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The Management
of Disorders of the
Child’s Cervical Spine

Jonathan H. Phillips
Editor in Chief
Daniel J. Hedequist
Suken A. Shah
Burt Yaszay
Editors

123
The Management of Disorders
of the Child’s Cervical Spine
Jonathan H. Phillips
Editor in Chief
Daniel J. Hedequist • Suken A. Shah
Burt Yaszay
Editors

The Management
of Disorders of the
Child’s Cervical Spine
Editor in Chief
Jonathan H. Phillips, MD
Arnold Palmer Hospital
Orlando, FL, USA

Editors
Daniel J. Hedequist, MD Suken A. Shah, MD
Harvard Medical School Nemours/Alfred I. DuPont Hospital
Boston, MA, USA for Children
Wilmington, DE, USA
Burt Yaszay, MD
Rady’s Children’s Hospital Associate
San Diego, CA, USA

ISBN 978-1-4939-7489-4    ISBN 978-1-4939-7491-7 (eBook)

https://doi.org/10.1007/978-1-4939-7491-7

Library of Congress Control Number: 2017959606

© Springer Science+Business Media LLC 2018

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Printed on acid-free paper

This Springer imprint is published by Springer Nature

The registered company is Springer Science+Business Media, LLC
The registered company address is: 233 Spring Street, New York, NY 10013, U.S.A.
This book is dedicated to all children who have disorders
of the cervical spine and to the people who care for them.
Foreword

In the early 1970s, I became interested in the cervical spine, specifically con-
genital anomalies. That led to the publication of a report on the Klippel-Feil
syndrome. I was fortunate to find a monograph entitled Upper Cervical Spine
published in 1972. The authors, Detlef von Torklus and Walter Gehle, were
from the Orthopedic Clinic and Outpatient Department of the University
Hospital in Hamburg, Germany. They had done an extensive review of the
literature and pathoanatomy of the cervical spine, and, importantly, nearly
half of their book was devoted to children. The authors identified many nor-
mal physiologic and anatomic variations that frequently mimic pathology.
Unlike the extremities, in spine issues, one cannot use a comparison X-ray of
the opposite side. Their work identified variations in the pediatric spine and
how they differed from the adult. This text became my go-to source for
insight in complex cervical spine problems.
The Management of Disorders of the Child’s Cervical Spine edited by
Jonathan Phillips, Daniel Hedequist, Suken Shah, and Burt Yaszay continues
that legacy. This text is comprehensive and includes an extensive review of
previous literature by individuals knowledgeable in the management of chil-
dren with complex cervical spine problems.
Part I, Basic Medical Science, is essential to effective diagnosis and treat-
ment. This section contains important chapters on anatomy, biomechanics,
radiology, advanced imaging, and current diagnostic techniques.
Part II, Clinical Aspects of Disorders of the Child’s Cervical Spine, con-
tains an extensive discussion of trauma to the immature spine and its potential
for serious morbidity and mortality. There is a special section on cervical
injury in the young athlete. The clinical aspects of many of the disorders that
can affect the child’s spine are presented in detail. This list is comprehensive
and includes inflammatory conditions, infection, tumors, congenital anoma-
lies, metabolic disorders, and bone dysplasias.
Part III, The Medical and Surgical Treatment of Cervical Disorders in
Children, covers management—including conservative techniques such as
immobilization and rehabilitation. Also included are surgical approaches,
including current instrumentation, anesthesia, and neurological monitoring.
There is a unique section on complications and revision surgery.

vii
viii Foreword

The strength of this text is that it is the product of an international panel of

experts, all of whom are recognized authorities. This is coupled with the skill-
ful oversight of Dr. Phillips and his colleagues to create a powerful text that
will be an important clinical resource for many years. This will be ­exceedingly
helpful to those involved in the management of cervical spine problems of
children, and it continues the legacy of von Torklus and Gehle.

Ann Arbor, MI, USA Robert N. Hensinger, MD

Preface

There is no one reason why we wrote this book. It came about, as so many
different things do, by way of a conversation at the dinner table. Suken Shah,
MD; Burt Yaszay, MD; and I were talking at such a dinner table in Orlando
at a meeting on early onset scoliosis. We all had a big interest in children’s
cervical spine problems, but agreed that they were pretty rare and there wasn’t
much of a forum for talking about them among us orthopedic surgeons who
specialize in pediatric problems.
I give Burt the credit for the statement that “peds cervical spine is the last
black hole in kids’ spinal knowledge” or something like that. And with that
prophetic statement the seed was sown.
Suken polled the membership of the Pediatric Orthopedic Society of North
America (POSNA), and within a very short time, we had a small but enthusi-
astic group of interested surgeons who formed the nidus of a new study group
which, for now at least, is called the Pediatric Cervical Spine Study Group
(PCSSG). The members of this international group have contributed most of
the chapters in this text, along with their fellows and other associates. We
meet a few times a year at POSNA and Scoliosis Research Society (SRS) and
International Congress on Early Onset Scoliosis (ICEOS) meetings and have
been supported by these organizations. I’m very happy to acknowledge their
support.
One of the early topics we discussed at PCSSG meetings was the possibil-
ity of writing a text that could guide the novice surgeon in this rare but dan-
gerous area. Both Fran Farley, MD, and Haemish Crawford, FRACS, were
the initial proponents of the idea and contributed chapters. Dan Hedequist,
MD, already was involved in writing a book for our publisher, Springer, and
put me in touch with Kris Spring in their New York office who has been
beyond patient in waiting for a long overdue final draft. Dan, Suken, Burt,
and I took on editorial responsibilities for this text, so the four of us are
responsible for its content.
There are many others who have put up with the long process of writing,
notably our families, of course. But I would also like to acknowledge the help
of my colleagues at Arnold Palmer Children’s Hospital in Orlando in disci-
plines apart from orthopedics, namely, neurosurgery, ENT, general surgery,
and physiatry, who have written chapters which complete the scope of this
book.

ix
x Preface

The final and most important thank you of all goes to my secretary and
friend of 20 years, Mary Regling, BA, who has been the “den mother” of the
PCSSG from its inception and the driving force behind getting this work
published. Without her, the project would have foundered and failed.

Orlando, FL, USA Jonathan H. Phillips, MD

Contents

Part I Basic Medical Science

1 Embryology and Anatomy of the Child’s Cervical Spine. . . . . . . . . 3

Jonathan H. Phillips
2 Biomechanics of the Growing Cervical Spine . . . . . . . . . . . . . . . . . 15
John Kemppainen and Burt Yaszay
3 Pathology of the Child’s Cervical Spine and Its Clinical
Implications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Ehsan Saadat, Daniel J. Hedequist, and Patrick Wright
4 Radiology of the Growing Cervical Spine. . . . . . . . . . . . . . . . . . . . . 53
Paul D. Kiely, Gregory Cunn, Jonathan H. Phillips,
and Jahangir K. Asghar

Part II Clinical Aspects of Disorders of the Child’s Cervical Spine

5 Clinical Presentation and Physical Examination of Children

with Cervical Spine Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
William C. Warner and Ilkka Helenius
6 Pediatric and Adolescent Cervical Spine Trauma. . . . . . . . . . . . . . 87
Mitesh Shah, Martin J. Herman, Craig Eberson,
and John T. Anderson
7 Infections and Inflammatory Conditions
of the Pediatric Cervical Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Kaela Frizzell, Archana Malik, Martin J. Herman,
and Peter Pizzutillo
8 Tumours of the Cervical Spine. . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Nanjundappa S. Harshavardhana and John P. Dormans
9 Congenital Disorders of the Child’s Cervical Spine . . . . . . . . . . . 155
Alejandro Dabaghi-Richerand, Robert N. Hensinger,
and Frances A. Farley
10 Dysplasias in the Child’s Cervical Spine. . . . . . . . . . . . . . . . . . . . . 169
Jennifer M. Bauer and William Mackenzie

xi
xii Contents

11 Congenital Muscular Torticollis . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

Kaela Frizzell, Archana Malik, Martin J. Herman,
and Peter Pizzutillo
12 Cervical Spine Injuries in Athletes. . . . . . . . . . . . . . . . . . . . . . . . . 191
Firoz Miyanji

Part III The Medical and Surgical Treatment of Cervical

Disorders in Children

13 Medical and Rehabilitative Techniques in Cervical

Disorders of the Child. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Katrina M. Lesher
14 Surgical Approaches to the Child’s Cervical Spine. . . . . . . . . . . . 219
Haemish A. Crawford and William Warner
15 Spinal Cord Monitoring in Pediatric Cervical
Spine Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Jonathan H. Phillips and Michael Isley
16 External Immobilization of the Child’s Cervical Spine. . . . . . . . . 245
Michael B. Johnson and Leah McLachlan
17 Posterior Cervical Arthrodesis in Children. . . . . . . . . . . . . . . . . . 261
Daniel J. Hedequist and Anthony Stans
18 Anterior Cervical Arthrodesis in Children. . . . . . . . . . . . . . . . . . . 275
Emmanuel N. Menga, Michael C. Ain, and Paul D. Sponseller
19 Anterior Transoral Approaches to the Upper Cervical
Spine in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Joshua Gottschall and James Kosko
20 Chiari Malformations and Foramen Magnum Stenosis. . . . . . . . 291
Christopher A. Gegg and Greg Olavarria
21 Miscellaneous Conditions of the Head and Neck
in Infants and Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
David Miller
22 Complication Types and Rates in Pediatric
Cervical Spine Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Urvij M. Modhia and Paul D. Sponseller
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Contributors

Michael C. Ain, MD Pediatric Orthopedics, Department of Orthopedic

Surgery, Johns Hopkins Bloomberg Children’s Center, Baltimore, MD, USA
John T. Anderson, MD University of Kansas School of Medicine,
Department of Orthopedic Surgery, Children’s Mercy Hospital and Clinics –
Kansas City, Kansas City, MO, USA
Jahangir K. Asghar, MD Department of Orthopedics, Division of Spinal
Surgery, Nicklaus Children’s Hospital, Miami, FL, USA
Jennifer M. Bauer, MD, MS Pediatric Orthopaedic Surgery, University of
Washington, Department of Orthopaedics and Sports Medicine/Seattle
Children’s Hospital, Seattle, WA, USA
Gregory Cunn, MD Department of Internal Medicine, New York
Presbyterian–Brooklyn Methodist Hospital, Brooklyn, NY, USA
Haemish A. Crawford, FRACS Starship Children’s Hospital, Auckland,
New Zealand
Alejandro Dabaghi-Richerand, MD Department of Orthopedic Surgery,
C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
John P. Dormans, MD Texas Children’s Hospital, Houston, TX, USA
Craig Eberson, MD Division of Pediatric Orthopedic Surgery, Orthopedic
Surgery Residency, Alpert Medical School of Brown University, Providence,
RI, USA
Frances A. Farley, MD Department of Orthopedic Surgery, C.S. Mott
Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
Kaela Frizzell, DO Department of Orthopedic Surgery, Philadelphia College
of Osteopathic Medicine, Philadelphia, PA, USA
Christopher A. Gegg, MD, FAANS, FACS Pediatric Neurosurgery, Arnold
Palmer Hospital, Orlando, FL, USA
Joshua Gottschall, MD Florida Pediatric Associates, LLC, Orlando, FL,
USA
Nanjundappa S. Harshavardhana, MS Golden Jubilee National Hospital,
Clydebank, Scotland, UK

xiii
xiv Contributors

Daniel Hedequist, MD Orthopedic Surgery, Children’s Hospital Boston/

Harvard Medical School, Boston, MA, USA
Ilkka Helenius, MD, PhD Department of Pediatric Orthopedic Surgery,
Turku University Central Hospital, Turku, Finland
Robert N. Hensinger, MD Department of Orthopedic Surgery, C.S. Mott
Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
Martin J. Herman, MD Drexel University College of Medicine, St.
Christopher’s Hospital for Children, Philadelphia, PA, USA
Michael Isley, PhD, DABNM, FASNM Intraoperative Neuromonitoring
Department, Orlando Regional Medical Center and Arnold Palmer Hospital
for Children, Orlando, FL, USA
Michael B. Johnson, FRACS Department of Orthopedics, Royal Children’s
Hospital, Parkville, VIC, Australia
John Kemppainen, MD Helen DeVos Children’s Hospital, Grand Rapids,
MI, USA
Paul D. Kiely, MCh, FRCS Centre for Spinal Disorders, Mater Private
Cork, Cork, Ireland
James Kosko, MD Children’s Ear Nose & Throat Associates, Orlando, FL,
USA
Katrina M. Lesher, MD Children’s Hospital of the Kings Daughters,
Norfolk, VA, USA
William Mackenzie, MD Nemours/Alfred I. duPont Hospital for Children,
Wilmington, DE, USA
Archana Malik, MD St. Christopher’s Hospital for Children, Orthopedic
Center for Children, Philadelphia, PA, USA
Leah McLachlan, BPO Department of Orthotics and Prosthetics, Royal
Children’s Hospital, Parkville, VIC, Australia
Emmanuel N. Menga, MD Department of Orthopedic Surgery, The Johns
Hopkins University, Baltimore, MD, USA
David Miller, MD Children’s Surgical Associates, Orlando, FL, USA
Firoz Miyanji, MD, FRCSC British Columbia Children’s Hospital,
Vancouver, BC, Canada
Urvij M. Modhia, MD Department of Orthopedic Surgery, The Johns
Hopkins University, Baltimore, MD, USA
Greg Olavarria, MD Neurosurgery, Arnold Palmer Hospital for Children,
Orlando, FL, USA
Jonathan H. Phillips, MD APH Center for Orthopaedics, Orlando Health,
Arnold Palmer Hospital, Orlando, FL, USA
Contributors xv

Peter Pizzutillo, MD St. Christopher’s Hospital for Children, Philadelphia,

PA, USA
Ehsan Saadat, MD Emory Orthopedics and Spine Center, Atlanta, GA,
USA
Mitesh Shah, MD Orthopedic Surgery and Pediatrics, Drexel University
College of Medicine, St. Christopher’s Hospital for Children, Philadelphia,
PA, USA
Suken A. Shah, MD Nemours/Alfred I. DuPont Hospital for Children,
Wilmington, DE, USA
Paul D. Sponseller, MD, MBA Division of Pediatric Orthopedics, Johns Hopkins
Medical Institute, Bloomburg Children’s Center, Baltimore, MD, USA
Anthony Stans, MD Division of Pediatric Orthopedics, Mayo Clinic,
Rochester, MN, USA
William C. Warner Jr, MD LeBonheur Children’s Hospital, University of
Tennessee/Campbell Clinic, Germantown, TN, USA
Patrick Wright, MD Department of Pediatric Orthopedic Surgery,
University of Mississippi Medical Center, Jackson, MS, USA
Burt Yaszay, MD Children’s Specialty, San Diego, CA, USA
Introduction

This book was written for a wide audience. Some of its readers will be famil-
iar, or even expert, in the care of children with neck and cervical spine disor-
ders. Others will be completely new to the subject. Though its emphasis is on
the orthopedic and neurosurgical approach to children’s cervical spine, there
are chapters that are contributed by other disciplines. Thus, an ENT surgeon
who may be called upon to perform an anterior trans-oral approach to the
dens will be reassured by the account of this technique in Chapter 19. Chapter
21 focuses on non-spinal disorders which may present to physicians and oth-
ers encountering children with neck problems in their clinics. Knowing what
their significance is and which consultant to engage with in their management
is important.
While it is unwise to try to be all things to all people, it is hoped that this
is a reference that can be dipped into by the occasional reader looking for
something specific and also be a comprehensive guide to the young surgeon
embarking on a career which may include pediatric cervical spine surgery.
The area we cover is quite rare and quite dangerous for the unprepared.
Yet with the changing demographics of childhood trauma and increasing sur-
vival of children with previously lethal syndromes, we are encountering these
rare diagnoses with greater frequency.
The reader is encouraged to approach the text in a traditional fashion. We
are all anxious to know “how to do it,” but such enthusiasm must be tempered
by acquiring the building blocks of “why.” Thus, we start with basic science,
and it cannot be overemphasized how important a thorough knowledge of the
anatomy (both normal and abnormal), pathology, biomechanics, and radiol-
ogy is to treating these rare disorders. The chapters on clinical assessment
and presentation of the multitude of problems in this area follow. Only after
these basic areas are covered do we embark on accounts of the surgical and
nonsurgical management of the problems encountered.
Each chapter is written by experts in the area and can be taken as stand-­
alone treatises. It is hoped, however, that the whole will be greater than the
sum of its parts.

 Jonathan H. Phillips, MD
 Daniel J. Hedequist, MD
 Suken A. Shah, MD
Burt Yaszay, MD

xvii
 Part I
Basic Medical Science
 Embryology and Anatomy
of the Child’s Cervical Spine 1
Jonathan H. Phillips

result in highly differentiated anatomical areas in

Embryology and Definitions vertebrates. Nowhere is this specialization more
apparent than in the upper cervical spine of the
The process of embryological development and human. The formation of the skull base and upper
maturation of the fetus can be described in vari- two cervical vertebrae is unique in the axial
ous stages known as Carnegie stages. These refer human skeleton and departs quite markedly from
to levels of development rather than gestational the lower cervical, thoracic, lumbar, and sacral
age or crown-rump length in millimeters. Though morphology where there are more structural sim-
the three systems overlap, we will use the ilarities than differences. We will see that the par-
Carnegie stages as much as possible in this ticular embryology of this rostral area of the
discussion. spine has highly complex origins.
The terms rostral and caudal and ventral and Segmentation describes a phenomenon of
dorsal—while intuitive in embryology—are used division of building blocks of tissues into repeat-
less often in descriptive surgical anatomy, and the ing units and is similar in concept to metamer-
terms superior and inferior and anterior and pos- ism. There is a further twist to the idea of
terior are used interchangeably in this chapter. In segmentation in the human spine, however,
addition, descriptive names such as basiocciput, because a process of resegmentation occurs dur-
atlas, and axis are interchanged with skull, C1, ing embryogenesis in which the caudal and ros-
and C2, which better describe the approach of the tral parts of adjacent segments fuse together to
surgeon in the operating theater to ensure accu- form the completed vertebrae. When this process
rate surgical instrumentation at correct levels. is corrupted, the vertebrae are malformed. In the
Metamerism is an important concept that so-called hemimetameric shift, for instance, the
relates to the general pattern of segmental repeti- process of resegmentation can fail unilaterally,
tion of similar structures in the developing resulting in the appearance of a hemivertebra and
embryo. It is this basic symmetrical template resulting in congenital scoliosis. This occurs
which is modified by localized gene expression most frequently in the thoracic spine, where cor-
to form region-specific structural changes which onal plane decompensation is an expected out-
come for a fully segmented coronal hemivertebra,
depending on the specific pattern of malforma-
tion. It occurs also in the cervical spine, both in
J.H. Phillips (*)
the coronal and sagittal planes. Sagittal plane
APH Center for Orthopedics, Orlando Health, Arnold
Palmer Hospital, Orlando, FL, USA abnormalities are more common than coronal,
e-mail: jonathan.phillips@orlandohealth.com the prototypical example of which is that seen in

© Springer Science+Business Media LLC 2018 3

J.H. Phillips et al. (eds.), The Management of Disorders of the Child’s Cervical Spine,
https://doi.org/10.1007/978-1-4939-7491-7_1
4 J.H. Phillips

Klippel-Feil syndrome, a failure of segmentation cells of the somitic mesoderm have spread toward
rather than a hemimetameric shift, though this this structure, which induces the formation of the
last can and does occur in the child’s neck, result- sclerotome. The sclerotomal segments (and this
ing in cervical congenital scoliosis. tissue mass is segmented) will form the verte-
Somites, or more properly their derivatives, brae, whereas the notochord, under the negating
sclerotomes, are the building blocks of the spine. influence of the neural tube, remains in the
They appear in increasing numbers during mature human only as the nucleus pulposus of
embryogenesis, and the number of these segmen- intervertebral discs and the alar and apical liga-
tal tissue blocks correlates with the anatomical ments of the craniocervical junction. This seg-
staging of the embryo. Somites are just one part mented system develops in a rostral to caudal
of the mesoderm layer of the three-layered early direction (Fig. 1.1).
embryonic disc. This disc, a few days old, has an Somite count increases from about one to four
outer epidermal layer facing the amniotic cavity, at age 20 days, first appearing at the head of the
a middle layer of mesoderm, and an endodermal embryo, to 34–35 at age 30 days toward the tail.
layer facing the yolk sac. This pattern is apparent Ultimately, 44 pairs of somites occur and form
by about 3 weeks postfertilization. The meso- the left and right half of the sclerotome. The other
derm is itself divided into three parts, medial, two parts of the somites go on to form muscle and
intermediate, and lateral mesoderm. The most skin. The remaining parts of mesodermal layer
medial band is called the paraxial mesoderm and lateral to the somites form splanchnic structures.
once again divides into three, this time from dor- These include gut, vascular, and urological struc-
sal to ventral. The area nearest the dorsal surface tures. Insult to the embryo at this stage can affect
is the dermatome, next the myotome, and further all these systems and explains the concomitant
to the center of the embryo is the sclerotome. All appearances in clinical practice of multi-system
of these areas are arrayed surrounding two struc- congenital formation failure. The best known
tures which carry powerful molecular signaling example of this is VACTERL syndrome in which
properties—the notochord in the very center of heart, gut, renal, and vertebral malformations
the embryo and the neural tube which by now coexist.
(stage 10 or about 4 weeks) has formed from the At about the 5- to 8-week period, or Carnegie
original neural plate and which lies right behind stages 15–22, the emerging pattern of spinal forma-
the notochord on its dorsal aspect. The notochord tion is becoming evident. However, the contribu-
will regress quickly, but not before the ventral tion of somites to their sclerotomal structures is

Fig. 1.1 The relationship and control of somatic mesoderm to the notochord and neural tube (Reproduced with permis-
sion from Gilbert [7]; © Sinauer Associates, Sunderland, MA)
1 Embryology and Anatomy of the Child’s Cervical Spine 5

highly complex at the cranial extent of the vertebral Sclerotomes Vertebra

column. There are designated pairs of sclerotomes
inasmuch as the upper four form the basiocciput, 1 Basioccipital
the next eight form the cervical vertebrae (of which
there are only seven, but with eight spinal nerves), 2
and the more caudal pattern (12 thoracic, five lum-
bar, and five sacral, variable coccygeal) is more 3
easily understood based on the gross anatomy of
the fully formed human skeleton. It is the complex
4
variation from the typical pattern of vertebral
development which gives rise to the unique shape
and function of the atlas and axis. These two verte- 5
C1 C1
brae share a common origin with the basiocciput,
and as such should be considered as an embryo- C2
6
logical, anatomical, and functional unit very differ- C2 C2
ent from the subaxial spine. This unit is uniquely
7
designed to transmit the termination of the brain- C3 C3
stem and emerging spinal cord in a highly flexible C3
protective tube that allows very roughly 50% of the 8
C4 C4
total movement of the skull on the spinal column. C4
The remaining cervical motion is distributed over 9
the five lower cervical segments. All of these cervi- C5 C5
C5
cal vertebral segments except C7, however, carry
the responsibility of transmitting the vertebral
Fig. 1.2 Relative somatic contributions to the spinal col-
arteries, a function solely attributed to neck verte- umns (Redrawn with permission from Muller and
brae. Once again the pattern of the vertebral arterial O’Rahilly, © 1994 Wiley Publishing)
anatomy is radically different at the atlas and axis,
and a thorough understanding of this arterial anat-
omy is fundamental to safe posterior surgical cause caudal or rostral homeotic transformations
approaches to the upper cervical spine. [1]. The Hox-4.2 gene expression can transform
The relative somatic contributions to the spi- occipital bones into neural arches [2]. Finally,
nal column are shown in Fig. 1.2. The upper four transgenic mice can be found to exhibit a third
sclerotomes form the basiocciput but also borrow occipital condyle fusing the skull base to the dens
from somite five, which is a cervical one, thus the [3], and rostral vertebral shifts have been seen
intimate relationship of the atlas to the skull base after heat exposure.
embryologically. Sclerotome five (a cervical one) Though murine and avian genetic models
forms both the posterior arch of the atlas and should be interpreted with caution in the human,
occipital condyles. The anterior arch of the atlas it is easy to imagine that altered expression of
has an origin in the hypochordal bow which these homeobox genes may be the basis for well-­
appears ventral to the notochord and undergoes known malformations at the upper cervical spine
chondrification and fusion with the posterior neu- such as assimilation of the atlas, which can occur
ral arch elements. There is a transient proatlas posteriorly and anteriorly.
centrum which is dissolved. There is no vertebral The formation of the axis is in many ways
body in C1 under normal circumstances. perhaps the most bizarre in the human axial
Teratogenic influences at this stage have been skeleton. A review by Muller and O’Rahilly in
shown in mice. Interference with Hox genes by 2003 explains the process well [4]. The fact that
retinoic acid (most commonly used in the human two, not one, sclerotomes form the posterior
for the treatment of acne) has been shown to neural arch of C2 explains why it is so massive
6 J.H. Phillips

e­ lements of the neural arches at the neurocentral

synchondrosis. This junctional area fuses
completely around age 7. The spinous process
uniting the left and right neural arch growth
centers unites at age 3. Thus, radiographically
there appears to be a spina bifida occulta present
in the toddler, though usually the laminae meet
at a complete cartilaginous bridge. The same
appearance may be present in more caudal ver-
tebrae also.
At C2 there is predictably a much more com-
plex arrangement consequent upon its develop-
ment from three sclerotomes. Five ossification
centers appear and there are also two secondary
centers (the tip of the dens and the ring apophy-
sis of the inferior/caudal aspect of the body of
the axis). These centers result in two radio-
graphically significant synchondroses (see
Chap. 4). The dentocentral synchondrosis repre-
sents the fusion of two sclerotomes at the level
of the future body of C2. However the fusion
level, though less distinct, may also be apparent
Fig. 1.3 Ossification centers of C2. L is the dentocentral
in the young child, most commonly on CT scan
synchondrosis; J is the neurocentral synchondrosis. There
are two Is, two Cs, and one A, totaling five primary cen- or MRI reformatted in the sagittal plane. As
ters. G and H are secondary centers of ossification mentioned above, this may be a source of con-
(Reproduced with permission from Bailey [8]; © The cern in the injured child as a potential fracture
Radiological Society of North America)
line [5]. The possible relationship of these syn-
chondroses to later formation of an os odontoi-
(and therefore ideally suited to the placement of deum is discussed elsewhere (see Chap. 4). The
translaminar screws during cervical instrumen- neurocentral synchondrosis represents the junc-
tation). It also helps us to understand the some- tion of two sclerotomes anteriorly (ventrally)
times confusing radiological appearance of the with the left and right neural arches derived dor-
synchondroses of C2 in the immature child sally from the same tissue. There are therefore
(Fig. 1.3), an important goal to achieve since two of these junctions left and right, and they
these areas are often misinterpreted as fractures. are best seen in coronal imaging modalities. The
Perhaps mutations of gene expression in this growth centers of C1 and C2 are represented
area can also explain the retroflexed dens seen graphically in Figs. 1.3, 1.4, and 1.5. These
in Chiari malformation and congenital types of describe the prototypical arrangements, but it
basilar invagination. must be emphasized that many anatomical vari-
The third cervical vertebra and its subjacent ations can occur, which may be confusing on
levels exhibit the so-called typical cervical mor- imaging studies of the young child. This point is
phology. As noted above, this is still distinguish- well made by Karwacki and Schneider in their
able from thoracic and lumbar vertebrae but 2012 analysis of atlas and axis growth center
approximates more closely to the general pattern variability based on 550 CT scans of children
of vertebral development. aged 0–17 years [6].
There are three primary ossification centers Growth centers are present at various stages in
at C1. The anterior center, derived from the the human embryo. Initially seen as chondrifica-
hypochordal bow, fuses with the posterior/dorsal tion centers, they become ossified and visible
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I should have had something to do instead of being expected merely
to dress well and look ornamental!”
As she spoke her face lost a little of its vivid color and animation, but
the slight pensiveness of her look seemed to Allestree to increase
the poignancy of her spell; there was a subtle suggestion of that
imaginative longing for the fulfilment of those vague youthful
conceptions of happiness and life and love which stir in all young
things, as the sap stirs in the trees in springtime and the bud forms
under the leaves.
He did not immediately reply, but continued to work on the portrait
before him which seemed to him more and more hopelessly colorless
and lifeless compared with his model. “Perhaps my point of view is
too concentrated to be of much value,” he said at length; “to me the
mere fact of your existence seems enough to compensate for the
loss of a good many more actively employed and earthly individuals
who must be working out your privileged season as a lily of the
field.”
She gave him a quick, slightly amazed look, and blushed. “You speak
as though I were selected from the rubbish heap!” she exclaimed
laughing, “as though I profited by the misfortunes of others. I don’t
know whether to regard it as a compliment or not!”
But Allestree was quite unmoved, absorbed indeed in his work. “Did
I ever pay you a compliment, Rose?” he asked, after an instant,
meeting her glance with one that was so eloquent of deeper feeling
that she withdrew hers, vaguely alarmed.
“I don’t believe you ever did,” she replied hastily, with an instinctive
desire to put off any suggestion of passion on his part, for much as
she liked him and long as she had known him, Allestree was only a
lay figure on her horizon; he had never stirred her heart, and she
dreaded a break in that friendship which she dreamed of prolonging
forever with a girl’s usual infatuated belief in the possibilities of such
a friendship between a man and a woman. The channel into which
their talk had unconsciously drifted so alarmed her indeed that she
rose abruptly and went to the window and stood looking down into
the street, her perfect profile and the soft upward sweep of her
beautiful hair showing against the dark draperies which she had
pushed aside, and moving the painter in turn to still deeper depths
of artistic self-abasement.
“Robert,” she said suddenly, after a moment’s embarrassed silence,
“who was that with you the other evening? Was it Mr. Fox?”
Allestree glanced up quickly, and then stooped to pick up a brush
which had dropped to the floor. “Yes,” he said quietly, “how did you
happen to recognize him?”
“I was not sure—but I’ve seen two or three pictures of him in the
magazines and the weeklies. One can’t forget his head, do you
think?” and she came slowly back to her chair, unconscious of the
change in Allestree’s expression.
“Well, I never tried,” he confessed; “I’ve known William Fox all my
life, and he’s my own first cousin besides. It’s rather odd,” he added,
“by the way, that you never met him, but then you have been away
from the city when he has been here.”
Rose regarded him thoughtfully, her composure fully restored. “He
has a very remarkable face,” she observed, “and it is fine and pale
like a bit of old ivory.”
“Oh, yes, all the women fall in love with him,” Allestree assented
with impatient irony.
“Do they? That doesn’t sound interesting, but I should not believe it
of his face, he doesn’t look like a lady’s man! Is it true—” she added
with a moment’s hesitation—“that he has never loved any one but
Margaret White?”
“It’s true that Margaret treated him abominably,” said Allestree
bluntly; “she was engaged to him when they were both very young
and threw him over to marry White.”
“What a singular choice,” Rose observed, “White has nothing
attractive about him, and he is so selfish, so hard; they say he treats
her badly.”
“He should—in poetic justice,” replied Allestree laughing, “for she
married him for his money and his position. Fox was a poor man
then with no prospects but his brains and, strange to say, Margaret
underestimated their possibilities.”
“And yet she is very clever. Did he really feel it so much?” she added,
her natural sympathy for a sentimental situation touched and
strengthened by the remembrance of Fox’s clear-cut face, which had
appeared to her vision cameo-like against the night.
“Now you are beginning to ask me your unanswerable questions,” he
retorted smiling grimly, with a keen sense of annoyance that Fox
could intrude so sharply into their talk. “I know he was very much in
love with her then, but he is on good terms with them both now and
—” he stopped abruptly; his quick ear had caught a step on the
stairs accompanied by another sound which startled him with an
impatient certainty of a surprise.
It was the tread of a large Scotch collie who lifted the portière on his
nose and walked deliberately into the room. Allestree laid down his
brush with a peculiarly exasperated expression.
“Well, Sandy,” he said, not unkindly, addressing the dog.
Rose turned and held out her hand. “What a beautiful creature,” she
remarked; “who does he belong to? Who is coming?”
Her companion gave her an enigmatical glance, observing the collie
as he approached and laid his head against her knee. The step on
the stair had now reached the landing, and they heard Aunt
Hannah’s chair scrape as she moved and her knitting needles rattled
on the floor, for she had been startled out of a nap.
“Who is it?” Rose repeated, framing the question with her lips.
“Fox,” replied Allestree dryly, laying down his palette and lighting a
cigarette; “he has an uncommonly retentive memory it appears.”
She glanced at him quickly, a suddenly illuminated understanding in
her eyes, and blushed exquisitely, for she was still young enough to
be easily embarrassed. At the same moment Fox pushed aside the
portière and entered the room.
“Hello, Bobby,” he began, and then paused abruptly at the sight of
Rose. “I fear I’m an intruder,” he added courteously.
Allestree smiled grimly and presented him to Miss Temple. “On the
contrary, I think you got the time pretty closely,” he remarked
ironically.
Fox laughed. “Guilty!” he exclaimed with perfect good humor; “down
Sandy!” he added sharply to his collie; “you’ve bewitched the dog,
Miss Temple; he rarely makes friends with strangers.”
“Then I appreciate all the more his advances,” she replied smiling, “a
dog always knows a friend.”
“And an honest man,” said Fox; “I’m free to confess that I don’t trust
one who dislikes dogs.”
“Every man has his crank,” remarked Allestree, walking to and fro
before his easel, “and if you begin on dogs with William there’s no
end.”
Rose laughed, glancing from Allestree’s slightly vexed countenance
to the serenity on the brow of his cousin, who had seated himself on
the edge of an elaborate brass-bound chest which was one of the
studio properties. “I can sympathize, Mr. Fox,” she said; “we’ve
always had dogs.”
Fox gave her one of his brilliant inscrutable looks. “I entirely agree
with Lamartine, Miss Temple,” he replied; “when a man is unhappy
God gives him a dog.”
“Good Lord, Billy, are you making a bid for our sympathy?”
exclaimed Allestree with exasperation.
Both Fox and Rose laughed merrily.
“He’s only quoting the modern classics,” she replied gayly.
“What I should like to know is how he gets out of school in the
middle of the day,” said Allestree dryly; “for a man who is supposed
to be a leader, he manages to desert at the most remarkable
moments. One of the party whips told me the other day that Fox
was as hard to trail as a comet.”
“Nothing of the sort,” replied Fox, with indolent amusement; “we
adjourned over, last night, until Monday, and I came around here as
usual to sit for my portrait.”
Allestree bit his lip, conscious that his irritability was thrown into
sharp relief by his cousin’s imperturbable good humor, and resenting,
with a sting of premonition, the effect of Fox’s pose upon Rose
Temple. He was not a dull man and could not close his eyes to the
fact that she had apparently come to life, been revivified and
animated by Fox’s entrance, and he knew well enough the interest
that the touch of romance in his past history added to his cousin’s
brilliant personality. However, it was useless to sulk at the inevitable
misfortune which had destroyed his hour with Rose, and he turned
his attention to hospitality.
“Will you make tea for us, Rose, if I set the kettle boiling?” he asked,
as he drew forward the table, “I’ve got some cakes in the cupboard
and a few sandwiches.”
“Why, of course; it will be delightful,” she assented readily, rising
from her chair to help him find the tea caddy. “I’m eternally
indebted, Mr. Fox; he’s going to let me off a half-hour’s posing,” she
added, smiling over her shoulder at him.
He laughed, moving over apparently to study the half outlined
portrait on the easel, but really enjoying the sight of the graceful
figure bending over the table, and her delicate hands engaged in
opening the caddy and measuring the tea into Allestree’s old tea-
pot. As she did so the light from the window fell vividly on her bright
head, and the exquisite details of her profile, the curve of her cheek
and chin, the thick lashed white eyelids, the short upper lip, the little
pink ear, all engaged Fox’s critical and appreciative eye. Like most
men who are forced to live in bachelor apartments, he felt keenly
the domesticity of the little scene and the touch of gracious
femininity which her presence lent to the tea-table. There was a
charm, too, in her unconsciousness, and he was almost sorry when
she finally turned with a steaming cup in her hands.
“You’ll have to take lemon,” she said, “for Robert never has cream
unless it’s sour, but do you take sugar?”
“He takes three lumps to a cup,” interposed Allestree bluntly; “but
he’ll probably deny it—he’s a politician.”
Fox laughed. “And in the house of my friends!” he said; “but that is
only a coup d’état on his part,” he added, “to keep me from asking
for his last lump, Miss Temple; I saw him looking for more just now.”
“We’ll draw lots for it, Robert,” said Rose gayly, taking her seat at the
table and smiling across at Fox from pure pleasure in the little
unconventional picnic.
But Allestree’s attention had been arrested by something in the
street below, and he interrupted them with a gesture of despair.
“Mrs. Osborne is coming!” he announced with a grimace.
Rose glanced hastily at the clock. “Oh, I must be going,” she
exclaimed; “I had no idea it was so late!” and she rose hurriedly and
reached for her hat.
Allestree murmured something uncomplimentary to his approaching
visitor, and Fox set down his cup of tea. The first tremor of an
earthquake shock could scarcely have broken up the little group
more abruptly. Rose had put on her hat and adjusted her filmy veil,
and it was Fox who helped her with her coat and her furs. Allestree,
instead, threw a cloth over the picture on the easel.
Rose held out her hand. “Good-by,” she said with a charming smile;
“I know I’m a trying model, but you’re a perfect angel of patience,
Robert.”
As she spoke there was a frou-frou of skirts in the hall, and Lily
Osborne came slowly and gracefully through the portière. She was a
handsome woman with an abundance of reddish gold hair and long
black eyes which had the effect of having no white, a peculiarity
possessed by Rachel and also, we are told, by the devil.
The two women bowed stiffly and Rose slipped out, attended by Fox
and Sandy, leaving Allestree to devour his chagrin and receive his
accomplished visitor.
 IV
ALLESTREE lived alone with his widowed mother in a roomy, old-
fashioned mansion in one of the older residential sections, which
stand now like decadent environs of the more brilliant quarters
where the millionaire and the multi-millionaire erect their palaces.
But these changes, in matters of fashion and display, did not trouble
the serene bosom of old Mrs. Allestree, who felt that she held her
place in the world by the inalienable rights of birth, blood, and long
established family position, for, happily, she had as yet no notion of
the shadowy nature of such claims in the event of financial disaster,
which is as impersonal as the deluge. She was contentedly aware
that her old-fashioned drawing-rooms had been the scene of many a
brilliant gathering even before her nephew, William Fox, became
such a figure in the public eye that his frequent presence in her
house was enough to draw there the most distinguished and
representative men at the capital. But the old lady herself was
clever, shrewdly conversant with the world and its affairs, and not
averse to giving ear to the current gossip; she was, indeed, often
amused at her son’s aloofness from these worldly concerns which
pleased and interested her the most. For, though a detached
spectator, because of her age and her comparatively delicate health,
she was yet keenly aware of the drift of events both social and
political, and possessed the advantages of age in being able to make
comparisons between the past and the present, with a touch of
eclecticism amusing in one who had been so devotedly attached to
the frivolities of fashion. She could draw more accurate deductions
than many who were more intimately concerned in the whirling
conflict of social and political ambitions which was raging around her.
When the President quarrelled with the party leaders, when
Congress administered a rebuke by withholding a vote of confidence,
she was able to recall this or that parallel case, this or that
precedent for an action which to many seemed unprecedented, and
when the entertainments at the White House began to evolve a new
system of exclusions she could point out an incident when some
former President’s wife had tried to introduce a similar measure and
had met with disaster on leaving her stronghold, lost at once in the
current of a social millrace which whirls to oblivion the queen of
yesterday and the leader of to-day, engulfing all past glories in a
maelstrom of forgetfulness; the inevitable condition in a republican
society where there can be no hereditary distinction and those of
class are constantly fluctuating with the rise and fall of fortunes, the
manipulations of the Stock Exchange, while birth and breeding have
no consideration at all in comparison with the purchase power of
gold.
Fully aware of these things, and rejoicing in the rich memories of a
varied past, when she had known all the great men of her day, old
Mrs. Allestree delighted in observing the world of fashion from her
retired corner and, though devoted to her son and admiring and
believing in his talent, she sometimes suffered a keen pang of regret
that her sister and not she had borne William Fox. But she was
jealously afraid of this secret thought, scarcely admitting it even to
herself, because of her intuitive feeling that Allestree had already
suffered and might suffer more at the hands of his brilliant and
careless cousin, and that he was supremely gifted in the refinements
of self-torture.
It was twilight, and Mrs. Allestree sat alone by her drawing-room
window watching for her son’s return from his workshop. She had
been a very handsome woman, and even in age retained much of
her beauty and dignity, and her figure and face were finely outlined
as she sat against the folds of heavy velvet curtains, looking down
into the street where the lamps had just been lighted and shone
with the vivid whiteness of electricity on the smooth pavements,
while the carriages and motor-cars were beginning to wheel by on
their return from afternoon receptions, teas, and matinées. Below, at
the circle, she saw the gayly lighted electric cars sweeping around
the curve and receding to a final vanishing point of light at the top of
a distant hill, while above it the sky was still bright with the
afterglow and one star shone like the tip of a naked sword. The city
in this retired quarter showed its most kind and friendly aspect,
suggesting nothing of the struggle and rush of modern life, but only
the whirl of winter gayety, the ceaseless rounds of society.
Within was an atmosphere of repose and comfort; the tea-table was
set by the open fire, and the rose-patterned, silver tea kettle was
emitting a little cloud of steam when Allestree finally opened the
door.
“Well, mother, you here alone in the dark?” he remarked, as he
turned on some light and revealed the warm homeliness of the large
old-fashioned room, with its mahogany furniture, its soft rugs and
velvet hangings, and its long, oval mirrors framed in gold and
surmounted by cupids and lovers’ knots.
“Never less alone than when alone,” she replied brightly, and then
glancing shrewdly at his slightly perturbed expression, she added:
“you’ll take some tea, you look tired.”
“No,” he replied, throwing himself into an easy chair by the fire;
“Rose made some tea in the studio, and it’s a bit too late now for
another cup.”
“So Rose kept her appointment? I hope you got on with the portrait.”
Allestree shrugged his shoulders. “Impossible, Fox came and then
Lily Osborne. The gods don’t mean that I shall finish that picture.
And Reynolds painted several of his best in eight hours!” he added
despairingly.
But his mother ignored the latter part of his speech. “Fox?” she
glanced at him keenly, “then the House adjourned?”
“Yes, and he knew Rose was to be there,” Allestree laughed a little
bitterly; “it was the merest chance in the world, he was with me
when I met her the other day. Of course he came in as handsome,
as gay as ever—and as careless!”
Mrs. Allestree had left her seat by the window and was mechanically
pouring out a cup of tea, her fine old hands under their falls of lace
as firm and deft as a girl’s. “I wish he was less careless,” she
observed quietly; “I’ve just heard some more gossip about him;
Martha O’Neal was here to lunch. It appears that he was really
selected for the Navy, could have had the portfolio for the lifting of
his finger and, at the last moment, when there was no apposite
reason for a change, there was a deal and White got it.”
“Well, we can’t blame him for that, can we?” said her son smiling,
“you know the saying is that the Administration will not ‘stand
hitched.’”
She shook her head. “That’s not it—he made the deal himself; he
deliberately favored White, and you can imagine what is said; every
one believes that silly story that he’s desperately in love with
Margaret still, and, of course, it looks like it. He could have saved
Wingfield, and he didn’t, and you know Mrs. Wingfield hates
Margaret!”
“I don’t believe a word of it,” said Allestree calmly; “Fox is too much
of an egoist. Probably he didn’t want to go into the Cabinet; in fact
I’ve heard him say it was a safe receiving-vault for the defunct
candidates. Can’t the women ever forget that he was in love with
Margaret?”
“Possibly they could,” his mother replied shrewdly, “if Margaret
wasn’t in love with him.”
“Good Lord, how you all flatter Fox!” her son exclaimed, with
exasperation, “for my part, I can’t fancy that Margaret ever loved
him; she treated him abominably to marry White, and now she has
everything she wants, money, luxury and power; she’s a perfect little
sybarite.”
The old woman looked at him with an expression of affectionate
tolerance. “My dear boy,” she said quietly, “Margaret is wildly
unhappy; money never yet purchased happiness; that’s the reason
she behaves so outrageously. Have you heard of her latest? She
danced a kind of highland fling or a jig after her dinner the other
night. White was furious, and they’re telling a story of an open
quarrel after the musicale when he swore at her and she laughed in
his face.”
“White is a brute, but Margaret chose him with her eyes open,” he
replied, “and I think Fox feels it. At any rate there’s nothing in that
gossip about Wingfield; he had quarrelled with the President. You
know the story is that he was found walking up and down his hall,
the Wednesday after Congress met, shaking his fist and shouting
about the message. ‘That damned message!’ he said, ‘it will ruin the
party—if I’d only been here!’ He was away at the time it was written
and, of course, that paragraph did virtually condemn his
administration of the department. He had to resign; that goes
without saying!”
“I suppose so, and Mrs. Wingfield talked; we all know what a tongue
she has!”
Allestree laughed, leaning back in his chair with his hands clasped
behind his head. “Well, she’s going, anyway.”
“But she isn’t,” sighed Mrs. Allestree; “she’s to stay over two months,
heaven knows why!”
“The Lord deliver Margaret then!” exclaimed her son, still laughing.
Mrs. Allestree nodded sagely. “Margaret can hold her own though,
Robert, and everybody knows how she has insulted Mrs. Wingfield.
Margaret’s bon mots have convulsed the town time and again. You
know, as well as I do, that it was Margaret who set half the stories
going about her. Margaret can do and say the most shocking and
heartless things at one moment and be the most charming creature
at the next. She often seems to me to be a perfect Undine, to have
no soul! Really, sometimes her treatment of White is impossible.
Even Lily Osborne professes to be shocked at the dance the other
night; she told Martha O’Neal that it was as suggestive as Salome.”
“Mrs. Osborne is a hypocrite,” retorted Allestree scornfully; “by the
way, I’m to paint her portrait. I put it at a figure which, I thought,
was prohibitive and precluded all possibility of an order, but she
closed it at once, without turning an eyelash.”
Mrs. Allestree gave him a long, comprehending look. “White pays for
it then,” she remarked dryly.
“Of course,” he replied, “and White pretends to quarrel with his
wife’s wild ways!”
The old woman set down her teacup and looked mournfully into the
fire. “It’s a terrible business from beginning to end,” she said finally;
“when I think of those two poor babies! Little Estelle is just
beginning to notice things too, and Margaret seems utterly
indifferent to them. What is the world coming to?”
Allestree laughed and patted his mother’s hand. “You can’t regulate
it, mother,” he said cheerfully.
“Heaven forbid! There are too many divorces; one can’t go out now
without meeting men with two wives and women with a plurality of
husbands; yet we are objecting to seating the Mormons in
Congress!”
“After all, is a divorce worse than such a marriage as Margaret’s?”
her son rejoined, indolently enjoying the controversy.
“There should have been no marriage,” she retorted firmly, pushing
back her chair and rising with a rustle of silks, “White could never
have loved her, he hasn’t been true to her for a moment. Her beauty
pleased him, or that charm which is more subtle than beauty and
which makes her what she is. Now he’s lost his head over the
gorgeous coloring, the flesh and blood of Lily Osborne; she would
have pleased Rubens, Robert. By the way, Martha O’Neal told me of
a curious rumor about her; it is said that she is in the secret employ
of the Russian Government; you know she has no conscience.”
“A spy?” Allestree laughed, “but why here? We’ve done Russia a
good turn, it’s Japan that is chewing the rag.”
“Robert! what a disgusting expression. But of course you know the
tales of the Black Cabinet and that our embassy dispatches were
tampered with.”
“Now you’re in your element, mother; you love a mystery!”
The old woman put her hand on his head, stroking back his hair with
a fond gesture. “Tell me about Rose,” she said, watching him
narrowly, with all her maternal intuition alive; “did she sit patiently—
and will your portrait please you? That’s really the only question;
every one else is sure to be pleased.”
He shook his head. “I can’t get it to please me,” he replied quietly;
“after all, Rose’s beauty is less a question of feature than I thought.
I might interpret a soul if I were a Raphael or a Fra Angelico—as it
is, it will never look like her.”
“Nonsense! Rose is very human; don’t put her on too high a
pedestal, my dear,” his mother counselled wisely; “you are too
sensitive, too imaginative. Fox would never make the mistake of
treating a woman like a saint on a pillar!”
Allestree made an inarticulate sound and rose also. “Fox—no!” he
said a little bitterly; “Fox could make love to Saint Catherine without
offending her; he’s one of the men whom women love!”
His mother smiled but made no reply; at heart she was fully aware
that there was much truth in the saying. Old as she was, she felt the
indescribable spell of Fox’s genius, and knowing her son’s heart as
she did, she foresaw difficulties in the way of his happiness if his
cousin should forget his old love and find a new one. Much as she
had desired and endeavored to break up the unfortunate intimacy
between Fox and the Whites, she had not foreseen that her own
son’s happiness might be, in a way, dependent on Margaret’s power
to hold her place in the regard of her early lover. As she stood
looking at the fire in silence the shrewd old woman reflected that the
ways of Providence are inscrutably hard to divine and that, after all,
it is sometimes fatal to thrust one’s hand into the fire to save a
brand from the burning.
 V
THAT Mrs. Allestree’s divinations were not very far short of the truth,
or unlikely of fulfilment, would have been apparent to her could she
have looked in, a few weeks later, on Rose and Fox together in
Judge Temple’s fine old library. In the judge’s estimation the library
was the one spot of the house, the sanctum sanctorum, and its
noble book-lined walls imparted a warmth of color and an erudite
dignity to a room of fine proportions lighted by an immense
southern bow-window which overlooked the walled garden, where
Rose had cultivated every flower which blooms in summer and every
evergreen vine and ilex which lives in winter.
Over the high wide mantel was one fine old painting which testified
both to the extravagance and distinctive taste of the judge’s
grandfather, and on the book littered table stood a slender vase filled
with roses. There was an exquisite delicacy, a refinement, an
atmosphere of culture, even in such minutiæ as these, which gave a
detailed charm to the perspective of the entire house.
Rose herself sat in a high-backed chair by the open fire, her bright
head and slender figure outlined against the dark background, while
she listened, with all the freshness and enthusiasm of girlhood, to
Fox’s gay, easy talk, his dog, Sandy, lying stretched on the hearthrug
between them in the blissful content of physical comfort and the
instinctive assurance of safety and friendship which Rose’s presence
seemed to increase.
To Fox, half the girl’s charm lay in a certain rigid mental uprightness,
a clear ethical point of view, which was entirely different from the
careless tolerance of the smart set in which he had hitherto almost
exclusively moved. Fox had no religion; Rose was devout, and swift
in her denunciation of wrong, for she had all the terrible unrelenting
standards of youth and the religion of youth which is wont to be the
religion of extremes. Her character was indeed just emerging from
that raw period of girlhood which is full of passionate beliefs and
renunciations as well as a shy pride which can inflict keen mental
suffering for a little hurt; a season when the mind is wonderfully
receptive and the young, untried spirit full of beautiful inspirations,
hopes, and beliefs which are too frequently destined to woeful
annihilation in later years.
Fox had recently made a great speech, a speech which had filled
both the floor and the galleries of the House to suffocation, and
even thronged the corridors with spectators who could gain no
admittance, yet, while it had thrilled Rose’s pulses with excitement
and enthralled her with the spell of its eloquence, her rigid sense of
the proprieties had been shocked; she had felt its flowing periods its
scornful references to mysteries which seemed to Fox as rotten as
they were immaterial, and the fact that she had taken umbrage at
phrases of his, which seemed to him sufficiently innocuous to escape
all criticism, amused and pleased him. It was a new point of view;
he liked to tease her into expressing a shy opinion, or into a sudden
outburst of righteous disapproval which brought the color to her
cheek and the sparkle to her eye. It delighted him to feel that even
disapproving of him she could not hate him, for in their dawning
intimacy he found ample assurance of her liking, and the unguarded
friendliness of her feeling showed in her eagerness to win him to her
side on any mooted question.
He leaned back in his chair, watching her with a keen appreciation of
her loveliness and her unconscious betrayal of her own emotions.
“So! after all you didn’t approve of me the other day?” he said, with
perfect good humor; “you were really condemning my ethics while
you applauded—you know you did applaud, you told me you
congratulated me on my ‘great speech.’”
Rose returned his teasing look seriously. “I did congratulate you; it
was a great speech, but I didn’t like it,” she said in a low voice and
with an evident effort.
“And why?” he asked, his brilliant gaze bent more fully on her.
She turned away, her cheek red, and resting her chin on her hand
she fell to studying the fire though she was still courageous. “I didn’t
like the tone of it; you belittle your own great gifts,” she said softly,
hesitating slightly and choosing her words with care; “you make
them of your own creation when they are really given you, given you
as the five talents were given to the man in the Scriptures. You
haven’t laid them away in a napkin; why then are you ashamed to
give the glory where it is justly due? You can’t deny that there is
glory in it all!”
He smiled. “You make me feel like a thief. To be entirely honest, I’m
not religious, but I read the Bible and Shakespeare as dictionaries of
eloquence. Do you think me a dreadful sinner—worse than those on
whom the tower of Siloam fell?”
Rose bit her lip. “I’ve no doubt you think me a hypocrite!” she
replied.
“I should like to tell you what I think of you,” he said softly, leaning
forward, his elbows on his knees, looking across at her, “but I’m
afraid—afraid of you!”
She laughed a little with a charming diffidence, for she had met the
sweetness of his glance which was full of gentle admiration.
“I sometimes wonder,” he continued, “how you would meet a great
moral question which involved your happiness and, perhaps, that of
another whom you loved.”
She shivered a little, stretching out one slender hand to the fire.
“Ah,” she said, with a faint smile, “I hope I may never meet such a
question! I see you make me a Pharisee.”
“God forbid!” he replied quickly, “you belong rather to the Christian
martyrs; I’m either a Barbarian or a Scythian!”
They both laughed softly at this, and Rose forgot her momentary
embarrassment. “I should try to be just!” she said.
He shook his head with that rare smile of his which seemed half
mocking, half caressing. “You couldn’t be!” he retorted provokingly,
“you are a little Puritan, narrow, firm, righteous; I begin to be more
and more afraid of you!”
She lifted her chin. “You think me too narrow to be just? Isn’t that
the charge that you worldlings always bring against—against—”
“The righteous?” he supplied quickly.
They laughed again. “You convict me out of my own mouth; I shall
dare no more arguments!”
“Ah, now you know how I feel under your criticisms!” he flashed
back at her.
His manner wore its happiest aspect, it was delightful to be with her;
through all contradictions he began to feel the temperamental
sympathy, and she, too young to understand these subtleties, was
aware of the glow and warmth of his presence, the sweetness of his
manner which could be, when he was neither stern nor angry nor
self-absorbed, one of a delicacy and sentiment uncommon in a man;
with all his egotism, his spoiled acceptance of the world’s homage,
he retained qualities that were inherently noble and lovable.
“But I have more reason,” she declared with warmth, “it’s unworthy
of you to espouse any cause for the mere sake of party, ‘to stand
pat’ when your heart is against the issue; I don’t believe in it!”
“You have been reading revolutionary documents; you are full of this
new heresy,” he retorted, still laughing softly; “you are like some of
the new politicians; they pull down the pillars of the temple on their
own heads.”
She leaned forward eagerly, her eyes sparkling. “Do you know what
this party worship reminds me of?” she said, “this devotion in a man
to his party? The tomb of Rosicrucius and the statue which crushed
the worshipper who entered there! So your party’s graven image
crushes out a man’s originality.”
“Little heretic!” he mocked, “little revolutionist! A party is a great
machine; we can’t do without it!”
She shook her head vehemently. “The children of Israel thought they
couldn’t do without the golden calf! You were not so strong a party
man five years ago, do you remember?”
He looked at her quickly. “Do you?”
“I read your speeches,” she confessed with charming ingenuousness,
her eyes kindling with emotion; “I read the first speech they ever
printed in the newspapers here. I’ve wanted to tell you how
beautiful I thought it, how eloquent!”
He regarded her a moment in silence; he felt suddenly that there
had always been a link between them, that across space and time
he had spoken not to the public but to her, and even been
understood by her; that the virgin whiteness of her young soul had
received the inscription of his mind. Then he was as suddenly and
vividly conscious of his folly, his egotism, his unworthiness! She was
too lovely and too innocent to have received the impression of his
spirit; and he—the thought of his careless life, his worship at
Margaret’s shrine, the strength of the old fetters which bound him,
made him suddenly humble. And then, the beauty of her smile, the
warm sympathy of her temperament created an angry impatience of
such restrictions; with characteristic scorn of conventionalities he
thrust them aside. The perfect innocence and spontaneity of her
praise and appreciation was the most subtle of all flattery, and he
possessed the temperament of genius which is, at one moment,
above the consideration of either praise or blame and the next
quivers with sensibility at the breath of either. He returned her shy
but glowing look with one of unusual humility. “I feel as if I didn’t
deserve it,” he said gently; “it is an exquisite happiness to be praised
by you!”
She smiled. “And I feel ashamed to have set myself up as a judge,”
she replied quickly, “but it was because—because I didn’t want you
to fall below your own standard! You see what it is to have a record
of great achievements.”
“Hereafter I shall only seek to deserve your praise,” he rejoined, “but
I feel myself a sublime egoist; I’ve sat here talking of myself, of my
work, and meanwhile I remember that my aunt told me of your
voice. Why do you never sing for me?”
“Because you have never asked me,” she replied simply, with an
involuntary smile.
Fox leaned toward her with an eloquent gesture of appeal. “Did I
deserve that? Am I such a miserable egoist?” he exclaimed, and
then: “I ask you now.”
Rose was entirely unaffected, and she went at once to the piano in
the room beyond, and seating herself began to play the first soft
notes of a prelude. Fox had followed her and took his place near the
instrument, again observing her with keen appreciation; her
sweetness, her whiteness of soul had taken possession of his
imagination with a force which he had supposed, until this moment,
impossible. For, after one bitter and humiliating experience in the
drama of love and passion, he had withdrawn with seared
sensibilities, and assuming a new attitude had regarded women as a
detached spectator, fancying that he possessed a high degree of
eclecticism in comparing the emotional phases of their existence
which should be henceforth quite apart from his; love and marriage
were mere episodes in a man’s life, and feeling no need of assuming
either the duties or the responsibilities of the latter state he had not
seriously contemplated the former as anything but a remote
possibility. Besides, in a curious way, his life seemed to be linked
with Margaret White’s; she continued to make claims upon him, to
tacitly presuppose his devotion, and he had been too uncertain of
himself, too indolent, too easily drifting with the tide to make any
effort to free himself from the shackles of that old love affair. But all
these things slipped out of mind as he sat listening to Rose’s song.
It was a simple Italian love-song, soft, caressing, gently plaintive,
and peculiarly suited to her voice, but the air and the words were
nothing compared with that voice. When Mrs. Allestree spoke of it,
Fox had thought of it as the usual vocal accomplishment of a raw
schoolgirl, something young and sweet, no doubt, but full of crudity
and weakness. Instead, he was suddenly aware that he was listening
to a voice which had a scope and richness beyond any that he had
ever heard except in opera, and there were but few of the great
singers who had such a gift as this. The thrill and exquisite freshness
of its tones touched his very soul. He found himself listening with a
keen feeling of depression; this gift of hers lifted her at once into
another sphere than his, and he reflected that her beautiful body
was an exquisite envelope for the spirit, her voice its divine
interpretation.
His mind drifted back to the sweeter and more sacred relations of
life, to those simple emotions which approach more nearly the
divine. The complex affairs of the world, of politics, passion, intrigue,
slipped away from him, and the holier aspects of a pure and devoted
life took visible shape to his imagination in this young and beautiful
girl. He had never fully appreciated his own susceptibility to the
uplifting power of music, and the charm of her voice seemed more
poignant because so unexpected; he lost himself in a delightful
revery, the poet in him awoke with a thrill of pleasure,—the joy we
feel in discovering a new power, a larger grasp; he was no longer
conscious of his surroundings, but only of the supreme delight of her
presence.
As she finished singing, her hands slipped from the keys into her lap
and she turned and looked at him, smiling, expecting some
applause, unconscious of the depth of his emotion. For a moment he
said nothing, then he rose and held out his hand, his eyes eloquent
of feeling.
“Exquisite!” he said, and she blushed with pleasure, knowing that he
could not express his appreciation in words.
She laid her hand in his, rising too. “Thank you,” she exclaimed, “I’m
so glad!”
As she spoke and while he still held her hand, intending to tell her
how profoundly she had moved him, they were both suddenly aware
of some one’s entrance, and turned to see Mrs. White standing just
inside the drawing-room door. She had entered unannounced, and
stopped abruptly as she came upon the little scene. She was
elaborately dressed in black velvet with ermine furs, and an
immense bizarre hat of violet velvet and chiffon with masses of
violets on the wide brim. Under her arm was a toy Pomeranian as
black as her gown and as glossy as silk, its little black head just
appearing over her immense ermine muff. She had evaded the
servant’s intention of announcing her, she had thought only of
surprising Rose at her music and had come upon this! She stood
still, a sudden spiritual perception sweeping over her and thrusting a
blade of agony into her heart. Every vestige of color ran out of her
cheeks, her gray eyes dilated. When they turned they surprised a
look on her face which distorted its usual gayety and defiance. Then
she thrust it aside with a great effort of will, with the force of a new
and vivid determination, and greeted their amazement with her light
little laugh.
“Caught!” she said, “next time I shall send a footman—or ring a
bell!”
Rose came forward with a blushing but eager welcome, but Fox
stood in a moment of awkwardness which both vexed and amused
the woman. Men have no resources, she thought bitterly.
As for him he experienced a shock of dismay; he was trying to shake
off a vague feeling which possessed him that he had no right to be
there, that he owed allegiance still to Margaret, that her look, her
manner, her very presence demanded it while, in fact, she had long
ago forfeited all claims upon him.
Meanwhile she had led the way back to the library, driven Sandy
away from her Pomeranian, and was seated in Rose’s chair, an
elegant and conspicuously important figure, at once the centre of
the stage; she had one of those personalities which are immediately
predominant in society. “So,” she said lightly, “this is why William
deserted my Sunday afternoons; I should have looked for him in
vain!”
“It seems you are yourself a deserter,” Fox retorted, “this is your day
at home.”
“You thought me safely anchored?” she laughed, with a little
mocking intonation, caressing the Pomeranian’s ears; “I should be,
but I had to make a call of condolence. Wicklow insisted; you know
he’s so conventional and so determined upon being the popular
public man! Mrs. Wingfield lost her grandmother two weeks ago so,
of course, I must call and make my condolences!”
Fox laughed softly; her manner brought back the normal tone of
affairs and he knew her moods to perfection. “Of course you
condoled?” he said.
She shrugged her shoulder, looking at Rose. “My dear,” she said,
“you will be interested; no mere man could understand. I’ve always
been uncertain in my mind about the correct mourning for a
grandmother; now I know,—it’s settled beyond appeal.”
“By Mrs. Wingfield?” Rose smiled her incredulity.
“By Mrs. Wingfield—it’s shrimp pink!” Margaret said, “she had on a
tea-gown with lace ruffles; it was a violent, vivid shrimp pink, and
her nose was red. Of course I said all manner of appropriate things.
Everybody stared, then I made a grand finale and departed. She was
furious. And Wicklow sends me out to make his way for him!” and
she threw out her hands with a little gesture of mock despair.
“Why do you tease that poor soul so?” Rose protested laughing, “she
falls an easy prey, too. I heard they were going abroad soon.”
“In three months,” Margaret said, “to the Riviera; they tried
Switzerland, she told me, a year ago, but she found ‘it wasn’t really
fashionable.’”
“Margaret!” Rose shook an admonishing finger, “you make her say
such things, you know you do!”
Mrs. White raised her eyebrows, her eyes haggard. “One would
suppose me a Sapphira. She truly said it and I kept on asking her
what she said; she repeated it twice,—they were all listening of
course, and M. de Caillou tried to look plaintive.”
“He’s solemn enough anyway, Margaret,” Fox said, amused; “he
might well be shocked at your levity.”
“Oh, I always want to make him sit up and beg for a lump of sugar,”
she retorted scornfully.
As she spoke she rose and went to the window, looking out with an
abruptness of manner which seemed to take no account of their
presence. She was struggling with an overwhelming dread; with the
keen intuition of unhappiness she read Fox’s mood, and her very
soul cried out against it. But she was an actress, an actress of long
training and accomplishment. She turned carelessly, lifting her
Pomeranian to her shoulder and resting her cheek against its long
black fur. “There’s my motor back,” she said, catching a glimpse of it
through the long window in the drawing-room. “I’m going home to
receive Wicklow’s public. Can I borrow Fox, Rose?”
Rose turned easily, mistress of herself and aware of his annoyance,
keenly alive to the possibility that his old love for Margaret might still
be a factor in his life. “I’m afraid I haven’t asked Mr. Fox to take a
cup of tea,” she said laughing; “father is late and you know we dine
early on Sundays; we’re very unconventional and old-fashioned.”
Margaret was trailing slowly to the door, her velvet draperies and her
long ermine stole seeming heavy and burdensome on her slender
figure. “Oh, I know,” she retorted, “you’re Old Testament Christians;
I’m always expecting to see the scapegoat caught in your fence-
railing! In spite of my shortcomings though, you are going to sing
for me some Sunday, Rose, and make my sinners think they’ve
found the gate of Paradise.”
But Rose shook her head, laughing. “Ask father,” she said; “he
declares that I shall not exhibit!”
 VI
“MAMMA, give me the beads!”
Margaret turned reluctantly and looked down at the child, a girl
between five and six years old, without even the ephemeral beauty
of babyhood, and showing already a strong resemblance to her
father. “By all means, only don’t swallow them; it’s after the doctor’s
office hours,” she replied carelessly.
She was seated before her toilet-table clad in a silk kimono, and her
maid had just finished doing her hair and gone in search of some
minor accessories of the toilet, for her mistress was dressing for a
large dinner at Mrs. O’Neal’s. Meanwhile Margaret sat looking into
the oval mirror in front of her, making a keen and critical survey of
her own face and figure. As she did so she moved a candle slightly,
and thus throwing a stronger light on her features was startled by
the haggard look in her eyes, the purple rings beneath them, the
hollowing of her cheeks. Was she beginning to lose her beauty? The
thought alarmed her, and she leaned forward looking at herself more
closely. Yes, there were lines, and she was thin, deplorably,
unquestionably thin. The vivid misery of her expression in this
unguarded moment was apparent even to her. Heavens, did she look
like that to others? The thought was pregnant with fierce
mortification; she must be wearing her heart upon her sleeve! And
Fox? Was she losing him? The keen pang of agony which had shot
through her at the sight of Fox and Rose together, at the glimpse of
that little scene by the piano, recurred to her with a burning sense of
humiliation. Was she to taste this bitter cup also?
She had known for years the miserable mistake of her choice of
White, she had grovelled in the dust of repentance, but there had
been one drop of honey in the cup of gall, one saving grace in the
situation; she was sure that Fox still loved her, that he would be true
to her. No other woman had been set up in her shrine. She knew
how deep the hurt had been, and she had fondly believed that she
alone could heal it. Through all those arid years, those years of
gayety, of luxury, of false happiness and false show, she had hugged
her secret to her heart; Fox still loved her!
And now? What had she read in the kindled sympathy of that look at
Rose Temple? She bit her lip, staring into the mirror with haggard
eyes. Could he give her up? She, who knew so much of the brutal
egotism of which a man can be capable, she who had seen such a
nature as White’s revealed in the scorching intimacy of married life,
—dared she picture Fox as unselfish enough to be still true to her, to
content himself with comforting her wretchedness when love and
youth and beauty—beauty such as she had never worn—might be
his? Her sore heart throbbed passionately in her bosom. She had
expiated her mistake, she had suffered for her fault, she had a right
to be happy! She would be happy; it is the eternal cry of the human
soul. “Every pitifullest whipster,” says Carlyle, “seeks happiness, a
happiness impossible even for the gods.” And Margaret’s wilful soul
cried out for happiness; why should it not be hers? She was
shackled, it was true, with fetters of her own forging, but—the eager
thought of liberty darted through her mind like an arrow—others had
been so bound and were now free, others were making new lives
out of the old, and the ease with which such ties can be dissolved
was not the least of her temptations.
Her glance fell suddenly on the child, Estelle, playing soberly with
the amethyst beads which she had begged for. The little girl had
learned to be quiet; if she was noisy or in the way she was
immediately dismissed to the nursery, and she had her lesson by
heart; she was making no noise but a soft crooning sound as she
fondled the beads. Her hair was flaxen, her face dull and not pretty,
her eyes like her father’s. Margaret shuddered and averted her gaze;
how cruel that she should look like him! And the baby, only two
years old but already like him; she felt it her curse, the retribution of
her loveless marriage, that these two living and visible links to bind
her to her vows were both like the man she had married without
love and without respect, because she could not give up her life and
its luxuries to be poor. A marriage with Fox then would have meant
the renunciation of everything which seemed to her essential to
existence, it would have combined the miseries of cheap living and
self-denial, of small and hideous economies, which made her
shudder even to contemplate; she had always been a sybarite.
Brought up by an extravagant, pleasure-loving mother, by a father
who had spent all to live well, Margaret had been unable to conceive
anything more horrible than genteel poverty, and White had offered
her a dazzling vista of wealth, position, social success. She was very
young, raw, untried, and the temptation had been too great.
As she sat there, idly, at her toilet-table, surrounded by all the
beautiful and splendid luxuries of a boudoir which had been fitted up
with reckless expense to meet her whims and self-indulgences, she
remembered with keen self-contempt her excitement over her own
magnificent wedding, her tour through France and Italy in a motor-
car which had cost a fortune; then a keen pang wrung her heart as
she remembered the boy they had killed in the little crooked Italian
village and the people who had stoned them! She had felt it then as
a cruel prognostication of ill luck, a terrible beginning of her married
life and now, whenever she closed her eyes, she could see again the
narrow street, the brown Italian houses, that seemed ready to
topple over on them, the children playing, the vivid sky above—then
the cry, the awful scene, the child’s dead face. She shuddered; so
had her gilded dream of happiness ended; a cry, a rush of misery,
and now her sore heart to hide, the dance of death to go on to the
end unless—again came the haunting thought; it had beset her
lately, tempted her, teased her. It was so easy, it would be so easy to
break the bonds, and who could blame her? To be happy!
“Mamma, it broke!” Estelle cried suddenly, with a quivering lip, “I
didn’t do it!”
Margaret turned and looked at her. “No matter,” she said strangely,
“it broke easily, didn’t it, Estelle? Thank heaven, one can break
chains!”
As she spoke there was a knock at her door, and White himself
entered. He was not a large man but his face was broad and heavy,
his hair had been light but was now gray above the ears, and his
jaws were slightly purpled by high living. There were some who
thought him distinguished, chiefly those who always perceive a halo
around officialdom and wealth. Actually he belonged to that type of
man who has been in clubs, political and social, from boyhood, who
has unlimited money, a mighty egotism and the unfailing preference
for his neighbor’s wife. Meeting Margaret’s challenging glance he
paused near the door, his hand on a chair, and looked at her with a
cold fixed eye which neither changed nor wavered as he spoke.
“I have something to say to you,” he began in a hard dry tone; “it
seems to me about time to speak out. I don’t know what’s come
over you; you’re clever enough, but you seem to forget that I’m a
public man. You were absolutely rude at the reception this
afternoon, and your whims are intolerable. It’s all very annoying! If I
choose to open my house to the public I expect my wife to accept
the rôle and then to play it to the end.”
Margaret looked at him. “I fail to understand you,” she said
ironically; “is this a lecture?”
“You may call it what you please,” he retorted angrily, walking to and
fro; “you know well enough!”
She shrugged her shoulders. “I’m dressing for dinner—you’d better
wait until another time,” she remarked with a yawn.
“There’s no time like the present,” he said harshly; “your manners
were detestable to-day; you treated people like dogs!”
She laughed bitterly. “For instance?” she said, “Lily Osborne?”
“Mrs. Osborne knows better than to care!”
“She should!” Margaret mocked, “she should expect it; I
congratulate you on her admirable humility.”
He gnawed his lip, the veins swelling in his forehead. “I warn you!”
he cried fiercely, “I will not permit such behavior—your dance at the
musicale is the talk of the town, and now you receive people who
come here with indifference—and I’m a Cabinet minister!”
“Which is a miracle!” his wife replied, laughing softly and
provokingly; “you made a mistake in your marriage, Wicklow; you
should have chosen a more popular person.”
“I’m aware of my mistake!” he retorted, still walking, and picking up
first one knick-knack and then another and setting them down
again; “I was a damned fool! I thought you witty and fond of
society; I fancied you a success and you can be one if you choose,
but everything’s upside down with your whims. You keep Fox
hanging around here—you know that he and I are at sword’s points
in politics, you know that he—”
“Leave him out please!” Margaret interposed in a cold, hard voice.
She had risen and her eyes glowed with passion.
White turned a lowering look on her. “Fox didn’t marry you!” he said
cuttingly, “he was too wise!”
She made no reply; she could have answered that she had given up
Fox to marry him, but the sting of the insult cut her to the quick, his
allusive familiar tone was a whiplash. She turned away, her white
face set, a singular light in her eyes. The passion of her hatred of
him at that moment was almost beyond restraint; her very flesh
quivered under the throb of her maddened nerves. His coarseness,
his brutality, his sensuousness revolted her; she felt, under the sting
of his lecture, a mere bondswoman, and her fetters fairly burned
into her soul. It seemed to her that she could no longer breathe the
same air with him.
The child caught her sleeve timidly. “Mamma, don’t!” she whispered,
“please don’t make papa look so—I’m afraid!”
Margaret looking down at her saw anew that hateful likeness. “Go
away!” she shuddered, “you’re just like him—I can’t bear it; go, I tell
you!”
The child’s hand dropped and her lip quivered with impotent
anguish; she could not understand, but she read her mother’s
chilled, repellant look and it frightened her still more; she drew her
arm across her face and fell away with a sob. Margaret, whose heart
would have been touched at another moment, hardly heard her.
“I want you to understand,” White began again, angrily, unmindful of
the little girl’s presence, “my position. I’m a—”
Margaret interrupted him with an impatient gesture. “Gertrude is
coming with my gown,” she said coolly, “I think you may spare me
any more at present.”
White turned with a frown, and seeing the maid at the door with her
arms full of white satin and lace, he gave way with a growl of
discontent while his wife smiled calmly at the startled girl and bade
her hurry; it was nearly eight o’clock.

At the dinner Margaret was the most conspicuous and observed

figure at the table; she was strikingly dressed in white satin, her lace
bodice fastened on the shoulders with jewels, her long, slender
throat wound with pearls, and the black lace scarf—which she wore
in deference to her hostess who was dining a cardinal—only
accentuated the peculiar pallor of her face and the whiteness of her
bare arms. She was radiant, witty, vivacious; her reckless tongue
never ceased its unmerciful chatter. She talked Spanish to the
Spanish ambassador, Italian to the Papal delegate who sat opposite,
she entertained the cardinal. Every eye was on her; she was at once
the most unusual and the most talked of woman in Cabinet and
Diplomatic circles, and she had a wit as keen as it was unmerciful.
White watched her with an increasing feeling of uneasiness, he read
defiance in her manner and began to dread some overt challenge;
he had been untimely in his remonstrance, and he felt it too late.
Meanwhile their hostess loved the fair offender, and aided and
abetted her in her wild sallies. Martha O’Neal was an old, old
woman, the widow of a famous and wealthy jurist, and she was
herself famous as a hostess and a social leader. Her eyes were still