The snakeroot plant has traditionally been a tonic in the east to calm patients; it is now used in orthodox medical practice to reduce blood pressure. Doctors in ancient India gave an extract of foxglove to patients with legs swollen by dropsy, an excess of fluid resulting from a weak heart; digitalis, a constituent of foxglove, is now a standard stimulant for the heart. Curare, smeared on the tip of arrows in the Amazonian jungle to paralyze the prey, is an important muscle relaxant in modern surgery.
In this review, the endlessness evolution of medical science and medical technology, and its effects on disease metamorphosis and increased life expectancy are discussed. In certain instances, the past will be compared with the present and predictions for the future will be outlined. Further, the constant role of the physician in maintaining the health of human beings is emphasized in this endlessness evolution.
The Catholic elites provided hospital services because of their theology of salvation that good works were the route to heaven. The Protestant reformers rejected the notion that rich men could gain God's grace through good works—and thereby escape purgatory—by providing cash endowments to charitable institutions. They also rejected the Catholic idea that the poor patients earned grace and salvation through their suffering.[92] Protestants generally closed all the convents[93] and most of the hospitals, sending women home to become housewives, often against their will.[94] On the other hand, local officials recognized the public value of hospitals, and some were continued in Protestant lands, but without monks or nuns and in the control of local governments.[95]

Meanwhile In 1875 Robert Koch (1843-1910) isolated the germ that causes anthrax. In 1882 he isolated the germ that causes tuberculosis and in 1883 he isolated the germ that causes cholera in humans. Meanwhile the organism that causes leprosy was discovered in 1879. The germ that causes typhoid was isolated in 1880. The germ that causes diphtheria was discovered in 1882 by Edwin Klebs. In 1884 the germs that cause tetanus and pneumonia were both discovered. Immunization against diphtheria was invented in 1890. A vaccine for typhoid was invented in 1896.


Last time we featured her, the Evolution of Medicine community showed support and interest that made a real difference. Thank you! We bring her back this week to share an update about Organize.  She and her team were recently at the White House to speak about their project with some important influencers from the industry.  She shares with us what she learned and what they were able to accomplish.

Another great surgeon was Ambroise Pare. In the 16th century surgeons put oil on wounds. However in 1536 during the siege of Turin Pare ran out of oil. He made a mixture of egg whites, rose oil and turpentine and discovered it worked better than oil. Pare also designed artificial limbs. In 1513 a man named Eucharius Roslin published a book about childbirth called Rosengarten. In 1540 an English translation called The Birth of Mankind was published. It became a standard text although midwives were women.
I’m really excited to have James Maskell from Functional Forum and Revive Primary Care.  He’s also the director of the Evolution of Medicine Summit just coming up that I’m participating in.  I asked James to come on this show so we could chat about functional medicine and the future of medicine in general, because there are some really big and exciting changes happening in the world of medicine and functional medicine in particular, and James has his hands in a lot of different pots in this field.
In 1865 Joseph Lister (1827-1912) discovered antiseptic surgery, which enabled surgeons to perform many more complicated operations. Lister prevented infection by spraying carbolic acid over the patient during surgery. German surgeons developed a better method. The surgeons hands and clothes were sterilized before the operation and surgical instruments were sterilized with superheated steam. Rubber gloves were first used in surgery in 1890. Anesthetics and antiseptics made surgery much safer. They allowed far more complicated operations.
The earliest references to medical care and surgical procedures are found in Babylonian texts like the laws of Hammurabi (1792-1750/43 BCE) describing the surgeon’s responsibilities and how much he should be paid. Pay was good, but penalties for mistakes harsh: “If a physician performs a major operation on a lord… and causes his death…. they shall cut off his hand”. Only wounds, fractures and abscesses were treated surgically. A Sumerian clay tablet (2150 BCE) describes wounds being washed in beer and hot water, poultices made from pine, prunes, wine dregs and lizard dung, and use of bandages (for a nose-bleed!). Other texts describe the symptoms and prognosis of epilepsy, bronchitis and scurvy. A list of 230 medicines using plant, animal and mineral ingredients was found in an Assyrian pharmacy and records of distillation of cedar oil proves that this was an earlier invention than we thought.
Public health measures became particular important during the 1918 flu pandemic, which killed at least 50 million people around the world.[171] It became an important case study in epidemiology.[172] Bristow shows there was a gendered response of health caregivers to the pandemic in the United States. Male doctors were unable to cure the patients, and they felt like failures. Women nurses also saw their patients die, but they took pride in their success in fulfilling their professional role of caring for, ministering, comforting, and easing the last hours of their patients, and helping the families of the patients cope as well.[173]
James Maskell:  Yeah, absolutely, it was great.  You know, we have a whole day based on the evolution of nutrition.  It includes you and Terry Wahls, talking about the nutrition side.  But we also have Food Babe in there because she’s not really in the Paleo world, but I think a big part of the evolution of nutrition is to really get active and find out what’s in the food.  And I really commend her.  I think she’s playing a big role in sort of holding some of these food companies accountable.  And I think activism is an important part of making sure that we do have good options in the future.  So she’s included on that day.  And then Darryl Edwards, who does his Primal Play. He’s just a great guy, another English guy.  He’s going to be talking about the evolution of exercise.  I had an opportunity to do one of his Primal Play sessions in Central Park.  And I can tell you, I was hurting the next day and the day after, in places that I didn’t realize I had muscles.
Retinal neurons and their axon output have evolved to be inside the layer of retinal pigment cells. This creates a constraint on the evolution of the visual system such that the optic nerve is forced to exit the retina through a point called the optic disc. This, in turn, creates a blind spot. More importantly, it makes vision vulnerable to increased pressure within the eye (glaucoma) since this cups and damages the optic nerve at this point, resulting in impaired vision.

Elites and the popular classes alike called on divine intervention in personal and society-wide health crises, such as the epidemic of 1737. The intervention of the Virgin of Guadalupe was depicted in a scene of dead and dying Indians, with elites on their knees praying for her aid. In the late eighteenth century, the crown began implementing secularizing policies on the Iberian peninsula and its overseas empire to control disease more systematically and scientifically.[110][111][112]


Byzantine physicians often compiled and standardized medical knowledge into textbooks. Their records tended to include both diagnostic explanations and technical drawings. The Medical Compendium in Seven Books, written by the leading physician Paul of Aegina, survived as a particularly thorough source of medical knowledge. This compendium, written in the late seventh century, remained in use as a standard textbook for the following 800 years.

The Section of the History of Medicine is a freestanding unit in the Yale University School of Medicine engaged with research and teaching in the history of medicine, the life sciences, and public health. In addition to instruction for medical students, including mentoring M.D. theses, the faculty collaborates with colleagues in the History Department, in the Program in the History of Science and Medicine, which offers graduate programs leading to the M.A., Ph.D., and combined M.D./Ph.D. degrees and an undergraduate major in the History of Science/History of Medicine. The Section contributes to the Program's colloquia, and Distinguished Annual Lectures, workshops, and symposia in medical history. Through research and teaching, the faculty seeks to understand medical ideas, practices, and institutions in their broad social and cultural contexts, and to provide intellectual tools to engage with the challenges faced by contemporary medicine.
The physicians drew upon a great store of knowledge in the Peri-Ankh, the Houses of Life; here, students were taught and papyri documenting procedures were stored. Physiotherapy and heat-therapy were used to treat aches and pains, and Ancient Egyptian medicine included repairing and splinting broken bones, as shown by successfully healed skeletons. Priest-doctors also practiced amputation, using linens and antiseptics to reduce the chance of infection and gangrene, and there is some evidence that they employed prosthetics where needed.

Dr. Dupuis started his functional medicine education with Functional Medicine University and The Kalish Institute. Later, he discovered the Functional Forum.  From there he took advantage of a free practice assessment with Gabe Hoffman, co-founder of Evolution of Medicine which resulted in working with Freedom Practice Coaching to change his practice model. After adding an additional 80k to his yearly income in just the first month with FPC, Dr. Dupuis added the Evolution of Medicine Practice Accelerator and from there he started using Nudge Coach to keep in touch with his new patients that now stretched 100 miles outside of his small town. He has recently become a Functional Forum Meetup Host and has become the "go to" doc in his community for practitioners looking to make the same changes in their personal and professional lives.
The advances in medicine made a dramatic difference for Allied troops, while the Germans and especially the Japanese and Chinese suffered from a severe lack of newer medicines, techniques and facilities. Harrison finds that the chances of recovery for a badly wounded British infantryman were as much as 25 times better than in the First World War. The reason was that:
The Greeks also knew that diet and exercise and keeping clean were important for health. Later Alexander the Great conquered Egypt. In 332 BC he founded the city of Alexandria and a great medical school was established there. Doctors in Alexandria dissected human bodies and they gained a much better knowledge of anatomy. However little progress was made in understanding disease.
Sushruta advises his students that however well read they are, they are not competent to treat disease until they have practical experience. Surgical incisions were to be tried out on the skin of fruits, while carefully extracting fruit seeds enabled the student to develop the skill of removing foreign bodies from flesh. They also practised on dead animals and on leather bags filled with water, before being let loose on real patients.

Byzantine physicians often compiled and standardized medical knowledge into textbooks. Their records tended to include both diagnostic explanations and technical drawings. The Medical Compendium in Seven Books, written by the leading physician Paul of Aegina, survived as a particularly thorough source of medical knowledge. This compendium, written in the late seventh century, remained in use as a standard textbook for the following 800 years.
Medical education instituted at the Royal and Pontifical University of Mexico chiefly served the needs of urban elites. Male and female curanderos or lay practitioners, attended to the ills of the popular classes. The Spanish crown began regulating the medical profession just a few years after the conquest, setting up the Royal Tribunal of the Protomedicato, a board for licensing medical personnel in 1527. Licensing became more systematic after 1646 with physicians, druggists, surgeons, and bleeders requiring a license before they could publicly practice.[108] Crown regulation of medical practice became more general in the Spanish empire.[109]
A leading journal in its field for more than three quarters of a century, the Bulletin spans the social, cultural, and scientific aspects of the history of medicine worldwide. Every issue includes reviews of recent books on medical history. Recurring sections include Digital Media & Humanities and Pedagogy. Bulletin of the History of Medicine is the official publication of the American Association for the History of Medicine (AAHM) and the Johns Hopkins Institute of the History of Medicine.
Chris Kresser:  I think that’s like the biggest change we’re going to see, is the nature of this device will change people’s awareness of health, and that’s incredible to think about.  There are so many people who are interested in tech that aren’t necessarily that interested in health.  But due to their interest in tech, they’re going to become interested in health, just because that’s going to be one of the main implementations of the iWatch.  And as you said, there’s going to be such a big community of people developing software.  And what we notice and pay attention to is what we can change.  If we’re not aware of something, we can’t change it.  And that, to me, is the most exciting factor of this new technology. It’s really going to dramatically increase people’s awareness of things—like how many steps they’re taking, and what kind of food they’re eating, and if they’re tracking that, and their heart rate, and how their heart rate variability might correlate to what type of exercise they should be doing that day.  And it’s not just about those kind of specific things that they’re becoming aware of.  It’s that focusing even on a few specific things like that is inevitably going to expand their awareness around all aspects of their health.  So I think it can really be a revolutionary impact.  And I know, as a clinician too, I’m really looking forward to having additional ways that I can both support my patients, by referring them to apps and things that can make implementing some of the recommendations that I give them easier and more practical.  But if I need to collect data for something, some of these devices are going to make that a lot easier and they’re going to be able to send it back to me in a way that’s very actionable for me as a clinician.  It’s a pretty exciting time to be involved in medicine and particularly the evolution of medicine.
After the atomic bombing at the end of World War II, anxieties about survival in the nuclear age led scientists to begin stockpiling and freezing hundreds of thousands of blood samples from indigenous communities around the world. These samples were believed to embody potentially invaluable biological information about genetic ancestry, evolution, microbes, and much more. In Life on Ice, Joanna Radin examines how and why these frozen blood samples shaped the practice known as biobanking.
In 1880 Pasteur and a team of coworkers searched for a cure for chicken cholera. Pasteur and his team grew germs in a sterile broth. Pasteur told a coworker to inject chickens with the germ culture. However the man forgot and went on holiday. The germs were left exposed to the air. Finally, when he returned the man injected chickens with the broth. However they did not die. So they were injected with a fresh culture. Still they did not die.
This week on the Evolution of Medicine podcast, we welcome Brian Mulvaney, Director of Strategy at CrossFit. If you’ve been part of our community for awhile, you know that we’re working towards helping create 100k micropractices. Our plan for micropractices very much mirrors the Crossfit strategy – reduce the overhead, empower individuals to become entrepreneurs.
From 1917 to 1923, the American Red Cross moved into Europe with a battery of long-term child health projects. It built and operated hospitals and clinics, and organized antituberculosis and antityphus campaigns. A high priority involved child health programs such as clinics, better baby shows, playgrounds, fresh air camps, and courses for women on infant hygiene. Hundreds of U.S. doctors, nurses, and welfare professionals administered these programs, which aimed to reform the health of European youth and to reshape European public health and welfare along American lines.[174]

Tracey and Patricia started their Functional Forum Meetup after we took the Functional Forum on the road. Like any new venture, there were some initial hurdles. With a little tweaking and getting the opinions of their practitioner community, they have been able to set up a very successful meetup every month. Learn more about attending or hosting a meetup here: meetup.functionalforum.com


Medieval doctors also prescribed laxatives for purging. Enemas were given with a greased tube attached to a pigs bladder. Doctors also prescribed baths in scented water. They also used salves and ointments and not just for skin complaints. Doctors believed it was important when treating many illnesses to prevent heat or moisture escaping from the affected part of the body and they believed that ointments would do that.
Their ideas may be gaining ground. This past summer, the American Association of Medical Colleges (AAMC) and the Howard Hughes Medical Institute (HHMI) published a joint report, titled Scientific Foundations for Future Physicians. The report calls for ambitious changes in the science content in the premedical curriculum and on the Medical College Admission Test (MCAT), including increased emphasis on evolution. “For the first time, the AAMC and HHMI are recommending that evolution be one of the basic sciences students learn before they come to medical school,” Nesse explained.

Furthermore during the 18th century a number of hospitals were founded. In 1724 Guys Hospital was founded with a bequest from a merchant named Thomas Guy. St Georges was founded in 1733 and Middlesex Hospital in 1745. Hospitals were also founded in Bristol in 1733, York in 1740, Exeter in 1741 and Liverpool in 1745. The first civilian hospital in America opened in Philadelphia in 1751. In the late 18th century and early 19th century dispensaries were founded in many towns. They were charities were the poor could obtain free medicines.
During the 19th century medicine made rapid progress. In 1816 a man named Rene Laennec invented the stethoscope. At first he used a tube of paper. Later he used a wooden version. In 1822 a trapper named Alexis St Martin was shot in the stomach. The wound healed leaving a hole into his stomach. A doctor named William Beaumont found out how a stomach works by looking through the hole.

Wes starts by sharing his own story of abuse and his journey to starting A Human Project. As he started to understand his own gut-brain connection and effects of the medications that were supposed to be helping him, he decided to take his life into his own hands. Now he focuses on helping children through things like stress, bullying and suicidal thoughts. We hope that this podcast inspires you as much as it has inspired us. Please consider supporting this very worthy cause at A Human Project.
The Department of the History of Medicine is the oldest such academic department in North America. We are dedicated to scholarship in the history of medicine, disease and the health sciences, and their relation to society. The Department seeks to bring historical perspectives to bear on contemporary health issues. Faculty members conduct research on a broad range of topics, time periods, and geographic areas. The Department offers a PhD in the History of Medicine.
The Catholic elites provided hospital services because of their theology of salvation that good works were the route to heaven. The Protestant reformers rejected the notion that rich men could gain God's grace through good works—and thereby escape purgatory—by providing cash endowments to charitable institutions. They also rejected the Catholic idea that the poor patients earned grace and salvation through their suffering.[92] Protestants generally closed all the convents[93] and most of the hospitals, sending women home to become housewives, often against their will.[94] On the other hand, local officials recognized the public value of hospitals, and some were continued in Protestant lands, but without monks or nuns and in the control of local governments.[95]
This week on the Evolution we welcome an internationally renowned authority on health, human potential development, and Self-Leadership, Dr. Mark Atkinson. As a functional medicine physician, author, and speaker, Dr. Atkinson has inspired hundreds of thousands of people to become healthier, more effective, human beings. He’s been on the cutting edge of neuro-performance for many years and has now taken his passion to the Bulletproof organization.

The three branches of Egyptian medicine included use of internal and external medicines, using ingredients like onions, hippopotamus fat and fried mice. The Ebers Papyrus and others list treatments of the eye, skin and abdomen, also 21 cough treatments. Egyptian surgeons never opened the abdomen, but performed external operations such as lancing boils, cutting out cysts and circumcision, as well as dealing with wounds and fractures. Their surgical equipment included scalpels, knives, forceps and probes, as well as red-hot irons to cauterize wounds. The Edwin Smith Papyrus (1600 BCE) makes detailed observations of the head, nose, face, ears, neck, chest and spine, describing 42 examinations leading to surgery. Sorcerers used incantations and amulets to combat evil spirits.
A revolution of a new age of medicine. It is time to make lifestyle changes, improve our education on what we are putting into our bodies on a daily basis, how often do we get fresh air and exercise, how many hours of restful deep sleep do we receive each night? How about our stress levels? All of these and many more affect us intrinsically but most of us just wait for things to go wrong and then expect the medical professional to make us better. We have got this so wrong it is time to take back responsibility and learn what it truly means to look after our health...mentally, physically and socially. This book is pioneering this change and laying the foundations for the medical profession to step up to the challenge of providing the education and the support that we will all need to make this leap...
During the 18th century superstition declined. In 1700 many people believed that scrofula (a form of tubercular infection) could be healed by a monarch's touch. (Scrofula was called the kings evil). Queen Anne (reigned 1702-1714) was the last British monarch to touch for scrofula. Despite the decline of superstition there were still many quacks in the 18th century. Limited medical knowledge meant many people were desperate for a cure. One of the most common treatments, for the wealthy, was bathing in or drinking spa water, which they believed could cure all kinds of illness.
Spearheaded by faculty in the HMS Department of Global Health and Social Medicine, a report by The Lancet Commission on Global Surgery reveals that 5 billion people are unable to access safe, timely and affordable surgery, leading to 18.6 million preventable deaths each year worldwide. The report also presents a blueprint for developing properly functioning surgical systems globally.
The Evolution of Medicine provides step-by-step instruction for building a successful "community micropractice," one that engages both the patient and practitioner in a therapeutic partnership focused on the body as a whole rather than isolated symptoms. This invaluable handbook will awaken health professionals to exciting new career possibilities. At the same time, it will alleviate the fear of abandoning a conventional medical system that is bad for doctors, patients, and payers, as well as being ineffectual in the treatment of chronic ailments.
Leeches had advantages over the common practice of bloodletting using a lancet – the loss of blood was more gradual and less of a shock for those of delicate constitution. And because Broussais’s followers used leeches in place of all the other medicines at the 19th-century physician’s disposal, patients were spared some harsh remedies that might otherwise have made them feel worse. In 1822, a British surgeon called Rees Price coined the term sangui-suction for leech therapy.
The History of Medicine Collections in the David M. Rubenstein Rare Book & Manuscript Library at Duke University is accepting applications for our travel grant program. https://library.duke.edu/rubenstein/history-of-medicine/grants Research grants of up to $1,500 will be offered to researchers whose work would benefit from access to the historical medical collections at the Rubenstein Rare Book & […]
In 1953 Jonas Salk announced he had a vaccine for poliomyelitis. A vaccine for measles was discovered in 1963. Meanwhile surgery made great advances. The most difficult surgery was on the brain and the heart. Both of these developed rapidly in the 20th century. A Swede named Rune Elmqvist invented the first implantable pacemaker in 1958. The first heart transplant was performed in 1967 by Christiaan Barnard. The first artificial heart was installed in 1982. The first heart and lung transplant was performed in 1987.
In 1865 Joseph Lister (1827-1912) discovered antiseptic surgery, which enabled surgeons to perform many more complicated operations. Lister prevented infection by spraying carbolic acid over the patient during surgery. German surgeons developed a better method. The surgeons hands and clothes were sterilized before the operation and surgical instruments were sterilized with superheated steam. Rubber gloves were first used in surgery in 1890. Anesthetics and antiseptics made surgery much safer. They allowed far more complicated operations.
This week, Dr. Wible joins us to talk about the epidemic of physician suicide. She's filmed a powerful TedMed talk on the epidemic of physician suicide where she read the words of physicians on the edge of taking their own lives. As we lose more brilliant minds and healers to suicide, Dr. Wible has started a project to bring this epidemic to light. Her film called "Do No Harm" will do exactly that and she tells us more about the film and how we can support the movement.

^ Bynum, W.F. (1974). "Rationales for therapy in British psychiatry: 1780–1835". Medical History. 18 (4): 317–34. doi:10.1017/s0025727300019761. PMC 1081592. PMID 4618306.; Digby, Anne (1988). "Moral Treatment at the Retreat 1796–1846". In Porter, Roy; Bynum, W.F.; Shepherd, Michael. The Anatomy of Madness: Essays in the History of Psychiatry. 2. London & New York: Tavistock. pp. 52–71. ISBN 978-0415008594.


The Roman contribution to the history of medicine is often overlooked, with only Galen, of Greek origin, believed to be notable of mention. However, this does the Romans a great disservice and they put their excellent engineering skills to use in preventative medicine. The Romans understood the role of dirt and poor hygiene in spreading disease and created aqueducts to ensure that the inhabitants of a city received clean water. The Roman engineers also installed elaborate sewage systems to carry away waste. This is something that Europeans did not fully understand until the 19th Century; before this period, sewage was still discharged close to drinking water.
The First Viennese School of Medicine, 1750–1800, was led by the Dutchman Gerard van Swieten (1700–1772), who aimed to put medicine on new scientific foundations—promoting unprejudiced clinical observation, botanical and chemical research, and introducing simple but powerful remedies. When the Vienna General Hospital opened in 1784, it at once became the world's largest hospital and physicians acquired a facility that gradually developed into the most important research centre.[128] Progress ended with the Napoleonic wars and the government shutdown in 1819 of all liberal journals and schools; this caused a general return to traditionalism and eclecticism in medicine.[129]

Across Europe medical schools relied primarily on lectures and readings. The final year student would have limited clinical experience by trailing the professor through the wards. Laboratory work was uncommon, and dissections were rarely done because of legal restrictions on cadavers. Most schools were small, and only Edinburgh, Scotland, with 11,000 alumni, produced large numbers of graduates.[99][100]
During the 18th century superstition declined. In 1700 many people believed that scrofula (a form of tubercular infection) could be healed by a monarch's touch. (Scrofula was called the kings evil). Queen Anne (reigned 1702-1714) was the last British monarch to touch for scrofula. Despite the decline of superstition there were still many quacks in the 18th century. Limited medical knowledge meant many people were desperate for a cure. One of the most common treatments, for the wealthy, was bathing in or drinking spa water, which they believed could cure all kinds of illness.
Scientists, led by Deborah Hung in the HMS Department of Microbiology and Immunobiology and at Mass General and Brigham and Women’s, show that a detailed RNA signature of specific pathogens can identify a broad spectrum of infectious agents, forming the basis of a diagnostic platform to earlier determine the best treatment option for infectious diseases.
After the fall of Rome in the 5th century the eastern half of the Roman Empire continued (we know it as The Byzantine Empire) and later Muslims took their knowledge of medicine from there. In the 9th century a man named Hunain Ibn Ishaq traveled to Greece collecting Greek books. He then returned to Baghdad and translated them into Arabic. Later the same works were translated into Latin and passed back to western Europe.

The Department of the History of Medicine at Johns Hopkins is proud to introduce new online CME modules that provide a historical perspective on issues of relevance to clinical practice today. Our first module, which launched in January 2018, explores the social, political, and economic forces that continue to shape the dynamic boundaries of the medical profession. Medical professionalism is...
James Maskell:  Absolutely.  The evolutionary concepts were one of the big reasons why I wanted you to be in there, Chris, because I know you do the Paleo, which is evolutionary in itself.  But also, one of the things that you talk about is how the Paleo diet is something that has needed to change and evolve, and how we’ve evolved to go beyond what our ancestors ate.  I don’t know, maybe for your listeners, they might be interested to just get a snapshot of that.  Because that’s one of the cool things in nutrition that I think that you bring together, is a very sensible approach to eating. I thought that was one of the highlights for the nutrition part of the summit.
This week on the Evolution of Medicine podcast, we welcome Gladys McGarey. At 97 years old, Galdys is a true pioneer in holistic and living medicine and we're absolutely thrilled to welcome her to the podcast. Dr. Gladys is internationally recognized as the Mother of Holistic Medicine.  Dr. Gladys, as she is affectionately known, is board certified in Holistic and Integrated Medicine and has held a family practice for more than sixty years.  
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