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vi CONTRIBUTORS
Megan E. Mooney, MSN, FNP-BC, C-EFM, C-OB Sherry Stott, MSN, RNC-OB, C-EFM, ACNS-BC
Family Nurse Practitioner Perinatal Clinical Nurse Specialist
Foxhall OBGYN; Banner Thunderbird Medical Center
Clinical Faculty Glendale, Arizona
The Catholic University of America
Washington, DC Candice J. Sullivan, MSN, RNC, lCCE
Education Coordinator
Susan Saffer Orr, PT, PCS, IBClC The Inova Learning Network
Lactation Consultant Falls Church, Virginia
Columbia Pediatrics Medical Group and Long
Beach Memorial Medical Center Lanette E. Tanaka, MSN, RN
Long Beach, California; Assistant Teaching Professor
Lactation Consultant and Clinical Specialist/ College of Nursing
Pediatric Physical Therapist University of Missouri-St. Louis
Torrance Memorial Medical Center St. Louis, Missouri
Torrance, California
lucy R. van Otterloo, PhD, RNC-OB, MSN
Sheryl E. Parfitt, RNC-OB, MSN Assistant Professor
Clinical Educator-Obstetrics School of Nursing
Scottsdale Lincoln Health Network California State University-Long Beach
Scottsdale, Arizona Long Beach, California
Debra Ann Rannalli, DNP, RN, CPNP-PC Connie von Kiihler, MSN, RNC-OB, C-EFM, CPHQ
Lecturer Program Director
School of Nursing Perinatal Outreach Education Program
California State University-Long Beach Miller Children's and Women's Hospital
Long Beach, California Long Beach, California
Kathryn Records, PhD, RN, FAAN Tamara Whitmer, MS, NPD RN-BC
Professor Clinical Education Specialist
College of Nursing Women and Infant Services
University of Missouri-St. Louis Banner Desert Medical Center
St. Louis, Missouri Mesa, Arizona
Mary Ann Rhode, RN, MS, CNM Pamela E. Xandre, DNP, WHNP-BC, FNP-BC
Saint Joseph Hospital Nurse Midwives Assistant Professor
Saint Joseph Hospital, Sisters of Charity of School of Nursing
Leavenworth Hospital System California State University-Long Beach
Denver, Colorado Long Beach, California
Charlotte Stephenson, RN, DSN, CLNC Margaret Yancy, DNP, RN, WHNP, ANP-C
Clinical Professor Clinical Associate Professor
College of Nursing College of Nursing and Health Innovation
Texas Woman's University Arizona State University
Houston, Texas Phoenix, Arizona
•
Reviewers
Jennifer Beth Albert, MSN, APN/CNP, WHNP-BC, RNC-OB, IBCLC, RLC Joy A. Price, MSN, RN, CNE, FNP-BC
Nurse Practitioner /Lactation Consultant Instructor
Midwest Center for Women's Health Associate Degree Nursing
Kenosha, Wisconsin; Northeast Mississippi Community College
Advocate Booneville, Mississippi
Lutheran General Hospital
Park Ridge, Illinois Deborah A. Raines, PhD, EdS, RN, ANEF
Associate Professor;
Karen M. Bennett Gural, RN, MS Educational Technology Pedagical Specialist
Nursing Faculty School of Nursing
Crouse Hospital College of Nursing University at Buffalo: SUNY
Syracuse, New York Buffalo, New York
Deborah Webb Corbett, PhD, RNC, FNP-C Mary Sandelski, RNC, MSN, CNM
Associate Professor Visiting Professor
College of Nursing School of Nursing
East Carolina University Purdue North Central
Greenville, North Carolina Westville, Indiana;
Clinical Nurse Specialist
Janie Corbitt, RN, MLS LDRP Unit
Central Georgia St. Catherine Hospital
Technical College East Chicago, Indiana
Milledgeville, Georgia
Angela Schooley, BSN, MSN
Marcella Hilts Gowan, EdD(c), MPH, CNM, BSN Assistant Professor
Assistant Professor School of Nursing
George Fox University Purdue North Central
Newberg, Oregon Westville, Indiana
vii
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•
Preface
This book is intended to be used by practicing nurses for several purposes. First, it can be a study
guide for those wishing to take certification examinations in maternal-newborn nursing. Basic and
complex information is presented and accompanied by an extensive reference list to augment the
knowledge base.
Second, the book may be used by development personnel and educators as an orientation for
new staff, a source of information and review for nurses entering or returning to maternal
newborn nursing, and a quick reference for nurses on those units.
Third, this book can be a course text, particularly for students requiring a resource or reference.
It is not designed to be a primary text for undergraduate students, but it could be a resource for
those graduate students in women's health nurse practitioner programs who want to review some
of the material relating to pregnancy that will be needed for their practice.
This edition has some significant changes that make the book more usable for a wider audi
ence, yet keeps the content directed toward the original audience. Chapter 2, "Genetics," in this
new edition has been expanded to reflect many of the advances that have occurred in this dynamic
and fast changing field. It is hoped that the genetic content of this chapter will further develop the
foundation of genetic knowledge within the labor-delivery-recovery (LDR) or maternal-newborn
nurse and stimulate a quest for more genetic and genomic knowledge as it develops in the near
future. Chapter 6, "Psychology of Pregnancy," has been updated to address same-gender expec
tant parents and various atypical family constellations. We updated and blended the content about
trauma and surgery during pregnancy in Chapter 23, "Management of Non-Obstetrical Surgery
and Trauma in Pregnancy," with the intent of streamlining and highlighting the relationship
between them. This makes it easier for the maternal-newborn or LDR nurse to identify the
high-risk status of trauma and / or non-obstetrical surgery in the pregnant woman and the special
ized care required until the woman stabilizes.
The format of the book continues to be an outline format with assessment/ clinical practice and
interventions, continued use of a section for health education, and the case studies and questions.
The fifth edition contains new case studies and new study questions.
We hope this book will be helpful to those of you using it for all purposes. As always, its edit
ing continues to be an educational and a character-building experience for us both.
Susan Mattson
Judy E. Smith
ix
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•
Acknowledgments
We would like to acknowledge the contributors to Judith H. Poole, PhD, BSN, BA, MN
the previous editions. Hypertensive Disorders in Pregnancy
Hemorrhagic Disorders
Linda Bond, PhD, RNC
Physiology of Pregnancy Margaret A. Putman, RN, MS, NNP
Risks Associated with Gestational Age and Birth
Diana E. Clokey, MS, RD, RPh, CDE Weight
Endocrine and Metabolic Disorders
Janet Scoggin, PhD, CNM
Catherine R. Coverston, PhD, RNC Physical and Psychologic Changes
Psychology of Pregnancy
Kathleen V. Smith, RNC, BSN, MSN
Sandra L. Gardner, RN, MS, CNS, PNP Normal Childbirth
Ethics
Keiko L. Torgersen, BSN, MS, RNC
Elizabeth Gilbert, RNC, MS, CFNP Antepartum Fetal Assessment
Labor and Delivery at Risk Intrapartum Fetal Assessment
Patricia Grant Higgins, PhD, RN, BSHEd, BSN, MN Gail M. Turley, RNC, MSN, CNAA
Postpartum Complications Essential Forces and Factors in Labor
Starre Haney, RN, MS, TNCC-1, ENPC Cheryl Wallerstedt, MS, RNC, IBLCE, FACCE
Trauma in Pregnancy Endocrine and Metabolic Disorders
xi
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•
Contents
SECTION ONE
REPRODUCTION: FETAL AND PLACENTAL DEVELOPMENT
2 Genetics, 19
LINDA CALLAHAN
SECTION TWO
NORMAL PREGNANCY
5 Physiology of Pregnancy, 83
KATHRYN RECORDS AND LANETIE TANAKA
SECTION THREE
MATERNAL-FETAL WELL-BEING
SECTION FOUR
INTRAPARTUM PERIOD
xiii
xiv CONTENTS
SECTION FIVE
POSTPARTUM PERIOD
14 Breastfeeding, 314
SUSAN SAFFER ORR
15 Contraception, 336
PAMELA E. XANDRE
SECTION SIX
THE NEWBORN
SECTION SEVEN
COMPLICATIONS OF CHILDBEARING
SECTION EIGHT
ETHICS AND ISSUES
28 Ethics, 662
CHARLOTIE STEPHENSON
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CHAPTER
1 Reproductive
• Anatomy, Physiology,
and the Menstrual
Cycle
DENISE G. LINK
OBJECTIVES
1. Identify and locate the female organs of reproduction.
2. Descri be the physiologic functioning of the female reproductive system .
3 . Identify the parameters of sexual maturation and menstruation, including cycle i nterva l , duration o f menstrual flow, and
peri menopause.
4. Descri be the physiologic changes i n the ovaries, uterus, and cervix that occur during the menstrual cycle.
5. Explain the physiologic pathways of the hypothalam ic-pitu itary-ovarian axis and their relationship to the normal
menstrual cycle.
6. Descri be variations i n anatomy that affect reproduction.
7. Descri be variations i n physiology that affect reproduction.
8. Identify the common variations i n the m enstrual cycle.
9. Analyze the data from a reproductive history and physical exami nation to determine overt and covert anato m i c and
physiologic factors that could affect pregnancy.
10. Prepare a set of i nterventions for teaching perti nent concepts of anatomy and physiology to clients.
INTRODUCTION
Female Organs of Reproduction
A. External genitalia: Vulva (Figure 1-1)
1. Mons pubis (or mons veneris)
a. A rounded pad of subcutaneous fatty tissue over the symphysis pubis; covered with
pubic hair
b. Function is the protection of the symphysis pubis during intercourse.
2. Labia majora
a. Two rounded folds of fatty and connective tissues, covered with pubic hair, that extend
from the mons pubis to the perineum
b. Function is the protection of the vaginal introitus.
3. Labia minora
a. Narrow folds of hairless skin located within the labia majora; begin beneath the clitoris
and extend to the fourchette
b. Highly vascular and rich in nerve supply; glands lubricate the vulva
c. Function is erotic; swell in response to stimulation and are highly sensitive.
Prepuce of
clitoris
Urethral
meatus
Labia majora--------tr¥7-
Labia minora --------+t-'lrl'f,f
Opening of
Skene's glands
Opening of
Bartholin's glands
Perineum
Anus
6. Vestibule
a. An oval-shaped area whose boundaries are the clitoris, fourchette, and labia minora;
contains the following:
(1) Urethral meatus
(a) The terminal portion of the urethra with puckered or slit appearance
(b) Located 2.5 cm (1 inch) below the clitoris
(2) Skene glands
(a) Located inside the urethral meatus
(b) Produce mucus for lubrication
(3) Hymen
(a) Tough, elastic, perforated, mucosa-covered tissue that forms a rim around the
internal perimeter of the vaginal introitus
(b) Hymenal opening might be absent or small, impeding menstrual flow and
intercourse.
(c) Characteristics of the hymen vary widely among women; the presence or
absence of the hymen can neither confirm nor rule out sexual experience.
(4) Bartholin glands
(a) Located at the base of each of the labia minora, just inside the vaginal orifice
(b) During coitus, secrete mucus that creates a favorable environment for sperm
7. Fourchette is a point located midline below the vaginal opening where the labia majora
and labia minora merge.
8. Perineum
a. Skin-covered muscular tissue located between the vaginal opening and the anus
b. The area of a midline episiotomy
c. Might be lacerated during childbirth
Fallopian
tube
Ovarian
ligament
Round
ligament
of uterus
Cervical canal
F I G U R E 1 -2 • Female reproductive organs. Front uterine wall has been removed so that the fallopian tube,
uterus, cervical canal, and vagina are seen as a continuous channel. (From Langley, L. L., Telford, I. R., &
Christensen, J. B. [1980] . Dynamic anatomy and physiology. New York: McGraw-Hill.)
c. Lined with a glandular mucous membrane that is arranged in folds called rugae
d. Highly vascular and relatively insensitive; adds little sensation for the female during
coitus
e. Functions as the outflow track for menstrual fluid and for vaginal and cervical secretions,
inches) long, 3.5 to 4 cm ( 1 .4 to 1 .6 inches) wide, and 2 to 2.5 cm (0.8 to 1 inch) deep; size
increases after childbirth.
d. Is similar in shape to a pear
e. Is a single organ composed of four distinct areas:
(1) Fundus
(a) The upper, rounded portion above the insertion of the fallopian tubes
(b) Beginning at the 20th week of pregnancy, uterine size is measured in centimeters
from the height of the fundus to the top of the symphysis pubis.
(2) Corpus (or body) is the main portion of the uterus, located between the cervix and the
fundus.
(3) Isthmus
(a) Also called the lower uterine segment during pregnancy
(b) Joins the corpus to the cervix
(4) Cervix (or opening of the uterus)
(a) Divided into two portions: the portion above the site of attachment of the cervix
to the vaginal vault is called the supravaginal portion; the portion below the
attachment site that protrudes into the vagina is called the vaginal portion.
(b) Composed of fibrous connective tissue
(c) Diameter varies from 2 to 5 cm (0.8 to 2 inches), depending on childbearing
history.
4 SECTION O N E • REPRODUCTION: FETAL AND PLACENTAL DEVELOPMENT
Posterior or
retroverted
A Anteflexed 8 c Retroflexed
F I G U R E 1 -3 • Uterine positions.
Reproductive Anatomy, Physiology, and the Menstrual Cycle • CHAPTER 1 5
h. Uterine wall
(1) Composed of three layers
(a) Endometrium is a highly vascular mucous membrane that responds to
hormone stimulation first by hypertrophy and then by secretion to prepare to
receive the developing ovum; it sloughs if pregnancy does not occur, resulting
in menstruation; if pregnancy occurs, it sloughs after delivery.
(b) Myometrium is composed of smooth muscle in layers.
[i] Outer layer is composed of longitudinal fibers, which predominate in the
fundus and provide power to expel the fetus.
[ii] Middle layer is composed of fibers interlaced with blood vessels in a
figure-eight pattern; contraction following childbirth helps control
blood loss.
[iii] Inner layer is composed of circular fibers concentrated around the
internal cervical os; provides sphincter action to help keep the cervix
closed during pregnancy.
(c) Parietal peritoneum covers most of the uterus, except for the cervix and a
portion of the anterior corpus.
3. Fallopian tubes or oviducts (see Figure 1-2)
a. Attached to the uterine fundus and curve around each ovary
b. Provide a passageway for the ovum into the uterus
c. 10 cm (4 inches) in length and 0.6 cm (0.25 inch) in diameter
d. Composed of four parts
(1) Fimbria: The most distal portion; a fringe of tissue around the opening of the
fallopian tube closest to the ovary that guides the ovum into the tube by creating
a wavelike motion
(2) Infundibulum: Funnel-shaped structure that forms a repository for the ovum
between the fimbria and the ampulla
(3) Ampulla: Longest section of the fallopian tube and site of fertilization
(4) Isthmus: Narrowed part of the fallopian tube that passes through the uterine
myometrium and opens into the uterine cavity
e. Functions
(1) Capture of the ovum
(2) Transport of the ovum into the uterus via peristaltic activity and wavelike motion
of the cilia that line the fallopian tube
(3) Secretion of nutrients to support the ovum during transport
4. Ovaries (female gonads) (see Figure 1-2)
a. Comparable with the testes in the male
b. Located on either side of the uterus, below and behind the fimbriated ends of the
oviducts
c. Supported by the ovarian ligaments and the mesovarian portion of the broad ligament
d. Similar to shelled almonds in size and shape; smooth, mobile, slightly tender, and firm
e. Functions include ovulation and production of hormones (estrogen, progesterone, and
androgens).
C. Support for organs of reproduction
1. Circulation
a. Blood is supplied to the pelvis by arteries branching from the hypogastric artery
(which branches from the iliac artery, a division of the aorta) .
b. Major pelvic arteries include the uterine, vaginal, pudendal, and perineal arteries.
c. Ovarian arteries branch directly from the aorta.
d. Lymphatic drainage is accomplished from the uterus, ovaries, and fallopian tubes to
nodes around the aorta with some use of the femoral, iliac, and hypogastric nodes.
2. Pelvic floor and perineum
a. Functions
(1) Support of the suspended internal organs of reproduction
(2) Support for sphincter control, allowing for expansion of the vagina with expulsion
of the fetus, and closure of the vagina after delivery
6 SECTION O N E • REPRODUCTION: FETAL AND PLACENTAL DEVELOPMENT
Urethral
Bulbocavernosus opening
Bulb of vestibule
tuberosity
Pudendal
vessels
Coccyx
F I G U R E 1 -4 • Muscles of the pelvic floor, from below. (From Sloane, E. [2002]. Biology of women [4th ed.].
Albany, NY: Delmar.)
Iliac crest
Ilium
Sac rum
Pelvic inlet
Iliac spine
Ischial spine
Coccyx
Symphysis
Ischial pubis joint
tuberosity
c.Ilium, ischium, and pubic bones fuse after puberty; the pelvic bone then is called the right
or left innominate bone.
d. False pelvis (Figure 1-6)
(1) Area of the pelvis above the anterior, superior iliac spines
(2) Provides no useful data for estimating the size of the birth canal
e. True pelvis (see Figure 1-6)
False pelvis
Linea te rminalis
True pelvis
F I G U R E 1 -6 • True pelvis and false pelvis divided by the linea terminalis. (From Ross Laboratories. Clinical
Education Aid No. 18, Columbus, OH.)
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saying farewell is not like saying “Jack Robinson”: it needs, without a
doubt, a touch of inhumanity, which, if it does not make the whole world
kin, can at least help to make a good part of it comfortable, as the humane
gentleman now honoured as Lord Balfour found when he was Secretary of
State for Ireland.
It was, then, with such thoughts as these that my mind was vexed during
my stay in Paris, much to the disorder of my pleasures, when whom should
I meet but my friend Dwight-Rankin! Gratified, I was yet surprised almost
beyond endurance. I had been at school with the man, but later we had lost
sight of one another, and still later I had heard of his death on Gallipoli. I
had been sorry.
Dwight-Rankin was a blood, and I have an intellectual leaning towards
bloods. They may have only the most moderate aspirations towards a state
of grace, theirs may be only the most superficial grasp of the culture of the
ages, but theirs not to reason why, theirs but to do nothing and die. They
may not Achieve, they may have nothing to Give to the world, but
nevertheless they serve several useful purposes and are decidedly a good
market for British-made and Dominion-made goods; such as golf-links,
foxes, spats, plover’s eggs, chorus girls, kippers, the Conservative party,
night-clubs, bookmakers, whisky, the Army, etc. They are also decorative
and are frequently used at balls and at our Embassies abroad.
Dwight-Rankin remarked with gratification upon my pleasure at the fact
that he was still alive and invited me to take a glass of wine with him at the
Ritz, which we were at that moment passing. Nothing could have been
more agreeable to me, in my troubled state of mind. We then indulged in
conversation. It had rained the day before, and we spoke of the rain. There
was a rumour that it had been snowing in England, and we spoke of the
snow. Dwight-Rankin had just returned from Monte Carlo, where he had
lost money, and I had just returned from Rome, where I had lost my
luggage. We confounded Monte Carlo and Rome. Then Dwight-Rankin said
that the report of his death on Gallipoli was a gross exaggeration and that
one should not believe all one hears. His younger brother, Dwight-Rankin
said, had believed the report with an agility surprising in one who was a
confirmed sceptic in all religious matters, had stepped into the property and
had gone bankrupt before Dwight-Rankin could say “knife.” Dwight-
Rankin said he was now a broken man. I extended him my sympathy, for
which he thanked me.
“Talking of death,” he added, “that was a nasty end for Mrs. Amp,
wasn’t it?”
“Mrs. Amp!” I said. “Mrs. Amp? Who was Mrs. Amp?”
Dwight-Rankin said: “Rheumatism and Roosevelt, you’ve never heard
of Mrs. Amp! Nor of the death? Nor of the Lady Surplice?”
“Lady Surplice?” I said. “Oh, yes, I’ve heard of the Countess of
Surplice! And how is she?”
“She can’t be at all well,” said Dwight-Rankin. “She’s dead. Tummy
trouble, they said. By the way, one doesn’t say ‘the Countess of’ Surplice.
One says ‘Lady Surplice.’ Do you mind?”
“Not in the least,” I said.
“Then don’t say it or write it, will you?” begged Dwight-Rankin. “All
you writers are very vague about your titles. No, not vague—you are
malinspired. It puts people against you, I assure you. I often had a mind to
tell Miss Marie Corelli about that, but I never had a chance.”
I said: “You see, Dwight-Rankin, I never hear any of these things, as I
am not in society.”
“That’s all right,” said Dwight-Rankin. “Hang on to me.”
“Waiter!” I said. “Two Martinis, please.”
“Dry,” said Dwight-Rankin. “Dry, waiter. And with a dash.”
It was luncheon time, and the foyer was crowded with people waiting for
each other whilst they passed the time of day with someone else. There
were many women with eager eyes and low heels. Dwight-Rankin said they
were American. There were many women with good complexions and large
feet. Dwight-Rankin said they were English. There was a young man who
looked like a pretty girl, except that his hair was long. Dwight-Rankin said
he was known as the Venus de Marlow and that his friends thought him too
marvellous. Pacing up and down was a French gentleman with drooping
ginger moustachios, a gardenia and a dog. Dwight-Rankin said that he wore
stays and that the dog was called “Hélöise and Abélard,” and when I asked
him how one dog came to be called “Hélöise and Abélard” Dwight-Rankin
said severely that even a dog must be called something.
“The man who owns him, her, it or them,” said Dwight-Rankin, “is the
Marquis des Beaux-Aces. He married a very rich American, but she turned
out to be a girl of strong character and instead of letting him spend her
money she spent all his and then divorced him for being incompetent. He
has never been the same man since, but he manages to make an honest
living by selling fancy needlework to Argentine polo-players. But you will
hear more of him when I tell you of the strange affair of Mrs. Amp and
Lady Surplice—of the late Mrs. Amp,” said Dwight-Rankin gloomily, “and
the late Lady Surplice. A great pity. By the way, are you lunching with
anyone?”
I said: “No, but——”
“That’s all right,” said Dwight-Rankin; “I will lunch with you. I am
supposed to be lunching with some people, but I am so short-sighted that I
can’t see them. If you should remark two beautiful women looking at me
with more than usual interest, just don’t take any notice. This short-
sightedness of mine is developing into a nuisance. The other day I was
having a clean-up at the club and when I came to wipe my face I found it
was quite dry for the simple reason that I had been washing the face of the
man next to me.”
I said: “In the meanwhile, shall we——”
“This is on me,” said Dwight-Rankin. “Waiter, two Martinis, please.”
“Dry,” I said.
“That’s all right,” said Dwight-Rankin. “They always wipe them for me
first.”
II
The death of Mrs. Amp, said Dwight-Rankin, was the sensation of Paris
in the spring of the year 1924. Who Mr. Amp was, it appeared, no one knew
for certain. But it was said that he had fallen in love with a photograph of an
English gentlewoman in Arab costume, had plunged into the desert to
commune with his passion and had been kidnapped by a sheikess in plus-
fours who had a fancy for bald Americans with bulging eyes. However....
Mrs. Amp, said Dwight-Rankin, died suddenly and terribly; and her
mangled remains were the subject of discussion in society for many a day.
It was a Friday evening, and all Paris was dressing itself to be present at a
dinner-party that Mrs. Amp was to give that evening at the Ritz Hotel. “Just
here, where we are sitting now,” said Dwight-Rankin, turning a glassy eye
about the restaurant and accepting an invitation hurled at him by the
Duchess of Putney to dine next Thursday to meet the Shah of Pongistan on
the occasion of his having lost his job.
On that Friday evening, said Dwight-Rankin, there was only one person
of note in Paris who was not dressing to be present at Mrs. Amp’s dinner-
party. That, said Dwight-Rankin, was Lady Surplice. Mrs. Amp and Lady
Surplice did not speak. That is to say, said Dwight-Rankin, they spoke to
everyone about each other; but when they met, had you dropped a pin
between them it would have made a noise like a bomb, and had you lit a
match there would have been a cascade of water from the melting ice.
Lady Surplice, said Dwight-Rankin, had been the greatest hostess in
Europe for twenty years. London dined with her when she was in London,
Paris dined with her when she was in Paris, Mussolini met her at the station
when she went to Rome, New York hailed her as the Duchess of Mayfair,
while Palm Beach was her rouge-pot and over Ascot she cast her lorgnette.
Naturally all this was very encouraging for Lady Surplice, and she bitterly
resented any interference with her habits. However....
Lord Surplice—only technically known, said Dwight-Rankin severely,
as “the Earl of”—did not assist at his wife’s entertainments. He was
understood to be taking the waters for diabetes at a hydropathic
establishment near Woodhall Spa. Or maybe, said Dwight-Rankin, it was
liver trouble and Tunbridge Wells, but one can’t know everything.
Then one day, when Lady Surplice was at the height of her success, Mrs.
Amp fell on Europe. Nay, said Dwight-Rankin, Mrs. Amp obliterated
Europe. Without Mr. Amp, but with Mr. Amp’s millions. Mrs. Amp, said
Dwight-Rankin, was a large woman: a very large woman: and hearty. Her
face was not that of Aphrodite: her figure not that of Mrs. Vernon Castle:
but she had, said Dwight-Rankin, a certain Charm. Her descent on Europe
was catastrophic. She enveloped Europe. And Europe loved it. She laid one
hand on London and one on Paris, threw Venice over one shoulder and
hung Deauville about her neck, and people just fell on to her lap. And what
a lap, said Dwight-Rankin. However....
For days and days people went about saying: “I say, what’s all this about
a Mrs. Amp? Who is Mrs. Amp? What?” Then for days and days people
went about saying: “Have you met Mrs. Amp? The devil, what a woman!
These Americans! What?” Then for days and days people went about
saying: “Are you dining with Mrs. Amp to-night? Am I? Good Lord, no!
Why should one dine with Mrs. Amp? What?” Then for ever and ever
people went about saying: “I’m sorry, but I must be going now. I am dining
with Mrs. Amp to-night. What? Oh, you are too! Good, we’ll meet over
dinner.”
Lady Surplice, however, stood firm. She wouldn’t, said Dwight-Rankin,
accept Mrs. Amp. “Mrs. Amp,” said Lady Surplice, “is a Low woman. One
does not know Mrs. Amp.” But thousands did, said Dwight-Rankin. So
Lady Surplice tore between London and Paris, giving luncheons, dinners,
dances and receptions right and left in the hope that no one would have time
to go to any of Mrs. Amp’s parties. But people always had time, said
Dwight-Rankin, to go to Mrs. Amp’s parties. Mrs. Amp’s parties were like
that. Unavoidable, inevitable, eternal. And, said Dwight-Rankin,
uncommonly amusing. One met all one’s friends at them, and the
champagne was always dry.
Mrs. Amp was American, and Lady Surplice was born in Notting Hill of
Nonconformist parents. And so, said Dwight-Rankin, they carried the same
weights in the blue-blood stakes. But Mrs. Amp was the larger woman, the
larger personality. Lady Surplice was very tall, very thin, dark, brittle,
brilliant. Mrs. Amp enveloped, and could touch the ceiling of a sleeping-car
with her hips when she lay on her side. Lady Surplice was relentless in her
generosity and indomitable in her indiscretion. Mrs. Amp was as mean with
money as a temperance hotel with matches; but even so she could stay the
stars in their courses, anyhow for at least five courses and then make them
sing and dance to her guests on top of it. Lady Surplice was very tall. But
Mrs. Amp stood six-feet-two in her tiara. Lady Surplice undoubtedly put up
a gallant fight. But Mrs. Amp undoubtedly won. Lady Surplice said: “That
low, beastly woman!” Mrs. Amp said: “Muriel Surplice is proud of having
discovered Europe. I am amused at having discovered Muriel Surplice.”
It gradually dawned on people, said Dwight-Rankin, that this between
Mrs. Amp and Lady Surplice was not an affair which could be settled by a
duel at Mah Jongg, that this was a case of war to the death. Mrs. Amp died
first.
On that Friday evening, Mrs. Amp was dressing for dinner in her house
near the Champs Élysées. She sat at her toilet-table, and whilst her maid did
this and that to her hair, which, said Dwight-Rankin, aspired doggedly
rather than beautifully to the mode, Mrs. Amp passed the time by looking
out of the windows upon the noble trees of the Champs Élysées; and
presently drew her maid’s attention to the fact that a circus was at that
moment taking its station beneath them. “I want to tell you,” said Mrs. Amp
to her maid, “that I am just crazy about circuses. Don’t forget to remind me
to engage one the next time I pull a party.”
Those, her maid later told Dwight-Rankin, were almost the last words
Mrs. Amp spoke in this world. For even as she uttered them an uproar
became audible from without: the air was filled with screams, yells and
curses: while the roars of savage beasts struck terror into the most stable
heart and convinced the maid, she told Dwight-Rankin, that the end of the
world was at hand.
With a cry to Mrs. Amp, who sat staring out of the window as though
transfixed, the maid fled; for the uproar from the circus was caused by
nothing less than the escape of the lions from their cages; and these, their
maddened nostrils attracted by Heaven knows what odour, were rushing
furiously on Mrs. Amp’s house, vainly pursued by their keepers. For the
keepers, said Dwight-Rankin, appeared to be quite helpless: their whips
lashed the air with inconceivable energy, but there seemed to be a grave
lack of entente between their commands and the lions’ movements; which
was later only half-explained by the fact that they were Italian keepers in
charge of French lions.
The lions, with a bound, with a series of bounds, passed the concierge’s
lodge, wherein the concierge was clinging to an excrescence from the
ceiling; and when the mangled corpse of poor Mrs. Amp was later found, it
was recognisable, said Dwight-Rankin, only by the perfume which the poor
lady was used to affect and which gave proof of its quality by rising
superior even to the lively odour of the lions. However....
In such manner, said Dwight-Rankin, did Mrs. Amp give up the spirit.
Nor was the sensation caused by her nasty death at all soothed by the
evidence of her trembling concierge, who, before the Conference of
Ambassadors that sat to enquire on the great hostess’s death, gave
testimony to the effect that as the lions rushed into her bedroom Mrs. Amp
was distinctly heard to cry: “This is the doing of Muriel Surplice! I will be
revenged, if I roast in hell-fire for it!”
The concierge, of course, said Dwight-Rankin, gave his evidence in
French; and when the interpreters had translated it for the benefit of the
Conference of Ambassadors, those distinguished gentlemen were not a little
disturbed by the ominous, if extravagant, burden of Mrs. Amp’s dying
words. And, said Dwight-Rankin, rightly.
III
It was when we came to the second and last part of the affair of Mrs.
Amp and Lady Surplice, which took place in London nearly a year later,
that he himself, said Dwight-Rankin, entered upon the scene. He was, in
point of fact, quite definitely responsible for the awful end to my Lady
Surplice’s last dinner-party, a circumstance which would prey on his mind
to his dying day. For, said Dwight-Rankin, had he not at the last moment
been compelled, by some force outside himself, to take a bird out for a spot
of dinner, and therefore to cancel his engagement to dine with Lady
Surplice, nothing untoward could possibly have happened to that poor lady.
He had, however, been able to piece together every detail of the terrible
events of that dinner-party with the help of the relations of those of his
friends who were present: the most reliable among these being Shelmerdene
(that lovely lady), Guy de Travest, most upright of men, and Percy
Wentworth, 1st Marquess of Marketharborough, the Lord Chancellor of
England, who was, said Dwight-Rankin, a very hearty man and a devil for
accuracy whether on the Woolsack or the roundabouts.
It was Christmas Eve, and a dirty night. A violent wind distracted the
town, hurling the rain with idiot fury against the windows of swift
limousines and, no doubt, said Dwight-Rankin, greatly inconveniencing
those thoughtless persons who had gone abroad without their limousines.
But since Lady Surplice’s dinner was in honour of royalty, in the person of
Son Altesse le Prince de Finaleauseltz, of the Royal house of Bonbon de
Jambon-Parme, her guests, with that polite servility which distinguishes the
freedom-loving peoples of England and America, were within the house in
St. James’s Square by a quarter-to-nine o’clock.
Dinner was not yet announced: the conversation, easy and elegant,
embraced the topics of the day: while the more youthful wandered, as
though aimlessly, towards the far corners of the spacious drawing-room,
where stood the busts of notable men by Epstein and Mestrovic. Now Lady
Surplice never would have cocktails served in her house since a friend of
hers, an honourary attaché at the Bulgarian Legation, had succumbed to a
ptomaine poisoning gotten from swallowing a cherry in a Manhattan
cocktail. But my lady’s butlers were wont, such is the ingenuity of the lower
sort, to secrete cocktails behind the busts of notable men by Epstein and
Mestrovic, thus killing two birds with one stone; for while, on the one hand,
they satisfied the reasonable thirst of the company, they also, on the other
hand, gave Lady Surplice much real pleasure in seeing how her friends
were enamoured of the most advanced art of the day. Lady Surplice herself
loved the most advanced art of the day. And the most advanced art of the
day loved Lady Surplice. Playwrights, for instance, doted on her. One had
put her into a play as a courtesan for money (1205 performances), one as a
courtesan by temperament (2700 performances), another as a courtesan by
environment (still running), and lastly another as a courtesan to pass the
time. This last, however, was never produced, as the Lord Chamberlain had
banned it on the ground that it was too cynical. However....
Imagine, said Dwight-Rankin, with what consternation Lady Surplice
suddenly discovered that the company was thirteen in number! She was
livid. She said: “It is the fault of that Dwight-Rankin man. I had forgotten
that he had put me off at the last moment. That low, detestable man! How
rude people with two names can be! But what shall we do? We cannot dine
thirteen, and on Christmas Eve! Your Highness, what would you advise? I
am quite unable, my dear Highness, to sit down thirteen at meat. I detest
meat, but you know what I mean. It would quite destroy my luck.”
“His Highness,” said Guy Godolphin Greville Hawke, 21st Viscount de
Travest, “might very possibly prefer to have his luck completely destroyed;
for the present luck of Royalty in Europe is, if I may say so, sickening.”
Lord Marketharborough had been for some time examining the busts of
notable men by Mestrovic and Epstein, and had therefore not heard what
had gone before; but that did not deter him from asking one of those
pertinent questions which came naturally to his fearless mind. “Since,” said
the Lord Chancellor, “we are thirteen, are we a woman too many or a man?
Let us first get that quite clear.”
“There is always a woman too many,” snapped Lady Surplice,
whereupon Dame Warp strode forward and said bitterly between her teeth:
“I see I am not wanted. Let it never be said that a decent woman—I said a
decent woman—ever stood in the way of her friends’ enjoyment. I will go.”
She was, however, soothed by Monsieur des Beaux-Aces, whilst the other
gentlemen very properly laughed the superstition to scorn. In particular Mr.
Warp, who was eminent in private life for his researches into the defunct
branch of political thought once known as Liberalism, but was better known
in public as the husband of Dame Warp, distinguished himself by the
elegant scholarship of his scepticism.
Nor, said Dwight-Rankin, were the ladies—to wit, Shelmerdene, the
Lady Fay Paradise, Lady Pynte, Miss Pamela Star and the Lady Amelia
Peep, who was a young lady of the highest fashion with her hair parted at
the side, a talent for writing poetry, and a governing-classes voice—nor
were they behindhand with their ridicule of so childish a fancy as Lady
Surplice’s, that they could be susceptible of the least harm through sitting
thirteen at table.
“Dinner,” said the doyen of the butlers from the door, “is served, my
lady.”
“Talbot!” cried Lady Surplice. “How dared you not warn me that we
were thirteen for dinner? Why do you not answer me? Is this a time for
silence?”
“Decidedly,” said the Lord Chancellor. “For I am hungry.”
“My lady,” said the wretched Talbot, “I am sorry. It quite escaped my
notice. I will send in my resignation in the morning.”
Says my lady with a high look: “Talbot, you will expiate your sin now.
You will at once leave the house. You will walk round St. James’s Square.
And you will invite the first person you meet in to dine with me. Go.”
The conversation after the butler had gone became, said Dwight-Rankin,
rather strained; and only the polished genius of Lady Surplice could have
sustained it at anything approaching a well-informed level, as when, turning
to the Lady Amelia Peep, she said: “And what, my child, is your father
doing to-night? I had asked him to dine with me, but he said he was
engaged. I hope it is not serious.”
“Wearing,” said the Lady Amelia, “rather than serious. He is in S. W. 1
district, in the queue outside Buck House, waiting to be made a Duke in the
New Year’s Honours. He is so old-fashioned in his tastes! He will be
wanting to learn dancing soon.”
“Dukes,” said Lady Surplice, “are not a fit subject for conversation. One
should avoid being a Duke. They are low. Look, for instance, how they took
up with that Amp woman! Look how that handsome but ill-mannered Duke
of Mall made a fuss of that dreadful Mrs. Omroy Pont! And look at the
Duke of Dear! One cannot know that man. He has actually been divorced
time over again. England is getting simply flooded with ex-Duchesses of
Dear. And while the Duke indulges his almost violent partiality for middle-
class indiscretions, his only son has invented a rod with which he can catch
smoked salmon. Is that patrician, is it even gentlemanly? Answer me, your
Highness. Is this a time for silence? Then look at the Duchess of Sandal and
Sand! She is in Paris now, and I hear she has lovers right and left and sits up
every night at the Jardin de Ma Sœur staring at people through an emerald
monocle and drinking pink champagne through a straw. Is that just, is it
reasonable, is it even decent? Monseigneur, what do you think? Is this a
time for silence?”
“Yes, please!” pleaded Fay Paradise. “For just look at what’s
happening!”
But it was Shelmerdene, said Dwight-Rankin, who had first seen the
great doors opening. And Shelmerdene was very favourably impressed.
“Captain Charity,” announced Talbot.
Lady Surplice, said Dwight-Rankin, was also very favourably impressed.
She cried: “My dear Captain Charity, how kind of you to come to a
perfectly strange house! But you are so good-looking that I feel I ought to
have known you all my life.”
Now he who was called Captain Charity did not appear to be of those
who suffer from nervousness. His lean presence, indeed, radiated a certain
authority. And he smiled at Lady Surplice in a cold but charming way. But
one can’t do better, said Dwight-Rankin, than take Shelmerdene’s swift first
impression of the man. Shelmerdene said that he was a tall, lean, young
man, dark and beautiful; his air was military, but with a pleasing suggestion
of culture; and as he came towards the company he appeared to look at
nobody but Guy de Travest, and always he smiled, Shelmerdene had told
Dwight-Rankin, in a cold but charming way.
“Haven’t we,” doubtfully said de Travest to the teeth of that faint smile,
“met before somewhere?”
One must imagine those two, said Dwight-Rankin, as making as brave-
looking a pair of men as one could wish to see: the stranger, dark and
beautiful, and Guy de Travest, quiet and yellow-fair: the lean dark dandy
with the mocking mouth and the fair thunder-god of dandies with the frozen
eyes.
“I think not,” said Captain Charity, and he said: “But you are very like
Michael.”
“Michael?” quoth my lord. “And who, pray, is your Michael?”
“The archangel,” said Captain Charity, and that was that, for Lady
Surplice, who was fairly taken with the dark beauty of the stranger, could
no longer brook these masculine asides. She said: “My dear Captain
Charity, you must be introduced. It is quite usual. I have already presented
you to His Highness. He is charming. Here are Dame Warp and Lady Pynte,
who buys her shoes at Fortnum and Mason’s and rides to hounds four days
in the week all through the summer just to set a good example. While this is
Miss Pamela Star, who was left many millions by an Armenian. Armenians
are rather difficult, my dear Captain Charity, but she is charming. And this
is Shelmerdene, who has no surname because she has no surname, but who
is becoming the heroine of all the ladies in all the suburbs because a
misguided young man once put her into a book. Ah, and Fay! My dear
Captain Charity, this is Lady Fay Paradise, the most beautiful woman in
England. She never eats with her meals and never uses the same lover
twice. Do you, darling? Whereas here is Lady Amelia Peep, who is as yet
unmarried but she writes poetry about birds and her father wants to be made
a Duke. You will like her. She is appointed with every modern convenience.
And here—Percy, where are you? Ah, there he is, always admiring works of
art! Look at the back of his head—the strength, the charm, the moral poise
of it! Percy, come here at once! This, my dear Captain Charity, is Lord
Marketharborough, who is a Lord Chancellor, you know. Aren’t you,
Percy? But why do you not answer me? Is this a time for silence?”
“Dinner,” said the man Talbot, “is served, my lady.”
“Good!” said Lord Marketharborough.
Now the high position that Lady Surplice had won for herself in the
hierarchy of hostesses was due to nothing so much as to the fact that she
would not ever tolerate any but general conversation about her table.
Whereas, said Dwight-Rankin, at every other dinner in London one must be
continually blathering in whispers to one’s right or left to women who have
nothing to say and don’t know how to say it, so that there never can be any
conversational give-and-take about the table. But Lady Surplice most
properly insisted on conversational give-and-take at her parties. She gave,
you took. She gave, said Dwight-Rankin, magnificently.
IV