the enlargement of a particular member. In ſome, a cough alſo accompanied the preceding ſymptoms. But there was a great difference as to the cough: for in ſome, it was ſlight, and rather abated, as the diſeaſe advanced; while in others, it encreaſed, and grew ſeverer each day than the preceding.

The ſcarlet Effloreſcence differed as to degree, and time of its appearance. In ſome it appeared immediately on the attack of the diſeaſe; and That, not always gradually, as many eruptive diſorders do; but in ſome it was ſudden, univerſal, and of an intenſe red; as intenſely red ſometimes upon its firſt appearance, as when the diſeaſe was further advanced. In ſome, there intervened one or more days between the firſt ſickening, and the ſcarlet effloreſcence; and in ſome, this effloreſcence was partial, and gradual in its advances. The legs and thighs [6]were ſpotted up and down with ſpots of various dimenſions, ſome as large, or larger than a ſix-pence, while the trunk of the body was covered with ſuch an infinite number of them, and ſo cloſely ſet together, that no interſtices appearing, the body was in ſome perſons as red almoſt, as if it had been dipped in blood. In others again the ſcarlet effloreſcence was trifling as to the degree of colour; and ſo very ſlightly was the ſkin tinged, that the diſeaſe was known, more from the collateral ſymptoms, than from the effloreſcence. Yet the ſameneſs of ſome ſymptoms, happening in a family to one or two, where the reſt had the diſeaſe compleat, abundantly ſatisfied me as to the genius of the diſtemper.

From this diverſity of ſymptoms, I have found ſome practitioners inclined to think, that this diſeaſe could not with propriety be called a ſcarlet fever. But I imagine, that ſuch diſputes are about words only. For altho' there is a conſiderable difference between the preſent ſcarlet fever, and that milder one, which Sydenham deſcribes; yet if an increaſed number of ſymptoms, and a more exaſperated degree [7]thereof, would authoriſe a phyſician to alter the name of the difeaſe, I fear, that confuſion would be the conſequence of ſuch a liberty. For the ſame reaſons, the ſmall Pox might ſuffer a change in its name; becauſe there is not ſo great, or a greater difference between a former, and the preſent Scarlet Fever, than there is between ſmall pox and ſmall pox; more eſpecially if the compariſon be made between the mildeſt degree of the diſtinct, and the moſt violent degree of the confluent ſort. But if a man conſults Morton, as well as Sydenham, he will find, that the febris ſcarlatina of the former differs greatly from the febris ſcarlatina of the latter, as to the appearance, degree, and period of the diſeaſe. For however mildly Sydenham repreſents this diſtemper, Morton ſcruples not emphatically to term it a plague; and his reaſons are the ſeverity of ſome of the ſymptoms. In his eleventh caſe, towards the cloſe, ſpeaking of a patient, he hath theſe words, a peſte, inquam, evaſit. And afterwards he goes on thus, quantum tonſillas, uvulam, fauces, nares, et quamdiu intumuiſſe vidi! quam turgida nonnunquam labia! et quam ſordida ſcabie obducta et exulcerata ab eadem cauſa animadverti!

[8]

I might obſerve, that this ſcarlet eſhoreſcence not only differed as to degree in different perſons, but in one and the ſame perſon, there was often this diverſity. The effloreſcence on the face, neck, and breaſt was even with the ſuperficies of the ſkin ( [...]ryſipelas-like) at leaſt ſo far as the eye could diſcover; while in other parts, the eruptions were more prominent, and carried the exact appearance of a Raſh, (with this difference only, that they were very red) and the cuticle felt with all the aſperity of Fiſhſkin, that ſpectacle caſes and the like are frequently made of.

I now proceed to the Fever, which in moſt was high, that is to ſay, intenſe thirſt, and the ſenſation of a burning heat upon the ſkin, were the prevailing complaints of the greater part of thoſe, who laboured under the diſeaſe. But even with all this extraordinary heat and increaſed celerity of the blood's motion, the tongue was commonly moiſt, furred but ſlightly, and here and there a perſon not very thirſty. Some underwent extreme anxiety and inquietude; ſome were delirious for four, [9]or more days together, without one lucid interval or ſlumber, inceſſantly talking incoherently. Others were comatous, and when awaked to drink, immediately relapſed to ſleep again. Only a few complained of head-achs; and even ſome of thoſe, who were afterwards moſt delirious, did not complain of previous pain in the head. Several were ſleepleſs whole days and nights ſucceſſively, without any delirium. Almoſt all complained of great dejection of ſpirits, and ſudden loſs of ſtrength, which leads me to ſpeak of the pulſe.

The Pulſe in general was very quick, and very ſmall; which circumſtance, in conjunction with lowneſs of ſpirits, and impaired ſtrength, contributed a good deal to embarraſs the method of cure. For however the inflammatory diſpoſition of the blood might ſeemingly call for Bleeding, the untoward ſymptoms abovementioned ſeemed either to forbid this diſcharge, or to permit it in ſuch ſmall quantities, that little ſervice could reaſonably be expected from it. And in fact I found that bleeding, tho' recourſe was had to it at the beginning, was very little beneficial towards the cure of the fever, [10]tho' often ſerviceable to the inflamed throat. But of bleeding more hereafter. Let me here add, that there were a few, whoſe pulſe was quick, and not weak; and in this caſe, I ordered plentiful bleeding, and even repeated it, if the difficulty of deglutition was conſiderable. I remember two patients particularly, the one about eleven years of age, the other about eighteen, each of whom I blooded the ſecond and third day of the diſeaſe. The firſt bleeding was followed with little, or no benefit to either of them. The next day, finding their tonſils ſtill greatly ſwelled and inflamed, and apprehending danger of ſuffocating in a few hours, I directed a further quantity of blood to be taken away, which preſently abated theſe complaints. Their blood was ſizey each time of bleeding. But tho' in theſe, and a few more perſons, the blood was ſizey, yet in others it was not ſo, notwithſtanding they were bled after the diſeaſe was pretty far advanced: for it is well known, that even in the ſmall pox, and many other inflammatory diſeaſes, the blood, when taken away at the beginning, is frequently not ſizey, tho' found to be ſo, upon bleeding ſome days afterwards. Nor can I recollect, that any [11]ill effect followed upon bleeding, where I directed it. Tho' there frequently occurred caſes, where the ſmallneſs of the pulſe, and lowneſs of the ſpirits deterred me from it. But then theſe circumſtances were ſo obvious and glaring, that they could not eſcape an inattentive practitioner.

The urine was ſeldom high coloured, not even the urine of adults; it was generally the complexion of water ſaturated with a paler clay. And when the fever abated, the urine, as uſually, ſeparated, and depoſited a thick clay-coloured ſediment. In ſome indeed, who were remarkably delirious, the urine was limpid and pale, as is common under ſuch circumſtances; but, as the patient mended, the urine had a better colour and conſiſtence, and threw down a plentiful ſediment.

There was ſome diverſity in the terminating of this diſeaſe, both as to the time and manner. When it was not very violent, it terminated, in ſome meaſure, on the fourth or fifth day; that is, the diſeaſe at that period had arrived to its height, and was on the decline. In few or none did the fever leave the patient [12]ſo totally, but it recurred once, twice, or more, the evenings following; and grew ſo mild at each return, as to be little more, than barely noticed: at which time too, all the glandulous ſwellings commonly vaniſhed. But in ſome, altho' the fever evidently remitted of its ſeverity on the fourth, or fifth day, its returns were of more hours duration, and higher in degree; and a large ſhare of inquietude continued, even to the eighth, or ninth day. In one perſon particularly, the delirium continued after the fever was off, the ſkin cool, the effloreſcence dying away, and the pulſe ſlow and regular. In another, when the fever was paſt its height, the Parotids began to ſwell for the firſt time, and continued to enlarge for three days ſucceſſively; when ſuddenly they ſubſided, in a night's time, one half of their increaſed magnitude. In two perſons, after the fever was quite removed, and the appetite for food returned, the tumor of the Parotids ſtill continued, which daily encreaſed in their bulk, and gradually grew harder, till a fortnight or three weeks afterwards, the right Parotid of the one, and the left Parotid of the other ſuppurated largely.

[13]

The diſtemper left a great many very low ſpirited, complaining of an ill taſte in their mouth, with loſs of ſtrength, and a ſlowly recovering appetite. The cuticle of almoſt all peeled off, as in other ſcarlet fevers; and many complained for a long time, that their bodies were as ſore within, as without. Such a ſenſibility indeed they ſuffered, as rendered them quite unhappy.

In ſome the nervous ſyſtem was ſhattered to ſuch a degree, that the dejection of ſpirits, which had accompanied the diſeaſe thro' all its ſtages, ſtill continued, when the diſtemper was over; and the patient dreaded the approach of the evening with an unuſual kind of horror, aſſuring me, that the ſhadows which were conſequent upon the lighting up of candles, affected their minds with extravagant terrors and perturbations. And I well remember, that in a child near three years old, this circumſtance was ſo very remarkable, that upon the candles entering the room, and the ſhadows ariſing thereupon, the boy appeared with a ghaſtly ſtare; and cried with a vehemence not to be pacified, on [14]diſcovering the moving ſhades on the walls of the chamber.

I now proceed to the cure, the method whereof was different in different patients. When the diſeaſe began with ſickneſs and purging, as it generally did, I commonly ordered a ſalt of wormwood mixture, with the teſtaceous powders in it; upon which the vomiting and diarrhoea uſually ſtopped, and truly I hardly remember, that they ever returned again. Then if the inflammation and ſwelling of the tonſils, and parts adjacent required, and the pulſe permitted, I directed bleeding, and repeated it as the ſymptoms indicated. If this method did not take ſpeedy effect, I ordered a veſicatory between the ſhoulders; and for internals, I commonly preſcribed draughts of ſperma ceti and nitre, with plentiful dilution, by means of barley-gruel, white wine whey, and other liquors. Sometimes too I ordered linctuſes, gratefully acidulated with ſpirit of vitriol, or in lieu of linctuſes, black currant jelly; in order to keep the parts ſoft and flexible, and to remove or abate that aridity, which is an attendant of inflamed parts, eſpecially ſuch as are expoſed to the air; and the [15]tonſils may be juſtly regarded in this view, becauſe the noſtrils being generally ſtopped, the patient was obliged to inſpire thro' his mouth.

And by this method alone the diſtemper, when not violent, went thro' its ſtages with ſucceſs. But if ſubſultus tendinum, deliria, and other threatening ſymptoms appeared, I immediately applied bliſters likewiſe to the arms. And if ſymptoms were not obviated hereby, but the pulſe alſo began to ſink, I directed a veſicatory to the head, and exchanged the nitre for warmer medicines, ſuch as the pulvis bezoardicus, contrayervae comp, and confectio cardiaca.

If the ulcers on the tonſils and fauces were fouler than common, deterſive and aſtringent gargariſms were found to be of ſervice, by contributing much to bring away the ſloughs, and facilitate deglutition.

If the fever ran high, and the body was very coſtive, I ordered an emollient clyſter. But the obſervations made on bleeding held true likewiſe here. For [16]the uſual weakneſs of the patient, and depreſſion of ſpirits, ſeemed to hint, that theſe inteſtinal diſcharges were the leſs neceſſary; and the ſcarlet effloreſcence ſeemed likewiſe to forbid a too great laxity being brought upon the inteſtines.

And now I ſhall conclude, by throwing together a few general obſervations, which could not conveniently be claſſed under the foregoing articles.

Opiates had no beneficial influences to remove watchfulneſs. This perhaps is not to be wondered at, during the febrile ebullition; tho' Sydenham recommends paregorics under the worſt ſymptoms, that he hath mentioned of this diſeaſe. But in three perſons or more, where the fever was in great part, or altogether off, I gave opiates aromatized; to one, that I might calm the delirium; and to others, that I might procure ſleep after many nights watching. But all to no purpoſe.

I bled one patient, whoſe pulſe was tolerably ſtrong, to remove the delirium and loquacity, that ſtill continued, after the fever was ſeemingly gone. [17]But no benefit ariſing in a few hours after bleeding, I ordered bliſters to the arms, adminiſtered more cordial medicines than before; and that night the patient ſlept ſeveral hours without waking, and afterwards mended apace.

The blood had no ſize upon it, the ſerum was a bright citron, and bore a due proportion to the craſſamentum, as in health.

In others, under pretty much the ſame circumſtances, as the foregoing, but where the pulſe was not ſo ſtrong indeed, I omitted bleeding, and preſcribed veſicatories, and generous medicines, but no ſleep enſued hereupon.

I was called to a child of four years old, the ſecond day of the diſeaſe. He appeared quite bereaved of ſenſe, almoſt ſuffocated, and at the point of death. Immediately I ordered him to be blooded to ſix ounces, ſpeedily after which he revived, and came to himſelf. The child was naturally ſubject to enlarged Tonſils. But this ſymptom of ſtrangling haſtily came on, I think, within the ſpace of half an [18]hour, or thereabouts. On the fourth day, at two in the afternoon, it returned again with greater ſeverity, if poſſible, than before; tho' ſeveral bliſters that had been applied, diſcharged moſt copiouſly. The Tonſils were ſwelled to that degree, as threatened every minute to preclude all admiſſion of air. Whereupon a Surgeon was called in, who attempted to relieve the child, by making inciſions on theſe glands. And ſo far the operation anſwered the end, that the boy who appeared before in danger every moment of being ſuffocated, lived 'till about ſeven in the evening. The operation was followed by a pretty deal of blood, and a little purulent matter, which was very offenſive to the ſmell.

There were two things remarkable in bliſtering; the one was, that oftentimes no good effect accrued hereby to the fever, tho' the pulſe by theſe means was generally raiſed, and the difficulty of deglutition ſomewhat abated. The ſpirits too were improved by theſe applications. And indeed in a diſeaſe ſo ſeemingly threatening, perhaps it would be imprudent to omit theſe applications. For altho' the fever [19]did not yield to them, ſo as to ſhorten its ſtages; yet it is probable, that ſymptoms were hereby prevented from riſing to a more dangerous height. And in general it was true, that few were delirious, whoſe complaints of the throat obliged them to the early application of bliſters. However this obſervation did not always hold good; for there were a few, who had bliſters timely applied, and nevertheleſs, a ſubſequent delirium not prevented.

Another remark worth noticing, was the great length of time, that the bliſters continued to diſcharge. In ſome, for eight or ten days ſucceſſively, and in ſome, much longer.

In general, few ſweated plentifully, till towards the concluſion of the cure; i. e. till the fever was paſt its height. The younger the patients, the earlier, and the more they ſweated, and ſo vice verſâ.

The appearance of the effloreſcence ſeemed to command but little regard, as to the method of cure. For I have ſeen ſome perſons raving, with the eruption [20]fully out, and intenſely red; and I have ſeen others equally delirious, with the eruption ſparing and pale. So that latterly I did not much conſult the appearance of the efflorence, but I ordered bleeding &c. as other circumſtances indicated.

It is a general law in eruptive diſorders, that the more liberally the eruption comes out, the ſecurer is the patient rendered thereby. And yet ſo little did this rule hold true here, that in two patients, who died, the effloreſcence was univerſal, and florid to the laſt. And in one of them, that anxietas circa praecordia, which is uſually moſt urgent in other eruptive fevers, before the eruption breaks out, was in this caſe as exquiſite, when the effloreſcence had attained its higheſt colour, as before the effloreſcence made its appearance.

Under the article of cure, I ſhould have obſerved, that the univerſal ſoreneſs within, which multitudes complained of, was alleviated much by ſolutions of ſperma ceti, light oleaginous mixtures, broths, &c. and when the cough continued, bleeding and aſſes milk removed this complaint.

[21]

But the moſt troubleſome ſymptom, which occurred after the fever was removed, was that great dread upon the ſpirits mentioned before, which occaſioned the unhappy patient to fear the approach of the evening. Here no nervous medicines, as they are called, ſeemed to take any immediate effect. But air and a reſtorative diet gradually reſtored the perſon to better ſpirits.

From the whole, that I have advanced upon this diſeaſe, I think it appears, that general rules of cure were precarious and uncertain; and that particular rules were not aſcertainable, on account of the various appearances, and ſymptoms of the diſeaſe, and the various conſtitutions of various patients. And this perhaps furniſhes a hint, why mankind are ſo often diſappointed in the peruſal of medicinal writers. We are apt to expect too much from them; indeed more, than it is poſſible for the art to ſupply. When authors write generally upon theſe ſubjects, they ſeldom write very uſefully; and when they write particularly, we grow weary of their prolixity. And perhaps, after the pains of turning over a variety [22]of volumes, we ſtill find, that the particular caſe we wanted, is either not mentioned at all, or too partially and ſuperficially, to ſerve our purpoſes.

So that it is in Medicine, as in Navigation. Rules may be laid down, and Charts exhibited; but when a man hath made himſelf maſter of all theſe, he will often find himſelf among ſhelves and quickſands; and muſt at laſt have recourſe to his own natural ſagacity, to extricate himſelf out of theſe difficulties.

When obſcurities ariſe, and emergencies preſs, every practitioner knows, how poor and inſufficient all ſyſtematic authors are; and how tedious, and oftentimes unavailing the beſt obſervators. The neceſſity therefore, and ſuperiority of a phyſician's own judgment, in many caſes, to the writings of others, Your practice and Your ſucceſs moſt abundantly teſtify. I am, with the greateſt reſpect,

SIR, Your very obedient Humble Servant, N. COTTON.

Appendix A BOOKS printed for, and ſold by R. MANBY and H. S. COX, Bookſellers, at the Prince's-Arms, over-againſt the Old-Bailey on Ludgate-Hill, LONDON.

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I. MEdicina Britannica: Or, a Treatiſe on ſuch phyſical Plants, as are generally to be found in the Fields or Gardens in Great-Britain: Containing a particular Account of their Nature, Virtues and Uſes. Together with the Obſervations of the moſt learned Phyſicians, as well ancient as modern, communicated to the late ingenious Mr. Ray, and the learned Dr. Sim. Pauli. Adapted more eſpecially to thoſe, whoſe Condition or Situation of Life deprives them, in a great Meaſure, of the Helps of the Learned. By Tho. Short, of Sheffield, M. D. The Second Edition. To which is added an Appendix: containing the true Preparation, Preſervation, Uſes and Doſes of moſt Forms of Remedies neceſſary for private Families. 8vo.

II. A General Syſtem of Surgery, in three Parts. Containing the Doctrine and Management, 1. Of Wounds, Fractures, Luxations, Tumors, and Ulcers of all Kinds. 2. Of the ſeveral Operations performed on all Parts of the Body. 3. Of the ſeveral Bandages applied in all Operations and Diſorders. The Whole illuſtrated with thirty eight Copper Plates, exhibiting all the Operations, Inſtruments, Bandages and Improvements, according to the modern and moſt approved Practice. To which is prefixed, an Introduction concerning the Nature, Origin, Progreſs and Improvement of Surgery; with ſuch other Preliminaries as are neceſſary to be known by the younger Surgeons; being a Work of thirty Years Experience. Tranſlated into Engliſh from the Latin of Dr. Laurence Heiſter, Profeſſor of Phyſick and Surgery in the Univerſity of Almſtadt, Fellow of the Royal Society at London, and of the Royal Academy at Paris. The Third Edition, 4to.

III. Medical Eſſays and Obſervations, publiſhed by a Society in Edinburgh. The Third Edition, reviſed and corrected by the Authors. In 6 Vols. 12mo.

IV A Treatiſe on all the Diſeaſes incident to Women; containing an Account of their Cauſes, Differences, Symptoms, Diagnoſtics, Prognoſtics, and Cure. By John Aſtruc, Phyſician to his preſent Majeſty []the King of France, &c. Regius Profeſſor at Paris, and Author of a Treatiſe on the venereal Diſeaſe. Tranſlated from a Manuſcript Copy of the Author's Lectures read at Paris, 1740. 8vo.

V. An Account of ſome new Experiments and Obſervations on Joanna Stephens's Medicine for the Stone: with ſome Hints for reducing it from an empirical to a rational Uſe. With Remarks on Dr. Hales's Experiments on the ſame Subject, and ſome additional Experiments on the comparative Efficacy of divers other Medicines, as Lithontripticks. Preſented to the Royal Society Jan. 14. 1741-2. By J [...]hy Rutty, M. D. The ſecond Edition, corrected and enlarged with divers new Experiments and practical Obſervations. Alſo an Account of the ſeveral new Caſes. To which is ſubjoin'd, an Account of the Effect of Soap Lees taken internally, in the Caſe of James Jurin, M. D. with an Appendix concerning a new Medicine for the Stone and Gravel. 8vo.

VI. Commercium Litterarium ad Rei Medicae et Scientiae naturalis incrementum inſtitutum, quo quicquid noviſſime obſervatum, agitatum, ſcriptum, vel peractum eſt ſuccincte dilucideque exponitur. Ab Anno 1732. uſque 1744. Accedunt Praefatio & Indices neceſſarii. 4to. 14 Vols.

VII. Philoſophical Experiments; containing uſeful and neceſſary Inſtructions for ſuch as undertake long Voyages at Sea. Shewing how Sea-Water may be made freſh and wholeſome, and how freſh Water may be preſerved ſweet; how Biſcuit, Corn, &c. may be ſecured from the Weavel, Maggots, and other Inſects; and Fleſh preſerved in hot Climates, by ſalting Animals whole. 8vo.

VIII. An Account of ſome Experiments and Obſervations on Tar-Water; wherein is ſhewn the Quantity of Tar that is therein, and alſo a Method propoſed to abate that Quantity conſiderably, and to aſcertain the Strength of the Tar-Water. Which was read before the Royal Society, 8vo.

IX. Synopſis Medicinae; or a ſummary View of the whole Practice of Phyſick. Being the Sentiments of the moſt celebrated Authors in all Ages, relating to Diſeaſes, their Cauſes and Cures. With moſt Caſes in Surgery and Midwifry. To which are added, ſome Obſervations very rare and uncommon; and a curious Treatiſe on all Sorts of Poiſons. In 2 vols. 8vo. By John Allen, M. D. and F. R. S. tranſlated by himſelf from the laſt Edition of his Latin Synopſis, with very large Improvements. The Third Edition corrected.

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Zitationsvorschlag für dieses Objekt
TextGrid Repository (2020). TEI. 5570 Observations on a particular kind of scarlet fever that lately prevailed in and about St Alban s In a letter to Dr Mead By Nathanael Cotton M D. University of Oxford Text Archive. . https://hdl.handle.net/21.T11991/0000-001A-609F-5