An official Soviet publication of the early 1920s concluded that about five million deaths occurred in 1921 from famine and related disease: this number is usually quoted in textbooks.[20] More conservative figures counted not more than a million, while another assessment, based on the ARA's medical division, spoke of two million.[21] On the other side of the scale, some sources spoke of ten million dead.[22] According to Bertrand M. Patenaude, "such a number hardly seems extravagant after the many tens of millions of victims of war, famine, and terror in the twentieth century".[23]