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 SECOND EDITION

Davis | Blankenbaker
ii
 SECOND EDITION

Kirkland W. Davis, MD, FACR

Professor of Radiology
Musculoskeletal Imaging and Intervention
Department of Radiology
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin

Donna G. Blankenbaker, MD
Professor of Radiology
Musculoskeletal Imaging and Intervention
Department of Radiology
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin

iii
 1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899

EXPERTDDX: MUSCULOSKELETAL, SECOND EDITION ISBN: 978-0-323-52483-4

Copyright © 2018 by Elsevier. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including
photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details
on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations
such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/
permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be
noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices,
or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the manufacturer
of each product to be administered, to verify the recommended dose or formula, the
method and duration of administration, and contraindications. It is the responsibility of
practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to
take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and/or damage to persons or property as a matter
of products liability, negligence or otherwise, or from any use or operation of any methods,
products, instructions, or ideas contained in the material herein.

Publisher Cataloging-in-Publication Data

Names: Davis, Kirkland W. | Blankenbaker, Donna G.

Title: ExpertDDx. Musculoskeletal / [edited by] Kirkland W. Davis and Donna G. Blankenbaker.
Other titles: Musculoskeletal.
Description: Second edition. | Salt Lake City, UT : Elsevier, Inc., [2017] | Includes
bibliographical references and index.
Identifiers: ISBN 978-0-323-52483-4
Subjects: LCSH: Musculoskeletal system--Diseases--Diagnosis--Handbooks, manuals, etc. |
Diagnosis, Differential--Handbooks, manuals, etc. | MESH: Musculoskeletal Diseases--
diagnosis--Atlases. | Musculoskeletal System--Atlases.
Classification: LCC RC925.7.E96 2017 | NLM WE 17 | DDC 612.7022’2--dc23
International Standard Book Number: 978-0-323-52483-4

Cover Designer: Tom M. Olson, BA

Printed in Canada by Friesens, Altona, Manitoba, Canada

Last digit is the print number: 9 8 7 6 5 4 3 2 1

iv
 Dedications
I owe a debt to all the colleagues, fellows, and residents with whom I have worked
along the way and who have helped grow my knowledge and love for musculoskeletal
radiology. I especially offer thanks to my mentors: Drs. Felix S. Chew and Carol A.
Boles from residency, Charles S. Resnik and Michael E. Mulligan from fellowship, and
Arthur A. De Smet from my early career. In addition, Donna Blankenbaker has been
a fantastic partner on this project and remains a great teammate, as she has been
throughout my career. Finally, I couldn’t do any of this without the love and support of
my wonderful children and especially my lovely wife, Jenni. Thank you.

KWD

To CMS for all of your support. I want to thank all of the authors for their
dedication to this project as well as my co-editor Kirkland Davis for his unwavering
work on this project.

DGB

v
vi
Contributing Authors
Carol L. Andrews, MD
Associate Professor
University of Pittsburgh School of Medicine
Chief, Division of Musculoskeletal Radiology
UPMC Department of Radiology
Pittsburgh, Pennsylvania

Robert Downey Boutin, MD

Chief, Musculoskeletal Radiology
Clinical Professor of Radiology
University of California, Davis School of Medicine
Sacramento, California

Julia R. Crim, MD
Chief of Musculoskeletal Radiology
Vice Chair for Clinical Affairs
Professor of Radiology
University of Missouri at Columbia
Columbia, Missouri

Michael Mulligan, MD
Professor
Department of Radiology and Nuclear Medicine
University of Maryland School of Medicine
Chief, Radiology Kernan Hospital/UMROI
Assistant Chief of Musculoskeletal Imaging UMMC
MSK Fellowship Program Director
Baltimore, Maryland

Cheryl A. Petersilge, MD, MBA

Clinical Professor of Radiology
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
Chair, Department of Radiology
Hillcrest Hospital
Cleveland, Ohio

Additional Contributors
B.J. Manaster, MD, PhD, FACR
Catherine C. Roberts, MD

vii
viii
 Preface
There is no doubt that interpreting radiology studies presents many challenges. One of those challenges
is the disparate array of diagnoses that may be responsible for a particular imaging finding, clinical sign, or
symptom. Musculoskeletal radiology is no exception to this rule; in fact, many of the differential diagnoses
that occur in musculoskeletal radiology are among the most lengthy and complex in the industry.

Radiologists and other practitioners who employ radiology in the care of their patients may develop their
own short lists of possible diagnoses for various radiologic findings and clinical presentations; however,
unique cases will always arise that fall outside a practitioner’s experience and knowledge base irrespective
of one’s level of expertise. When appropriate, one should still endeavor to generate a reasonable differential
diagnosis for the problem at hand. It is our ambition that this text/atlas will serve as the most helpful resource
for that purpose.

One of the difficulties associated with constructing a reference for differential diagnoses in radiology lies
with the question of scope: If one purely lists a series of differential diagnoses for a specific finding or
scenario, the reference will not provide enough information for the practitioner to narrow the differential
sufficiently. Alternatively, providing complete information about diagnosing every entity in every differential
list would make the reference far too voluminous to be practical. As with all the texts in the ExpertDDx series,
this second edition of ExpertDDx: Musculoskeletal seeks to strike an appropriate balance. The differential
diagnosis lists are complete though not always exhaustive. Within each list, the diagnoses are separated
into common, uncommon, and rare but important presentations. Each chapter provides additional details
about the individual diagnoses that may help the reader to recognize a specific entity or narrow the list of
possibilities by including some and excluding others, and sometimes suggest other imaging studies or body
parts to examine to further assess the possible diagnosis. Imaging examples are provided for most of the
diagnoses in every list. If the reader desires a more in-depth discussion of a diagnosis, the electronic version of
this text has links embedded to additional resources that allow for a more complete discussion of individual
entities.

Several new chapters have been added to the text since the first edition, and thousands of new cases have
been added to supplement the best of the cases from the first edition. We strove to achieve a fresh look at all
the material. To that end, although we have been fortunate to retain two of the authors from the first edition,
Carol L. Andrews, MD and Cheryl A. Petersilge, MD, they took on completely different sections of the work. In
addition, Michael E. Mulligan, MD, Robert Downey Boutin, MD, and Julia R. Crim, MD lent their considerable
expertise in musculoskeletal radiology to the work. We are grateful to all of the authors for contributing their
extensive knowledge and all of the time and effort they spent on the project.

When an oncologist, rheumatologist, or endocrinologist poses a question to us about a difficult case, we often
find our greatest satisfaction in guiding them to the correct diagnosis for their patients. It is our great hope
that this text will be a uniquely helpful resource for many and assist the reader in improving patients’ lives.

Kirkland W. Davis, MD, FACR

Professor of Radiology
Musculoskeletal Imaging and Intervention
Department of Radiology
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin

Donna G. Blankenbaker, MD
Professor of Radiology
Musculoskeletal Imaging and Intervention
Department of Radiology
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin
ix
x
Acknowledgments
Lead Editor
Nina I. Bennett, BA

Text Editors
Arthur G. Gelsinger, MA
Terry W. Ferrell, MS
Lisa A. Gervais, BS
Karen E. Concannon, MA, PhD
Matt W. Hoecherl, BS
Megg Morin, BA

Image Editors
Jeffrey J. Marmorstone, BS
Lisa A. M. Steadman, BS

Illustrations
Richard Coombs, MS
Lane R. Bennion, MS
Laura C. Wissler, MA

Art Direction and Design

Tom M. Olson, BA
Laura C. Wissler, MA

Production Coordinators
Rebecca L. Bluth, BA
Angela M. G. Terry, BA
Emily C. Fassett, BA

xi
 Sections
PART I: Anatomy Based
SECTION 1: Flat Bones
SECTION 2: Long Bone, Epiphyseal
SECTION 3: Long Bone, Metaphyseal
SECTION 4: Long Bone, Metadiaphyseal and Diaphyseal
SECTION 5: Long Bone, Growth Plate
SECTION 6: Periosteum
SECTION 7: Joint Based
SECTION 8: Shoulder Girdle and Arm
SECTION 9: Elbow and Forearm
SECTION 10: Wrist and Hand
SECTION 11: Fingers and Toes
SECTION 12: Intervertebral Disc
SECTION 13: Paraspinal Abnormalities
SECTION 14: Vertebral Shape
SECTION 15: Vertebral Lesions
SECTION 16: Ribs
SECTION 17: Pelvis
SECTION 18: Hip and Thigh
SECTION 19: Knee and Leg
SECTION 20: Foot and Ankle

xii
 PART II: Image Based
SECTION 1: Radiograph/CT, Osseous
SECTION 2: Radiograph/CT, Soft Tissue
SECTION 3: MR, Osseous
SECTION 4: MR, Soft Tissue
SECTION 5: MR, Joint
SECTION 6: Ultrasound
SECTION 7: Nuclear Medicine

PART III: Clinically Based

SECTION 1: Shoulder and Arm
SECTION 2: Elbow and Forearm
SECTION 3: Wrist and Hand
SECTION 4: Pelvis, Hip, and Thigh
SECTION 5: Knee and Leg
SECTION 6: Ankle and Foot
SECTION 7: Spine
SECTION 8: Systemic Disease

xiii
 TABLE OF CONTENTS

Part I: Anatomy Based SECTION 4: LONG BONE,

METADIAPHYSEAL AND DIAPHYSEAL
SECTION 1: FLAT BONES 76 Long Bone: Central Diaphyseal Lesion,
4 Flat Bones: Bubbly Lesion With Expansile Nonaggressive
Remodeling Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR 80 Long Bone: Diaphyseal Lesion, Aggressive: Adult
10 Flat Bones: Permeative Lesion Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR 86 Long Bone: Diaphyseal Lesion, Aggressive: Child
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
SECTION 2: LONG BONE, EPIPHYSEAL 90 Long Bone: Aggressive Diaphyseal Lesion With
Endosteal Thickening
18 Long Bone: Irregular or Stippled Epiphyses
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
92 Long Bone: Cortically Based Diaphyseal Lesion,
22 Long Bone: Epiphyseal Overgrowth/Ballooning
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR Sclerotic
24 Long Bone: Sclerotic/Ivory Epiphysis Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR 96 Long Bone: Cortically Based Diaphyseal Lesion, Lytic
28 Long Bone: Epiphyseal/Apophyseal/Subchondral Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
102 Tibial Metadiaphyseal Cortically Based Lesion
Lytic Lesion
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
104 Long Bone: Diffuse Cortical/Endosteal Thickening
SECTION 3: LONG BONE, METAPHYSEAL Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
MD
34 Long Bone: Metaphyseal Bands & Lines 108 Long Bone: Undertubulation
Cheryl A. Petersilge, MD, MBA and Carol L. Andrews, MD Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
38 Long Bone: Metaphyseal Cupping 114 Long Bone: Overtubulation
Cheryl A. Petersilge, MD, MBA and Michael Mulligan, MD Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
40 Long Bone: Metaphyseal Fraying
Cheryl A. Petersilge, MD, MBA and Michael Mulligan, MD SECTION 5: LONG BONE, GROWTH PLATE
42 Long Bone: Central Metaphyseal Lesion,
120 Growth Plate: Premature Physeal Closure
Nonaggressive
Carol L. Andrews, MD
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
122 Growth Plate: Widened Physis
48 Long Bone: Central Metaphyseal Lesion, Aggressive
Robert Downey Boutin, MD and B.J. Manaster, MD, PhD,
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
52 Long Bone: Metaphyseal Lesion, Bubbly FACR
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR SECTION 6: PERIOSTEUM
56 Long Bone: Eccentric Metaphyseal Lesion,
Nonaggressive 128 Periosteum: Aggressive Periosteal Reaction
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
60 Long Bone: Eccentric Metaphyseal Lesion, MD
Aggressive 132 Periosteum: Solid Periosteal Reaction
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
64 Long Bone: Cortically Based Metaphyseal Lesion MD
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR 138 Periosteum: Bizarre Horizontal Periosteal Reaction
68 Long Bone: Surface (Juxtacortical) Lesion Robert Downey Boutin, MD and B.J. Manaster, MD, PhD,
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR FACR
142 Periosteum: Periosteal Reaction Multiple
Bones/Acropachy, Adult
Robert Downey Boutin, MD and B.J. Manaster, MD, PhD,
FACR

xiv
 TABLE OF CONTENTS
146 Periosteum: Periosteal Reaction Multiple Bones, 236 Glenohumeral Malalignment
Child Robert Downey Boutin, MD
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR 238 Anterosuperior Glenoid Labrum
Variations/Pathology
SECTION 7: JOINT BASED Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
152 Arthritis With Normal Bone Density MD
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR 242 Fluid Collection About Shoulder
156 Arthritis With Osteopenia Michael Mulligan, MD and Carol L. Andrews, MD
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
160 Arthritis With Productive Changes SECTION 9: ELBOW AND FOREARM
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR 248 Dysplasia/Aplasia of Radius
164 Erosive Arthritis Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR MD
170 Mixed Erosive/Productive Arthritis 250 Forearm Deformity
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
172 Arthritis With Large Subchondral Cysts MD
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
176 Atrophic Joint Destruction SECTION 10: WRIST AND HAND
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts, 256 Cystic/Lytic Lesion in Carpal Bone
MD Kirkland W. Davis, MD, FACR and Cheryl A. Petersilge,
180 Arthritis Mutilans MD, MBA
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts, 258 Abnormal Radiocarpal Angle
MD Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
182 Neuropathic Osteoarthropathy MD
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
184 Arthritis With Preserved Joint Space SECTION 11: FINGERS AND TOES
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
264 Arachnodactyly
188 Widened Joint Space
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
266 Soft Tissue Mass in Finger
MD
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
194 Ankylosis
MD
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
272 Acro-Osteolysis
198 Intraarticular Mass
Carol L. Andrews, MD
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
276 Acro-Osteosclerosis
202 Calcified Intraarticular Body/Bodies
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
MD
206 Chondrocalcinosis
278 Cystic/Lytic Lesion in Phalanx
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
208 Periarticular Calcification
284 Sesamoiditis
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
214 Metacarpophalangeal Joint-Predominant Arthritis
286 Short Metacarpal/Metatarsal
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
216 Interphalangeal Joint-Predominant Arthritis
290 Ulnar Deviation of MCP Joints
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
220 Monoarthritis
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR MD
224 Joint Replacement With Lytic/Cystic Lesions 292 Swelling & Periosteal Reaction of Digit (Dactylitis)
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR

SECTION 8: SHOULDER GIRDLE AND ARM SECTION 12: INTERVERTEBRAL DISC

228 Clavicle Lesion, Nonarticular 296 Lesion Crossing Disc Space
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD, Julia R. Crim, MD and Cheryl A. Petersilge, MD, MBA
298 Disc Mineralization
MBA
Julia R. Crim, MD
232 Distal Clavicle Resorption
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
MBA
234 Proximal Humerus: Erosion of Medial Metaphysis
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
MD

xv
 TABLE OF CONTENTS
364 Symphysis Pubis Widening
SECTION 13: PARASPINAL Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
ABNORMALITIES MD
304 Ossification/Calcification Anterior to C1-C2 368 Supraacetabular Bone Destruction
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD, Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
MBA MD
306 Paravertebral Ossification/Calcification
Donna G. Blankenbaker, MD SECTION 18: HIP AND THIGH
310 Linear Ossification Along Anterior Spine 374 Protrusio Acetabuli
Donna G. Blankenbaker, MD and Cheryl A. Petersilge, MD, Michael Mulligan, MD and Carol L. Andrews, MD
MBA 378 Coxa Magna Deformity
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
SECTION 14: VERTEBRAL SHAPE 380 Acetabular Labrum Tears, Etiology
314 Bullet-Shaped Vertebra/Anterior Vertebral Body Donna G. Blankenbaker, MD and B.J. Manaster, MD, PhD,
Beaking FACR
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
MBA SECTION 19: KNEE AND LEG
316 Congenital & Acquired Childhood Platyspondyly 388 Enlargement of Intercondylar Notch
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD, Michael Mulligan, MD and Carol L. Andrews, MD
MBA 390 Lytic Lesion of Patella
320 Fish (Biconcave) or H-Shaped Vertebra Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD, 394 Tibial Bowing
MBA Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
322 Squaring of 1 or More Vertebrae 398 Fluid Collection About the Knee
Julia R. Crim, MD and Cheryl A. Petersilge, MD, MBA Carol L. Andrews, MD
404 Popliteal Mass, Extraarticular
SECTION 15: VERTEBRAL LESIONS Carol L. Andrews, MD
326 Vertebral Body Sclerosis 408 Alterations in Meniscus Size
Julia R. Crim, MD and Cheryl A. Petersilge, MD, MBA Carol L. Andrews, MD
332 Spinal Osteophytes 412 Genu Valgum (Knock Knees)
Julia R. Crim, MD and Cheryl A. Petersilge, MD, MBA Carol L. Andrews, MD
334 Lesion Originating in Vertebral Body 414 Genu Varum (Bow Leg Deformity)
Julia R. Crim, MD and Cheryl A. Petersilge, MD, MBA Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
340 Lesion Originating in Posterior Elements
Julia R. Crim, MD and Cheryl A. Petersilge, MD, MBA SECTION 20: FOOT AND ANKLE
418 Achilles Tendon Thickening/Enlargement
SECTION 16: RIBS Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
344 Rib Notching, Inferior 420 Calcaneus Erosion, Posterior Tuberosity
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts, Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
MD 424 Retrocalcaneal Bursitis
346 Rib Notching, Superior Michael Mulligan, MD and Carol L. Andrews, MD
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts, 426 Soft Tissue Mass in Foot
MD Michael Mulligan, MD and Carol L. Andrews, MD
348 Solitary Rib Lesion 432 Talar Beak
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
MD
SECTION 17: PELVIS 434 Cystic/Lytic Lesions of Tarsal Bone
354 Sacroiliitis, Bilateral Symmetric Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR MD
358 Sacroiliitis, Bilateral Asymmetric
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR Part II: Image Based
360 Sacroiliitis, Unilateral
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR SECTION 1: RADIOGRAPH/CT, OSSEOUS
362 Symphysis Pubis With Productive Changes/Fusion
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts, 442 Polyostotic Lesions, Adult
MD Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
448 Polyostotic Lesions, Child
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR

xvi
 TABLE OF CONTENTS
454 Solitary Geographic Lytic Lesion
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
SECTION 2: RADIOGRAPH/CT, SOFT
MD
TISSUE
460 Sclerotic Bone Lesion, Solitary 548 Soft Tissue Ossification
Carol L. Andrews, MD Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
466 Sclerotic Bone Lesions, Multiple MD
Carol L. Andrews, MD 552 Nodular Calcification
472 Sclerotic Lesion With Central Lucency Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts, MD
MD 558 Linear and Curvilinear Calcification
476 Sequestrum Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts, MD
MD 564 Soft Tissue Neoplasm Containing Calcification
480 Target Lesion of Bone Carol L. Andrews, MD
Cheryl A. Petersilge, MD, MBA
484 Matrix-Containing Bone Lesion SECTION 3: MR, OSSEOUS
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR 570 Bone Marrow Edema Syndromes (Proximal Femur)
490 Benign Osseous Lesions That Can Appear Aggressive Michael Mulligan, MD and Carol L. Andrews, MD
Carol L. Andrews, MD 574 Subchondral Edema-Like Signal
496 Metastases to Bone Michael Mulligan, MD and Carol L. Andrews, MD
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts, 576 Abnormal Epiphyseal Marrow Signal
MD Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
500 Generalized Increased Bone Density, Adult 580 Increased Marrow Fat
Michael Mulligan, MD and Carol L. Andrews, MD Michael Mulligan, MD and Carol L. Andrews, MD
504 Generalized Increased Bone Density, Child 584 Marrow Hyperplasia
Michael Mulligan, MD and Carol L. Andrews, MD Michael Mulligan, MD and Carol L. Andrews, MD
508 Sclerosing Dysplasia 588 Bone Lesion With Fluid-Fluid Levels
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
514 Hypertrophic Callus Formation MD
Carol L. Andrews, MD and Cheryl A. Petersilge, MD, MBA
516 Bone-Within-Bone Appearance SECTION 4: MR, SOFT TISSUE
Cheryl A. Petersilge, MD, MBA 592 Lesion With Bright T1 Signal
520 Osteopenia Cheryl A. Petersilge, MD, MBA, Kirkland W. Davis, MD,
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
FACR, and Catherine C. Roberts, MD
MBA 596 Soft Tissue Lesion With Predominately Low T1 & T2
522 Osteoporosis, Generalized
Signal
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
MBA
MD
528 Osteoporosis, Regional
600 Soft Tissue Lesion With Fluid-Fluid Levels
Kirkland W. Davis, MD, FACR and Robert Downey Boutin,
Cheryl A. Petersilge, MD, MBA
MD 604 Target Lesion of Soft Tissues
532 Cortical Tunneling Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
MD
MBA 606 Cystic Mass
534 Pseudoarthrosis Cheryl A. Petersilge, MD, MBA, Catherine C. Roberts, MD,
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
and Kirkland W. Davis, MD, FACR
MBA 612 Subcutaneous Mass
536 Enthesophyte Cheryl A. Petersilge, MD, MBA
Donna G. Blankenbaker, MD 618 Enlarged Muscle
540 Tendon & Ligament Ossification Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
MBA
MBA 622 Muscle Atrophy
542 Bone Age, Advanced Cheryl A. Petersilge, MD, MBA
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts, 626 Intermuscular Edema
MD Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
544 Bone Age, Delayed MD
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts, 630 Tenosynovitis/Tenosynovial Fluid
MD Michael Mulligan, MD and Carol L. Andrews, MD

xvii
 TABLE OF CONTENTS
632 Enlarged Peripheral Nerves
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
SECTION 3: WRIST AND HAND
710 Wrist Clicking/Clunking/Instability
SECTION 5: MR, JOINT Michael Mulligan, MD and Carol L. Andrews, MD
638 Intraarticular Low-Signal Material, All Sequences 714 Ulnar-Sided Wrist Pain
Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR Michael Mulligan, MD and Carol L. Andrews, MD
720 Radial-Sided Wrist Pain
SECTION 6: ULTRASOUND Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
644 Anechoic Mass SECTION 4: PELVIS, HIP, AND THIGH
Michael Mulligan, MD and Carol L. Andrews, MD
646 Hypoechoic Mass 728 Groin/Hip Pain
Kirkland W. Davis, MD, FACR Donna G. Blankenbaker, MD
734 Lateral Hip Pain
SECTION 7: NUCLEAR MEDICINE Donna G. Blankenbaker, MD
738 Snapping Hip
654 Photopenic Lesions & False-Negative Scans
Donna G. Blankenbaker, MD
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
740 Hip Impingement
MBA
Donna G. Blankenbaker, MD
656 Soft Tissue Uptake on Bone Scan
744 Thigh Pain
Kirkland W. Davis, MD, FACR and Robert Downey Boutin,
Donna G. Blankenbaker, MD and Carol L. Andrews, MD
MD
748 Nerve Entrapment, Lower Extremity
662 Superscan
Carol L. Andrews, MD
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
752 Hip Pain, Elderly Patient
MBA Michael Mulligan, MD and Carol L. Andrews, MD
664 Hypermetabolic Lesion, Osseous 758 Painful Hip Replacement
Carol L. Andrews, MD Carol L. Andrews, MD and B.J. Manaster, MD, PhD, FACR
670 Hypermetabolic Lesion, Soft Tissue
Carol L. Andrews, MD SECTION 5: KNEE AND LEG
766 Anterior Knee Pain
Part III: Clinically Based Michael Mulligan, MD and Carol L. Andrews, MD
772 Medial Knee Pain
SECTION 1: SHOULDER AND ARM Michael Mulligan, MD and Carol L. Andrews, MD
778 Calf Pain
676 Painful or Enlarged Sternoclavicular Joint
Michael Mulligan, MD and Carol L. Andrews, MD
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
784 Painful Knee Replacement
MBA
Carol L. Andrews, MD
678 Rotator Cuff Symptoms
Michael Mulligan, MD and Carol L. Andrews, MD SECTION 6: ANKLE AND FOOT
682 Shoulder Instability
Michael Mulligan, MD and Carol L. Andrews, MD 792 Anterior Ankle Pain/Impingement
686 Anteroinferior Glenoid Labrum/Capsule Injury Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
Michael Mulligan, MD and Carol L. Andrews, MD MBA
688 Nerve Entrapment, Shoulder 796 Medial Ankle Pain
Michael Mulligan, MD and Carol L. Andrews, MD Michael Mulligan, MD and Carol L. Andrews, MD
802 Lateral Ankle Pain
SECTION 2: ELBOW AND FOREARM Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
692 Elbow Deformities in Children and Young Adults MBA
Carol L. Andrews, MD and Cheryl A. Petersilge, MD, MBA 808 Heel Pain
694 Lateral Elbow Pain Cheryl A. Petersilge, MD, MBA, Donna G. Blankenbaker,
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts, MD, and Catherine C. Roberts, MD
MD 814 Metatarsalgia
698 Medial Elbow Pain Robert Downey Boutin, MD and Cheryl A. Petersilge, MD,
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD, MBA
MBA 820 Flatfoot Deformity
702 Olecranon Bursitis Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
Robert Downey Boutin, MD and Cheryl A. Petersilge, MD, 824 Cavus Foot Deformity
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
MBA
704 Nerve Entrapment, Elbow & Wrist MD
Michael Mulligan, MD and Carol L. Andrews, MD

xviii
 TABLE OF CONTENTS
826 Congenital Foot Deformity
Michael Mulligan, MD and B.J. Manaster, MD, PhD, FACR
832 Diabetic Foot Complications
Carol L. Andrews, MD

SECTION 7: SPINE
836 Painful Scoliosis
Julia R. Crim, MD and Cheryl A. Petersilge, MD, MBA

SECTION 8: SYSTEMIC DISEASE

842 Arthritis in Teenager
Kirkland W. Davis, MD, FACR
846 Anemia With Musculoskeletal Manifestations
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
MD
850 Osteonecrosis
Kirkland W. Davis, MD, FACR
856 Heterotopic Ossification
Cheryl A. Petersilge, MD, MBA
860 Rickets and Osteomalacia
Robert Downey Boutin, MD
864 Soft Tissue Contractures
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
MD
866 Short Limb, Unilateral
Kirkland W. Davis, MD, FACR
872 Hemihypertrophy
Cheryl A. Petersilge, MD, MBA and Robert Downey
Boutin, MD
874 Focal Gigantism/Macrodactyly
Kirkland W. Davis, MD, FACR and Robert Downey Boutin,
MD
878 Dwarfism With Major Spine Involvement
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
MD
880 Dwarfism With Short Extremities
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
MD
882 Dwarfism With Short Ribs
Cheryl A. Petersilge, MD, MBA and Catherine C. Roberts,
MD
884 Dwarfism With Horizontal Acetabular Roof
Kirkland W. Davis, MD, FACR and Catherine C. Roberts,
MD

xix
Another random document with
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The Project Gutenberg eBook of Neva's three
lovers: a novel
 This ebook is for the use of anyone anywhere in the United
States and most other parts of the world at no cost and with
almost no restrictions whatsoever. You may copy it, give it away
or re-use it under the terms of the Project Gutenberg License
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laws of the country where you are located before using this
eBook.

Title: Neva's three lovers: a novel

Author: Harriet Lewis

Release date: June 10, 2022 [eBook #68274]

Language: English

Original publication: United States: Street & Smith, 1892

Credits: Demian Katz, Craig Kirkwood, and the Online

Distributed Proofreading Team at https://www.pgdp.net
(Images courtesy of the Digital Library@Villanova
University.)

*** START OF THE PROJECT GUTENBERG EBOOK NEVA'S

THREE LOVERS: A NOVEL ***
 Transcriber’s Notes:
The Table of Contents was created by the transcriber and placed in the public domain.
Additional Transcriber’s Notes are at the end.
 CONTENTS
Chapter I. The Game Well Begun.
Chapter II. A Decisive Move Commanded.
Chapter III. A Fateful Move Decided Upon.
Chapter IV. A Door Opened to Wickedness.
Chapter V. Settling Into Her Place.
Chapter VI. Her Ladyship’s Accomplice.
Chapter VII. Neva’s First Lover.
Chapter VIII. The Son of the Honorable Craven
Black.
Chapter IX. A Knot Summarily Severed.
Chapter X. Neva at Home Again.
Chapter XI. Lady Wynde’s Idea Acted Upon.
Chapter XII. Black Continues His Conspiracy.
Chapter XIII. How Neva Received the Forgeries.
Chapter XIV. The Meeting of Neva and Rufus.
Chapter XV. Mr. Black Gets a New Idea.
Chapter XVI. Rufus Asks the Momentous
Question.
Chapter XVII. The Young Wife’s Desolation.
Chapter XVIII. One of Neva’s Lovers Disposed of.
Chapter XIX. Neva’s Choice Foreshadowed.
Chapter XX. Was It a Dream?
Chapter XXI. A Scene in India.
Chapter XXII. Back as From the Dead.
Chapter XXIII. Neva’s Decision About Rufus.
Chapter XXIV. Lally Finds a New Home.
Chapter XXV. Lally in Her New Situation.
SELECT LIBRARY No. 231
Neva’s Three Lovers
BY
Mrs. Harriet Lewis
 Neva’s Three Lovers

A NOVEL

BY
MRS. HARRIET LEWIS
AUTHOR OF
“Adrift in the World,” “The Bailiff’s Scheme,” “The Belle of the
Season,” “Cecil Rosse,” “The Haunted Husband,” “Sundered
Hearts,” and numerous other books published in the
Eagle, New Eagle, and Select Libraries.

STREET & SMITH CORPORATION

PUBLISHERS

79-89 Seventh Avenue, New York

Copyright, 1871 and 1892
By Robert Bonner’s Sons
Neva’s Three Lovers
NEVA’S THREE LOVERS.
 CHAPTER I.
THE GAME WELL BEGUN.

Sir Harold Wynde, Baronet, was standing upon the pier head at
Brighton, looking idly seaward, and watching the play of the sunset
rays on the waters, the tossing white-capped waves, and the white
sails in the distance against the blue sky.
He was not yet fifty years of age, tall and handsome and stately, with
fair complexion, fair hair, and keen blue eyes, which at times
beamed with a warm and genial radiance that seemed to emanate
from his soul. The rare nobility of that soul expressed itself in his
features. His commanding intellect betrayed itself in his square,
massive brows. His grand nature was patent in every look and smile.
He was a widower with two children, the elder a son, who was a
captain in a fine regiment in India, the younger a daughter still at
boarding-school. He possessed a magnificent estate in Kent, a
house in town, and a marine villa, and rejoiced in a clear income of
seventy thousand pounds a year.
As might be expected from his rare personal and material
advantages, he was a lion at Brighton, even though the season was
at its height, and peers and peeresses abounded at that fashionable
resort. Titled ladies—to use a well-worn phrase—“set their caps” for
him; manœuvring mammas smiled upon him; portly papas with their
“quivers full of daughters,” and with groaning purses, urged him to
dine at their houses or hotels; and widows of every age looked
sweetly at him, and thought how divine it would be to be chosen to
reign as mistress over the baronet’s estate of Hawkhurst.
But Sir Harold went his ways quietly, seeming oblivious of the hopes
and schemes of these manœuverers. He had had a good wife, and
he had no intention of marrying again. And so, as he stood
carelessly leaning against the railing on the pier head, under the gay
awning, his thoughts were far away from the gaily dressed
promenaders sauntering down the chain pier or pacing with slow
steps to and fro behind him.
The sunset glow slowly faded. The long gray English twilight began
to fall slowly upon promenaders, beach, chain pier, and waters. The
music of the band swallowed up all other sounds, the murmur of
waters, the hum of gay voices, the sweetness of laughter.
But suddenly, in one of the interludes of the music, and in the midst
of Sir Harold’s reverie, an incident occurred which was the beginning
of a chain of events destined to change the whole future course of
the baronet’s life, and to exercise no slight degree of influence upon
the lives of others.
Yet the incident was simple. A little pleasure-boat, occupied by two
ladies and a boatman, had been sailing leisurely about the pier head
for some time. The boatman, one of the ordinary pleasure boatmen
who make a living at Brighton, as at other maritime resorts, by letting
their crafts and services to chance customers, had been busy with
his sail. One of the ladies, a hired companion apparently, sat at one
side of the boat, with a parasol on her knee. The other lady, as
evidently the employer, half reclined upon the plush cushions, and
an Indian shawl of vivid scarlet lavishly embroidered with gold was
thrown carelessly about her figure. One cheek of this lady rested
upon her jewelled hand, and her eyes were fixed with a singular
intentness, a peculiar speculativeness, upon the tall and stalwart
figure of Sir Harold Wynde.
There was a world of meaning in that long furtive gaze, and had the
baronet been able to read and comprehend it, the tragical history we
are about to narrate would never have happened. But he, wrapped in
his own thoughts, saw neither the boat nor its occupants.
The little craft crept in quite near to the pier head—so near as to be
but a few rods distant—when the boatman shifted his helm to go
about and stand upon the other tack. The small vessel gave a lurch,
the wind blowing freshly; the lady with the Indian shawl started up,
with a shriek; there was an instant of terrible confusion; and then the
sail-boat had capsized, and her late occupants were struggling in the
waters.
In a moment the promenaders of the chain pier had thronged upon
the pier head. Cries and ejaculations filled the air. No one could
comprehend how the accident had occurred, but one man who had
been watching the boat averred that the lady with the shawl had
deliberately and purposely capsized it. And this was the actual fact!
Sir Harold Wynde was startled from the trance-like musings by the
lady’s shriek. He looked down upon the waters and beheld the result
of the catastrophe. The boat’s sail lay half under water. The boatman
had seized the lady’s companion and was clinging to the upturned
boat. The companion had fainted in his arms, and he could not
loosen his hold upon her unless he would have her drown before his
eyes. The lady, at a little distance from her companions in peril,
tangled in her mass of scarlet and gold drapery, her hat lost, her long
hair trailing on the waves, seemed drowning.
Her peril was imminent. No other boats were near, although one or
two were coming up swiftly from a distance.
The lady threw up her white arms with an anguished cry. Her glance
sought the thronged pier head in wild appealing. Who, looking at her,
would have dreamed that the disaster was part of a well-contrived
plan—a trap to catch the unwary baronet?
As she had expected from his well-known chivalrous character, he
fell into the trap. His keen eyes flashed a rapid glance over beach
and waters. The lady was likely to drown before help could come
from the speeding boats. Sir Harold pulled off his coat and made a
dive into the sea. He was an expert swimmer, and reached the lady
as she was sinking. He caught her in his arms and struck out for the
boat. The lady became a dead weight, and when he reached the
capsized craft her head lay back on his breast, her long wet tresses
of hair coiled around him like Medusean locks, and her pale face
was like the face of a dead woman.
Sir Harold clung to the side of the boat opposite that on which the
boatman supported his burden. And thus he awaited the coming of
the boats.
Among the eager thronging watchers on the pier head above was a
tall, fair-faced man, with a long, waxed mustache, sinister eyes and a
cynical smile. He alone of the throng seemed unmoved by the tragic
incident.
“It was pretty well done,” he muttered, under his breath—“a little
transparent, perhaps, and a trifle awkward as well, but pretty well
done! The baronet fell into the trap too, exactly as was hoped. Your
campaign opens finely, my beautiful Octavia. Let us see if the result
is to be what we desire. In short, will the baronet be as unsuspicious
all the way through?”
Sir Harold certainly was unsuspicious at that moment. The helpless
woman in his arms aroused into activity all the chivalry of his
chivalric nature. He held her head above the creeping waves until
the foremost boat had reached him. His burden was the first to be
lifted into the rescuing craft; the lady’s companion followed; the
baronet and the boatman climbing into the boat last, in the order in
which they are named.
The capsized boat was righted and its owner took possession of her.
The rescuing craft transported the baronet and the two ladies to the
beach. The lady companion had recovered her senses and self-
possession, but the lady employer lay on the cushions pale and
motionless.
On reaching the landing, a cab was found to be in waiting, having
been summoned by some sympathizing spectator. The companion,
uttering protestations of gratitude, entered the vehicle, and her
mistress was assisted in after her. The former gathered her employer
in her arms, crying out:
“She is dead! She is dead! I have lost my best friend—”
“Not so, madam,” said Sir Harold, in kindly sympathy. “The lady has
only fainted, I think. To what place shall I tell the cabman to drive?”
“To the Albion Hotel. Oh, my poor, poor lady! To die so young! It is
terrible!”
Sir Harold made some soothing response, but being chilled and wet,
did not find it necessary to accompany to their hotel the heroines of
the adventure. He gave their address to the cabman, watched the
cab as it rolled away, and then breaking loose from the crowd of
friends who gathered around him with anxious interrogatories, he
secured his coat and procured a cab for himself and proceeded to
his own hotel.
It was not until he had had a comfortable bath, and was seated in dry
attire in his private parlor, that Sir Harold remembered that he did not
know the name of the lady he had served, or that he had not even
seen her face distinctly.
“She is as ignorant of my name and identity,” he thought, “as I am of
hers. If the incident could be kept out of the papers, I need never be
troubled with the thanks of her husband, father, or brother.”
But the incident was not kept out of the papers. Sir Harold Wynde,
being a lion, had to bear the penalty of popularity. The next
morning’s paper, brought in to him as he sat at his solitary breakfast,
contained a glowing account of the previous evening’s adventure,
under the flaming head line of “Heroic Action by a Baronet,” with the
sub-lines: “Sir Harold Wynde saves a lady’s life at the risk of his own.
Chivalry not yet dead in our commonplace England.” And there
followed a highly imaginative description of the lady’s adventure, her
name being as yet unknown, and a warm eulogy upon Sir Harold’s
bravery and presence of mind.
The baronet’s lip curled as he read impatiently the fulsome article.
He had scarcely finished it when a waiter entered, bringing in upon a
silver tray a large squarely enveloped letter. It was addressed to Sir
Harold Wynde, was stamped with an unintelligible monogram, and
sealed with a dainty device in pale green wax. As the baronet’s only
lady correspondent was his daughter at school, and this missive was
clearly not from her, he experienced a slight surprise at its reception.
The waiter having departed, Sir Harold cut open the letter with his
pocket knife, and glanced over its contents.
They were written upon the daintiest, thickest vellum paper unlined,
and duly tinted and monogrammed, and were as follows:
Albion Hotel, Tuesday Morning.
 “Sir Harold Wynde: The lady who writes this letter is the
lady whom you so gallantly rescued from a death by
drowning last evening. I have read the accounts of your
daring bravery in the morning’s papers, and hasten to offer
my grateful thanks for your noble and gallant kindness to
an utter stranger. Life has not been so sweet to me that I
cling to it, but yet it is very horrible to go in one moment
from the glow and heartiness of health and life down to the
very gates of death. It was your hand that drew me back
at the moment when those gates opened to admit me, and
again I bless you—a thousand thousand times, I bless
you. Alas, that I have to write to you myself. I have neither
father, lover, nor husband, to rejoice in the life you have
saved. I am a widow, and alone in the wide world. Will you
not call upon me at my hotel and permit me to thank you
far more effectively in person? I shall be waiting for your
coming in my private parlor at eleven this morning.
“Gratefully yours,
“Octavia Hathaway.”
The baronet read the letter again and again. His generous soul was
touched by its sorrowful tone.
“A widow and alone in the world!” he thought. “Poor woman! What
sentence could be sadder than that? She is elderly, I am sure, and
has lost all her children. I do not want to hear her expressions of
gratitude, but if I can make the poor soul happier by calling on her I
will go.”
Accordingly, at eleven o’clock that morning, attired in a gentleman’s
unexceptionable morning dress, Sir Harold Wynde, having sent up
his card, presented himself at the door of Mrs. Hathaway’s private
parlor at the Albion Hotel, and knocked for admittance.
The door was opened to him by the lady’s companion, who greeted
him with effusiveness, and begged him to be seated.
She was a tall, angular woman, with sharp features, whose
characteristic expression was one of peculiar hardness and severity.
Her lips were thin, and were usually compressed. Her eyes were a
light gray, furtive and sly, like a cat’s eyes. Her pointed chin gave a
treacherous cast to her countenance. Her complexion was of a pale,
opaque gray; her hair, of a fawn color, was worn in three puffs on
each side of her face, and her dress was of a tint to match her hair.
Sir Harold conceived an instinctive aversion to her.
“Mrs. Hathaway?” he said politely, with interrogative accent.
“No, I am not Mrs. Hathaway,” was the reply, in a subdued voice, and
the furtive eyes scanned the visitor’s face. “I am only Mrs.
Hathaway’s companion—Mrs. Artress. Mrs. Hathaway has just
received your card. She will be out directly.”
The words were scarcely spoken when the door of an inner room
opened, and Mrs. Hathaway made her appearance.
Sir Harold stood up, bowing.
The lady was by no means the elderly, melancholy personage he
had expected to see. She was about thirty years of age, and looked
younger. She had a tall, statuesque figure, well-rounded and inclined
to embonpoint. She carried her head with a certain stateliness. Her
hair was dressed with the inevitable chignon, crimped waves, and
long, floating curl, and despite the monstrosity of the fashion, it was
decidedly and undeniably picturesque. Her face, with its clear
brunette complexion, liquid black eyes, Grecian nose, low brows,
and faultless mouth, was very handsome. There was a fascination in
her manners that was felt by the baronet even before she had
spoken.
She was not dressed in mourning, and it was probable, therefore,
that her widowhood was not of recent beginning. She was clothed in
an exquisitely embroidered morning dress of white, which trailed on
the floor, and was relieved with ornaments of pale pink coral, and a
broad coral-colored sash at her waist.
“This is Mrs. Hathaway, Sir Harold,” said the gray looking lady’s
companion.
The lady sprang forward after an impulsive fashion, and clasped the
baronet’s hands in both her own. Her black eyes flooded with tears.
And then, in a broken voice, she thanked her preserver for his
gallant conduct on the previous evening assuring him that her
gratitude would outlast her life. Her protestations and gratitude were
not overdone, and unsuspecting Sir Harold accepted them as
genuine, even while they embarrassed him.
He remained an hour, finding Mrs. Hathaway charming company and
thoroughly fascinating. The companion sat apart, silent, busy with
embroidery, a mere gray shadow; but her presence gave an easy
unconstraint to both the baronet and the lady. When Sir Harold took
his departure, sauntering down to the German Spa, he carried with
him the abiding memory of Mrs. Hathaway’s handsome brunette face
and liquid black eyes, and thought himself that she was the most
charming woman he had met for years.
From that day, throughout the season, the baronet was a frequent
visitor at Mrs. Hathaway’s private parlor. The gray companion was
always at hand to play propriety, and the tongues of gossips, though
busy, had no malevolence in them. Sir Harold had his own horses at
Brighton, and placed one at Mrs. Hathaway’s disposal. The widow
accepted it, procured a bewitching costume from town, and had daily
rides with the baronet. She also drove with him in his open, low
carriage, and bowed right and left to her acquaintances upon such
occasions with the gracious condescension of a princess. She sailed
with him in his graceful yacht, upon day’s excursions, her companion
always accompanying, and rumor at length declared that the pair
were engaged to be married.
Sir Harold heard the reports, and they set him thinking. The society
of Mrs. Hathaway had become necessary to him. She understood
his tastes, studying them with a flattery so delicate that he was
pleased without understanding it. She read his favorite books, played
his favorite music, and displayed talents of no mean order. She was
fitted to adorn any position, however high, and Sir Harold thought
with a pleasant thrill at his heart, how royally she would reign over
his beautiful home.
In short, questioning his own heart, he found that he had worshiped
his dead wife, who would be to him always young, as when he had
buried her—but with the passion of later manhood, an exacting,