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Mary Cybulski/Cinemax

Interview: Dr. Stanley Burns, The Knick's Medical Advisor

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Mary Cybulski/Cinemax

Dr. Stanley Burns is the medical advisor for The Knick, a medical drama starring Clive Owen and directed by Steven Soderbergh. He's also curator of an encyclopedic archive of historical medical photography; this comes in handy because the show is set in 1900, and is all about period details. mental_floss interviewed Burns about his role on the show and some quirks of medical history. First up, here's a brief preview to give you a taste of what the show is like (note, some surgical gore and mild early-episode spoilers are here):

Where to watch The Knick: Fridays at 10pm on Cinemax. You can catch up on clips on The Knick's website.

On Historic Medical Photography

Chris Higgins: Can you talk to me a little bit about what The Burns Archive is and what led you to start it?

Dr. Stanley Burns: Well, I was always a historian and when I discovered the value of the photographic and historic documents in 1975, I aggressively collected photographs. My original photography is The Burns Collection and The Burns Archive are the copy prints and the other paraphernalia related to my collections. And I've used that over the last almost 40 years, to write and work with the media, and create documents. It's basically a collection of medical photography, memorial photography, and historic documentary photography. As I tell everyone, there is no art, music, or sports in there, because all the other institutions have that.

Higgins: You were—and are, I suppose—an ophthalmologist, is that right?

Dr. Burns: Yes, I am. I still practice. I have a big day tomorrow in the office. I don't do major surgery anymore, I just don't have the time for that.

His Role in The Knick

Higgins: Right. So, let's get into The Knick. As a medical advisor to the show you have an unusual job. How does that job work? I mean, what do you do? Are you there on set during shooting, are you reading scripts and giving notes?

Dr. Burns: Yes, I'm on set. I was on set from three to five days a week. Certainly for all of the medical episodes when medical things of interest, all the surgeries [take place]. [Before shooting,] Michael [Begler] and Jack [Amiel] and Steven Soderbergh came to me with their pilot and they spent some time here and realized the treasure trove, the Tutankhamun Tomb of early medical photography that's here—and the stories. Remember, I had written 44 photographic historic textbooks. At least 40 of them are on medical photo history and I've written over 1,100 articles in medical photographic history. So, this is the work I've been doing and continue to do. My next book comes out in November, it's called Stiffs, Skulls & Skeletons: Medical Photography and Symbolism. [...]

Higgins: I've seen the video that shows you giving a tour of the collection and putting it in context. It is massive.

Dr. Burns: Well, I have about a million photographs and probably somewhere in the neighborhood of 80,000 good medical photographs, but it's also supplemented, which is what makes the writing and the research easy, by the major textbooks of the time period and the journals of the time period. So for instance, I have all the issues from 1880 to about 1930 of the Annals of Surgery, the Archives of Surgery, the International Journal of Surgery, and the Synopsis of Surgery. So, I have the original articles that these great doctors wrote on their great cases and also a lot of the great articles they wrote on their foibles, the things that went wrong. And so, you'll see both aspects in the show.

Organizing a Million Photos

Higgins: How do you keep all this stuff organized? Is there a database or some sort of taxonomic system?

Dr. Burns: Well, no, it's in my head. But see, every time we do a book, then that subject gets organized, it gets scanned, it gets numbered, labeled. So that as far as Stiffs, Skulls & Skeletons are concerned, the book will have 450 photographs, but in order to produce that we've scanned about somewhere between 2,500 and 3,000 images from which we edit it down.

Higgins: Right on.

Dr. Burns: So, each time I do a book the subject matter gets scanned and localized. Put in a box and put up on a shelf until it's called for.

Recreating Period Props

Props (before surgery) / Mary Cybulski/Cinemax

Higgins: So, when you talk about folks coming through to do a production like this, are there set designers, costumers, looking at things to find period details and such?

Dr. Burns: Yeah. Well, we work with all of them. And I tell you it was a thrill, because everyone was so professional. For instance, if we had a rusty instrument, but it was important you can't have [an] instrument made in 1900 that's rusty, they'd make a new one. [...] Probably the most amazing thing [the prop people] created were Lister's antiseptic vaporizers. This is an essential part of surgery of the era and they're very expensive machines, if you can find an original one, which they did and then they accurately reproduced it, because they needed four or six of them in the operating rooms. And so, that went on throughout the entire show.

[... For one episode], they had to cool someone's head and I had in my photograph collection one of the early 1900 devices or 1890 devices that consisted of a cap with a rubber tube running around it for which they'd put cold water in with multiple layers of rubber tube. It looked like a little coil, and I would show them the picture and I worked with them and out came a hat from 1895.

Higgins: That's awesome.

Dr. Burns: But that's really a good example. And another example: [...] I said, "You know, you really need this certain neurological condition that this baby has. You really should show that, because that's really a dramatic exposé of what it meant to have this condition." And they produced it. I gave them the pictures, they sent it away to...I think it was done in California where they have the latex labs, because I think there's only one here [in New York], so most of the latex and the models came from California, and so, they made it. And that to me was the most amazing aspect of this show, other than the Lister atomizers, because they made an animatronic person, but that exhibited the medical maladies that I wanted it to. So, it was kind of strange to see that, but as a medical historian it was kind of wonderful to see that it was produced so accurately.

Reorganizing the Operating Theater

The Knick's Operating Theater / Mary Cybulski/Cinemax

Higgins: Are there any memorable moments where you had to step in, either in the writing phase or in the room, and suggest that something be changed to make it more accurate?

Dr. Burns: Oh, yeah. That happened on the very first day. [...] I walked into the operating room and I looked at the audience, they had already seated about a hundred distinguished doctors and they were about to operate and I said, "Steven, this is wrong." [It] was something like the fact that if Martin Scorsese and Steven Spielberg invited you to direct a movie he wouldn't put you in the back row. And so, likewise in medicine. In the front row would be the old distinguished doctors and the next row would be the associate professors and assistant professors, et cetera. So, what they did is they had to spend the time to reorder the entire audience [...]. They were shifting beards, hairs, and lookalikes, depending on how the film was going to be shot.

But of course I only had to do that once, because they knew afterwards what to do and they just shuffled the older doctors in the first row and the young doctors were all the way on top.

The Knickerbocker Hospital Medical School

Higgins: I gather from reading other interviews that you had to train the actors in the basics of suturing and some surgical procedures. What was that like?

Dr. Burns: Well, for me it was a lot fun. First of all we created the Knickerbocker Hospital Medical School, where I [taught] my medical students, which consisted of all the actors, including Clive [Owen]. He had a couple of extra lessons, because he really wanted to learn. I showed them the procedures, I had books that showed step-by-step the operative techniques, and most importantly I taught them how to place sutures in operative wounds. We did that because the prop department provided us with latex arms that were very realistic and I had the needle holders and needles. And so, I taught the actors how to do a mattress suture, continuous running sutures, and subcuticular sutures. I taught them how to tie with their hands very quickly as you will see onscreen as a surgeon does till this day.

I taught them how to use hemostats, which are these little clamp-like devices that we closed off blood vessels. And I showed them pictures of one procedure where there were over a hundred hemostats in this relatively small wound.

Just as a sidebar, that was one of the great accomplishments of William Halsted, whom Thackery's character is modeled after. Halsted taught people how to be delicate with tissue and how, if you want to have a great result to your surgery it had to be a bloodless surgery, that if you left pools of blood inside it would usually attract bacteria. And so, the hemostat was really an important advent of the time. [...] I taught my students how to hold a hemostat on the second finger of the hand and how to be able to tie or hold a scalpel to make a cut, while holding the hemostat in that second finger and then swing it around, open it to clamp the blood vessel and then go back to doing their stuff, and they loved it.

And one comment was, [...] of all the things they learned during the show, this would probably hold in the greatest stead throughout their entire lives, because they felt confident. They'd say, "Well, if I came across an accident or if I had to suture someone up now, I know how to do it." And this was a general comment right across the board and it is something great to learn, how to be able to put stitches in and take stitches and do all that.

Dr. Burns and Clive Owen on set / Mary Cybulski/Cinemax

Higgins: That is excellent.

Dr. Burns: Oh, the one other thing I should tell you. They were so attentive and so serious, more than medical students! [...] If you learn it and you don't do it right if you're a medical student, you'll do it again the next time or you'll learn next week. But when you're filming you get this one chance and you better look good. And so they all strove, not to look good, but to look great, and they did. And I'd let Clive suture me up. I mean, these guys know how to do it. This was their expertise, this one little aspect in medicine.

Scrubbing In

Higgins: So, a couple of specific questions that came up while watching. I've seen the first seven episodes. So, by 1900 the germ theory is well established and we see things like surgeons scrubbing in. One thing that jumped out at me in the first minutes of the first episode is seeing doctors dipping their hands and beards into a series of bowls of liquid—

Dr. Burns: Right.

Higgins: I'm curious—what is that liquid and why are there three tubs of it?

Dr. Burns: Well, there are three liquids used. One was an acidic solution to sterilize the hand, carbolic acid was another weak solution. Then there was a potassium permanganate solution, which colored the hands, which all sterilized. And then there was a washing solution. And the point was to get rid of germs and this was a good technique at the time.

How Doctors Became Addicts

Higgins: Now, we also see several doctors addicted to cocaine and other substances. I'm wondering if you have a sense...how common was this for doctors in 1900 to be hooked on cocaine and opiates?

Dr. Burns: Well, it was common, but not for the reasons that you think. It was common because this was an era when doctors experimented on themselves. [...] I always talk about the great neurologist Henry Head, who cut his own nervesand of course he would have a permanent defect afterwardsto find out what innervation was and what it was like.

And Halsted again, who the [Dr. John Thackery] character is modeled after, was one who developed infiltrative anesthesia, that is injecting cocaine locally, to be able to operate without giving general anesthesia. They practiced on themselves and they didn't know the side effects of all these drugs. One of Halsted's [colleagues], a close associate when he was practicing in New York before he went to Hopkins, died. Halsted's effect was the fact that he became a cocaine addict. And I know during his tenure at Johns Hopkins when William Henry Welch was the head of the institution would try to take [Halsted] on his boat during the summer to somehow make him break the habit. But I think [Halsted] was an addict until he died and I think ultimately he became a morphine addict.

Cadavers vs. 3D

Clive Owen (Thack) contemplates a pig / Mary Cybulski/Cinemax

Higgins: Can you talk a little about the problems obtaining cadavers in 1900? We see this a lot in the show—the use of pigs and other sort of substitutes.

Dr. Burns: Well, doctors did need to get cadavers and there was a short supply of cadavers. They used to get them from Potter's Fieldunclaimed bodies. And this had always been a problem because as medical institutions proliferated you needed more cadavers. It became almost an auction and who you knew. Stiffs, Skulls & Skeletons actually addresses this [...].

What's happening today is they're actually using, in some medical schools, three-dimensional models and stereography and interactive models to do dissections. It's not the same as going into an old-fashioned room and smelling the body, but the way medicine's going today for a lot of people this may work. [Encountering a cadaver] used to be one of the obstacles to becoming a physician to try to get through your first year anatomy course. But that was a problem, grave robbing was a problem, but most of that in New York State was really done with at that time, it was just a matter of where you could steal the unidentified bodies from.

Higgins: Also in an early episode we see some interesting photos of medical oddities, we see those briefly during a burglary. Are those from your collection?

Dr. Burns: Yes. All the photographs used are from my collection. They have 80,000 real great ones, it was just a matter of choice about which ones they would use for that particular scene, and I think they used some of my favorites. Living with this stuff every day, writing and doing work so we picked some great ones, and I think they chose some great ones what they wanted to show.

Early X-Rays


Clive Owen (Thack) with an x-ray / Mary Cybulski/Cinemax

Higgins: At one point we see an early X-ray machine. Can you talk about how useful this would be and how dangerous it might have been?

Dr. Burns: How dangerous? Okay. The X-ray was discovered in November...I think, November 8, 1895 by Rӧntgen, a physicist in Germany. It was one of the few inventions that was instantly accepted medically, it went around the world. By March of 1896 people were publishing papers on the medical use of the X-ray and it was not very powerful. And again, let's talk about the cocaine, this is really the worst example of doctors not knowing the effect. Edison, who of course was a great electrical scientist of the erabecause you need electricity to run the machinerecognized that his hands were getting red, so he had his assistant [Clarence] Dally doing all the X-rays and the fluoroscopies, and Dally was dead by 1904. I think he had only been working on it for about seven or eight years and what happens is the doctor's fingers were falling off, they were getting squamous cell carcinoma, and a whole bunch of other carcinomas from exposure to the X-ray. An X-ray of the abdomen for instance in 1900 was over 45 minutes.

In the Spanish-American War there was this great woman radiologist in San Francisco who took photographs of the soldiers, of the bullets, it was really the major exposé of war injuries that was published, this Spanish-American War book, with these early X-rays. And she died also about 1904. So it was extraordinarily dangerous both for the doctor and for the patient.

But the X-ray opened up dramatic fields. For instance, by 1901 it was routine to treat skin cancers with X-rays, as well as the dreaded condition Lupus Vulgaris, which is tuberculosis of the face. And as I said, this time period was when these inventions...all the great inventions of medicine were put into practical use. It was a time, as I always explain, that the chest, the head, and the abdomen became the playground of the surgeon. They were able to operate within those organs for the first time and heal patients successfully, operate on the brain and the heart. The first heart suturing was being done at that time.

The Burns Archive

Higgins: So getting back to The Burns Archive. Is the Archive something that people can visit?

Dr. Burns: Not really, we're working. We can't have people coming through here when I'm talking and Elizabeth's writing. We work in there all the time. [...] The public gets to see our materials via our books and our website [...] But we do have researchers come all the time.

About 20 years ago we were open to the public and we were listed among the unusual museums of New York City, but we're just dancing as fast as we can. There are only four of us here and lots of stuff to do and we produce more than most museums with the number of exhibits, books, and other things that we do.

Historical Perspective in Medicine

Dr. Burns: One of the statements I say to everyone I meet, just so you get the correct idea about these doctors, is that these doctors from 1900 and the doctors from 1700 and 1800 are just as smart as you and I, just as innovative, just as genius. The problem is they labored under inferior knowledge in technology and all they tried to do was help and heal. They did the best they could, but the advance of medicine and technology is so great that a hundred years later a lot of the stuff looks foolish and you're wondering why a patient would put up with it. And what we're doing today will be looked at, I'm sure, a hundred years from now the same way.

Where to watch The Knick: Fridays at 10pm on Cinemax. You can catch up on clips on The Knick's website.

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6 Eponyms Named After the Wrong Person
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Salmonella species growing on agar.

Having something named after you is the ultimate accomplishment for any inventor, mathematician, scientist, or researcher. Unfortunately, the credit for an invention or discovery does not always go to the correct person—senior colleagues sometimes snatch the glory, fakers pull the wool over people's eyes, or the fickle general public just latches onto the wrong name.

1. SALMONELLA (OR SMITHELLA?)

In 1885, while investigating common livestock diseases at the Bureau of Animal Industry in Washington, D.C., pathologist Theobald Smith first isolated the salmonella bacteria in pigs suffering from hog cholera. Smith’s research finally identified the bacteria responsible for one of the most common causes of food poisoning in humans. Unfortunately, Smith’s limelight-grabbing supervisor, Daniel E. Salmon, insisted on taking sole credit for the discovery. As a result, the bacteria was named after him. Don’t feel too sorry for Theobald Smith, though: He soon emerged from Salmon’s shadow, going on to make the important discovery that ticks could be a vector in the spread of disease, among other achievements.

2. AMERICA (OR COLUMBIANA?)

An etching of Amerigo Vespucci
Henry Guttmann/Getty Images

Florentine explorer Amerigo Vespucci (1451–1512) claimed to have made numerous voyages to the New World, the first in 1497, before Columbus. Textual evidence suggests Vespucci did take part in a number of expeditions across the Atlantic, but generally does not support the idea that he set eyes on the New World before Columbus. Nevertheless, Vespucci’s accounts of his voyages—which today read as far-fetched—were hugely popular and translated into many languages. As a result, when German cartographer Martin Waldseemüller was drawing his map of the Novus Mundi (or New World) in 1507 he marked it with the name "America" in Vespucci’s honor. He later regretted the choice, omitting the name from future maps, but it was too late, and the name stuck.

3. BLOOMERS (OR MILLERS?)

A black and white image of young women wearing bloomers
Hulton Archive/Getty Images

Dress reform became a big issue in mid-19th century America, when women were restricted by long, heavy skirts that dragged in the mud and made any sort of physical activity difficult. Women’s rights activist Elizabeth Smith Miller was inspired by traditional Turkish dress to begin wearing loose trousers gathered at the ankle underneath a shorter skirt. Miller’s new outfit immediately caused a splash, with some decrying it as scandalous and others inspired to adopt the garb.

Amelia Jenks Bloomer was editor of the women’s temperance journal The Lily, and she took to copying Miller’s style of dress. She was so impressed with the new freedom it gave her that she began promoting the “reform dress” in her magazine, printing patterns so others might make their own. Bloomer sported the dress when she spoke at events and soon the press began to associate the outfit with her, dubbing it “Bloomer’s costume.” The name stuck.

4. GUILLOTINE (OR LOUISETTE?)

Execution machines had been known prior to the French Revolution, but they were refined after Paris physician and politician Dr. Joseph-Ignace Guillotin suggested they might be a more humane form of execution than the usual methods (hanging, burning alive, etc.). The first guillotine was actually designed by Dr. Antoine Louis, Secretary of the Academy of Surgery, and was known as a louisette. The quick and efficient machine was quickly adopted as the main method of execution in revolutionary France, and as the bodies piled up the public began to refer to it as la guillotine, for the man who first suggested its use. Guillotin was very distressed at the association, and when he died in 1814 his family asked the French government to change the name of the hated machine. The government refused and so the family changed their name instead to escape the dreadful association.

5. BECHDEL TEST (OR WALLACE TEST?)

Alison Bechdel
Alison Bechdel
Steve Jennings/Getty Images

The Bechdel Test is a tool to highlight gender inequality in film, television, and fiction. The idea is that in order to pass the test, the movie, show, or book in question must include at least one scene in which two women have a conversation that isn’t about a man. The test was popularized by the cartoonist Alison Bechdel in 1985 in her comic strip “Dykes to Watch Out For,” and has since become known by her name. However, Bechdel asserts that the idea originated with her friend Lisa Wallace (and was also inspired by the writer Virginia Woolf), and she would prefer for it to be known as the Bechdel-Wallace test.

6. STIGLER’S LAW OF EPONYMY (OR MERTON’S LAW?)

Influential sociologist Robert K. Merton suggested the idea of the “Matthew Effect” in a 1968 paper noting that senior colleagues who are already famous tend to get the credit for their junior colleagues’ discoveries. (Merton named his phenomenon [PDF] after the parable of talents in the Gospel of Matthew, in which wise servants invest money their master has given them.)

Merton was a well-respected academic, and when he was due to retire in 1979, a book of essays celebrating his work was proposed. One person who contributed an essay was University of Chicago professor of statistics Stephen Stigler, who had corresponded with Merton about his ideas. Stigler decided to pen an essay that celebrated and proved Merton’s theory. As a result, he took Merton’s idea and created Stigler’s Law of Eponymy, which states that “No scientific discovery is named after its original discoverer”—the joke being that Stigler himself was taking Merton’s own theory and naming it after himself. To further prove the rule, the “new” law has been adopted by the academic community, and a number of papers and articles have since been written on "Stigler’s Law."

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WWI Centennial: Battle of Mărăști

By summer 1917 the outlook for the Allies on the Eastern Front was grim at best, as Russia descended into chaos and a combined Austro-German counterattack routed demoralized troops on the Galician front following the failure of the Kerensky Offensive, while everywhere the once-great Russian Army was rapidly hollowed by mutiny and mass desertions.

Against this gloomy backdrop, late July brought a rare and unexpected bright spot on the Romanian front, where the Romanian Second Army (rested, reorganized and resupplied after the disaster of 1916) mounted a surprise offensive along with the Russian Fourth and Ninth Armies against the junction of the German Ninth Army and Austro-Hungarian First Army, and scored an impressive tactical victory at the Battle of Mărăști, from July 22 to August 1, 1917. However the larger planned offensive failed to materialize, and Romania’s isolated success couldn’t shore up the crumbling Eastern Front amid Russia’s collapse.

Map of Europe July 22 1917
Erik Sass

The Allied success at Mărăști was due to a number of factors, most notably the careful artillery preparation, which saw two days of heavy bombardment of Austro-German positions beginning on July 22, guided by aerial spotters. The Austro-German forces were also deployed on hilly terrain in the foothills of the Vrancea Mountains, meaning their trenches were discontinuous, separated in many places by rough terrain, although they tried to compensate for this with heavily fortified strongholds. Pockets of forest and sheltered gorges also allowed the Romanians to advance in between the zigzagging enemy trenches undetected; on the other hand, the hills and tree cover also made it difficult to move up artillery once the advance began (a task made even more difficult by torrential rain, the familiar companion of the First World War). 

After two days of fierce, concentrated bombardment, on July 24 at 4 a.m. the Romanians and Russian infantry went over the top, with the Romanians advancing along a 30-kilometer-long stretch of front behind a “creeping barrage” of the type recently adopted by the French and British on the Western Front. With three divisions from the Russian Fourth Army supporting them on the southern flank, 56 Romanian battalions advanced up to 19 kilometers in some places – a major breakthrough by the standards of trench warfare. Engineers followed close behind to create roads bypassing the most inaccessible terrain, but unsurprisingly it still proved difficult to move heavy guns as the new roads quickly turned to mud in the rain.

On July 25 the Romanians began to consolidate their gains, spelling the end of major offensive operations during the battle, although smaller actions continued until August 1. The decision was prompted by events elsewhere on the Eastern Front (above, Romanian civilians look at enemy guns captured during the battle). The Battle of Mărăști was supposed to be part of a larger pincer movement by Romanian and Russian forces, including an attack by the Romanian First Army and Russian Sixth Army to the southeast, which were supposed to outflank the German Ninth Army from the southeast. However the disastrous defeat of Russian forces further north in Galicia and Bukovina, widespread insubordination in the Russian Army, and political turmoil in the Russian rear all combined to derail the Allied plan, forcing them to go on the defensive.

The victory at Mărăști was not fruitless: along with an even bigger defensive victory atMărășești two weeks later, Mărăști seriously complicated the Central Powers’ strategy for the remainder of the year, which called for knocking Romania and Russia out of the war before returning to the Western Front to finish off France. 

But the big picture was bad and getting worse, as hundreds of thousands of Russian troops deserted or refused to fight, effectively paralyzing the Allied war effort along most of the Eastern Front, while in Galicia the Austro-German advance continued. Florence Farmborough, a British nurse serving with a Red Cross unit in the Russian Army, described a typical day during the Russian retreat in her diary entry on July 25, 1917 (and noted the growing hostility of ordinary Russian soldiers towards the foreign nurses, representatives of the Western Allies, whom the Russians accused of leaving them in the lurch):

And then there came again that peremptory voice we dreaded. It roused us as no other could ever do, for it was the voice of Retreat. ‘Wake up! Get up at once! No time to lose!’ We started up, seized what we could and helped the orderlies collect the equipment. We were told it was a proruiv [breakthrough] on the right flank of our Front and that the enemy was pouring through the gap. The Sister-on-duty began to weep… Troops were passing quickly by in the darkness; whole regiments were there. We were given a lantern and told to stand by the gate and await transport. Some soldiers entered the yard swearing; we hoped they would not see us. But they did, and soon they were shouting ugly things about us. I too felt like weeping, but we had to keep a straight face and pretend that we had not heard… The soldiers who had always been our patient, grateful men, seemed to have turned against us. Now for the first time we realised that our soldiers might become our enemies and were capable of doing us harm.

This was not an isolated occurrence, but rather one small incident in a rising tide of insubordination and sheer chaos. Later Farmborough noted another encounter:

More soldiers went by in the darkness. There were no officers with them, they too were deserters. Curing and shouting they made their way along the highroad. We were frightened and crouched low against the fence so that they could not see us, and we dared not speak lest they should hear… The night was very dark and the confusion great. Wheels creaked and scrunched; frightened horses slid forwards by leaps and bounds; cart grated against cart; whips twanged and swished; and agitated voices shouted and cursed in one and the same breath... All around us were fires; even in front of us buildings were blazing. My driver said that some of the soldiers thought that they were already surrounded by the enemy.

See the previous installment or all entries.

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