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Did Superior Health Care Lead to the Dominance of Christianity?

Interesting question from a recent member of the blog:



In the August 5/12 New Yorker, a review of a new book, “The mosquito: A Human History of our Deadliest Predator.” In this review, this sentence: “In the third century, malaria epidemics helped drive people to a small, much persecuted faith that emphasized healing and care of the sick, propelling Christianity into a world-altering religion.” I realize that medical history is not your thing. If nonetheless you’d care to comment, any warrant for this assertion?



       I don’t know that I’ve ever written about mosquitoes before, either on the blog or anywhere else, but I have dealt with issues connected with ancient health care, and in particular with the theory that superior health care was one of the factors that led Christianity to expand to become a dominant (*the* dominant religion) of the Roman world.   It is an intriguing idea indeed, and was a popular theory for a very brief moment, about when this book reviewed in the New Yorker came out.  But I’m afraid I don’t think it passes muster  I explained why in my book The Triumph of Christianity.  See if you agree.  Here’s what I said.




One benefit of joining the church recently touted as particularly important for Christian growth was the availability of better health care.  This was one of the many controversial proposals set forth by sociologist Rodney Stark in his popular discussion, The Rise of Christianity, and was the thesis behind a more extensive treatment by Hector Avalos, Health Care and the Rise of Christianity.[i]

Despite Avalos’s in-depth discussion of how early Christians organized, managed, and implemented health care, he (somewhat oddly, given the title of his book) never mounts an argument to show how the Christian health care system attracted converts or led to church growth.  Stark, on the other hand, applies his sociological training to the question and makes some intriguing suggestions.  He points out that epidemics swept through the Roman world on more than one occasion during the period that Christianity was gaining members.  The terrible plague that ravaged the empire during the reign of Marcus Aurelius killed, Stark avers, between a quarter and a third of the entire population of the empire.  The emperor himself was one of the fatalities.

Stark notes that Christian sources celebrate the eagerness of Christians to minister to the sick in times of illness.  This was unlike …

To see the rest of this post you will need to be a blog member.  If not now, when?  You get tons of information for a small fee, and the entire fee goes to charity. 

This was unlike the pagans, Stark claims, who, as a rule, simply let the sick fend for themselves.  He goes on to point to studies which indicate that even without access to modern medicine, simple nursing – trying to care for someone who is ill – can have a drastic effect on survival rates.   Stark concludes that Christians emerged from epidemics far more intact as a population group than pagans, so their relative numbers grew through nothing more than the decision to nurse the sick.

This is an intriguing perspective, but it has not proved widely persuasive, for several reasons.   For one thing, Stark unrealistically and uncritically assumes that when Christian sources praise Christians and malign pagans for their health care practices, they are giving factual information.  For him, a Christian author is simply stating historical reality when he praises fellow Christians for acts of love far superior to anything found elsewhere, and maligns outsiders for neglecting even their dying family members.   Historians of early Christianity are never this sanguine when it comes to our sources.   One always needs to consider their obvious biases.[ii]

Beyond that, there is a fairly obvious reason for doubting that Christian nursing practices in times of epidemic led to growth in the church.  If our sources are indeed to be trusted that Christians tended to the sick more often than did pagans, that would surely also mean that Christians were more often infected.

As it turns out, early Christian texts bemoan precisely this fact:  Christians frequently died because they acquired the diseases they were trying to heal.  This is a point that Stark, naturally enough, glosses over.  But it is clearly stated in the eyewitness accounts, nowhere more grippingly than in a letter written by a mid-third-century bishop of Alexandria Egypt, Dionysius, as quoted by the church historian Eusebius.  In this letter Dionysius refers to an epidemic that “came out of the blue” and notes how the Christians dealt with it in their community:

Heedless of the danger, they took charge of the sick, attending to their every need and ministering to them in Christ, and with them departed this life serenely happy; for they were infected by others with the disease, drawing in themselves the sickness of their neighbors and cheerfully accepting their pains.  Many, in nursing and curing others, transferred their death to themselves and died in their stead… The best of our brothers lost their lives in this manner, a number of presbyters, deacons, and laymen.

Dionysius claims that the care of the sick continued post-mortem, leading to yet more deaths within the community:

With willing hands they raised the bodies of the saints to their bosoms; they closed their eyes and mouths, carried them on their shoulders, and laid them out; they clung to them, embraced them, washed them, and wrapped them in grave clothes.  Very soon the same services were done for them, since those left behind were constantly following those gone before.[iii]

We have no indication from outsiders that they were drawn to the church because of the improved possibilities of health care, and it seems unlikely that a Christian inclination to stay in intimate contact with the contaminated led to a growth in Christian numbers.  We should therefore look elsewhere to discover what attracted converts to the church.   The best place to begin are the actual accounts of conversions from the early church.  These are relatively abundant and scattered throughout the decades and centuries with which we are concerned.  Moreover, these narratives are unambiguous about what attracted outsiders to the faith.   The Christians did amazing miracles.[iv]

[I later devote an entire chapter of the book to this issue of converts joining the Christian community because of miracles]



[i] Rodney Stark, The Rise of Christianity, chapter 4; Hector Avalos, Health Care and the Rise of Christianity (Grand Rapids: Baker Academic, 1999).

[ii] Stark’s uncritical use of sources is probably the most criticized aspect of his work among scholars in the field of early Christian studies.  For a particularly trenchant critique, see Elizabeth A. Castelli, “Gender, Theory, and the Rise of Christianity: A Response to Rodney Stark,” Journal of Early Christian Studies 6 (1998) 227-57.

[iii] Eusebius, Church History, 7.22.

[iv] No scholar has argued this case more forcefully than Ramsay MacMullen, Christianizing the Roman Empire (New Haven: Yale University Press, 1984).

Can We Reconstruct the Entire New Testament from Quotations of the Church Fathers?
On Producing a New Translation of Ancient Texts



  1. Avatar
    fishician  August 28, 2019

    I’m a physician. It seems to me that early Christian sources may have implied that Christians cared more for the sick, but are there any secular sources that say this? I seem to recall there were some secular sources that suggested this. Even so, being around sick people actually increases your odds of getting that disease! But it might gain you some PR!

    • Bart
      Bart  September 1, 2019

      No, it was really just a Christian claim for themselves, so far as I know. And yup, PR all the way to the cemetery!

  2. Avatar
    forthfading  August 28, 2019

    Dr. Ehrman,

    I have an unrelated question, sorry. Would you be willing to discuss and share how you ended up at UNC? By my accounts, there are not many graduates from a seminary working for top tier state run research institutions of higher learning. I have a feeling it is probably a great story.

    Thanks, Jay

    • Bart
      Bart  September 1, 2019

      Yeah, it’s pretty amazing really, and tragic (for someone else). I think maybe I will (if I haven’t already! Need to check)

  3. Avatar
    Pattycake1974  August 28, 2019

    I think one of the main reasons Christianity took over is due to the mission of *caring* for the sick and the poor, not so much about recovery from illness. Christians persevered with their mission even though they were dying too, and that belief system led to the founding of the first hospitals. The simple act of caring for such a large, neglected (majority?) group would seem to impact conversion rates on some level.

  4. Avatar
    qditt  August 28, 2019

    Dr. Ehrman,

    This is a question of curiosity as I’ve gone back and forth on the subject as I reflect on life experiences. Do you think humans are innately good or evil? I cannot find a post on this, but perhaps you can shed your opinion. Nature V Nurture has always been a question looming in my head, and I suppose it is both, as grey almost always overshadows black and white. Your thoughts are always appreciated (really), and thanks again for the work you do for those in need.

    • Bart
      Bart  September 1, 2019

      I think it’s very complicated. For one thing, “good” and “evil” are not biological terms and don’t mean the same thing in every context — they are socially, not naturally, constructed (i.e., a “good” act in one culture or context is “evil” in another). For another thing, I htink people have natural inclinations to do what most people would say is “good” and other inclinations to do what is “evil,” and in widely different mixtures from one person to another. Since “humans” are not all constructed the same, by inclination and upbringing, I don’t think there can be a binary between whether htey are naturally good or evil. Everyone is a bit of both, in different measures, in different contexts.

  5. Robert
    Robert  August 29, 2019

    “For him [Stark], a Christian author is simply stating historical reality when he praises fellow Christians for acts of love far superior to anything found elsewhere, and maligns outsiders for neglecting even their dying family members.   Historians of early Christianity are never this sanguine when it comes to our sources.   One always needs to consider their obvious biases.”

    How do you and Stark deal with Julian the Apostate’s praise of Christian charity toward the poor, the widows, and orphans? Julian would not have had a pro-Christian bias.

    • Bart
      Bart  September 1, 2019

      Yes indeed, I deal with Julian in my book (but don’t recall if Stark does). Julian is referring to Christian social projects in the mid second century, not about individual acts of nursing in times of epidemic one or two centuries earlier — about which he would have had no knowledge. But it’s a fascinating passage, and shows how Christians did indeed proclaim, and partially enact, an entirely different ideology of service in contrast with the traditional ideology of dominance.

  6. Avatar
    Iskander Robertson  August 29, 2019

    any evidence that christians used to wash their hands, cups, pots and kettles before meals?

    • Bart
      Bart  September 1, 2019

      Nothing comes to mind. Ancients, of course, had no idea at all about germs….

  7. Avatar
    Lopaka  August 29, 2019

    Sorry if this has been asked – I searched and didn’t see.

    If “Jesus'” name was Yeshua, why do we call him the Greek name Jesus? We don’t call Matthew Matthaios…

    And is Yeshua closer to Joshua or Josh?


    • Bart
      Bart  September 1, 2019

      Because our source of information about him is Greek, not Aramaic. This is common. That is, we are talking about the figure from the New Testament, and in the New Testament his name is Jesus. Make sense? Some people of course to refer to him as Yeshua; but they typically do so because they think they are getting back closer to the historical figure that way, somehow. But these people do not quote his sayings in Aramaic, but in English, based on what was translated from the Greek. So I’d say they are not being consistent!

      • Avatar
        Sisu  September 4, 2019

        Dr. Ehrman,

        Not sure I agree with you on this one. Your name is your name. His name was Yeshua, as best as we can figure. The fact that a Greek equivalent was used by the Greek writers of the Gospels doesn’t change the fact. It’s more to the point that we are accustomed to calling him Jesus, so that’s what we should call him to avoid confusion. But that wasn’t his “name.”

        • Bart
          Bart  September 8, 2019

          Well, kind of. But his name was not Yeshua. Yeshua is spelled in English letters.

  8. Avatar
    Matt2239  August 29, 2019

    Not all contagious diseases are assuredly fatal. Measles, chicken pox, smallpox, and many other afflictions are contagious, can be fatal if untreated, and, best of all, can become harmless to those who survive them. Hence, those who attempted to heal the sick sometimes helped those who would have died if their maladies had been assumed to be hopeless. But it doesn’t stop with just poxes. Food poisoning, which can appear to be a contagious affliction and which can be fatal without immediate help, was ever-present in the ancient world. Any religious believer who trusted a higher power and gave nursing assistance to the sick in the ancient world would find many converts. But there are always stories like those of Father Damien too.

  9. Avatar
    Fernando Peregrin Gutierrez  August 30, 2019

    I have read with interest and profit this article by Bart Ehrman:
    Inside the Conversiion Tactis of the Early Christian Church
    Let me ask our host Bart these considerations that are consequence and complement of the text his article cited:
    First, Christianity was the only missionary religion in the Roman Empire. Jews and pagans did not try to convert each other. Christianity had that field all to itself.
    Second, Christianity was an exclusivist religion. If an ancient Roman converted from one brand of paganism to another, he was free to keep his old gods. One brand of paganism gained an adherent, and another did not lose one. But Christianity was intolerant of other beliefs. If someone converted to Christianity, then Christianity gained an adherent and paganism lost one. This was also true of Judaism, but Jews did not evangelize

    Third, Christianity offered equal status to women, who had very low status in Judaism and in Roman society.

    Fourth, we have no mention of primary evidence relating to Jesus that ancient people could use to defend or discredit Christianity.
    Fifth, Christianity competed only with Judaism – which had no missionaries – as a text-driven religion. Texts are a powerful way to spread, unify, and preserve religious movements, and the pagan world had few of any importance. Christianity was and remains – although less and less – an orthodoxy. On the other hand, Judaism and to a lesser extent almost all paganism of that era were ortho-praxis. For example prior to Christianity, Roman religion was bereft of revelation, dogma, and orthodoxy, and its primary requirement was instead orthopraxis, the correct performance of prescribed rituals
    It is easier to change the doxia than the praxis.

    Sixth, after Emperor Constantine converted to Christianity, whole villages thought it best to “convert” to Christianity, and entire cities of barbarians “converted” with their leader when their settlement was subsumed in the Roman Empire.

    A very important part of Christian orthodoxy has always been and is, the resurrection and eternal life, Christianity’s unique promise of eternal salvation, something no pagan religions offered.

    • Bart
      Bart  September 1, 2019

      1. Agree; 2. Agree; 3. It’s more complicated than that. Women were not accorded equal status in most Christian churches after the early decades (were not allowed major leadership roles, e.g.); and on the other hand, there were elements of Greek, Roman, and Jewish society where women *were* given positions of authority; 4. I don’t know what you mean by “primary evidence; 6. I don’t think the textual nature of the religion wa a major factor in its expansion; 6. I don’t know of any evidence of that.

      • Avatar
        dankoh  September 1, 2019

        And seventh (unnumbered), I don’t think it’s correct to say Christianity was the only player at the time offering eternal life. Aren’t there reports of the followers of Isis and Cybele, and maybe others (I’m being a bit hazy here and would appreciate a little fresh air) who also offered eternal life during the late BCE-early CE? (Eternal life not being quite the same thing as eternal salvation, of course.)

        • Bart
          Bart  September 2, 2019

          These cults were not offering eternal life per se; they seem to be *assuming* that people would live after death (a widespread view generally; you find it in lots of Greek and Roman literature) and what they were offering was a *better* afterlife for the initiates.

  10. Avatar
    Fernando Peregrin Gutierrez  August 30, 2019

    Additionally, and since the parallel case of the Mormons exponential growth in its beginnings has been widely used to show that the also exponential growth of Christianity in the first centuries of its existence has nothing exceptional or supernatural miracle, attached, for those who are interested, the case of the also enormous growth (superior to that of Christianity) of atheism and agnosticism in the twentieth and early twenty-first centuries.
    The explosion of atheism
    There is another problem for Christians who want to say that the explosive growth of early Christianity must be due to God. Compared to Christianity, atheism grew even faster during the 20th century. According to the World Christian Encyclopedia (the most respected source for religious demographics):
    The number of nonreligionists… throughout the 20th century has skyrocketed from 3.2 million in 1900… to 918 million in AD 2000… From a miniscule presence in 1900, a mere 0.2% of the globe, [atheism and agnosticism] are today expanding at the extraordinary rate of 8.5 million new converts each year, and are likely to reach one billion adherents soon. A large percentage of their members are the children, grandchildren or the great-great-grandchildren of persons who in their lifetimes were practicing Christians.
    At the early Christian rate of 40% per decade and 3.2 million in 1900, non-believers would have only numbered 74 million in 2000, not 918 million. The growth rate of non-belief in the 20th century was 76% per decade.

    • Bart
      Bart  September 1, 2019

      We’ll all be atheists before we know it. (If we’re not Mormons or Muslims — two of the other fast growing options!)

      • Avatar
        thebigskyguy  September 1, 2019

        Well, I think what atheists really need is a hit Broadway musical!

        • Bart
          Bart  September 2, 2019

          Yup! Of course it won’t involve them knocking on doors….

  11. Avatar
    RonaldTaska  August 30, 2019

    A very interesting theory and an even more interesting analysis of that theory.

  12. epicurus
    epicurus  August 30, 2019

    Stark seems to be another example of a scholar who lets his faith determine his research conclusions

  13. Avatar
    sfordstark  August 30, 2019

    I agree that the practices of early Christians would not have led to better health, since proximity is connected to increased disease incidence – per Louis Pasteur and the germ theory.
    If you study the flu outbreak of 1918, you will see that mass congregations and celebrations were often linked to surges in the flu in specific area.

    S. Stark, MD (no relationship to Rodney that I know of…)

  14. Avatar
    Steefen  August 30, 2019

    Professor, did Christians in the first three centuries C.E. ever use a dolphin and anchor symbol for Christ?
    Someone has made this claim and will provide evidence later in his presentation, but in our lack of familiarity and surprise, we are immediately asking you. Thank you very much. (Independent of your reply, it might take a week or more before we know the full evidence being presented for the claim.)

    Thank you, very much.

    • Bart
      Bart  September 1, 2019

      No, I don’t believe so. But I’m open to learning!

      • Avatar
        Steefen  September 2, 2019

        I believe you have been to the catacombs in Rome. I also believe you have visited the British Museum. I also believe you have read St. Clement of Alexandria, Christ, the Instructor, Book III, Chapter XI.

        “And let our seals be either a dove, or a fish, or a ship scudding before the wind, or a musical lyre, which Polycrates used, or ~ ~ ~ a ship’s anchor ~ ~ ~, which Seleucus got engraved as a device; and if there be one fishing, he will remember the apostle and the children drawn out of the water.”

        The Catholic Encyclopedia says of the dolphin [on the anchor]

        The use of the dolphin as a Christian symbol is connected with the general ideas underlying the more general use of the fish. The particular idea is that of swiftness and celerity symbolizing the desire with which Christians, who are thus represented as being sharers in the nature of Christ the true Fish, should seek after the knowledge of Christ. Hence the representation is generally of two dolphins tending towards the sacred monogram or some other emblem of Christ. In other cases the particular idea is that of love and tenderness. Aringhi (Roma Subterr., II, 327) gives an example of a dolphin with a heart, and other instances have some such motto as PIGNUS AMORIS HABES (i.e. thou hast a pledge of love). It is sometimes used as an emblem of merely conjugal love on funeral monuments. With an anchor the dolphin occurs frequently on early Christian rings, representing the attachment of the Christian to Christ crucified. Speaking generally, the dolphin is the symbol of the individual Christian, rather than of Christ Himself, though in some instances the dolphin with the anchor seems to be intended as a representation of Christ upon the Cross.


        The archaeological evidence:


        I searched the ehrmanblog for Ichthys, but you did not inform in your reply that the anchor and fish appeared in the catacombs and did not inform in your reply that there were 2nd century Christian rings with Ichthys, anchor, and fish.

        Finally, the Anchor and Dolphin was a popular symbol when the gospels were being written because they were on the back of coins for Titus and on the back of the denarius of Domitian.

        The dolphin is also a symbol of resurrection.

        You have not or will you include this information in Intro to Early Christianity textbooks?

        • Bart
          Bart  September 3, 2019

          I thinkn the question was about the first four Christian centuries? Where is (specifically) the Anchor and Dolphin in Christian materials then? I’m not asking about fishes in general or anchors in general but the specific symbol of the anchor and dolphin together, before 400 CE. It’s a genuine question.

          • Avatar
            Steefen  September 5, 2019

            Thank you for prompting me to question the evidence and question the authors themselves about their “evidence”. The authors were unable to give me verification that the British Museum had an insignia, a ringstone, or a ring with dolphin ON anchor with letters surrounding the image confirming a Christian nature of the piece/s.

            What a waste of time, except to be aware of what poor quality product can be put into the marketplace of ideas.

          • Avatar
            Steefen  September 6, 2019

            The curator at the British Museum who entered this object (intaglio:The term refers to stone or glass (or other materials) into which an image or text has been cut or incised. These texts or images are sometimes cut in reverse in order to produce a positive impression for use as a stamp or seal) into the museum’s catalog says it is from the 3rd or 4th century and provides reference information for the piece. The curator references a dictionary entry with illustration from

            “A Dictionary of Christian antiquities : comprising the history, institutions, and antiquities of the Christian Church, from the time of the apostles to the age of Charlemagne.” URL:

            So, before looking at the curator’s notes on this intaglio, let’s look at that dictionary entry which matches the museum piece.

            Note, page 714 tells us the letters used to Christianize heather jewelry are the letters: IXOYG. These letters do NOT appear on the museum piece in question. Reading further to the part (iii) Anchor, let’s see what we find.
            The British Museum contains four examples “probably of Christian work”:
            1) Anchor between two fish [we know that from the catacombs]
            2) Another with dolphin twisted around the anchor with letters translatable to “Lay hold” [intaglio in question]
            3) a different anchor between two fish
            4) an anchor between two fish and two branches with a dove on each branch [but I would have to see it to be sure]

            The following is more important and unquestionably Christian:
            5) Anchor with two fish and the legend IHCOY
            The museum piece does not have the letters IXOYG and it does not have the letters IHCOY. The Dictionary is saying Example 2 [intaglio in question]: Lay hold is “probably” of Christian work.
            Inscription Content
            The curator states that the text may not mean lay hold or take hold: it may be translated as “May you be successful;” but it may be the name of the owner Epitynchanus in the genitive.
            Lay hold, take hold, may you be successful, Epitynchanus is Christian in what way?
            The dictionary entry ties the symbol back to Seleucid Jewish coinage NOT imperial coinage. The Seleucids tried to Hellenize the Jews. Titus wanted to Hellenize the Jews to the extent of ending violent messianism. Did Titus see himself as continuing the efforts of the Seleucids? And which Christians would have wanted that but the Pauline Christians?
            This is Seleucid Provenance as much as it is Roman Provenance.

  15. Avatar
    Zak1010  August 31, 2019

    Dr Ehrman,

    There are clear indications that The Church did offer certain social / societal benefits to both believers and non- believer ( in hopes of conversion ) such as medical care ( the catholic church ). Question is why and what were their intentions? Worldly or spiritually?
    I read an article recently about the decline of church attendance in the US and specially in Europe. To increase attendance, the Church now publicly announced that they Today Accept certain minority groups that in the past considered unacceptable in the Church ( won’t mention the denomination ). ( to drive more people in ). Huh …Worldly or Spiritual intentions?

    If it didn’t work then, you think it will work today?

    To extend health care to a people should be realized by a government. Right? Would you say that the power Constantine gave to church leaders / fathers in civil government interfered with religious values and tended to meld Christian into Roman values or vice versa?

    • Bart
      Bart  September 1, 2019

      I think the Christian social institutions were a direct effort to implement the love command that was at the center of Jesus’ ethics. both because it was the right thing to do and because doing so could bring rewards.

  16. galah
    galah  August 31, 2019

    “We should therefore look elsewhere to discover what attracted converts to the church. The best place to begin are the actual accounts of conversions from the early church.”

    Dr. Ehrman, would you consider touching a little on this subject in a blog?

    • Bart
      Bart  September 1, 2019

      I think maybe I have, but I’ll look! The actual accounts discuss miracles, time and time again….

  17. Avatar
    dankoh  September 1, 2019

    I have a recollection that one reason Christianity became popular is because it fed the poor and hungry, in effect taking over this function from the state. Any truth to that? And while they may have been moved to do so because Jesus (and Isaiah) told them to, I can’t help suspecting that once they saw how it gave them new converts, they began to increase their efforts in order to gain more.

    Certain modern charities such as the Salvation Army operate with that goal in mind.

    • Bart
      Bart  September 2, 2019

      The state never fed teh hungry and the poor; the idea that it *should* arose (in the Roman world, at least) with Christianity (the state before then did so only if it helped to prevent riots, etc.; not out of concern for the poor). This may have contributed a bit to conversions at some point, but it’s hard to say. Julian the Apostate certainly seems to have thought so. Maybe I should post on that.

  18. Avatar
    tadmania  September 5, 2019

    The rise of Christianity was certainly aided by superior living conditions in middle period of modern Europe, conditions that continued into the western hemisphere beyond. Vast tracts of arable land, plentiful and navigable water, and a temperate climate facilitated the embedment of Christianity in Europe so thoroughly that the religion prospered unabated, even after the schism of the Reformation. The translation of scripture into English was another boon.

    There is a wealth of writing on the role of disease and pestilence in human history.

  19. Avatar
    Smithjacusmc  September 6, 2019

    I think it is interesting how the Old Testement law, as we have it, is very specific on how to deal with dead bodies, terminally ill, and contagious diseases, even though the knowledge of what these things actually were was non existant, I assume. But yet there it is, why then would these christians act so careless? Perhaps a lack of teaching on the Jewish traditions? Or nothing to teach from.

    • Bart
      Bart  September 8, 2019

      Most Christians were not following purity laws of the Torah.

  20. Avatar
    Wondless  September 10, 2019

    Dr. Ehrman have you watched the Discovery Channel documentary, “How Beer Saved the World”? May not seem at first glance relevant to the question at hand, but I think you and your readers might find it interesting especially you being a historian.

    • Bart
      Bart  September 10, 2019

      Can’t say I have. But it’s a topic I’m interested in. For personal reasons. 🙂

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