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 Chapter 6 Selecting and Using Protective Sports Summary 159
Equipment 105 Websites 161
Safety Standards for Sports Equipment and
Facilities 105 Chapter 9 Bloodborne Pathogens, Universal
Legal Concerns in Using Protective Precautions, and Wound Care 162
Equipment 106
What Are Bloodborne Pathogens? 162
Using Off-the-Shelf versus Custom Protective
Dealing with Bloodborne Pathogens in
Equipment 107
Athletics 165
Head Protection 107
Universal Precautions in an Athletic
Face Protection 111 Environment 166
Trunk and Thorax Protection 114 Caring for Skin Wounds 169
Lower-Extremity Protective Equipment 118 Summary 172
Elbow, Wrist, and Hand Protection 123 Websites 173
Summary 124
Websites 126
Chapter 10 Wrapping and Taping Techniques 174
Chapter 7 Understanding the Potential Dangers Elastic Wraps 175
of Adverse Environmental Conditions 127 Nonelastic and Elastic Adhesive Taping 179
Hyperthermia 127 Common Taping Techniques 182
Hypothermia 134 Kinesio Taping 188
Overexposure to Sun 135 Summary 189
Safety in Lightning and Thunderstorms 135 Websites 190
Summary 137
Websites 138 Chapter 11 Understanding the Basics of Injury
Rehabilitation 191
Therapeutic Exercise versus Conditioning
PART III Exercise 191
Philosophy of Athletic Injury
Techniques for Treating and Rehabilitation 191
Managing Sport-Related Basic Components and Goals of a
Rehabilitation Program 192
Injuries 141 Using Therapeutic Modalities 197
Criteria for Return to Full Activity 198
Chapter 8 Handling Emergency Situations
Summary 199
and Injury Assessment 142
Websites 200
The Emergency Action Plan 142
Principles of On-the-Field Injury
Assessment 145 Chapter 12 Helping the Injured Athlete
Primary Survey 145 Psychologically 201
Conducting a Secondary Assessment 150 The Athlete’s Psychological Response to
Off-Field Assessment 152 Injury 201
Immediate Treatment Following Acute Predictors of Injury 202
Musculoskeletal Injury 153 Goal Setting as a Motivator to
Emergency Splinting 155 Compliance 204
Moving and Transporting the Injured Providing Social Support to the Injured
Athlete 156 Athlete 204

Contents vii

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 Return to Competition Decisions 207 Recognition and Management of Injuries
Referring the Athlete for Psychological Help 207 to the Knee 265
Summary 208 Recognition and Management of Injuries and
Websites 209 Conditions Classified as Patellofemoral Pain
Syndrome 272
Summary 275
PART IV
Recognition and Management Chapter 17 The Thigh, Hip, Groin, and
Pelvis 277
of Specific Injuries and Anatomy of the Thigh, Hip, Groin, and Pelvic
Conditions 211 Region 277
Assessing Thigh, Hip, Groin, and Pelvis
Chapter 13 Recognizing Different Sports Injuries 278
Injuries 212 Prevention of Injuries to the Thigh, Hip, Groin,
Acute (Traumatic) Injuries 212 and Pelvic Region 281
Chronic Overuse Injuries 219 Recognition and Management of Injuries
The Importance of the Healing Process to the Thigh 281
Following Injury 221 Recognition and Management of Hip
Summary 223 and Groin Injuries 284
Websites 225 Recognition and Management of Injuries
to the Pelvis 288
Chapter 14 The Foot and Toes 226 Summary 290
Foot Anatomy 226 Websites 291
Prevention of Foot Injuries 228
Foot Assessment 229 Chapter 18 The Shoulder Complex 292
Recognition and Management of Foot Anatomy of the Shoulder 292
Injuries 230 Prevention of Shoulder Injuries 294
Summary 239 Assessing the Shoulder Complex 296
Recognition and Management of Shoulder
Injuries 298
Chapter 15 The Ankle and Lower Leg 241 Summary 304
Ankle and Lower-Leg Anatomy 241
Websites 305
Prevention of Lower-Leg and Ankle
Injuries 243 Chapter 19 The Elbow, Forearm, Wrist,
Assessing the Ankle Joint 245 and Hand 306
Recognition and Management of Injuries Anatomy of the Elbow Joint 306
to the Ankle 246
Assessing Elbow Injuries 306
Assessing the Lower Leg 251
Prevention of Elbow, Forearm, and Wrist
Recognition and Management of Injuries Injuries 308
to the Lower Leg 251
Recognition and Management of Injuries
Summary 255 to the Elbow 309
Websites 257 Anatomy of the Forearm 312
Assessing Forearm Injuries 313
Chapter 16 The Knee and Related Structures 258 Recognition and Management of Injuries
Knee Anatomy 258 to the Forearm 314
Prevention of Knee Injuries 261 Anatomy of the Wrist, Hand, and
Assessing the Knee Joint 262 Fingers 315

viii Contents

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 Assessment of the Wrist, Hand, and Preventing Dental Injuries 363
Fingers 316 Recognition and Management of Specific
Recognition and Management of Wrist Dental Injuries 363
and Hand Injuries 316 Anatomy of the Nose 365
Recognition and Management of Finger Recognition and Management of Specific Nasal
Injuries 320 Injuries 365
Summary 323 Anatomy of the Ear 366
Recognition and Management of Specific
Chapter 20 The Spine 325 Injuries to the Ear 367
Anatomy of the Spine 325 Anatomy of the Eye 368
Preventing Injuries to the Spine 329 Recognition and Management of Specific
Assessment of the Spine 331 Eye Injuries 369
Recognition and Management of Cervical Spine Recognition and Management of Injuries
Injuries and Conditions 333 to the Throat 371
Recognition and Management of Lumbar Spine Summary 371
Injuries and Conditions 335 Websites 373
Recognition and Management of Sacroiliac
Joint and Coccyx Injuries 338 Chapter 23 General Medical Conditions and
Summary 339 Additional Health Concerns 374
Websites 340 Skin Infections 374
Respiratory Conditions 378
Chapter 21 The Thorax and Abdomen 341 Gastrointestinal Disorders 382
Anatomy of the Thorax 341 Other Conditions that Can Affect the
Anatomy of the Abdomen 342 Athlete 383
Preventing Injuries to the Thorax and Cancer 387
Abdomen 343 Menstrual Irregularities and the Female
Assessment of the Thorax and Abdomen 343 Reproductive System 388
Recognition and Management of Thoracic Sexually Transmitted Diseases (STDs) 390
Injuries 345 Summary 392
Recognition and Management of Abdominal Websites 394
Injuries 348
Summary 352 Chapter 24 Substance Abuse 395
Websites 353 Performance-Enhancing Drugs 395
Recreational Drug Abuse 399
Chapter 22 The Head, Face, Eyes, Ears, Nose, Drug-Testing Programs 400
and Throat 354 Summary 401
Preventing Injuries to the Head, Face, Eyes, Websites 402
Ears, Nose, and Throat 354
Anatomy of the Head 354 Chapter 25 Preventing and Managing Injuries in
Assessing Head Injuries 355 Young Athletes 403
Recognition and Management of Specific Head Cultural Trends 403
Injuries 357 Physical Maturity Assessment in Matching
Anatomy of the Face 362 Athletes 405
Recognition and Management of Specific Facial Physical Conditioning and Training 406
Injuries 362 Psychological and Learning Concerns 407
Dental Anatomy 363 Coaching Qualifications 408

Contents ix

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 Common Injuries in the Young Athlete 409 Appendix B Requirements for Certification as an
Sports Injury Prevention 410 Athletic Trainer 420
Summary 413 Appendix C Directional Movements for Body Joints 422
Websites 416
Glossary 430
Appendixes Index 434
Appendix A Employment Settings for the Athletic
Trainer 417

x Contents

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 Preface
WHO SHOULD USE THIS TEXT?
The tenth edition of Essentials of Athletic
Injury Management is written for those stu-
dents interested in the fitness profession, ki-
nesiology, coaching, or some aspect of sport
science or physical education. The majority of
students who take courses about the prevention
and management of injuries that typically occur in
an athletic population have little or no intention of
pursuing athletic training as a career. However, it is
also true that a large percentage of those students
who are taking these courses are doing so because
they intend to pursue careers in coaching, fitness,
physical education, or other areas related to exer-
cise and sports science. For these individuals, some
knowledge and understanding of the many aspects
of health care for both recreational and competitive
athletes is essential for them to effectively perform
the associated responsibilities of their job.
Other students who are personally involved in
fitness, or training and conditioning, may be inter-
ested in taking a course that will provide them with
guidelines and recommendations for preventing in-
juries, recognizing injuries, and learning how to cor-
rectly manage a specific injury. Thus, Essentials of
Athletic Injury Management has been designed to
provide basic information on a variety of topics, all
of which relate in one way or another to health care
for the athlete.
Essentials of Athletic Injury Management was
created from the foundations established by another
well-recognized textbook, Principles of Athletic
Training, currently in its fifteenth edition. Whereas
Principles of Athletic Training serves as a major
text for professional athletic trainers and those indi-
viduals interested in sports medicine, Essentials of
Athletic Injury Management is written at a level
more appropriate for the coach, fitness profes-
sional, and physical educator. It provides guid-
ance, suggestions, and recommendations for
handling athletic health care situations when an
athletic trainer or physician is not available.
ORGANIZATION AND COVERAGE
The tenth edition of Essentials of Athletic Injury
Management provides the reader with the most cur-
rent information on the subject of prevention and
pre22754_fm_i-xx.indd 11
basic care of sports injuries. The general philosophy
of the text is that adverse effects of physical activ-
ity arising from participation in sport should be pre-
vented to the greatest extent possible. However, the
nature of participation in physical activity dictates
that sooner or later injury may occur. In these situ-
ations, providing immediate and correct care can
minimize the seriousness of an injury.
Overall, this text is designed to take the begin-
ning student from general to specific concepts.
Each chapter focuses on promoting an understand-
ing of the prevention and care of athletic injuries.
Essentials of Athletic Injury Management is di-
vided into four parts: Organizing and Establishing
an Effective Athletic Health Care System,
Preventing Injuries in an Athletic Health Care
System, Techniques for Treating and Managing
Sport-Related Injuries, and Recognition and
Management of Specific Injuries and Conditions.
Part I, Organizing and Establishing an
Effective Athletic Health Care System, begins in
Chapter 1 with a discussion of the roles and re-
sponsibilities of all the individuals on the “sports
medicine team” who in some way affect the deliv-
ery of health care to the athlete. Chapter 2 provides
guidelines and recommendations for setting up a
system for providing athletic health care in situ-
ations where an athletic trainer is not available to
oversee that process. In today’s society, and in par-
ticular for anyone who is remotely involved with
providing athletic heath care, the issue of legal re-
sponsibility and, perhaps more importantly, legal
liability is of utmost concern. Chapter 3 discusses
ways to minimize the chances of litigation and also
to make certain that both the athlete and anyone
who is in any way involved in providing athletic
health care are protected by appropriate insurance
coverage.
Part II, Preventing Injuries in an Athletic
Health Care System, discusses a variety of top-
ics that both individually and collectively can re-
duce the chances for injury to occur. Chapter 4
emphasizes the importance of making certain that
the athlete is fit to prevent injuries. Chapter 5 dis-
cusses the importance of a healthy diet, giving
attention to sound nutritional practices and pro-
viding sound advice on the use of dietary supple-
ments. Chapter 6 provides guidelines for selecting
and using protective equipment. Chapter 7 looks at
xi
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 ways to minimize the potentially negative threats
of various environmental conditions on the health
of the athlete.
Part III, Techniques for Treating and Managing
Sport-Related Injuries, begins with Chapter 8,
which details how to assess the severity of an in-
jury and then provides specific steps that should
be taken to handle emergency situations. Chapter 9
provides guidelines that can help reduce the
chances of spreading infectious diseases by taking
universal precautions in dealing with bloodborne
pathogens. Chapter 10 discusses the more common
wrapping and taping techniques that can be used to
prevent new injuries from occurring and old ones
from becoming worse. Chapter 11 includes a brief
discussion of the general techniques that may be
used in rehabilitation following injury. Chapter 12
discusses the psychology of preparing to compete
and proposes recommendations for how a coach
should manage an injury.
Part IV, Recognition and Management of
Specific Injuries and Conditions, begins with
Chapter 13, which defines and classifies the various
types of injuries that are most commonly seen in the
physically active population.
Chapters 14 through 22 discuss injuries
that occur in specific regions of the body, in-
cluding the foot; the ankle and lower leg; the
knee; the hip, thigh, groin, and pelvis; the
shoulder; the elbow, forearm, wrist, and hand;
the spine; the thorax and abdomen; and the head,
face, eyes, ears, nose, and throat. Injuries are
discussed individually in terms of their most com-
mon causes, the signs of injury you would expect
to see, and a basic plan of care for that injury.
Chapter 23 provides guidelines and suggestions
for managing various illnesses and other health
conditions that may affect athletes and their
ability to play and compete. Chapter 24 focuses
specifically on issues related to substance
abuse and the potential effects on the athlete.
Chapter 25 provides special considerations for
injuries that may occur in young athletes.
NEW TO THIS EDITION
Chapter Changes and Additions
Numerous changes and clarifications have been
made in content throughout the entire text.
xii Preface
pre22754_fm_i-xx.indd 12
Chapter 1
• Updated information on the roles and
responsibilities of fitness professionals
who may find themselves in positions that
require them to have some knowledge of
the athletic health care system.
• Reorganized and updated the roles and
responsibilities of athletic trainers accord-
ing to the latest role delineation study.
• Added new discussion for referring injured
individuals to the appropriate health care
professionals.
• Reemphasized the role of the orthopedic
physician in caring for the injured athlete.
• Significantly updated the recommended ref-
erences and the annotated bibliography to
make them as current as possible.
Chapter 2
• Updated information on hiring certified
athletic trainers in secondary schools.
• Added new discussion of the NATA consen-
sus statement that discusses appropriate
medical care for secondary school athletes.
• Added new information on the 2013 Youth
Sports Safety Alliance’s Secondary School
Athletes’ Bill of Rights
• Added new information on the Pubertal
Development Scale used to determine
pubertal growth and development.
• Added new drawing of an ideal athletic
health care facility.
• Significantly updated the recommended ref-
erences and the annotated bibliography to
make them as current as possible.
Chapter 3
• Added new information on the Affordable
Care Act.
• Added a new Focus Box discussing key
features and benefits of the Affordable
Care Act.
• Updated the recommended references to
make them as current as possible.
Chapter 4
• Updated information on and recommenda-
tions for the warm-up.
21/09/15 5:09 PM
 • Calisthenic exercises are now referred to
more correctly, as bodyweight exercises.
• Added new photos that better illustrate the
various exercises that may be done in a
training and conditioning program to help
prevent injuries.
• Completely revised and updated informa-
tion on calculating a target heart rate for
improving cardiorespiratory endurance.
• Added the new American College of Sports
Medicine recommendation on training
intensities.
• Changed the term interval training
to the more appropriately used term
high-intensity interval training.
• Significantly updated the recommended ref-
erences and the annotated bibliography to
make them as current as possible.
Chapter 5
• Added a discussion on how the body’s me-
tabolism utilizes the various foodstuffs to
produce energy.
• Added new suggestions on foods that can
provide energy during activity.
• The Athletic Injury Management
Checklist focuses on a nutritious diet for
the athlete.
• Added new information on binge eating as a
newly recognized eating disorder.
• Significantly updated the recommended ref-
erences and the websites to make them as
current as possible.
Chapter 6
• Replaced most of the photographs to
show examples of the newest available
equipment.
• Updated the new NOCSAE warning label
that must be placed on all football helmets.
• Added an update on the latest in helmet
technology that attempts to minimize the
impact forces transmitted to the athlete’s
head.
• Added a discussion on the newest facemask
fasteners.
• Significantly updated the recommended
references to make them as current as
possible.
pre22754_fm_i-xx.indd 13
Chapter 7
• Replaced the heat index chart with a new
chart that is much easier to read.
• Updated information on psychrometers
used to monitor the heat index.
• Updated information on using sunscreens.
• Replaced photo of a lightning detector with
the newest digital lightning detector.
• Significantly updated the recommended ref-
erences to make them as current as possible.
Chapter 8
• Added a new definition of an emergency.
• Added a new Focus Box that provides a
sample emergency action plan.
• Reordered the life-threatening injuries in
the emergency procedures flowchart.
• Made slight adjustments in the CPR Sum-
mary table to clarify the procedures.
• Replaced photos of football facemask
fasteners.
• Added a photo showing correct hand and
finger placement for taking blood pressure.
• Added a new photo and brief discussion of
the head-squeeze technique for immobiliz-
ing the cervical spine.
• Added the most current recommendations
from an inter-association task force to
consider removing the helmet and shoulder
pads by trained personnel prior to trans-
porting an athlete with a suspected cervical
spine injury.
• Significantly updated the recommended
references and annotated bibliography to
make them as current as possible.
Chapter 9
• Replaced photos showing lacerations and
incision skin wounds.
• Clarified recommendations for cleaning
wounds and using an occlusive dressing.
• Significantly updated the recommended
references and annotated bibliography to
make them as current as possible.
Chapter 10
• Added a discussion of kinesio taping and its
efficacy as a treatment technique.
Preface xiii
21/09/15 5:09 PM
 Chapter 11
• Added a discussion that clarifies the
purpose of this chapter and gives a caution
about who is legally able to suggest or
supervise a program of rehabilitation for an
injured athlete.
Chapter 13
• Significantly updated the recommended ref-
erences to make them as current as possible.
Chapter 14
• Added a definition of a tailor’s bunion or
bunionette.
• Significantly updated the recommended
references and annotated bibliography to
make them as current as possible.
Chapter 15
• Added an updated photo of a new ankle
brace.
• Clarified the difference between Achilles
tendinitis and Achilles tendinosis.
• Significantly updated the recommended
references and annotated bibliography to
make them as current as possible.
Chapter 16
• Added an in-depth discussion of shoe type
and its impact on preventing knee injuries
on different playing surfaces.
• Added a new discussion of anterior and
posterior drawer tests and a new photo that
demonstrates those tests.
• Added new information that clarifies the
mechanisms of injury for both noncontact
and contact ACL injuries.
• Added a new photo that more accurately
shows the combination of forces that col-
lectively cause ACL injury.
• Redefined patellofemoral pain syndrome.
• Significantly updated the recommended
references and annotated bibliography to
make them as current as possible.
Chapter 17
• Added in a new photo that will help explain
piriformis syndrome.
xiv Preface
pre22754_fm_i-xx.indd 14
• Clarified the information on the mechanism
of injury for a hip pointer.
• Significantly updated the recommended
references and annotated bibliography to
make them as current as possible.
Chapter 18
• Updated photos showing acromioclavicular
joint sprains with labels to clarify the
different grades of injury.
• Added a new drawing of biceps tenosynovi-
tis that shows the location of the tendon and
the most common area of inflammation.
• Significantly updated the recommended
references and websites to make them as
current as possible.
Chapter 19
• Added a new discussion of and new photos
for lateral and medial epicondylitis tests.
• Briefly mentioned dinner fork deformity to
refer to a Colles’ fracture.
• Added a new x-ray photo to clearly show an
example of a forearm fracture of both the
radius and the ulna.
• Added a new drawing that shows the causes
of carpal tunnel syndrome in the wrist.
• Significantly updated the recommended
references and annotated bibliography to
make them as current as possible.
Chapter 20
• Added a new x-ray photo that more clearly
depicts a spondylolisthesis.
• Deleted reference to sleeping on a waterbed.
• Significantly updated the recommended
references and annotated bibliography to
make them as current as possible.
Chapter 21
• Added a discussion of referred pain that often
results from palpation of abdominal organs.
• Identified noncardiac causes of sudden
death syndrome in athletes.
• Clarified the distinction between a sports
hernia, which should be more correctly
identified as athletic pubalgia, and an
inguinal or femoral hernia.
21/09/15 5:09 PM
 • Significantly updated the recommended
references and annotated bibliography to
make them as current as possible.
Chapter 22
• Updated image of the brain with labels
more clearly showing the different regions
of the brain.
• Added a section that clarifies the relation-
ship between the terms mild traumatic
brain injury and concussion.
• Added a new discussion of the most recent
definition of concussion and associated
symptoms and signs.
• Updated and added new information about
evaluating concussions that currently uses
the SCAT 3 as the most accepted evaluation
tool.
• Added new guidelines for caring for con-
cussions including the new state laws that
specify how concussions must be managed
and return-to-play decisions.
• Added a new table, the Graded Symptoms
Checklist, that identifies the possible symp-
toms associated with concussion.
• Added a new Focus Box that details the
procedures that should be followed on
the sidelines for a player with a suspected
concussion.
• Significantly updated the recommended
references and annotated bibliography to
make them as current as possible.
Chapter 23
• Added updated recommendations for
managing herpes simplex.
• Added new photos showing how to
correctly use a metered-dose inhaler.
• Replaced photos for several dermatologic
conditions to better show exactly what
these conditions look like.
• Updated treatment information for tinea
pedis (athlete’s foot).
• Added a discussion of contraceptive
devices that are alternatives to birth-
control pills.
• Significantly updated the recommended
references and annotated bibliography to
make them as current as possible.
pre22754_fm_i-xx.indd 15
Chapter 24
• Based on reviewer consensus, expanded the
discussion on abuse of recreational drugs
including alcohol, abused illegal drugs, and
abused prescription drugs.
• Updated the Focus Box on drugs banned by
the NCAA and the USADA.
• Significantly updated the recommended
references, annotated bibliography, and
websites to make them as current as
possible.
Chapter 25
• Updated Youth Sports Safety Alliance
statistics on injuries in youth sports.
• Updated recommendations for youth
strength-training programs from the
American Academy of Pediatrics Council
on Sports Medicine and Fitness.
• Added information on the USOC Coaching
Education Department that supports the
national governing bodies of 40 sports.
• Updated the table on sports injury
prevention tips from the American
Academy of Pediatrics.
• Updated the Sports Parents Safety
Checklist from Safe Kids Worldwide.
• Added a new table on the National Action
Plan for Sports Safety from the Youth
Sport’s Safety Alliance.
• Significantly updated the recommended
references, annotated bibliography, and
websites to make them as current as
possible.
Appendix A
• Updated the information on employment
of certified athletic trainers in secondary
schools.
PEDAGOGICAL FEATURES
• Chapter objectives. Objectives are
presented at the beginning of each chapter,
to reinforce learning goals.
• Focus Boxes. Important information is
highlighted to provide additional content
that supplements the main text.
Preface xv
21/09/15 5:09 PM
 • Margin information. Key concepts, selected
definitions and pronunciation guides, help-
ful training tips, and illustrations are placed
in margins throughout the text for added
emphasis and ease of reading and studying.
• Illustrations and photographs. Every il-
lustration and photograph throughout
the book is in full color, with over 40 new
photographs that will help to enhance the
visual learning experience for the student.
• Critical thinking exercises. Included in
every chapter, these brief case studies cor-
respond with the accompanying text and
help students apply the content just learned.
Solutions for each exercise are located at
the end of the chapters.
• Athletic Injury Management Checklists.
These checklists help organize the details
of a specific procedure when managing ath-
letic health care.
• Chapter summaries. Chapter content is
summarized and bulleted to reinforce key
concepts and aid in test preparation.
• Review questions and class activities. A list
of questions and suggested class activities
follows each chapter for review and appli-
cation of the concepts learned.
• Recommended references. All chapters have
a bibliography of pertinent references that
includes the most complete and up-to-date
resources available.
• Annotated bibliography. To further aid in learn-
ing, relevant and timely articles, books, and
topics from the current literature have been
annotated to provide additional resources.
• Websites. A list of useful websites is included
to direct the student to additional relevant in-
formation that can be found on the Internet.
• Glossary. A comprehensive list of key
terms with their definitions is presented at
the end of the text.
• Appendixes. For those students interested
in learning more about athletic training,
Appendixes A and B provide information
about employment settings for the athletic
trainer and the requirements for certifi-
cation as an athletic trainer. Appendix C
shows the directional anatomic motions of
the joints discussed in this text.
xvi Preface
pre22754_fm_i-xx.indd 16
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experience how McGraw-Hill Create empowers you
to teach your students your way.
ACKNOWLEDGMENTS
Special thanks are extended to Gary O’Brien, my
Development Editor and most importantly my
“wing-man” on this and several additional projects.
As always he has provided invaluable guidance in
the preparation of the tenth edition of Essentials
of Athletic Injury Management and I cannot thank
him enough for everything he does for me.
I would also like to thank the following individu-
als who served as reviewers for their input into the
revision of this text:
Johannah Elliott
Arizona Western College–Yuma
Matthew Hamilton
D’Youville College
Carie Mueller
San Jacinto College–South
Finally, I would like to thank my family, Tena, Brian,
and Zach, for always being an important part of
everything I do.
William E. Prentice

Preface xvii

pre22754_fm_i-xx.indd 17 21/09/15 5:09 PM

 Applications at a Glance
List of professional sports medicine
organizations 4
Clarifying roles 8
Athletic injury management checklist 13
Looking to hire a certified athletic trainer? 18
Secondary School Student Athletes’ Bill of
Rights 18
Rules and policies of the athletic health care
facility 19
Suggestions for maintaining a sanitary
environment 19
Cleaning responsibilities 20
Recommended health practices checklist 20
Orthopedic Screening Examination 24
Recommended basic health care facility
supplies 27
Recommended basic field kit supplies 28
Athletic injury management checklist 30
Athletic injury management checklist 34
Key Features and Benefits of the Affordable Care
Act 36
Athletic injury management checklist 39
Periodization training 45
Principles of conditioning 46
Guidelines and precautions for stretching 50
Techniques for improving muscular
strength 60
Progressive resistance exercise terminology 62
Comparison of aerobic versus anaerobic
activities 75
Rating of perceived exertion 79
Athletic injury management checklist 80
Vitamins 86
Major minerals 88
Most widely used herbs and purposes for use 93
Tips for selecting fast foods 97
Guidelines for weight loss 99
Recognizing the individual with disordered
eating 100
Athletic injury management checklist 101
Equipment regulatory agencies 106
Guidelines for purchasing and reconditioning
helmets 107
Proper football helmet fit 109
Rules for fitting football shoulder pads 115
Shoe comparisons 119
Athletic injury management checklist 124
WBGT index and recommendations for fluid
replacement and work/rest periods 129
xviii
pre22754_fm_i-xx.indd 18
Summary and comparison of heat disorders,
treatment and prevention 130
Recommendations for fluid replacement 133
Recommendations for preventing heat
illness 133
Athletic injury management checklist 137
Sample emergency action plan 144
Consent form for medical treatment of a
minor 145
CPR summary 147
Vital signs 151
Initial management of acute injuries 153
Athletic injury management checklist 159
Transmission of hepatitis B and C viruses and
human immunodeficiency virus 164
HIV risk reduction 165
Bloodborne pathogen risk categories for sports 165
Glove removal and use 167
Suggested practices in wound care 170
Care of skin wounds 171
Athletic injury management checklist 171
Taping supplies 180
Athletic injury management checklist 188
Return to running following lower-extremity injury
functional progression 196
What are therapeutic modalities used for? 197
Using ice versus heat? 198
Full return to activity 198
Athletic injury management checklist 199
Progressive reactions of injured athletes
based on severity of injury and length of
rehabilitation 202
Nine factors to incorporate into goal setting for the
athlete 204
Things a coach or fitness professional can do
to provide social support for an injured
athlete 205
Athletic injury management checklist 208
Muscles of the foot 228
Caring for a torn blister 237
Managing the ingrown toenail 238
Muscles of the ankle joint 243
Technique for controlling swelling immediately
following injury 249
Muscles of the knee joint 260
Muscles of the thigh, hip, and groin 280
Muscles of the shoulder complex 295
Muscles of the elbow 307
Muscles of the forearm 313
21/09/15 5:09 PM
 Muscles of the wrist, hand, and fingers 318
Muscles of the spine 329
Recommended postures and practices for
preventing low back pain 330
Muscles of the abdomen and thorax 342
When an athlete shows any signs of a
concussion 358
The Graded Symptoms Checklist 359
Common viral, bacterial, and fungal skin infections
found in athletes 375
Preventing the spread of MRSA 377
Basic care of athlete’s foot 378
Symptoms and management of the acute
asthmatic attack 381
Using a metered-dose inhaler 382
Classifying blood pressure 386
Some infectious viral diseases 387
Identifying a woman at risk for female
athletic triad 389
pre22754_fm_i-xx.indd 19
Sexually transmitted diseases 391
Identifying an individual who may be using
performance-enhancing drugs 396
Examples of caffeine-containing products 396
Examples of deleterious effects of anabolic
steroids 397
Banned drugs—common ground 400
Estimated number of young people ages 5–17
enrolled in specific categories of youth
sports 404
Tanner stages of maturity 406
Guidelines for Youth Strength Training 407
Sports Safety Tips 411
Sports parents safety checklist 412
National Action Plan for Sports Safety 412
Athletic injury management checklist 413
Board of certification requirements for certification
as an athletic trainer 420
Applications at a Glance xix
21/09/15 5:09 PM
pre22754_fm_i-xx.indd 20 21/09/15 5:09 PM
 PART I
Organizing and Establishing an Effective Athletic
Health Care System

1 Fitness Professionals, Coaches, and the Sports Medicine Team:

Defining Roles
2 Organizing and Administering an Athletic Health Care Program
3 Legal Liability and Insurance

pre22754_ch01_001-015.indd 1 21/09/15 4:34 PM

 1
Fitness Professionals, Coaches,
and the Sports Medicine Team:
Defining Roles
■ Objectives
When you finish this chapter you will be able to:
• Define the umbrella term sports medicine.
• Identify various sports medicine organizations.
• Contrast athletic health care in organized
versus recreational sports activities.
• Discuss how fitness professionals, including
personal fitness trainers and strength and
conditioning coaches, relate to the sports
medicine team.
• Describe the role of an individual supervising
a recreational program in athletic injury
management.
• Analyze the role of the athletic administrator
in the athletic health care system.
M illions of individuals in our American
society participate on a regular basis in
both organized and recreational sports
or physical activities. There is great demand for
well-educated, professionally trained personnel to
supervise and oversee these activities. Among those
professionals are coaches, fitness professionals such
as strength and conditioning specialists and per-
sonal fitness trainers, recreation specialists, athletic
administrators, and others interested in some aspect
of exercise and sports science.
Ironically, participation in any type of physi-
cal activity places the “athlete” in situations in
which injury
An athlete is an individual who is likely to
engages in and is proficient in
occur. Athletes
sports and/or physical exercise.
who engage in
pre22754_ch01_001-015.indd 2
• Describe the role of the coach in injury
prevention, emergency care, and injury
management.
• Identify the responsibilities of the athletic
trainer in dealing with the injured athlete.
• Describe the role of the team physician
and his or her interaction with the athletic
trainer.
• Explain how the sports medicine team should
interact with the athlete.
• Identify other members of the sports medicine
team and describe their roles.
organized sports and/or recreational activities have
every right to expect that their health and safety
will be a high priority for those who supervise or
organize those activities. Thus it is essential to have
some knowledge about how injuries can best be pre-
vented or at least minimized. Should injury occur, it
is critical to be able to recognize that a problem ex-
ists, to learn how to correctly provide first-aid care,
and to then refer the athlete to the appropriate medi-
cal or health care personnel for optimal treatment.
However, it must be emphasized that these well-
trained professionals are NOT health care profes-
sionals. In fact, attempting to provide health care to
an injured or ill athlete is in most states illegal and
likely violates the practice acts of several different
professional health care provider groups licensed by
the state to give medical care to an injured athlete.
21/09/15 4:34 PM
 Medic
The intent throughout this text is to provide
students who intend to become coaches, fitness

rts
o
professionals, recreation specialists, athletic
administrators, physical education teachers,
exercise physiologists, biomechanists, sport

Sp

ine
psychologists, or sports nutritionists with an Performance Injury Care &
introduction or exposure to a variety of topics Enhancement Management
that relate to athletic injury management. This
Exercise Physiology Practice of Medicine
chapter introduces the members of the sports medi-
Biomechanics (Physicians, Physician’s
cine team with whom these professionals are likely Sport Psychology Assistants)
to interact throughout their careers. Specific roles Sports Nutrition Athletic Training
and responsibilities of each member of the sports Strength & Conditioning Sports Physical Therapy
Personal Fitness Training Sports Massage Therapy
medicine team in managing the health care of the Coaching Sports Dentistry
athlete are discussed in detail. Physical Education Osteopathic Medicine
Orthotists/Prosthetists
Sports Chiropractic
WHAT IS SPORTS MEDICINE? Sports Podiatry
Emergency Medical Specialists
The term sports medicine refers generically to a
broad field of health care related to physical activ-
ity and sport. The American College of Sports Medi- FIGURE 1–1 Areas of specialization under the sports
cine (ACSM) has used the term sports medicine to medicine “umbrella.”
describe a multidisciplinary approach to health man-
roles that members of their organizations play in
agement or achievement of full potential, including
providing health care to an injured patient. Profes-
the physiological, biomechanical, psychological, and
sional organiza-
pathological phenomena associated with exercise
tions have many Many professional organizations
and sports. The clinical application of the work of
goals: (1) to up- are dedicated to achieving
these disciplines is performed to improve and main-
grade the field health and safety in sports.
tain an individual’s functional capacities for physi-
by devising and
cal labor, exercise, and sports. It also includes the
maintaining a set of professional standards, includ-
prevention and treatment of diseases and injuries
ing a code of ethics; (2) to bring together profes-
related to exercise and sports. The field of sports
sionally competent individuals to exchange ideas,
medicine encompasses under its umbrella a num-
stimulate research, and promote critical thinking;
ber of more specialized aspects of dealing with the
and (3) to give individuals an opportunity to work
physically active or athletic populations that may be
as a group with a singleness of purpose, thereby
classified as relating either to performance enhance-
making it possible for them to achieve objectives
ment or to injury care and management (Figure 1–1).
that, separately, they could not accomplish. Ad-
Those areas of specialization that are primarily con-
dresses and websites for these organizations are
cerned with performance enhancement include ex-
listed in Focus Box 1–1.
ercise physiology, biomechanics, sport psychology,
Many of the national organizations interested in
sports nutrition, strength and conditioning, personal
athletic health and safety have state and local as-
fitness training, coaching, and physical education.
sociations that are extensions of the larger bodies.
Areas of specialization that focus more on health
National, state, and local sports organizations have
care and injury/illness management specific to the
all provided extensive support to the reduction of
athlete are the practice of medicine (physicians and
illness and injury risk to the athlete.
physician assistants), athletic training, sports physi-
cal therapy, massage therapy, dentistry, osteopathic
medicine, orthotists/prosthetists, sports chiropractic,
sports podiatry, and emergency medical specialists.
ATHLETIC HEALTH CARE
Certainly, some of the specializations listed under IN ORGANIZED VERSUS
this umbrella could be concerned with both perfor-
mance enhancement and injury care and manage-
RECREATIONAL SPORTS
ment (for example, sports nutrition). ACTIVITIES
The system or methods by which athletic health
Sports Medicine Organizations care is delivered by members of the sports medi-
A number of professional organizations are dedi- cine team largely depend on whether the activity
cated to the field of sports medicine and dictate the is organized or recreational. An organized activity

Chapter One ■ Fitness Professionals, Coaches, and the Sports Medicine Team: Defining Roles 3

pre22754_ch01_001-015.indd 3 21/09/15 4:34 PM

 FOCUS BOX 1–1
List of professional sports medicine organizations
• American Academy of Pediatrics, Council on
Sports Medicine and Fitness, 141 Northwest
Point BoulevardElk Grove Village, IL 60007-
1098 www.aap.org
• American Board of Physical Therapy Specialists,
American Physical Therapy Association, 1111
North Fairfax St., Alexandria, VA 22314 www
.abpts.org/Certification/Sports/
• American College of Sports Medicine, 401 W.
Michigan St., Indianapolis, IN 46202-3233
www.acsm.org
• American Orthopaedic Society for Sports Medi-
cine, Suite 202, 70 West Hubbard, Chicago, IL
60610 www.sportsmed.org
• National Athletic Trainers’ Association, 1620
Valwood Parkway, Suite 115, Carrollton TX
75006 www.nata.org
refers to a situation that is generally competitive in
which there is some type of team or league involve-
ment, as would be the case with secondary school,
collegiate, and professional athletic teams. With or-
ganized sports activities, the primary players on the
sports medicine team are employed on either a full-
time or part-time basis by a school or organization
and include the coach, the athletic trainer, and a
physician who is designated as a “team” physician.
At the collegiate and professional levels, a strength
and conditioning coach, a sports nutritionist, a
sports massage therapist, and a sport psychologist
are also usually involved. In organized sports ac-
tivities, the athletic health care system is generally
well organized and comprehensive, and in many in-
stances the sports medicine coverage would be con-
sidered highly sophisticated.
Certainly a recreational sports activity can be
competitive. However, a recreational activity is
one that is done more for leisure and free time en-
joyment and involves a much less formal structure,
with many of the organizers being primarily vol-
unteers. These include city- or community-based
recreational leagues and teams. Many individu-
als choose to engage in fitness-oriented exercise
activities such as running or weight training as a
recreational activity. These “recreational athletes”
may decide to hire personal fitness trainers to help
them with their fitness programs. Should injury
occur, they are likely to consult their family physi-
cian, an athletic trainer, a sports chiropractor, or a
sports physical therapist. Athletic health care for
4 Part One ■ Organizing and Establishing an Effective Athletic Health Care System
pre22754_ch01_001-015.indd 4
• National Collegiate Athletic Association, Com-
petitive Safeguards and Medical Aspects of
Sports Committee, 700 W. Washington St., P.O.
Box 622, Indianapolis, IN 46206-6222 www
.ncaa.org
• National Federation of State High School Ath-
letic Associations, 11724 Plaza Circle, P.O.
Box 20626, Kansas City, MO 64195 www
.nfhs.org
• National Strength and Conditioning Association,
P.O. Box 38909, Colorado Springs, CO 80937-
8909 www.nsca-lift.org
• American Osteopathic Academy of Sports Medi-
cine, 7600 Terrace Ave., Middleton, WI 53562
www.aoasm.org
recreational athletes is generally provided on a fee-
for-care basis.
THE PLAYERS ON THE SPORTS
MEDICINE TEAM
Providing health care to the athlete requires a
group effort to be most effective.38 The sports medi-
cine team involves a number of individuals, each of
whom must perform specific functions relative to
caring for the injured athlete.5,12
How Does the Fitness Professional Relate
to the Sports Medicine Team?
Earlier in this chapter, the term fitness professional
was used to refer collectively to strength and con-
ditioning coaches, personal fitness trainers, and
others interested in exercise and sport sciences. In
this group we may also include physical education
teachers, exercise physiologists, biomechanists,
sport psychologists, and sports nutritionists. If we
consider the “sports medicine umbrella” model, the
focus of this group is on improving performance.
Certainly an argument can be made that if athletes
achieve a high level of fitness through training and
conditioning, they are not only more likely to per-
form athletically at a higher level but they are also
less likely to sustain some type of activity-related
injury. Therefore, there is a relationship between
those areas that specialize in performance enhance-
ment and those that focus on health care in that
both groups are concerned with injury prevention.
21/09/15 4:34 PM
 Strength and Conditioning Coaches The respon-
sibility for making certain that an athlete is fit for
competition depends on the personnel available to
oversee this aspect of an athletic program. At the
professional level and at most colleges and univer-
sities, a full-time strength and conditioning coach is
employed to conduct both team and individual train-
ing sessions. Many, but not all, strength coaches are
certified by the National Strength and Conditioning
Association (NSCA).24 This association has more
than 30,000 members. It is the responsibility of
the strength and conditioning coach to commu-
nicate freely and work in close cooperation with
both the athletic trainers and the team coaches to
ensure that the athletes achieve an optimal level of
fitness.9 All strength and conditioning coaches
should be certified in CPR/AED (cardiopul-
monary resuscitation/automated external de-
fibrillator) by the American Red Cross, the
American Heart Association, or the National
Safety Council. They should also be certified
in first aid by the American Red Cross or the
National Safety Council.
If an athlete is injured and is undergoing a re-
habilitation program, it should be the strength
and conditioning coach’s responsibility to com-
municate with the athletic trainer as to how the
conditioning program should be limited and/or
modified.22 The athletic trainer must respect the
role of the strength and conditioning coach in get-
ting the athlete fit. However, the responsibility for
rehabilitating an injured athlete clearly belongs to
the athletic trainer. The athletic trainer should be
allowed to critically review the training and condi-
tioning program designed by the strength and con-
ditioning coach and to be very familiar with what
is expected of the athletes on a daily basis. The
athletic trainer should dictate what an injured
athlete can or cannot do when engaging in a
strength and conditioning program.41
In the majority of high school settings, a
strength and conditioning coach is not available.
In this situation either the athletic trainer or team
coach often assumes the role of a strength and con-
ditioning coach in addition to his or her athletic
training or coaching responsibilities. The athletic
trainer or coach frequently finds it necessary not
only to design training and conditioning programs
but also to oversee the weight room and to educate
young, inexperienced athletes about getting them-
selves fit to compete. The athletic trainer must
cooperate with team coaches in supervising the
training and conditioning program.
Personal Fitness Trainers A personal fitness trainer
is responsible for designing comprehensive exercise
Chapter One ■ Fitness Professionals, Coaches, and the Sports Medicine Team: Defining Roles
pre22754_ch01_001-015.indd 5
or fitness pro- Fitness professionals include:
grams for an
• strength and conditioning coaches
individual cli- • personal fitness trainers
ent based on • coaches
that person’s • others associated with exercise and
health history, sport sciences
capabilities, and
objectives for
fitness.18 Once thought of as a service for the rich and
famous, people from all income levels are using per-
sonal fitness trainers to increase their fitness levels
and to get advice about living a healthy lifestyle.13
There are around 300,000 personal trainers in
North America, who offer their services to a va-
riety of people and businesses. Although asso-
ciations and certification agencies can count the
number of personal fitness trainers in their orga-
nization, many personal fitness trainers have one
or more certifications and belong to more than one
professional organization, making it almost impos-
sible to accurately assess the number of certified
personal fitness trainers in the United States.
Unfortunately, no single standard qualification
is required before a person can practice as a per-
sonal fitness trainer.7 Washington D.C. is the only
jurisdiction in the United States where personal
fitness trainers must be registered. About 400 or-
ganizations in the United States offer certification
to personal fitness trainers. Of that number, only a
few are considered legitimate by most profession-
als. Among the most respected are the American
College of Sports Medicine (ACSM), the National
Academy of Sports Medicine (NASM), the National
Strength and Conditioning Association (NSCA), and
the American Council on Exercise (ACE).21 These
organizations have specific requirements based on
tested and practical knowledge, mandatory retest-
ing at renewal periods, and continuing education.
A recent trend by some of these organizations is to
require that their certified personal fitness train-
ers have a formal educational degree in exercise
science or a related field.23 However, the require-
ments for other organizations are not so strict.
Some award certification after a person takes a
correspondence course over the Internet or attends
as little as a weekend or single-day training ses-
sion. Individuals who hire personal fitness trainers
should check qualifications and certifications. All
personal fitness trainers should be certified
in CPR/AED by the American Red Cross, the
American Heart Association, or the National
Safety Council. They should also be certified
in first aid by the American Red Cross or the
National Safety Council.
Personal fitness training is without question the
strongest growth segment of the fitness industry, and
5
21/09/15 4:34 PM
Another random document with
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was an artistic enthusiasm; he was captivated by his own skill in
persuasion. And whenever, for a moment, this interest in his own
artistry waned, there came on him afresh the feeling of deep
weariness, and a desire only to rest and sleep and be friends with
everybody.
At last he persuaded her. It had taken from nine o'clock until
midnight. He was utterly tired out when he had finished. Yet there
seemed to be no tiredness in her, only a happiness that she could
now take and caress him as her own. She could not understand how,
now that they had made their reconciliation, he should not be eager
to cement it by endearments. Instead of which he lit a cigarette and
said that he was hungry.
While she busied herself preparing a small meal he found himself
watching her continually as she moved about the room, and
wondering, in the calmest and most aloof manner, whether he was
really glad that he had won. Eventually he decided that he was. She
was his wife and he loved her. If they were careful to avoid
misunderstandings no doubt they would get along tolerably well in
the future. The future! The vision came to him again of the term that
was in front of him; a vision that was somehow frightening.
Yet, above all else, he was tired—dead tired.
The last thing she said to him that night was a soft, half-
whimpered: "Kenneth, I believe you do want Clare."
He said sleepily, and without any fervour: "My dear, I assure you I
don't."
And he fell asleep wondering very vaguely what it would be like to
want Clare, and whether it would ever be possible for him to do so.

CHAPTER TWO

I
 Term began on the Wednesday in the third week in January.
Once again, the first few days were something of an ordeal.
Constant anticipations had filled Speed's mind with apprehensions;
he was full of carefully excogitated glooms. Would the hostility of the
Masters be more venomous? Would the prefects of his own house
attempt to undermine his discipline? Would the rank and file try to
"rag" him when he took preparation in the Big Hall? Somehow, all his
dreams of Millstead and of Lavery's had turned now to fears; he had
slipped into the position when it would satisfy him merely to avoid
danger and crush hostility. No dreams now about Lavery's being the
finest House in Millstead, and he the glorious and resplendent
captain of it; no vision now of scouring away the litter of mild
corruptions and abuses that hedged in Lavery's on all sides; no
hopes of a new world, made clean and wholesome by his own
influence upon it. All his desire was that he should escape the pitfalls
that were surrounding him, that he should, somehow, live through
the future without disaster to himself. Enthusiasm was all gone.
Those old days when he had plunged zestfully into all manner of
new things, up to his neck in happiness as well as in mistakes—
those days were over. His one aim now was not to make mistakes,
and though he did not know it, he cared for little else in the world.
That first night of term he played the beginning-of-term hymn in
the chapel.

"Lord, behold us with Thy blessing,

Once again assembled here ..."

The words fell on his mind with a sense of heavy, unsurmountable

gloom. He looked into the mirror above his head and saw the choir-
stalls and the front rows of the pews; the curious gathering of
Millsteadians in their not-yet-discarded vacation finery; Millsteadians
unwontedly sober; some, perhaps, a little heart-sick. He saw Ervine's
back, as he read the lesson from the lectern, and as he afterwards
stood to pronounce the Benediction. "The grace of God, which
passeth—um—understanding, and the—um—fellowship of the—um
—the Holy Spirit ..."
 He hated that man.
He thought of the dark study and Potter and the drawing-room
where he and Helen had spent so many foolish hours during the
summer term of the year before.
Foolish hours? Had he come to the point when he looked back
with scorn upon his courtship days? No, no; he withdrew the word
"foolish."
" ... rest upon—um—all our hearts—now and—um—for ever—um
—Ah—men.... I would—um, yes—be glad—if the—um—the—the
new boys this term—would stay behind to see me—um, yes—to see
me for a moment...."
Yes, he hated that man.
He gathered his gown round him and descended the ladder into
the vestry. A little boy said "Good-evening, Mr. Speed," and shook
hands with him. "Good-evening, Robinson," he said, rather quietly.
The boy went on: "I hope you had a nice Christmas, sir." Speed
started, checked himself, and replied: "Oh yes, very nice, thanks.
And you too, I hope." "Oh yes, sir," answered the boy. When he had
gone Speed wondered if the whole incident had been a subtle and
ironical form of "ragging." Cogitation convinced him that it couldn't
have been; yet fear, always watching and ready to pounce, would
have made him think so. He felt really alarmed as he walked back
across the quadrangle to Lavery's, alarmed, not about the Robinson
incident, which he could see was perfectly innocent, but because he
was so prone to these awful and ridiculous fears. If he went on
suspecting where there was no cause, and imagining where there
was no reality, some day Millstead would drive him mad. Mad—yes,
mad. Two boys ran past him quickly and he could see that they
stopped afterwards to stare at him and to hold some sort of a
colloquy. What was that for? Was there anything peculiar about him?
He felt to see if his gown was on wrong side out: no, that was all
right. Then what did they stop for? Then he realised that he was
actually speaking that sentence out aloud; he had said, as to some
corporeal companion: What did they stop for? Had he been
gibbering like that all the way across the quadrangle? Had the two
boys heard him talking about going mad? Good God, he hoped not!
That would be terrible, terrible. He went in to Lavery's with the sweat
standing out in globes on his forehead. And yet, underfoot, the
ground was beginning to be hard with frost.
Well, anyway, one thing was comforting; he was getting along
much better with Helen. They had not had any of those dreadful,
pathetic scenes for over a fortnight. His dreams of happiness were
gone; it was enough if he succeeded in staving off the misery. As he
entered the drawing-room Helen ran forward to meet him and kissed
him fervently. "The first night of our new term," she said, but the
mention only gave a leap to his anxieties. But he returned her
embrace, willing to extract what satisfaction he could from mere
physical passion.

II

An hour later he was dining in the Masters' Common-Room. He

would have avoided the ordeal but for the unwritten law which
ordained that even the housemasters should be present on the first
night of term. Not that there was anything ceremonial about the
proceedings. Nothing happened that did not always happen, except
the handshaking and the disposition to talk more volubly than usual.
Potter arched his long mottled neck in between each pair of diners in
exactly the same manner as heretofore; there was the same
unchanged menu of vegetable soup, undercooked meat, and a very
small tart on a very large plate.
But to Speed it seemed indeed as if everything was changed. The
room seemed different; seemed darker, gloomier, more chronically
insufferable; Potter's sibilant, cat-like stealthiness took on a degree
of sinisterness that made Speed long to fight him and knock him
down, soup-plates and all; the food tasted reminiscently of all the
vaguely uncomfortable things he had ever known. But it was in the
faces of the men around him that he detected the greatest change of
all. He thought they were all hating him. He caught their eyes
glancing upon him malevolently; he thought that when they spoke to
him it was with some subtle desire to insult him; he thought also, that
when they were silent it was because they were ignoring him
deliberately. The mild distaste he had had for some of them, right
from the time of first meeting, now flamed up into the most virulent
and venomous of hatreds. And even Clanwell, whom he had always
liked exceedingly, he suspected ever so slightly at first, though in a
little while he liked him as much as ever, and more perhaps, because
he liked the others so little.
Pritchard he detested. Pritchard enquired about his holiday, how
and where he had spent it, and whether he had had a good time;
also if Mrs. Speed were quite well, and how had she liked the visit to
Beachings Over. Somehow, the news had spread that he had taken
Helen to spend Christmas at his parents' house. He wondered in
what way, but felt too angry to enquire. Pritchard's questions stung
him to silent, bottled-up fury; he answered in monosyllables.
"Friend Speed has the air of a thoughtful man," remarked
Ransome in his oblique, half-sarcastic way. And Speed smiled at
this, not because it amused him at all, but because Ransome
possessed personality which submerged to some extent his own.
Finally, when Clanwell asked him up to coffee he declined,
courteously, but with a touch of unboyish reserve which he had
never previously exhibited in his relations with Clanwell. "I've got
such a lot of work at Lavery's," he pleaded. "Another night,
Clanwell...."
And as he walked across the quadrangle at half-past eight he
heard again those curious sounds that had thrilled him so often
before, those sounds that told him that Millstead had come to life
again. The tall blocks of Milner's and Lavery's were cliffs of yellow
brillance, from which great slanting shafts of light fell away to form a
patchwork on the quadrangle. He heard again the chorus of voices in
the dormitories, the tinkle of crockery in the basement studies, the
swish of water into the baths, the babel of miscellaneous busyness.
He saw faces peering out of the high windows, and heard voices
calling to one another across the dark gulf between the two houses.
It did not thrill him now, or rather, it did not thrill him with the beauty
of it; it was a thrill of terror, if a thrill at all, which came to him. And he
climbed up the flight of steps that led to the main door of Lavery's
and was almost afraid to ring the bell of his own house.
Burton came, shambling along with his unhappy feet and beaming
—positively beaming—because it was the beginning of the term.
"Once again, sir," he said, mouthing, as he admitted Speed. He
jangled his huge keys in his hand as if he were a stage jailer in a
stage prison. "I don't like the 'ockey term myself, sir, but I'd rather
have any term than the 'olidays."
"Yes," said Speed, rather curtly.
There were several jobs he had to do. Some of them he could
postpone for a day, or perhaps, even for a few days, if he liked, but
there was no advantage in doing so, and besides, he would feel
easier when they were all done. First, he had to deliver a little
pastoral lecture to the new boys. Then he had to chat with the
prefects, old and new—rather an ordeal that. Then he had to patrol
the dormitories and see that everything was in proper order. Then he
had to take and give receipts for money which anybody might wish to
"bank" with him. Then he had to give Burton orders about the
morning. Then he had to muster a roll-call and enquire about those
who had not arrived. Then, at ten-thirty, he had to see that all lights
were out and the community settled in its beds for slumber....
All of which he accomplished automatically. He told the new boys,
in a little speech that was meant to be facetious, that the one
unforgivable sin at Lavery's was to pour tea-leaves down the waste-
pipes of the baths. He told the prefects, in a voice that was harsh
because it was nervous, that he hoped they would all co-operate
with him for the good of the House. He told Burton, quite tonelessly,
to ring the bell in the dormitories at seven-thirty, and to have
breakfast ready in his sitting-room at eight. And he went round the
dormitories at half-past ten, turning out gases and delivering brusque
good-nights.
 Then he went downstairs into the drawing-room of his own house
where Helen was. He went in smiling. Helen was silent, but he knew
from experience that silence with her did not necessarily betoken
unhappiness. Yet even so, he found such silences always unnerving.
To-night he wanted, if she had been in the mood, to laugh, to be jolly,
to bludgeon away his fears. He would not have minded getting
slightly drunk.... But she was silent, brooding, no doubt, happily, but
with a sadness that was part of her happiness.
As he passed by the table in the dimly-lit room he knocked over
the large cash-box full of the monies that the boys had banked with
him. It fell on to the floor with a crash which made all the wires in the
piano vibrate.
"Aren't you careless?" said Helen, quietly, looking round at him.
He looked at her, then at the cash-box on the floor, and said
finally: "Damn it all! A bit of noise won't harm us. This isn't a funeral."
He said it sharply, exasperated, as if he were just trivially enraged.
After he had said it he stared at her, waiting for her to say something.
But she made no answer, and after a long pause he solemnly picked
up the cash-box.

III

There came a January morning when he had a sudden and

almost intolerable longing to see Clare. The temperature was below
freezing-point, although the sun was shining out of a clear sky; and
he was taking five alpha in art drawing in a room in which the
temperature, by means of the steamiest of hot-water pipes, had
been raised to sixty. His desk was at the side of a second-floor
window, and as he looked out of it he could see the frost still white
on the quadrangle and the housemaids pouring hot water and ashes
on the slippery cloister-steps. He had, first of all, an urgent desire to
be outside in the keen, crisp air, away from the fugginess of heated
class-rooms; then faintly-heard trot of horses along the Millstead
lane set up in him a restlessness that grew as the hands of his watch
slid round to the hour of dismissal. It was a half-holiday in the
afternoon, and he decided to walk up to Dinglay Fen, taking with him
his skates, in case the ice should be thick enough. The thought of it,
cramped up in a stuffy class-room, was a sufficiently disturbing one.
And then, quite suddenly, there came into his longing for the fresh air
and the freedom of the world a secondary longing—faint at first, and
then afterwards stormily insurgent—a longing for Clare to be with
him on his adventures. That was all. He just wanted her company,
the tread of her feet alongside his on the fenland roads, her answers
to his questions, and her questions for him to answer. It was a
strange want, it seemed to him, but a harmless one; and he saw no
danger in it.
Dismissal-hour arrived, and by that time he was in a curious
ferment of desire. Moreover, his brain had sought out and discovered
a piece of casuistry suitable for his purpose. Had not Clare, on the
occasion of his last visit to her, told him plainly and perhaps
significantly that she would never tell anyone of his visit? And if she
would not tell of that one, why should she of any one—any one he
might care to make in the future? And as his only reason for not
visiting her was a desire to please Helen, surely that end was served
just as easily if he did visit her, provided that Helen did not know.
There could be no moral iniquity in lying to Helen in order to save her
from unhappiness, and anyway, a lie to her was at least as honest as
her subterfuge had been in order to learn from him of his last visit.
On all sides, therefore, he was able to fortify himself for the
execution of his desire.
But, said Caution, it would be silly to see her in the daytime, and
out-of-doors, for then they would run the risk of being seen together
by some of the Millstead boys, or the masters, and the affair would
pretty soon come to Helen's ears, along channels that would by no
means minimise it in transmission. Hence again, the necessity to see
Clare in the evenings, and at her house, as before. And at the
thought of her cosy little upstairs sitting-room, with the books and the
Persian rugs and the softly-shaded lamp, he kindled to a new and
exquisite anticipation.
So, then, he would go up to Dinglay Fen alone that afternoon,
wanting Clare's company, no doubt, but willing to wait for it happily
now that it was to come to him so soon. Nor did he think that there
was anything especially Machiavellian in the plans he had decided
upon.

IV

But he saw her sooner than that evening.

Towards midday the clouds suddenly wrapped up the sky and
there began a tremendous snowstorm that lasted most of the
afternoon and prevented the hockey matches. All hope of skating
was thus dispelled, and Speed spent the afternoon in the drawing-
room at Lavery's, combining the marking of exercise-books with the
joyous anticipation of the evening. Then, towards four o'clock, the
sky cleared as suddenly as it had clouded over, and a red sun shone
obliquely over the white and trackless quadrangle. There was a
peculiar brightness that came into the room through the window that
overlooked the snow; a strange unwonted brightness that kindled a
tremulous desire in his heart, a desire delicate and exquisite, a
desire without command in it, but with a fragile, haunting lure that
was more irresistible than command. As he stood by the window and
saw the ethereal radiance of the snow, golden almost in the rays of
the low-hanging sun, he felt that he would like to walk across the
white meadows to Parminters. He wanted something—something
that was not in Millstead, something that, perhaps, was not in the
world.
He set out, walking briskly, facing the crisp wind till the tears came
into his eyes and rolled down his cold cheeks. Far beyond old
Millstead spire the sun was already sinking into the snow, and all the
sky of the west was shot with streams of pendulous fire. The stalks
of the tallest grasses were clotted with snow which the sun had tried
hard to melt and was now leaving to freeze stiff and crystalline; as
the twilight crept over the earth the wind blew colder and the film of
snow lately fallen made the path over the meadows hard and
slippery with ice.
Then it was that he met Clare; in the middle of the meadows
between Millstead and Parminters, at twilight amidst a waste of
untrod snow. Her face was wonderfully lit with the reflection of the
fading whiteness, that his mind reacted to it as to the sudden brink
was in her eyes.
He felt himself growing suddenly pale; he stopped, silent, without
a smile, as if frozen stiff by the sight of her.
And she said, half laughing: "Hello, Mr. Speed! You look unusually
grim...." Then she paused, and added in a different voice: "No—on
further observation I think you look ill.... Tell me, what's the matter?"
He knew then that he loved her.
The revelation came on him so sharply, so acidly, with such
overwhelming and uncompromising directness, that his mind reacted
to it as to the sudden brink of a chasm. He saw the vast danger of
his position. He saw the stupendous fool he had been. He saw, as if
some mighty veil had been pulled aside, the stream of tragedy
sweeping him on to destruction. And he stopped short, all the
manhood in him galvanised into instant determination.
He replied, smiling: "I'm feeling perfectly well, anyway. Beautiful
after the snowstorm, isn't it?"
"Yes."
It was so clear, so ominously clear that she would stop to talk to
him if he would let her.
Therefore he said, curtly: "I'm afraid it's spoilt all the chances of
skating, though.... Pity, isn't it? Well, I won't keep you in the cold—
one needs to walk briskly and keep on walking, doesn't one? Good
night!"
 "Good night," she said simply.
Through the fast gathering twilight they went their several ways.
When he reached Parminters it was quite dark. He went to the
Green Man and had tea in the cosy little firelit inn-parlour with a huge
Airedale dog for company. Somehow, he felt happier, now that he
knew the truth and was facing it. And by the time he reached
Lavery's on the way home he was treating the affair almost jauntily.
After all, there was a very simple and certain cure for even the most
serious attack of the ailment which he had diagnosed himself as
possessing. He must not see Clare again. Never again. No, not even
once. How seriously he was taking himself, he thought. Then he
laughed, and wondered how he had been so absurd. For it was
absurd, incredibly absurd, to suppose himself even remotely in love
with Clare! It was unthinkable, impossible, no more to be feared than
the collapse of the top storey of Lavery's into the basement. He was
a fool, a stupid, self-analysing, self-suspecting fool. He entered
Lavery's scorning himself very thoroughly, as much for his cowardly
decision not to see Clare again as for his baseless suspicion that he
was growing fond of her.

CHAPTER THREE

Why was it that whenever he had had any painful scene with
Helen the yearning came over him to go and visit Clare, not to
complain or to confess or to ask advice, but merely to talk on the
most ordinary topics in the world? It was as if Helen drew out of him
all the strength and vitality he possessed, leaving him debilitated,
and that he craved the renewal of himself that came from Clare and
from Clare alone.
 The painful scenes came oftener now. They were not quarrels;
they were worse; they were strange, aching, devitalising dialogues in
which Helen cried passionately and worked herself into a state of
nervous emotion that dragged Speed against his will into the
hopeless vortex. Often when he was tired after the day's work the
mere fervour of her passion would kindle in him some poignant
emotion, some wrung-out pity, that was, as it were, the last shred of
his soul; when he had burned that to please her he was nothing but
dry ashes, desiring only tranquillity. But her emotional resources
seemed inexhaustible. And when she had scorched up the last
combustible fragment of him there was nothing left for him to do but
to act a part.
When he realised that he was acting he realised also that he had
been acting for a long while; indeed, that he could not remember
when he had begun to act. Somehow, she lured him to it; made
insatiable demands upon him that could not be satisfied without it.
His acting had become almost a real part of him; he caught himself
saying and doing things which came quite spontaneously, even
though they were false. The trait of artistry in him made him not
merely an actor but an accomplished actor; but the strain of it was
immense. And sometimes, when he was alone, he wished that he
might some time break under it, so that she might find out the utmost
truth.
Still, of course, it was Clare that was worrying her. She kept
insisting that he wanted Clare more than he wanted her, and he kept
denying it, and she obviously liked to hear him denying it, although
she kept refusing to believe him. And as a simple denial would never
satisfy her, he had perforce to elaborate his denials, until they were
not so much denials as elaborately protestant speeches in which
energetically expressed affection for her was combined with subtle
disparagement of Clare. As time went on her demands increased,
and the kind of denial that would have satisfied her a fortnight before
was no longer sufficient to pacify her for a moment. He would say,
passionately: "My little darling Helen, all I want is you—why do you
keep talking about Clare? I'm tired of hearing the name. It's Helen I
want, my old darling Helen." He became eloquent in this kind of
speech.
But sometimes, in the midst of his acting an awful, hollow moment
of derision would come over him; a moment when he secretly
addressed himself: You hypocrite. You don't mean a word of all this!
Why do you say it? What good is it if it pleases her if it isn't true?
Can you—are you prepared to endure these nightly exhibitions of
extempore play-acting for ever? Mustn't the end come some day,
and what is to be gained by the postponement of it?
Then the hollow, dreadful, moment would leave him, and he would
reply in defence of himself: I love Helen, although the continual
protestation of it is naturally wearisome. If she can only get rid of the
obsession about Clare we shall live happily and without this
emotional ferment. Therefore, it is best that I should help her to get
rid of it as much as I can. And if I were to protest my love for her
weakly I should hinder and not help her.
Sometimes, after he had been disparaging Clare, a touch of real
vibrant emotion would make him feel ashamed of himself. And then,
in a few sharp, anguished sentences he would undo all the good that
hours of argument and protestation had achieved. He would
suddenly defend Clare, wantonly, obtusely, stupidly aware all the
time of the work he was undoing, yet, somehow, incapable of
stopping the words that came into his mouth. And they were not
eloquent words; they were halting, diffident, often rather silly. "Clare's
all right," he would say sometimes, and refuse to amplify or qualify. "I
don't know why we keep dragging her in so much. She's never done
us any harm and I've nothing against her."
"So. You love her."
"Love her? Rubbish! I don't love her. But I don't hate her—surely
you don't expect me to do that!"
"No, I don't expect you to do that. I expect you to marry her,
though, some day."
"Marry her! Good God, what madness you talk, Helen! I don't
want to marry her, and if I did she wouldn't want to marry me! And
besides, it happens that I'm already married. That's an obstacle, isn't
it?"
"There's such a thing as divorce."
"You can't get a divorce just because you want one."
"I know that."
"And besides, my dear Helen, who wants a divorce? Do you?"
"Do you?"
"Of course I don't."
"Kenneth, I know it seems to you that I'm terribly unreasonable.
But it isn't any satisfaction to me that you just don't see Clare. What I
want is that you shan't want to see her."
"Well, I don't want to see her."
"That's a lie."
"Well—well—what's the good of me telling you I don't want to see
her if you can't believe me?"
"No good at all, Kenneth. That's why it's so awful."
He said then, genuinely: "Is it very awful, Helen?"
"Yes. You don't know what it's like to feel that all the time one's
happiness in the world is hanging by a thread. Kenneth, all the time
I'm watching you I can see Clare written in your mind. I know you
want her. I know she can give you heaps that I can't give you. I know
that our marriage, was a tragic mistake. We're not suited to one
another. We make each other frightfully, frightfully miserable. More
miserable than there's any reason for, but still, that doesn't help.
We're misfits, somehow, and though we try ever so hard we shall
never be any better until we grow old and are too tired for love any
more. Then we shall be too disinterested to worry. It was my fault,
Kenneth—I oughtn't to have married you. Father wanted me to,
because your people have a lot of money, but I only married you
because I loved you, Kenneth. It was silly of me, Kenneth, but it's the
truth!"
 "Ah!" So the mystery was solved. He softened to her now that he
heard her simple confession; he felt that he loved her, after all.
She went on, sadly: "I'm not going to stay with you, Kenneth. I'm
not going to ruin your life. You won't be able to keep me. I'd rather
you be happy and not have anything to do with me."
Then he began one of his persuasive speeches. The beginning of
it was sincere, but as he used up all the genuine emotion that was in
him, he drew more and more on his merely histrionic capacities. He
pleaded, he argued, he implored. Once the awful thought came to
him: Supposing I cried? Doubt as to his capacity to cry impressively
decided him against the suggestion.... And once the more awful
thought came to him: Supposing one of these times I do not succeed
in patching things up? Supposing we do agree to separate? Do I
really want to win all the time I am wrestling so hard for victory?
And at the finish, when he had succeeded once again, and when
she was ready for all the passionate endearments that he was too
tired to take pleasure in giving, he felt: This cannot last. It is killing
me. It is killing her too. God help us both....

II

One day he realised that he was a failure. He had had some

disciplinary trouble with the fifth form and had woefully lost his
temper. There had followed a mild sort of scene; within an hour it
had been noised all over the school, so that he knew what the boys
and Masters were thinking of when they looked at him. It was then
that the revelation of failure came upon him.
But, worst of all, there grew in him wild and ungovernable hates.
He hated the Head, he hated Pritchard, he hated Smallwood, he
hated, most intensely of all, perhaps, Burton. Burton was too familiar.
Not that Speed disliked familiarity; it was rather that in Burton's
familiarity he always diagnosed contempt. He wished Burton would
leave. He was getting too old.
They had a stupid little row about some trivial affair of house
discipline. Speed had found some Juniors playing hockey along the
long basement corridor. True that they were using only tennis balls;
nevertheless it seemed to Speed the sort of thing that had to be
stopped. He was not aware that "basement hockey" was a time-
honoured custom of Lavery's, and that occasional broken panes of
glass were paid for by means of a "whip round." If he had known that
he would have made no interference, for he was anxious not to
make enemies. But it seemed to him that this extempore hockey-
playing was a mere breach of ordinary discipline; accordingly he
forbade it and gave a slight punishment to the participators.
Back in his room there came to him within a little while, Burton,
eagerly solicitous about something or other.
"Well, what is it, Burton?" The mere sight of the shambling old
fellow enraged Speed now.
"If you'll excuse the libutty, sir. I've come on be'alf of a few of the
Juniors you spoke to about the basement 'ockey, sir."
"I don't see what business it is of yours, Burton."
"No, sir, it ain't any business of mine, that's true, but I thought
perhaps you'd listen to me. In fact, I thought maybe you didn't know
that it was an old 'ouse custom, sir, durin' the 'ockey term. I bin at
Millstead fifty-one year come next July, sir, an' I never remember an
'ockey term without it, sir. Old Mr. Hardacre used to allow it, an' so
did Mr. Lavery 'imself. In fact, some evenings, sir, Mr. Lavery used to
come down an' watch it, sir."
Speed went quite white with anger. He was furiously annoyed with
himself for having again trod on one of these dangerous places; he
was also furious with Burton for presuming to tell him his business.
Also, a slight scuffle outside the door of the room suggested to him
that Burton was a hired emissary of the Juniors, and that the latter
were eavesdropping at that very moment. He could not give way.
 "I don't know why you think I should be so interested in the habits
of my predecessors, Burton," he said, with carefully controlled voice.
"I'm sure it doesn't matter to me in the least what Hardacre and
Lavery used to do. I'm housemaster at present, and if I say there
must be no more basement hockey then there must be no more.
That's plain, isn't it?"
"Well, sir, I was only warning you—"
"Thanks, I don't require warning. You take too much on yourself,
Burton."
The old man went suddenly red. Speed was not prepared for the
suddenness of it. Burton exclaimed, hardly coherent in the midst of
his indignation: "That's the first time I've bin spoke to like that by a
housemaster of Lavery's! Fifty years I've bin 'ere an' neither Mr.
Hardacre nor Mr. Lavery ever insulted me to my face! They were
gentlemen, they were!"
"Get out!" said Speed, rising from his chair quickly. "Get out of
here! You're damnably impertinent! Get out!"
He approached Burton and Burton did not move. He struck Burton
very lightly on the shoulder. The old man stumbled against the side
of the table and then fell heavily on to the floor. Speed was
passionately frightened. He wondered for the moment if Burton were
dead. Then Burton began to groan. Simultaneously the door opened
and a party of Juniors entered, ostensibly to make some enquiry or
other, but really, as Speed could see, to find out what was
happening.
"What d'you want?" said Speed, turning on them. "I didn't tell you
to come in. Why didn't you knock?"
They had the answer ready. "We did knock, sir, and then we
heard a noise as if somebody had fallen down and we thought you
might be ill, sir."
Burton by this time had picked himself up and was shambling out
of the room, rather lame in one leg.
 The days that followed were not easy ones for Speed. He knew
he had been wrong. He ought never to have touched Burton. People
were saying "Fancy hitting an old man over sixty!" Burton had told
everybody about it. The Common-Room knew of it. The school
doctor knew of it, because Burton had been up to the Sick-room to
have a bruise on his leg attended. Helen knew of it, and Helen rather
obviously sided with Burton.
"You shouldn't have hit an old man," she said.
"I know I shouldn't," replied Speed. "I lost my temper. But can't
you see the provocation I had? Am I to put up with a man's
impertinence merely because he's old?"
"You're getting hard, Kenneth. You used to be kind to people, but
you're not kind now. You're never kind now."
In his own heart he had to admit that it was true. He had given up
being kind. He was hard, ruthless, unmerciful, and God knew why,
perhaps. Yet it was all outside, he hoped. Surely he was not hard
through and through; surely the old Speed who was kind and gentle
and whom everybody liked, surely this old self of his was still there,
underneath the hardness that had come upon him lately!
He said bitterly: "Yes, I'm getting hard, Helen. It's true. And I don't
know the reason."
She supplied the answer instantly. "It's because of me," she said
quietly. "I'm making you hard. I'm no good for you. You ought to have
married somebody else."
"No, no!" he protested, vehemently. Then the old routine of
argument, protest, persuasion, and reconciliation took place again.

III
 He made up his mind that he would crush the hardness in him,
that he would be the old Speed once more. All his troubles, so it
seemed to him, were the result of being no longer the old Speed. If
he could only bring to life again that old self, perhaps, after sufficient
penance, he could start afresh. He could start afresh with Lavery's,
he could start afresh with Helen; most of all perhaps, he could start
afresh with himself. He would be kind. He would be the secret,
inward man he wanted to be, and not the half-bullying, half-cowardly
fellow that was the outside of him. He prayed, if he had ever prayed
in his life, that he might accomplish the resuscitation.
It was a dark sombrely windy evening in February; a Sunday
evening. He had gone into chapel with all his newly-made desires
and determinations fresh upon him; he was longing for the quiet
calm of the chapel service that he might cement, so to say, his
desires and resolutions into a sufficiently-welded programme of
conduct that should be put into operation immediately. Raggs was
playing the organ, so that he was able to sit undisturbed in the
Masters' pew. The night was magnificently stormy; the wind shrieked
continually around the chapel walls and roof; sometimes he could
hear the big elm trees creaking in the Head's garden. The preacher
was the Dean of some-where-or-other; but Speed did not listen to a
word of his sermon, excellent though it might have been. He was too
busy registering decisions.
The next day he apologized to Burton, rather curtly, because he
knew not any other way. The old man was mollified. Speed did not
know what to say to him after he had apologized; in the end half-a-
sovereign passed between them.
Then he summoned the whole House and announced equally
curtly that he wished to apologize for attempting to break a
recognised House custom. "I've called you all together just to make a
short announcement. When I stopped the basement hockey I was
unaware that it had been a custom in Lavery's for a long while. In
those circumstances I shall allow it to go on, and I apologize for the
mistake. The punishments for those who took part are remitted.
That's all. You may go now."
 With Helen it was not so easy.
He said to her, on the same night, when the house had gone up to
its dormitories: "Helen, I've been rather a brute lately. I'm sorry. I'm
going to be different."
She said: "I wish I could be different too."
"Different? You different? What do you mean?"
"I wish I could make you fond of me again." He was about to
protest with his usual eagerness and with more than his usual
sincerity, but she held up her hand to stop him. "Don't say anything!"
she cried, passionately. "We shall only argue. I don't want to argue
any more. Don't say anything at all, please, Kenneth!"
"But—Helen—why not?"
"Because there's nothing more to be said. Because I don't believe
anything that you tell me, and because I don't want to deceive myself
into thinking I do, any more."
"Helen!"
She went on staring silently into the fire, as usual, but when he
came near to her she put her arms round his neck and kissed him. "I
don't believe you love me, Kenneth. Goodness knows why I kiss
you. I suppose it's just because I like doing it, that's all. Now don't
say anything to me. Kiss me if you like, but don't speak. I hate you
when you begin to talk to me."
He laughed.
She turned on him angrily, suddenly like a tiger. "What are you
laughing at? I don't see any joke."
"Neither do I. But I wanted to laugh—for some reason. Oh, if I
mustn't talk to you, mayn't I even laugh? Is there nothing to be done
except kiss and be kissed?"
"You've started to talk. I hate you now."
"I shouldn't have begun to talk if you'd let me laugh."
"You're hateful."