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Dietary Reference Intakes (DRI)
The Dietar y Reference Intakes (DRI) include two sets of The DRI also include the Tolerable Upper Intake Level
­nutrient intake goals for individuals—the Recommended (UL) that represents the estimated maximum daily amount
­Dietary ­A llowance (RDA) and Adequate Intake (AI). The RDA of a ­nutrient that appears safe for most healthy people to con-
ref lects the average daily amount of a nutrient considered sume on a regular basis. Turn the page for a listing of the UL
­adequate to meet the needs of most healthy people. If there for selected vitamins and minerals. Note that the absence of
is insufficient evidence to determine an RDA, an AI is set. a UL for a nutrient does not indicate that it is safe to consume
In a­ ddition, the Estimated Energy Requirement (EER) repre- in high doses, but only that research is too limited to set a UL.
sents the average dietary energy intake considered adequate Chapter 1 describes these DRI values in detail.
to maintain energy balance in healthy people.

Estimated Energy Requirements (EER), Recommended Dietary Allowances (RDA), and Adequate Intakes (AI) for Water,
Energy, and the Energy Nutrients

Linolenic Acidc
EERb (kcal/day)
Reference BMI

RDA (g/kg/day)
Height cm (in.)

Weight kg (lb)

Carbohydrate

Linoleic Acid

RDA (g/day) d
RDA (g/day)

Total Fiber
Reference

Reference

AI (g/day)

AI (g/day)

AI (g/day)

AI (g/day)
AI (L/day)

Total Fat

Protein

Protein
Water a

Energy
Age (yr)
Males
0–0.5 — 62 (24) 6 (13) 0.7e 570 60 — 31 4.4 0.5 9.1 1.52
0.5–1 — 71 (28) 9 (20) 0.8 f 743 95 — 30 4.6 0.5 11 1.20
1–3g — 86 (34) 12 (27) 1.3 1046 130 19 — 7 0.7 13 1.05
4–8 g 15.3 115 (45) 20 (44) 1.7 1742 130 25 — 10 0.9 19 0.95
9–13 17.2 144 (57) 36 (79) 2.4 2279 130 31 — 12 1.2 34 0.95
14–18 20.5 174 (68) 61 (134) 3.3 3152 130 38 — 16 1.6 52 0.85
19–30 22.5 177 (70) 70 (154) 3.7 3067h 130 38 — 17 1.6 56 0.80
31–50 22.5i 177 (70)i 70 (154)i 3.7 3067h 130 38 — 17 1.6 56 0.80
>50 22.5i 177 (70)i 70 (154)i 3.7 3067h 130 30 — 14 1.6 56 0.80
Females
0–0.5 — 62 (24) 6 (13) 0.7e 520 60 — 31 4.4 0.5 9.1 1.52
0.5–1 — 71 (28) 9 (20) 0.8 f 676 95 — 30 4.6 0.5 11 1.20
1–3g — 86 (34) 12 (27) 1.3 992 130 19 — 7 0.7 13 1.05
4–8 g 15.3 115 (45) 20 (44) 1.7 1642 130 25 — 10 0.9 19 0.95
9–13 17.4 144 (57) 37 (81) 2.1 2071 130 26 — 10 1.0 34 0.95
14–18 20.4 163 (64) 54 (119) 2.3 2368 130 26 — 11 1.1 46 0.85
19–30 21.5 163 (64) 57 (126) 2.7 2403j 130 25 — 12 1.1 46 0.80
31–50 21.5i 163 (64)i 57 (126)i 2.7 2403j 130 25 — 12 1.1 46 0.80
>50 21.5i 163 (64)i 57 (126)i 2.7 2403j 130 21 — 11 1.1 46 0.80
Pregnancy
1st trimester 3.0 +0 175 28 — 13 1.4 46 0.80
2nd trimester 3.0 +340 175 28 — 13 1.4 71 1.10
3rd trimester 3.0 +452 175 28 — 13 1.4 71 1.10
Lactation
1st 6 months 3.8 +330 210 29 — 13 1.3 71 1.30
2nd 6 months 3.8 +400 210 29 — 13 1.3 71 1.30
NOTE: BMI is calculated as the weight in kilograms divided height, and physical activity level. The values listed are based gFor energy, the age groups for young children are 1–2 years

by the square of the height in meters. For all nutrients, values on an “active” person at the reference height and weight and and 3–8 years.
for infants are AI. The glossary on the insert defines units of at the midpoint ages for each group until age 19. Chapter 8 hFor males, subtract 10 kcalories per day for each year of age

nutrient measure. Dashes (—) indicate that values have not and Appendix F provide equations and tables to determine above 19.
been determined. estimated energy requirements. iBecause weight need not change as adults age if activity is
aThe water AI includes drinking water, water in beverages, and cThe linolenic acid referred to in this table and text is the main­tained, reference weights for adults 19 through 30 years
water in foods; in general, drinking water and other beverages omega-3 fatty acid known as alpha-linolenic acid. are applied to all adult age groups.
con­tribute about 70 to 80 percent, and foods, the remainder. d The values listed are based on reference body weights. jFor females, subtract 7 kcalories per day for each year of age

Conver­sion factors: 1 L = 33.8 fluid oz; 1 L = 1.06 qt; eAssumed to be from human milk. above 19.
1 cup = 8 fluid oz. fAssumed to be from human milk and complementary foods
bThe Estimated Energy Requirement (EER) represents the and beverages. This includes approximately 0.6 L (~2½ cups) SOURCE: Adapted from the Dietary Reference Intakes
aver­age dietary energy intake that will maintain energy as total fluid including formula, juices, and drinking water. series, National Academies Press. National Academies of
balance in a healthy person of a given gender, age, weight, Sciences.

A
Recommended Dietary Allowances (RDA) and Adequate Intakes (AI) for Vitamins

RDA (mg/day)a

RDA (μg/day) b

RDA (μg/day) c

RDA (μg/day) d
RDA (mg/day)

RDA (mg/day)

RDA (mg/day)
RDA (μg/day)
Pantothenic

AI (mg/day)

AI (mg/day)
Vitamin B12
AI (μg/day)

AI (μg/day)
Vitamin B 6
Riboflavin

Vitamin A

Vitamin D
Vitamin C

Vitamin K
Vitamin E
RDA (mg/

RDA (mg/
Thiamin

Choline
Niacin

Folate
Biotin

day)e
acid
day)
Age (yr)
Infants
0–0.5 0.2 0.3 2 5 1.7 0.1 65 0.4 125 40 400 10 4 2.0
0.5–1 0.3 0.4 4 6 1.8 0.3 80 0.5 150 50 500 10 5 2.5
Children
1–3 0.5 0.5 6 8 2 0.5 150 0.9 200 15 300 15 6 30
4–8 0.6 0.6 8 12 3 0.6 200 1.2 250 25 400 15 7 55
Males
9–13 0.9 0.9 12 20 4 1.0 300 1.8 375 45 600 15 11 60
14–18 1.2 1.3 16 25 5 1.3 400 2.4 550 75 900 15 15 75

From Whitney/Rolfes, Understanding Nutrition, 13E. © 2013 Cengage Learning.

19–30 1.2 1.3 16 30 5 1.3 400 2.4 550 90 900 15 15 120
31–50 1.2 1.3 16 30 5 1.3 400 2.4 550 90 900 15 15 120
51–70 1.2 1.3 16 30 5 1.7 400 2.4 550 90 900 15 15 120
>70 1.2 1.3 16 30 5 1.7 400 2.4 550 90 900 20 15 120
Females
9–13 0.9 0.9 12 20 4 1.0 300 1.8 375 45 600 15 11 60
14–18 1.0 1.0 14 25 5 1.2 400 2.4 400 65 700 15 15 75
19–30 1.1 1.1 14 30 5 1.3 400 2.4 425 75 700 15 15 90
31–50 1.1 1.1 14 30 5 1.3 400 2.4 425 75 700 15 15 90
51–70 1.1 1.1 14 30 5 1.5 400 2.4 425 75 700 15 15 90
>70 1.1 1.1 14 30 5 1.5 400 2.4 425 75 700 20 15 90
Pregnancy
≤18 1.4 1.4 18 30 6 1.9 600 2.6 450 80 750 15 15 75
19–30 1.4 1.4 18 30 6 1.9 600 2.6 450 85 770 15 15 90
31–50 1.4 1.4 18 30 6 1.9 600 2.6 450 85 770 15 15 90
Lactation
≤18 1.4 1.6 17 35 7 2.0 500 2.8 550 115 1200 15 19 75
19–30 1.4 1.6 17 35 7 2.0 500 2.8 550 120 1300 15 19 90
31–50 1.4 1.6 17 35 7 2.0 500 2.8 550 120 1300 15 19 90
NOTE: For all nutrients, values for infants are AI. The glossary on the inside back cover b
Folate recommendations are expressed as dietary folate equivalents (DFE).
defines units of nutrient measure. c
Vitamin A recommendations are expressed as retinol activity equivalents (RAE).
a
Niacin recommendations are expressed as niacin equivalents (NE), except for d
Vitamin D recommendations are expressed as cholecalciferol and assume an absence of
recommendations for infants younger than 6 months, which are expressed as preformed adequate exposure to sunlight.
niacin. e
Vitamin E recommendations are expressed as α-tocopherol.

Recommended Dietary Allowances (RDA) and Adequate Intakes (AI) for Minerals
RDA (mg/day)

RDA (mg/day)

RDA (mg/day)

RDA (mg/day)

RDA (mg/day)

RDA (μg/day)

RDA (μg/day)

RDA (μg/day)

RDA (μg/day)
Molybdenum
Phosphorus

Manganese
Magnesium
AI (mg/day)

AI (mg/day)

AI (mg/day)

AI (mg/day)

AI (mg/day)

AI (μg/day)
Potassium

Chromium
Selenium
Chloride

Fluoride
Calcium
Sodium

Copper
Iodine
Zinc
Iron

Age (yr)
Infants
0–0.5 120 180 400 200 100 30 0.27 2 110 15 200 0.003 0.01 0.2 2
0.5–1 370 570 700 260 275 75 11 3 130 20 220 0.6 0.5 5.5 3
Children
1–3 1000 1500 3000 700 460 80 7 3 90 20 340 1.2 0.7 11 17
4–8 1200 1900 3800 1000 500 130 10 5 90 30 440 1.5 1.0 15 22
Males
9–13 1500 2300 4500 1300 1250 240 8 8 120 40 700 1.9 2 25 34
14–18 1500 2300 4700 1300 1250 410 11 11 150 55 890 2.2 3 35 43

From Whitney/Rolfes, Understanding Nutrition, 13E. © 2013 Cengage Learning.

19–30 1500 2300 4700 1000 700 400 8 11 150 55 900 2.3 4 35 45
31–50 1500 2300 4700 1000 700 420 8 11 150 55 900 2.3 4 35 45
51–70 1300 2000 4700 1000 700 420 8 11 150 55 900 2.3 4 30 45
>70 1200 1800 4700 1200 700 420 8 11 150 55 900 2.3 4 30 45
Females
9–13 1500 2300 4500 1300 1250 240 8 8 120 40 700 1.6 2 21 34
14–18 1500 2300 4700 1300 1250 360 15 9 150 55 890 1.6 3 24 43
19–30 1500 2300 4700 1000 700 310 18 8 150 55 900 1.8 3 25 45
31–50 1500 2300 4700 1000 700 320 18 8 150 55 900 1.8 3 25 45
51–70 1300 2000 4700 1200 700 320 8 8 150 55 900 1.8 3 20 45
>70 1200 1800 4700 1200 700 320 8 8 150 55 900 1.8 3 20 45
Pregnancy
≤18 1500 2300 4700 1300 1250 400 27 12 220 60 1000 2.0 3 29 50
19–30 1500 2300 4700 1000 700 350 27 11 220 60 1000 2.0 3 30 50
31–50 1500 2300 4700 1000 700 360 27 11 220 60 1000 2.0 3 30 50
Lactation
≤18 1500 2300 5100 1300 1250 360 10 13 290 70 1300 2.6 3 44 50
19–30 1500 2300 5100 1000 700 310 9 12 290 70 1300 2.6 3 45 50
31–50 1500 2300 5100 1000 700 320 9 12 290 70 1300 2.6 3 45 50
NOTE: For all nutrients, values for infants are AI. The glossary on the inside back cover defines units of nutrient measure.
Tolerable Upper Intake Levels (UL) for Vitamins

Vitamin B 6

Vitamin A

Vitamin D
Vitamin C

Vitamin E
(mg/day)c
(mg/day)a

(μg/day)a

(μg /day)b
(mg/day)

(mg/day)

(mg/day)

(μg /day)
Choline
Niacin

Folate
Age (yr)
Infants
0–0.5 — — — — — 600 25 —
0.5–1 — — — — — 600 38 —
Children

From Whitney/Rolfes, Understanding Nutrition, 13E. © 2013 Cengage Learning.

1–3 10 30 300 1000 400 600 63 200
4–8 15 40 400 1000 650 900 75 300
9–13 20 60 600 2000 1200 1700 100 600
Adolescents
14–18 30 80 800 3000 1800 2800 100 800
Adults
19–70 35 100 1000 3500 2000 3000 100 1000
>70 35 100 1000 3500 2000 3000 100 1000
Pregnancy
≤18 30 80 800 3000 1800 2800 100 800
19–50 35 100 1000 3500 2000 3000 100 1000
Lactation
≤18 30 80 800 3000 1800 2800 100 800
19–50 35 100 1000 3500 2000 3000 100 1000
a
The UL for niacin and folate apply to synthetic forms The UL for vitamin E applies to any form of supplemental
c

obtained from supplements, fortified foods, or a α-tocopherol, fortified foods, or a combination of the two.
combination of the two.
b
The UL for vitamin A applies to the preformed vitamin only.

Tolerable Upper Intake Levels (UL) for Minerals

Molybdenum
Phosphorus

Manganese
Magnesium

Vanadium
(mg/day)d

Selenium
(mg/day)

(mg/day)

(mg/day)

(mg/day)

(mg/day)

(mg/day)

(mg/day)

(mg/day)

(mg/day)

(mg/day)

(mg/day)
Chloride

Fluoride
Calcium

(μg/day)

(μg/day)

(μg/day)

(μg/day)
Sodium

Copper

Nickel
Iodine

Boron
Zinc
Iron

Age (yr)
Infants
0–0.5 — — 1000 — — 40 4 — 45 — — 0.7 — — — —
0.5–1 — — 1500 — — 40 5 — 60 — — 0.9 — — — —
Children
1–3 1500 2300 2500 3000 65 40 7 200 90 1000 2 1.3 300 3 0.2 —
4–8 1900 2900 2500 3000 110 40 12 300 150 3000 3 2.2 600 6 0.3 —
9–13 2200 3400 3000 4000 350 40 23 600 280 5000 6 10 1100 11 0.6 —
Adolescents
14–18 2300 3600 3000 4000 350 45 34 900 400 8000 9 10 1700 17 1.0 —
Adults
19–50 2300 3600 2500 4000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 1.8
51–70 2300 3600 2000 4000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 1.8
>70 2300 3600 2000 3000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 1.8
Pregnancy
≤18 2300 3600 3000 3500 350 45 34 900 400 8000 9 10 1700 17 1.0 —
19–50 2300 3600 2500 3500 350 45 40 1100 400 10,000 11 10 2000 20 1.0 —
Lactation
≤18 2300 3600 3000 4000 350 45 34 900 400 8000 9 10 1700 17 1.0 —
19–50 2300 3600 2500 4000 350 45 40 1100 400 10,000 11 10 2000 20 1.0 —
d
The UL for magnesium applies to synthetic forms obtained from supplements or drugs SOURCE: Adapted with permission from the Dietary Reference Intakes for Calcium and
only. Vitamin D, © 2011 by the National Academies of Sciences, Courtesy of the National
NOTE: An upper Limit was not established for vitamins and minerals not listed and for Academies Press, Washington, D.C.
those age groups listed with a dash (—) because of a lack of data, not because these
nutrients are safe to consume at any level of intake. All nutrients can have adverse effects
when intakes are excessive.
 Nutrition for Health
seventh edition and Health Care

Linda Kelly DeBruyne

Kathryn Pinna

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 Nutrition for Health and Health Care, © 2020, 2017, 2014 Cengage Learning, Inc.

Seventh Edition
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Linda Kelly DeBruyne, Kathryn Pinna

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Printed in the United States of America

Print Number: 01    Print Year: 2018
Linda Kelly DeBruyne

Kathryn Pinna

iii
 About the Authors
Linda Kelly DeBruyne, M.S., R.D., received her B.S. and M.S. degrees
in nutrition and food science at Florida State University. She is a founding member
of Nutrition and Health Associates, an information resource center in Tallahassee,
Florida, where her specialty areas are life cycle nutrition and fitness. Her other
publications include the textbooks Nutrition and Diet Therapy and Health: Making
Life Choices. She is a registered ­dietitian and maintains a professional membership in
the Academy of Nutrition and Dietetics.

Kathryn Pinna, Ph.D., R.D., received her M.S. and Ph.D. degrees in nutrition
from the University of California at Berkeley. She taught nutrition, food science, and
human biology courses in the San Francisco Bay Area for over 25 years and also
worked as an outpatient dietitian, Internet consultant, and freelance writer. Her other
publications include the textbooks Understanding Normal and Clinical Nutrition and
Nutrition and Diet Therapy. She is a registered dietitian and a member of the American
Society for Nutrition and the Academy of Nutrition and Dietetics.

v
 Brief Contents
Chapter 1 Chapter 13
Overview of Nutrition and Health 1 Nutrition Care and Assessment 379

Chapter 2 Chapter 14
Digestion and Absorption 39 Nutrition Intervention and Diet-Drug
Interactions 403
Chapter 3
Carbohydrates 67 Chapter 15
Enteral and Parenteral Nutrition Support 433
Chapter 4
Lipids 95 Chapter 16
Nutrition in Metabolic and Respiratory
Chapter 5
Stress 469
Protein 125
Chapter 17
Chapter 6
Nutrition and Upper Gastrointestinal
Energy Balance and Body Composition 147 Disorders 489
Chapter 7 Chapter 18
Weight Management 173 Nutrition and Lower Gastrointestinal
Disorders 513
Chapter 8
The Vitamins 199 Chapter 19
Nutrition and Liver Diseases 545
Chapter 9
Water and the Minerals 237 Chapter 20
Nutrition and Diabetes Mellitus 565
Chapter 10
Nutrition through the Life Span: Pregnancy and Chapter 21
Lactation 271 Nutrition and Cardiovascular Diseases 595
Chapter 11 Chapter 22
Nutrition through the Life Span: Infancy, Nutrition and Renal Diseases 625
Childhood, and Adolescence 303
Chapter 23
Chapter 12
Nutrition, Cancer, and HIV Infection 653
Nutrition through the Life Span: Later Adulthood 351
vii
viii
 Contents
Preface xvi
The Vascular System 50
Acknowledgments xx The Lymphatic System 51
Transport of Lipids: Lipoproteins 51
Chapter 1
Overview of Nutrition and Health 1 Gastrointestinal Hormones and Nerve Pathways 53
Gastrointestinal Microbes 53
The System at Its Best 54
Six Classes of Nutrients 6 Nutrition in Practice Food Safety 57
kCalories: A Measure of Energy 6

Chapter 3
Dietary Reference Intakes 8
Acceptable Macronutrient Distribution Ranges 10 Carbohydrates 67

National Health Goals 11 Monosaccharides 68

National Trends 11 Disaccharides 69
Polysaccharides 69

Dietary Ideals 13
Dietary Guidelines for Americans 14
Fitness Guidelines 16
The USDA Food Patterns 18 Sugars 74
MyPlate 23 Alternative Sweeteners: Sugar Alcohols 78
Alternative Sweeteners: Nonnutritive Sweeteners 79
The Ingredient List 24
Nutrition Facts Panel 25 Carbohydrates: Disease Prevention
Claims on Labels 27 and Recommendations 81
Nutrition in Practice Finding the Truth about Carbohydrates: Food Sources 84
Nutrition 34
Carbohydrates: Food Labels and Health Claims 86
Nutrition in Practice The Glycemic Index in Nutrition
Chapter 2 Practice 90
Digestion and Absorption 39
Chapter 4
The Digestive Organs 40 Lipids 95
The Involuntary Muscles and the Glands 42

Digestion in the Mouth 45

Digestion in the Stomach 46 Triglycerides 97
Digestion in the Small and Large Intestines 46 Fatty Acids 98
Phospholipids 101
Sterols 101
The Small Intestine 48
Absorption of Nutrients 49

ix
 Chapter 7
Fats and Heart Health 103
Recommendations 106 Weight Management 173

Finding the Fats in Foods 108 Genetics and Weight 174

Cutting Solid Fats and Choosing Unsaturated Environmental Stimuli 177
Fats 110
Nutrition in Practice Figuring Out Fats 117
Over-the-Counter Weight-Loss Products 180
Chapter 5 Other Gimmicks 180
Protein 125
Obesity Drugs 180
Surgery 181
The Structure of Proteins 126
Nonessential and Essential Amino Acids 127
A Healthful Eating Plan 182
Physical Activity 185
Behavior and Attitude 186
Protein Turnover 129 Weight Maintenance 188
Nitrogen Balance 129

Nutrition in Practice Fad Diets 195

Protein Deficiency 132 Chapter 8

Malnutrition 133
Protein Excess 134 The Vitamins 199
Protein and Amino Acid Supplements 135
Protein Recommendations and Intakes 136
Vitamin A and Beta-Carotene 203
Protein Quality 137 Vitamin D 207
Protein Sparing 138 Vitamin E 211
Protein on Food Labels 138 Vitamin K 212
Nutrition in Practice Vegetarian Diets 141
The B Vitamins 214
Chapter 6 Thiamin 216
Riboflavin 216
Energy Balance and Body Composition 147 Niacin 217
Pantothenic Acid and Biotin 218
Feasting 148 Vitamin B6 218
The Economics of Fasting 149 Folate 219
Vitamin B12 220
Energy In 152 Non–B Vitamins 222
Energy Out 152 Vitamin C 222
Estimating Energy Requirements 155 Nutrition in Practice Phytochemicals and Functional
Foods 229
Defining Healthy Body Weight 156
Body Composition 159 Chapter 9
How Much Body Fat Is Too Much? 160 Water and the Minerals 237

Health Risks of Underweight 161 Water Balance 238

Health Risks of Overweight and Obesity 162 Fluid and Electrolyte Balance 240
Guidelines for Identifying Those at Risk from Acid–Base Balance 241
Obesity 163
Other Risks of Obesity 163
Sodium 243
Nutrition in Practice Eating Disorders 166 Chloride 244

x Contents
 Potassium 244
Calcium 245 Energy and Nutrient Needs 316
Phosphorus 249 Hunger and Malnutrition in Children 320
Magnesium 249 Lead Poisoning in Children 321
Sulfate 251 Food Allergy 322
Hyperactivity 324
Iron 251 Childhood Obesity 325
Zinc 256 Mealtimes at Home 330
Selenium 258 Nutrition at School 334
Iodine 259
Copper 260 Growth and Development during Adolescence 336
Manganese 260 Energy and Nutrient Needs 336
Fluoride 261 Food Choices and Health Habits 337
Chromium 261 Nutrition in Practice Childhood Obesity and
Other Trace Minerals 261 the Early Development of Chronic Diseases 345
Nutrition in Practice Vitamin and Mineral
Supplements 267 Chapter 12
Nutrition through the Life Span: Later
Chapter 10
Adulthood 351
Nutrition through the Life Span: Pregnancy
and Lactation 271 Slowing the Aging Process 353
Nutrition and Disease Prevention 355

Nutrition Prior to Pregnancy 272

Prepregnancy Weight 272 Cataracts and Macular Degeneration 356
Healthy Support Tissues 273 Arthritis 356
The Events of Pregnancy 274 The Aging Brain 357
Nutrient Needs during Pregnancy 276
Food Assistance Programs 281
Weight Gain 282 Energy and Energy Nutrients 360
Weight Loss after Pregnancy 283 Vitamins and Minerals 362
Physical Activity 284 Nutrient Supplements for Older Adults 363
Common Nutrition-Related Concerns of Pregnancy 285 The Effects of Drugs on Nutrients 364
Problems in Pregnancy 286
Practices to Avoid 288 Individual Preferences 365
Adolescent Pregnancy 291 Meal Setting 365
Depression 365
Nutrition during Lactation 292 Food Assistance Programs 365
Contraindications to Breastfeeding 294 Meals for Singles 366

Nutrition in Practice Encouraging Successful Nutrition in Practice Hunger and Community

Breastfeeding 300 Nutrition 373

Chapter 11 Chapter 13

Nutrition through the Life Span: Infancy, Nutrition Care and Assessment 379
Childhood, and Adolescence 303
How Illness Affects Nutrition Status 380
Responsibility for Nutrition Care 381
Nutrient Needs during Infancy 304 Identifying Risk for Malnutrition 382
Breast Milk 306 The Nutrition Care Process 383
Infant Formula 309
The Transition to Cow’s Milk 311
Introducing First Foods 311 Historical Information 385
Looking Ahead 314 Dietary Assessment 386
Mealtimes 315 Anthropometric Data 389

Contents xi
 Biochemical Analyses 392 Chapter 16
Physical Examination 395 Nutrition in Metabolic and Respiratory Stress 469
Nutrition in Practice Nutritional Genomics 399
Hormonal Responses to Stress 471
Chapter 14 The Inflammatory Response 472
Nutrition Intervention and Diet-Drug
Interactions 403 Determining Nutritional Requirements 474
Approaches to Nutrition Care in Acute Stress 476

Care Planning 404

Approaches to Nutrition Care 406 Chronic Obstructive Pulmonary Disease 477
Respiratory Failure 480

Energy Intakes in Hospital Patients 408 Nutrition in Practice Multiple Organ Dysfunction
Modified Diets 409 Syndrome 486
Variations in the Diet Order 413
Chapter 17
Food Selection 414 Nutrition and Upper Gastrointestinal
Food Safety 414 Disorders 489
Improving Food Intake 414

Drug Effects on Food Intake 416 Dry Mouth 490

Drug Effects on Nutrient Absorption 416 Dysphagia 490
Dietary Effects on Drug Absorption 417 Gastroesophageal Reflux Disease 494
Drug Effects on Nutrient Metabolism 418
Dietary Effects on Drug Metabolism 419
Drug Effects on Nutrient Excretion 420 Dyspepsia 496
Dietary Effects on Drug Excretion 420 Nausea and Vomiting 497
Drug-Nutrient Interactions and Toxicity 420 Gastroparesis 497
Gastritis 498
Nutrition in Practice Complementary and Alternative Peptic Ulcer Disease 498
Therapies 424

Gastrectomy 500
Chapter 15 Bariatric Surgery 503
Enteral and Parenteral Nutrition Support 433 Nutrition in Practice Nutrition and Oral Health 509

Oral Supplements 434 Chapter 18

Candidates for Tube Feedings 435 Nutrition and Lower Gastrointestinal
Tube Feeding Routes 436
Enteral Formulas 438 Disorders 513
Administration of Tube Feedings 441
Medication Delivery during Tube Feedings 445 Constipation 514
Tube Feeding Complications 446 Intestinal Gas 516
Transition to Table Foods 446 Diarrhea 516

Candidates for Parenteral Nutrition 448 Fat Malabsorption 519

Venous Access 449 Bacterial Overgrowth 521
Parenteral Solutions 450 Lactose Intolerance 521
Administering Parenteral Nutrition 454
Managing Metabolic Complications 455 Pancreatitis 523
Cystic Fibrosis 524
Candidates for Home Nutrition Support 457
Planning Home Nutrition Care 457 Celiac Disease 526
Quality-of-Life Issues 458 Inflammatory Bowel Diseases 528
Nutrition in Practice Inborn Errors of Metabolism 463 Short Bowel Syndrome 531

xii Contents
 Vitamin Supplementation and CHD Risk 603
Irritable Bowel Syndrome 534 Lifestyle Changes for Hypertriglyceridemia 605
Diverticular Disease of the Colon 535 Drug Therapies for CHD Prevention 605
Colostomies and Ileostomies 536 Treatment of Heart Attack 607
Nutrition in Practice Probiotics and Intestinal
Health 542 Stroke Prevention 608
Stroke Management 608
Chapter 19
Nutrition and Liver Diseases 545 Factors That Influence Blood Pressure 609
Factors That Contribute to Hypertension 609
Treatment of Hypertension 611
Fatty Liver 546
Hepatitis 547
Consequences of Heart Failure 614
Medical Management of Heart Failure 615
Consequences of Cirrhosis 549
Treatment of Cirrhosis 552 Nutrition in Practice Helping People with Feeding
Nutrition Therapy for Cirrhosis 552 Disabilities 620

Chapter 22
Nutrition in Practice Alcohol in Health and Disease 561
Nutrition and Renal Diseases 625
Chapter 20
Consequences of the Nephrotic Syndrome 627
Nutrition and Diabetes Mellitus 565 Treatment of the Nephrotic Syndrome 627

Symptoms of Diabetes Mellitus 566 Causes of Acute Kidney Injury 630

Diagnosis of Diabetes Mellitus 567 Consequences of Acute Kidney Injury 630
Types of Diabetes Mellitus 567 Treatment of Acute Kidney Injury 631
Prevention of Type 2 Diabetes Mellitus 569
Acute Complications of Diabetes Mellitus 569
Chronic Complications of Diabetes Mellitus 571 Consequences of Chronic Kidney Disease 633
Treatment of Chronic Kidney Disease 635
Kidney Transplants 640
Treatment Goals 573
Evaluating Diabetes Treatment 574
Nutrition Therapy: Dietary Recommendations 575 Formation of Kidney Stones 642
Nutrition Therapy: Meal-Planning Strategies 577 Consequences of Kidney Stones 643
Insulin Therapy 580 Prevention and Treatment of Kidney Stones 643
Antidiabetic Drugs 583 Nutrition in Practice Dialysis 648
Physical Activity and Diabetes Management 584
Sick-Day Management 585 Chapter 23
Nutrition, Cancer, and HIV Infection 653
Pregnancy in Type 1 or Type 2 Diabetes 586
Gestational Diabetes 586
How Cancer Develops 654
Nutrition in Practice The Metabolic Syndrome 591 Nutrition and Cancer Risk 655
Consequences of Cancer 658
Chapter 21 Treatments for Cancer 658
Nutrition and Cardiovascular Diseases 595 Nutrition Therapy for Cancer 661

Consequences of Atherosclerosis 597 Prevention of HIV Infection 665

Causes of Atherosclerosis 597 Consequences of HIV Infection 666
Treatments for HIV Infection 668
Nutrition Therapy for HIV Infection 669
Symptoms of Coronary Heart Disease 599
Evaluating Risk for Coronary Heart Disease 599 Nutrition in Practice Ethical Issues in Nutrition
Lifestyle Management to Reduce CHD Risk 600 Care 675

Contents xiii
Appendix A Aids to Calculation A-2 Chapter 19
a.1 Conversion Factors A-2 Man with Cirrhosis 556
a.2 Percentages A-2 Chapter 20
a.3 Weights and Measures A-3
Child with Type 1 Diabetes 585
Appendix B WHO: Nutrition Recommendations B-1
Woman with Type 2 Diabetes 587
Appendix C Choose Your Foods: Food Lists for
Chapter 21
Diabetes C-1
C.1 The Food Lists C-1 Patient with Cardiovascular Disease 614
C.2 Serving Sizes C-1 Chapter 22
C.3 The Foods on the Lists C-1 Woman with Acute Kidney Injury 632
C.4 Controlling Energy, Fat, and Sodium C-2 Man with Chronic Kidney Disease 640
C.5 Planning a Healthy Diet C-3
Chapter 23
Appendix D Physical Activity and Energy
Woman with Cancer 664
Requirements D-1
Man with HIV Infection 671
Appendix E Nutrition Assessment: Supplemental
Information E-1
E.1 Weight Gain during Pregnancy E-1 How To Features
E.2 Growth Charts E-1 Chapter 1
E.3 Measures of Body Fat and Lean Tissue E-2 Calculate the Energy a Food Provides 7
E.4 Nutritional Anemias E-8
Chapter 3
E.5 Cautions about Nutrition Assessment E-12
Reduce Intakes of Added Sugars 76
Appendix F Enteral Formulas F-1
Chapter 4
Glossary GL-1
Make Heart-Healthy Choices—by Food Group 110
Index I-1
Chapter 5
Calculate Recommended Protein Intakes 136
Case Studies
Chapter 6
Chapter 10
Estimate Energy Requirements 156
Woman in Her First Pregnancy 294
Chapter 7
Chapter 11
Apply Behavior Modification to Manage Body
Boy with Disruptive Behavior 324 Fatness 187
Chapter 12
Chapter 9
Elderly Man with a Poor Diet 366 Cut Salt Intake 243
Chapter 13 Add Calcium to Daily Meals 249
Nutrition Screening and Assessment 396 Add Iron to Daily Meals 257
Chapter 14 Chapter 11
Implementing Nutrition Care 407 Protect against Lead Toxicity 322
Chapter 15 Chapter 12
Injured Hiker Requiring Enteral Nutrition Support 448 Turn Convenience Foods into Nutritious Meals 368
Patient with Intestinal Disease Requiring Parenteral Stretch Food Dollars and Reduce Waste 375
Nutrition 456
Chapter 13
Chapter 16
Measure Length and Height 390
Patient with a Severe Burn 477 Measure Weight 390
Elderly Man with Emphysema 480 Estimate and Evaluate Changes in Body Weight 392
Chapter 17
Chapter 14
Woman with GERD 496 Estimate Appropriate Energy Intakes for Hospital
Nutrition Care after Gastric Surgery 503 Patients 408
Chapter 18 Help Hospital Patients Improve Their Food
Patient with Short Bowel Syndrome 533 Intakes 415
Young Adult with Irritable Bowel Syndrome 535 Prevent Diet-Drug Interactions 421

xiv Contents
Chapter 15 Chapter 18
Help Patients Improve Intakes with Oral Supplements 435 Follow a Fat-Restricted Diet 522
Help Patients Cope with Tube Feedings 442 Chapter 19
Plan a Tube Feeding Schedule 444 Help the Cirrhosis Patient Eat Enough Food 554
Administer Medications to Patients Receiving Tube Chapter 20
Feedings 446
Use Carbohydrate Counting in Clinical Practice 578
Express the Osmolar Concentration of a Solution 449
Chapter 21
Calculate the Macronutrient and Energy Content
of a Parenteral Solution 453 Implement a Heart-Healthy Diet 604
Reduce Sodium Intake 613
Chapter 16
Estimate Energy Needs Using Disease-Specific Stress Chapter 22
Factors 475 Help Patients Comply with a Renal Diet 640
Chapter 17 Chapter 23
Improve Acceptance of Mechanically Altered Foods 493 Increase kCalories and Protein in Meals 662
Manage Gastroesophageal Reflux Disease 496 Help Patients Handle Food-Related Problems 663
Alter the Diet to Reduce Symptoms of Dumping
Syndrome 502
Alter Dietary Habits to Achieve and Maintain Weight Loss
after Bariatric Surgery 505

Contents xv
 Preface
We are pleased to present this seventh edition
Nutrition for Health and Health Care
Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Changes for This Edition Chapter 7

xvi
Chapter 8
Chapter 16

Chapter 17
Chapter 9

acid regurgitation, heartburn, bloating, pernicious

anemia.

Chapter 18
Chapter 10

Chapter 11
Chapter 19

Chapter 20
Chapter 12

Chapter 13

Chapter 14

Chapter 21
Chapter 15

specialized nutrition support oral nutrition

support

Preface xvii
Chapter 22

protein-energy wasting.

hypocitraturia

Chapter 23

MindTap: Empower Your

Students

Features of this Text

Access Everything You Need

in One Place

Empower Students to Reach

their Potential

xviii Preface
Control Your Course— Ancillaries
and Your Content ●●
A test bank is available through Cengage Learning
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that allows instructors to author, edit, and manage test
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Preface xix
 Acknowledgments

xx
 Overview of Nutrition
and Health
Chapter Sections and Learning Objectives (LOs)

1.1 Food Choices

LO 1.1 Describe the factors that influence personal food choices.

1.2 The Nutrients

LO 1.2 Identify which of the major classes of nutrients are organic and which
yield energy.

1.3 Nutrient Recommendations

LO 1.3 Describe the four categories of the Dietary Reference Intakes (DRI),
the Estimated Energy Requirement (EER), and the Acceptable Macronutrient
Distribution Ranges (AMDR).

1.4 National Nutrition Surveys

LO 1.4 Describe the ways in which the kinds of information collected by
researchers from nutrition surveys are used.

1.5 D
 ietary Guidelines, Fitness Guidelines,
and Food Guides
LO 1.5 Explain how each of the dietary ideals can be used to plan a healthy
diet, and how the Dietary Guidelines and USDA Food Patterns help make diet
planning easier.

1.6 Food Labels

LO 1.6 Compare the information on food labels to make selections that meet
specific dietary and health goals.

1.7 Nutrition in Practice: Finding the Truth about Nutrition

LO 1.7 Discuss how misinformation and reliable nutrition information can be
identified.

chapter

Rosenfeld/Flirt/Corbis
1
 Every day, several times a day, you make choices that will either
health

wellness

1.1 Food Choices

health: a range of states with physical,
nutrition
mental, emotional, spiritual, and social
components. At a minimum, health
means freedom from physical disease,
mental disturbances, emotional
distress, spiritual discontent, social
maladjustment, and other negative
states. At a maximum, health means
wellness.
wellness: maximum well-being; the cultural competence
top range of health states; the goal
of the person who strives toward
realizing his or her full potential Preference
physically, mentally, emotionally,
spiritually, and socially.
nutrition: the science of foods and the
nutrients and other substances they
contain, and of their ingestion, digestion,
absorption, transport, metabolism,
interaction, storage, and excretion. A
broader definition includes the study of bioactive food components phytochemicals
the environment and of human behavior
as it relates to these processes.
cultural competence: an awareness
and acceptance of one’s own and
others’ cultures, combined with the
skills needed to interact effectively
Habit
with people of diverse cultures.
bioactive food components:
compounds in foods (either nutrients
or phytochemicals) that alter client patient
physiological processes in the body.
client

2 CHAPTER 1 Overview of Nutrition and Health

 FIGURE 1-1 The Health Line phytochemicals (FIGH-toe-CHEM-ih-
cals): compounds in plants that confer
No matter how well you maintain your health today, you may still be able to improve tomorrow. color, taste, and other characteristics.
Likewise, a person who is well today can slip by failing to maintain health-promoting habits. Some phytochemicals are bioactive
food components in functional foods.
Nutrition in Practice 8 provides details.
Wellness— foodways: the eating habits and
optimal physical,
mental, emotional, culinary practices of a people, region,
spiritual, and social health
or historical period.

Superior
ethnic diets: foodways and cuisines
level of typical of national origins, races,
health
cultural heritages, or geographic
Good
level of locations.
health

Moderate
level of
health

Marginal
level of
health
Death Poor
from level of
disease health

Associations

Ethnic Heritage and Regional Cuisines

foodways

ethnic diets Photo 1-1

Values
Monkey Business Images/Shutterstock.com

ecolabels

halal Ethnic meals and family gatherings

nourish the spirit as well as the
body.

Food Choices 3
 TABLE 1-1 Selected Ethnic Cuisines and Food Choices
Protein
Grains Vegetables Fruit Foods Milk

Asian Millet, rice, Baby corn, bamboo Kumquats, Pork; duck and Soy milk
rice or wheat shoots, bok choy, loquats, lychee, other poultry;

Becky Luigart-Stayner/
noodles leafy greens (such as mandarin fish, octopus,

Encyclopedia/Corbis
amaranth), cabbages, oranges, sea urchin,
mung bean sprouts, melons, pears, squid, and
­scallions, seaweed, persimmon, other seafood;
snow peas, straw plums soybeans, tofu;
mushrooms, water eggs; cashews,
chestnuts, wild yam peanuts

Mediterranean Bulgur, cous- Artichokes, Berries, dates, Fish and other Feta, goat,
cous, focaccia, cucumbers, figs, grapes, seafood, mozzarella,
Italian bread, eggplant, fennel, lemons, ­melons, gyros, lamb, parmesan, provo-
pastas, pita grape leaves, leafy olives, oranges, pork, ­sausage, lone, and ricotta
Photodisc, Inc./
Getty Images

pocket bread, greens, leeks, pomegranates, chicken, fava cheeses; yogurt

polenta, rice onions, peppers, raisins beans, ­lentils, and yogurt
tomatoes almonds, walnuts beverages

Mexican Hominy, Bell peppers, ­cactus, Avocado, Beans, refried Cheese, flan
masa (corn cassava, chayote, bananas, guava, beans, beef, (baked caramel
Photodisc/Getty Images

flour dough), chili ­pepper, corn, lemons, limes, goat, pork, custard), milk in
tortillas (corn jicama, onions, mango, oranges, ­chorizo, chicken, beverages
Mitch Hrdlicka/

or flour), rice summer squash, papaya, plantain fish, eggs

tomatoes, winter
squash, yams

Social Interaction

Emotional State

Marketing

Availability, Convenience, and Economy

4 CHAPTER 1 Overview of Nutrition and Health

 Photo 1-2

wavebreakmedia/Shutterstock.com
Age

Nutrition is only one of the many factors

that influence people’s food choices.

Body Weight and Image

Medical Conditions

Health and Nutrition

whole foods: fresh foods such as

whole foods
vegetables, grains, legumes, meats,
and milk that are unprocessed or
minimally processed.
processed foods processed foods: foods that have been
intentionally changed by the addition
of substances, or a method of cooking,
preserving, milling, or such.
ultra-processed foods: foods that have
ultra-processed foods been made from substances that are
typically used in food preparation, but
not consumed as foods by themselves
(such as oils, fats, flours, refined
starches, and sugars) that undergo
further processing by adding a little,
if any, minimally processed foods, salt
and other preservatives, and additives
such as flavors and colors.

Food Choices 5
Another Random Scribd Document
with Unrelated Content
"If you do, you will destroy the best safeguard you have against the
escape of your prisoner," said Haidee, shortly.
"Ah! well, let him live a little longer then, but you must teach him
not to forget his old friends," was the careless reply.
"You come late, doctor. We did not expect you, and were about
retiring," said old Peter.
"Yes, we thought it better to come by stealth," said Pratt, shortly.
"The fact is, Colville has taken it in his head that we are watched by
some fellow, and it suits us to be wary just now. We wish to see
Miss Lawrence at once. Is she safe and well?"
"As safe and well as usual. Starvation does not seem to agree with
her very well," answered Haidee, leading the way up-stairs with her
flaring candle.
"It will break her proud spirit all the sooner," said Colville, brutally, as
he followed them.
Haidee stepped into the hall, opened Lily's door and entered, nearly
falling over the prostrate form of the girl. She started back in dismay.
"Why, what—the devil!" cried Pratt, entering behind her. "What has
happened to the girl? Is she dead?"
He knelt down, felt the pulse, and laid his ear over the heart as
Colville and Peter entered after him.
"She is in a faint," he said, looking up into Colville's frightened face.
"Our arrival was most opportune. Haidee, bring wine or whatever
stimulants you have in the house. Her vitality is exhausted. The late
regimen has been too severe for her weak constitution, perhaps."
He straightened the still form out upon the floor and applied a vial of
pungent smelling salts to her nostrils. In a moment life came
fluttering back, and Lily's languid gaze opened upon the faces of her
enemies. The white lids closed again and a heart-wrung sigh drifted
over her lips.
Doctor Pratt lifted the light form in his arms and laid her upon the
bed as Haidee entered, carrying a glass of wine. He took it from her
hand and held it to the lips of his patient.
"Drink this, Miss Lawrence," he said, "you are weak and faint; it will
revive you."
She drank it thirstily, and felt a momentary thrill of returning
strength. Rising on her elbow she looked at them all languidly.
"You time your visit late, gentlemen," she said, with a slight
inflection of scorn on the concluding word.
"We are obliged to consult our own convenience rather than yours,
Lily. Pardon our informal and ill-timed visit," said Mr. Colville, coming
forward to her side.
She flashed a look of scorn upon him, but deigned no reply. He
turned to the two old people who stood waiting.
"You may go," he said. "We will apprise you when we are about to
leave."
"No, let them remain," said Lily, imperiously. "I have something to
say to you, Mr. Colville, and I desire that these, your friends, may
hear it."
Old Peter and Haidee looked at each other in some trepidation at her
words and manner, but stood still, curious and a little frightened.
"My friends," muttered Colville, indignantly; "Miss Lawrence, I do not
choose my friends from among such rabble, I assure you!"
"Do you not?" said she, contemptuously. "Yet if you had a precious
treasure, Mr. Colville, and desired to guard it very carefully, you
would entrust it to your best friends rather than your enemies—
would you not?"
"Assuredly," he answered, wondering what she meant by her strange
words and manner.
"You would? and yet you have professed to regard me as the thing
most precious upon earth to you while you have given the lie to the
assertion by leaving me here in the keeping of these wretches whom
you disdain to own as your friends. Is it not so?"
He quailed before the scorn in her ringing voice, and the proud
gesture of her lifted finger.
"You were safe with them," he muttered. "My dearest friends could
not have guarded you more faithfully than they have done."
"It is false," she said, scornfully. "My life has been in constant
jeopardy at their hands ever since I first entered this house."
"Miss Lawrence, you are raving," said Doctor Pratt. "These people
have been paid to keep you here: it is to their interest to do so. And
why should you fancy yourself in danger from them?"
"It is no fancy," she answered, coldly, while her scathing glance fell
upon the cowering pair of interrupted murderers like lightning a
moment, then returned to the faces of those she addressed. "I
assure you, Doctor Pratt, and you, Mr. Colville, that your sudden
coming interrupted her—I was on the point of being murdered by
that woman there!"
"She lies!" cried Haidee and Peter, simultaneously.
"Silence, wretches!" thundered Dr. Pratt, furiously, reading guilt in
their very faces. "Let the lady tell her story, then deny it if you can."
"It is the wine that has got into her head," whined Peter, abjectly.
"Silence, fellow! Now, go on with your story, Miss Lawrence," said
the physician, impatiently.
Thus encouraged, Lily related every word of the frightful
conversation that was indelibly stamped on her memory. There was
no discrediting her assertions. The truth was unmistakable.
"She was just opening the door," concluded Lily, "when your loud
knocking frightened her away. My relief from the pressure of over-
wrought feeling was so great that I fainted when I attempted to
stand up again!"
Dr. Pratt was foaming at the mouth with such furious rage that he
could not speak. Colville, pale, trembling, with chattering teeth and
staring eyes, found his voice first.
"Wretches! Devils!" he shouted, in a voice hoarse with passion, as
he pointed to the door. "Go hide yourselves from my sight before I
rend you limb from limb!"
The craven wretches slunk away and locked themselves into their
room in wild fear lest the two infuriated men should put their threat
into execution. Colville came forward and stood by the bedside of
the young girl who had fallen back panting from weariness after her
denunciation of the would-be murderers.
"Lily," he said abjectly, "I am so unnerved by the thought of the
horrible fate you have just escaped that I can scarcely speak: but,
believe me, my dearest girl, I thought you perfectly safe in this
place, I never dreamed of such perfidy in these hired servants of my
will."
"This is no time for apologies," interrupted the doctor abruptly.
"Make them hereafter when you have more leisure and better
command of your feelings. At present the most important thing is to
remove Miss Lawrence from this house immediately, and place her in
a safer retreat."
He drew Colville aside one moment.
"I know of a place a few miles from here," he whispered, "to which I
have the entree. The place is a private mad-house, and is kept by a
doctor who is a very particular friend of mine. I know of no better
retreat at present for our fair little friend. He will receive her with
pleasure, and you can represent her as insane if it pleases you."
"Let us take her there then," answered Colville.
Doctor Pratt took down a dark cloak with a hood attached which
hung against the wall.
"Miss Lawrence," he said, quite courteously, "my carriage is at the
gate and I find it necessary to remove you at once from the perils
that environ you here. Put on this cloak and let us go. I will find
means afterward to punish these wretches for their perfidy."
Lily obeyed in silence, and was led down between them to the
waiting carriage.
The Leverets did not appear again, nor did the hound offer to molest
them.
Placing their prisoner in the carriage the two confederates drove
rapidly away over the country road.
 CHAPTER XXIX.
The inquest that was held over the dead bodies of Peter and Haidee
Leveret developed no information that could lead to the conviction of
their destroyer.
An expert examined the bodies and declared that the cause of their
death was strychnine poison.
Large quantities of this baneful drug was found in the tea pot and in
the partly emptied cups of the victims.
Mr. Shelton testified to the accidental finding of the bodies, and to
his extinguishing the flames which had been lighted for their funeral
pyre—also to the finding of the chained prisoner in the gloomy
dungeon. His evidence threw no light on the subject.
Fanny Colville testified to the names and general bad character of
the deceased, but knew nothing which was calculated to enlighten
the jury as to the mystery of their death.
She had not seen Peter for two years. Haidee had been in the habit
of bringing her some bread and water once a week, but had
neglected to return the last time, and nine days had elapsed since
Fanny had seen her, two of which days she was entirely without
food.
She supposed that the old witch was putting into execution her
often-reiterated threat of starving her to death.
This was all they learned of Fanny. She had given her evidence with
many pauses and turns of faintness. At length she became so ill and
exhausted that it seemed cruel to weaken her with farther
questioning, and it was decided to defer it until she became stronger
and better.
The jury, in accordance with the facts elicited, rendered a verdict
that the pair had come to their death by strychnine poisoning at the
hands of some person unknown.
Search was made for the hidden treasure the misers were supposed
to have concealed about the house, but nothing of value was found,
and the bodies of the iniquitous pair were committed to burial at the
expense of the city. They had lived their evil life, and the world being
rid of them was better off.
Mrs. Colville was removed to the home of Mrs. Mason, and the kind
soul was shocked at the spectacle of human misery thus presented
to her view.
She gave the poor creature a warm bath, clothed her skeleton limbs
in soft and comfortable apparel, and shingled her long, inextricably
tangled hair close to her head.
This done she proceeded to put her to bed and feed her with warm
and nourishing food.
The poor, starved woman could scarcely realize her good fortune.
She lay looking about her at the pleasant little room with its neat
carpet and curtains, its comfortable bed and cheery fire, and feared
it was all a dream from which she would awaken to the horrors of
her lonely, fireless dungeon.
But the gentle voice of her hostess soothed away her fears and
lulled her into profound and restful sleep.
For several days the most of her time was spent in eating and
sleeping.
The warm room and nourishing food seemed to induce slumber, and
she began to improve very slowly, but still so perceptibly that when
the detective came to see her after the lapse of a week he was
delighted at the change.
"Mrs. Mason, you must be a capital nurse," said he, smiling. "Your
patient looks very well, and begins to improve at a rate I hardly
dared hope for; I should scarcely have known her."
"And, but for your timely help I should have been dead ere this,"
said the invalid, giving him a grateful look from her large, hollow,
dark eyes. "I owe you my life. I do not know how to thank you."
"Do not try," answered the detective, feeling shy under the gratitude
that was about to be showered upon him. "The revelation you made
me when I found you fully repays the debt."
"Ah! that dear girl," sighed Fanny. "Have you learned anything
further about her, Mr. Shelton?"
He shook his head sadly.
"I am sorry to say I have not. The wretches have eluded me in some
way, and managed to remove her without my knowledge. But I do
not despair of catching up with them yet, and restoring the
unfortunate young creature to her friends."
"God grant you may," she murmured, fervently.
"There is one thing I wish to ask you," said he, suddenly. "When you
were telling me your story that day in the dungeon, you made an
assertion that threw a new light on the subject of Miss Lawrence's
supposed death."
"Ah! what was that?" she inquired.
"You know, or, perhaps, you do not know," said he, "that the jury's
verdict was suicide. Yet you made the assertion that she was
murdered by a jealous woman."
"Miss Lawrence was my informant, sir," answered Mrs. Colville.
"Perhaps she knew all the circumstances better than the jury."
"No doubt she did," he answered, smiling at her demure tone. "And
the woman?"
"Was a beautiful widow who lives under the Lawrence roof, and is
dependent on the banker for the very means of existence. I cannot
recall her name, for I have a peculiar faculty for forgetting names,
but perhaps you have heard it."
"I have," he answered, gravely. "And indeed it amazes me. It passes
belief that she should have struck a blow so terrible at the heart of
Mr. Lawrence, to whom she owes nothing but gratitude."
"She was maddened by jealousy, sir. She loved the young man
whom Lily Lawrence was on the point of marrying. I heard this from
the young girl's own lips. She told me she had long before suspected
her love, and pitied her sincerely, without a thought of the cruel
vengeance she was about to take."
"Cruel! It was fiendish," said Mr. Shelton.
"Yes, sir, it was fiendish. She crept into the room while Miss
Lawrence was trying on her wedding-dress, caught up a dagger
from the table, and exclaimed, as she plunged it into her victim's
heart: 'Girl, you shall die because Lancelot Darling loves you!'"
"Horrible!" exclaimed the detective.
"Miss Lawrence became immediately unconscious," continued Mrs.
Colville, "and does not know how the woman left the room after
locking her door on the inside, but thinks it probable she slid down
the long vine that runs up to her chamber window."
"It is very probable she did," said Mr. Shelton. "Heavens! what a
tissue of crime and villany has been woven about the innocent life of
that beautiful girl! But I will see her righted, I swear it by all that I
hold most sacred. And then let Mrs. Vance and Pratt and Colville look
to themselves. I hold the evidences of their crime in my hands now.
They only bide my time to see the inside of a prison cell!"
Mrs. Mason, sitting with her knitting, had been an interested listener
to the above conversation. The detective turned to her now, saying
kindly:
"We have been discussing secrets very freely in your presence, my
kind hostess, but I suppose you know how to keep silence regarding
them."
"Wild horses should not drag a word from me, sir, without
permission," replied she, earnestly.
"I fully believe it," answered Mr. Shelton. "Therefore I shall
commission Mrs. Colville to take you fully into our confidence after I
leave here. You will thereby hear a very romantic story regarding the
young lady whom you so nobly befriended some time ago."
"Bless her sweet face! I never shall forget her," said Mrs. Mason, on
whom indeed that little incident had made a deep and lasting
impression.
"I hope you may yet have the pleasure of meeting her under more
favorable auspices," said the detective, strong in the faith that he
should yet rescue Lily from her cruel and unrelenting captors.
"Mr. Shelton," said the invalid, abruptly, "I have been thinking of
sending for my poor old mother from the country. I must tell you
that I ran away from home to marry that villain, Colville. I have
never seen my poor old mother since, but I sent her my marriage
certificate to keep for me, and to assure her that I was an honorable
wife. I have never seen or heard from her since. I would like to see
her very much."
"Well?" he said, as she paused, looking wistfully at him.
"Would you advise me to send for her?" asked Fanny.
Mr. Shelton took down a little mirror hanging over the small toilet
table and held it before her face.
"Is it possible your mother would recognize you?" he inquired,
gently.
Poor Fanny did not know how sadly she was changed before. She
looked at herself and shuddered.
"Oh! no, sir!" said she, mournfully; "I was a black-eyed, rosy-
cheeked young girl when I left home. I am a gray-headed skeleton
now."
"Then take my advice and wait a little while. In the meantime, let
Mrs. Mason feed you and nurse you until you get some flesh on your
limbs, and some color in your ghostly face. Then as soon as you get
strong enough to travel, I myself will take you home to your
mother."
"Oh! thank you, thank you; that will be best," she murmured,
gratefully.
"No thanks," he answered, and bidding them adieu, he went
hurriedly away.
 CHAPTER XXX.
Lily Lawrence leaned back in the physician's carriage and wept
silently as she was whirled onward to her new prison.
Her companions were very taciturn. Doctor Pratt was driving and
gave the most of his attention to his task. Beyond one or two
questions as to her comfort he did not address either Lily or Colville.
The latter sat entirely silent opposite the young girl through the
whole time.
At length, after several miles of rapid driving the carriage came to a
pause, and the young girl was lifted out in front of a large, frowning
brick edifice which loomed up gloomily in the darkness of the chilly
night. She was led up a flight of stone steps and Doctor Pratt rang
the bell.
The summons was quickly answered by a small dark man, who
showed surprise at the visit, but welcomed Doctor Pratt with the
cordiality of an old friend.
"Doctor Heath, this is Mr. Colville, a friend of mine," said Doctor Pratt
as they stepped into the hall. "We have brought you a patient in the
person of this young lady."
"Indeed!" said the host, bowing gracefully to these two new
acquaintances, and ushering them into a small reception-room on
the right. "Pray take seats, my friends, and draw near the fire. The
night is raw and chilly."
Mr. Colville placed a comfortable chair near the fire for Lily, and she
sat down and held out her numbed hands to the cheerful blaze that
burned on the hearth.
Doctor Heath took a seat near her regarding her with looks of
surprise and admiration. Her colorless beauty shone out like a lily
indeed from the dark hood over her head.
"She looks very ill," said he in an undertone to his colleague, and
unseen by Lily, he tapped his forehead significantly.
Doctor Pratt gave a shy affirmative nod.
"She has been very ill," he answered, "and has had a tiresome drive
to-night in addition. Perhaps it would be better to let her have some
refreshments and retire at once. I wish to have a private
conversation with you."
Doctor Heath retired to give the necessary order. Lily's blue eyes
turned upon her captors with a look of dread in their soft depths.
"Doctor Pratt," said she, "what new trials am I about to experience
here?"
"None at all, I hope," said he, smoothly. "Your health is visibly
declining, Miss Lawrence, and I have concluded to place you under
the constant care of my friend, Doctor Heath. I think you will find
this a more comfortable place than old Haidee Leveret's and you will
have kinder treatment; I shall leave orders for a rather more
generous diet than has been lately allowed you, for I fear your
constitution may be ruined by your recent course of starvation. Yet I
must say your own obstinacy brought it upon you. One kind word
from your lips to Mr. Colville would have placed every luxury at your
command."
"And I would die rather than speak that word!" said Lily, with a
scornful curl of her beautiful lip.
"You will change your mind, doubtless, before you have remained
long in this place," said Mr. Colville, in a tone so significant that she
stared and looked at him keenly, as if trying to fathom its hidden
meaning, but she could not read the expression on his face, and
dropped her eyes with a weary sigh.
Doctor Heath came in, followed by a neat young woman with a large
and apparently very strong frame. She came in and stood behind
Lily's chair.
"This young woman will attend you to your room," said Doctor
Heath, with a polite bow. "I dare say you are tired and would like to
seek repose."
Mr. Colville approached Lily and bent down to say, softly:
"I may not see you again for several weeks, Lily; but if you should
change your mind and wish to recall me sooner, you need only
signify it to Doctor Heath, and he will communicate with me at
once."
"I am not likely to change my mind," she answered, coldly, turning
from him and following the strong-limbed young woman out of the
room.
Her guide led her up a stairway and along a wide hall, with a
number of closed doors on each side. At length she paused and
threw open the door, saying, politely:
"This will be your room for the present, miss."
Thus addressed, Lily stepped reluctantly across the threshold and
looked around her.
She found herself in a small and neatly-furnished room. The floor
was covered with a bright, warm carpet, a nicely-cushioned chair
was drawn before a comfortable fire, and a tray containing
refreshments was placed on a little stand in front of it.
The attendant entered behind her and closed the door.
"Allow me to assist you," said she, removing Lily's cloak, and seating
her in the easy-chair before the fire.
Lily's lip quivered slightly at the gentle kindness of the woman's
tone. Poor girl! harshness and coldness and threatening had become
the only familiar sounds to her ears. This woman, though she looked
young herself, assumed a motherly tone like one talking to a sick
child.
"You would like a cup of tea, I reckon," said she, pouring out the
fragrant beverage, and putting in cream and sugar, "and a bit of this
toast and cold chicken? You look very cold and tired, my dear."
"Thank you," answered Lily, taking the tea and drinking it thirstily.
After her long fast upon bread and water the food tasted simply
delicious to her. She did not know how much its quality was
sweetened by the kind looks of her attendant, who sat by and
watched her with a good-natured smile on her round and rosy face.
"Perhaps you would like me to help you to bed before I take away
the tray," said she, as Lily finished her tea and leaned back wearily in
her chair.
"Thanks; presently I will avail myself of your kindness, but now I
wish to ask you some questions," said Lily, quietly.
"Yes, miss," said the woman, kindly, but she looked at Lily with a
great deal of surprise at her tone.
"What is your name?" inquired the young prisoner.
"Mary Brown, if you please, miss," answered the woman in her kind,
soothing tone.
"You live here, I suppose, Mary?" pursued the young girl.
"Yes, miss."
"Then, Mary, I wish you would tell me what kind of a house this is. I
have been fancying that it must be a hospital, as there seems to be
a resident physician. Am I right?"
"Oh! yes, miss, certainly, this is a hospital. We have a number of sick
people here," said the woman, like one humoring an inquisitive child.
"But don't you wish to retire now, miss? It's about midnight I should
think."
"In a minute, Mary. Tell me first, is it a public hospital?"
"Oh! no, miss. It's perfectly private, and very select indeed. We
receive none but first-class people here—we don't indeed."
She was turning down the covers of the bed as she spoke, and now
she said, persuasively:
"Come, now, let me help you to bed, miss, I want to tuck you up
warm and comfortable before I leave you."
Lily submitted patiently, but as she laid her tired head on the pillow,
she asked, suddenly:
"Is Dr. Heath a good man, Mary?"
"La, now, miss, you must judge of that yourself. You will see him
often enough before you get well," said Mary Brown.
Lily was about to open her lips to refute the charge of her illness,
when she was suddenly interrupted by the sound of a wild and
piercing shriek which seemed to come from the room that was next
her own. In her alarm she sprang up and caught Mary Brown's arms
in both hers, shuddering with surprise and terror.
"Oh! what is it?" she cried, as the wild shriek was repeated again
and again, mingled with frenzied shouts and peal after peal of
frightful, demoniacal laughter.
"It's only one of the sick ones, miss," said Mary Brown, uneasily.
"Don't fret yourself, my dear. Lie down again. He will soon be quiet,
and then you can go to sleep."
A horrible suspicion flashed into Lily's mind.
"Mary Brown, you have been deceiving me with your kind face and
friendly talk. This is not a hospital for the sick. It is a private mad-
house—is it not?"
"Well, it is for people who are sick in their heads," admitted Mary.
"You mean for people who are insane," said she, holding tightly to
the woman's arm.
Mary Brown nodded acquiescence.
Lily was silent a moment, lost in painful thought. At length she said,
sadly:
"I hope you do not think that I am insane, Mary Brown?"
"Oh! dear, no, miss," said Mary, in her placid tone. "Of course not."
"But you do believe it. I can see that plainly," cried Lily, in an
anguished tone. "You have been humoring and petting me, taking
me for some insane creature. But I assure you I am not. I am
perfectly sane, though I have suffered cruelty and injustice enough
to have driven me mad long ago. I have been brought here by two
wicked men to be made a prisoner because I will not marry a man
whom I hate."
"You poor, injured dear," said the good nurse, affecting to believe the
young girl's story, though in her heart she set it down simply as one
of the vagaries of madness.
"You do not believe me," cried Lily, passionately. "Oh! God, is this
crowning insult to be added to my sufferings? Must they represent
me as mad, and thus drive me into insanity indeed?"
The attendant began to think that her beautiful and gentle patient
was becoming violent. She gently but forcibly released her arms
from Lily's clasp, and laid the moaning girl back on her pillow.
"My dear," she said, "you must not excite yourself. You look too ill to
stand agitation. I must go now and help Doctor Heath to manage
that poor shrieking maniac in the next room. Try and go to sleep, my
pretty dear."
She drew the warm covers up carefully over the patient, brushed
back the disordered golden hair with a coarse but kindly hand,
extinguished the light, and, taking up the tray of dishes, went out,
carefully locking the door after her.
In the hall she encountered Doctor Heath about entering the room
of the shrieking patient. He paused at sight of her.
"How is your new patient?" he inquired, abruptly.
"A little excited at present, sir. She appeared very quiet and sensible
at first, but after the violent patient began his shrieks she became
violent and wild, sir!"
"Did she tell you her name?" he inquired.
Mary Brown replied in the negative.
"Her case is rather peculiar," said Doctor Heath. "She is the victim of
a strange hallucination. A wealthy young lady of New York
committed suicide last summer under very romantic circumstances.
This young person imagines herself to be the identical young lady
who killed herself, and asserts that she was resurrected by a
physician and his friend, who detain her in durance vile because the
latter wishes to marry her. She will tell you her story, of course. Do
not contradict her, but gently humor her. She will not give you much
trouble, I think, as it is a mere case of melancholy madness. The
young lady she personates was named Miss Lawrence. Be particular
and call her by that name, Mary."
"I will, sir," said Mary, passing on.
 CHAPTER XXXI.
Mrs. Vance read in the daily papers an account on the inquest that
had been held over the dead bodies of her two victims.
She was surprised and troubled at first because her scheme for
burning the house down and destroying the bodies had failed, but as
she saw that no clew to the perpetrator of the poisoning had been
discovered, her courage rose in proportion.
"I am free now," she thought, with a guilty thrill of triumph. "The
two old harpies who preyed upon me are dead, and their secret with
them. No one will ever discover my agency in their death. Suspicion
would never dream of fastening upon me. Who would believe that
these white hands could be stained with crime?"
She held them up, admiring their delicate whiteness and the costly
rings that glittered upon them, then went to the mirror and looked
at her handsome reflection.
"I am beautiful," she said to herself with a proud smile. "There is no
reason why I should not win Lancelot Darling. A woman can marry
whom she will when she is gifted with beauty and grace like mine.
And I will yet be Lancelot Darling's wife. I solemnly swear that I
will!"
In the exuberance of her triumph and her pride in herself, she
ordered the carriage and went out to spend the money she had
rescued from Peter and Haidee in some new feminine adornment
wherewith to deck her beauty for the eyes of the obdurate young
millionaire.
Time flew past and brought the cold and freezing days of November.
The latter part of it was exceedingly cold, and snow covered the
ground with a thick, white crust.
Lancelot Darling came into the drawing-room one day where Ada
and the beautiful widow sat by the glowing fire, Mrs. Vance busy as
usual with some trifle of fancy work, and Ada yawning over the
latest novel. They welcomed him without surprise or formality, for he
had fallen into a habit of dropping in familiarly and with the freedom
of a brother. Mrs. Vance, after the first few weeks of affected
shyness and prudence, had resumed her old frank relations with
Lance, though but feebly seconded by that young man, who had not
recovered from the shock of her unwomanly avowal of love for
himself.
"Well, Ada, how does the novel please you?" he inquired, looking at
the book that she had laid aside.
"Either the author is very dull, or I am out of spirits," she returned,
smiling, "for I have failed to become interested in the woes of the
heroine, this morning. Have you read it, Lance?"
"Oh, yes, a week ago," he answered, carelessly. "I found it readable
and interesting. I dare say you are in fault to-day, not the author.
You are out of tune."
"Perhaps so," said Ada, "but what am I to do about it? Can you
suggest a remedy?"
"The sleighing is very fine just now," he returned. "It thrills one very
pleasurably. Have you tried it?"
"Oh, yes, Mrs. Vance and myself have been out twice with papa this
week."
"By daylight?" he queried.
"Yes, by daylight," she answered.
"The latest sensation, however, is sleigh-riding by moonlight,"
rejoined Lance. "There is a full moon, you know, and the nights are
superb. Parties go out to Dabney's hotel—it is far out on the suburbs
—and have hot coffee and oysters by way of refreshment, you know
—then they return to the city, getting home near midnight usually.
Altogether it is very exhilarating."
"You speak from experience, I presume?" said Ada.
"Yes. I tried it myself last night, being induced thereto by the
glowing representations of two young friends of mine. I found the
drive quite as bracing and delightful as they described it. I should be
tempted to try it again to-night if I could persuade you, Ada, and
Mrs. Vance to accompany me."
"Why, that would be delightful," said Ada, clapping her hands, with
the pleasure of a child over a new toy. "I think that is just what I am
needing—a new sensation."
"You consent, then?" said he, smiling at her pretty enthusiasm.
"Oh, yes, if Mrs. Vance will go, too. Will you do so?" inquired she,
turning to the lady, who had as yet taken no part in the
conversation.
"Do you wish to go very much?" inquired she, looking up from her
work with a very pleasant smile.
"I think I should enjoy it very much."
"I don't know that I care for it very much," said the widow, with a
light sigh; "but I will go to please you, Ada."
"It is settled then," said Lance. "We will go, and I think I can
promise you both a very enjoyable evening."
It could not fail to be otherwise, Mrs. Vance thought to herself, with
a thrill of pleasure at the knowledge that she would be seated beside
him for hours, hearing his musical voice and looking into his
handsome face.
"If it were not for that hateful Ada going, too," she said to herself,
"what a chance I could have to make an impression on his heart!"
But regret it as she would she could not prevent Ada from going, for
she saw plainly enough that the excursion was planned for the
young girl's pleasure, not her own. She was merely secondary in the
affair. A thrill of jealous pain cut through her heart like a knife, and
the furtive glance of hatred she cast upon Ada boded no good to the
lovely and high-spirited young girl.
Night came, and Lance appeared with his elegant little sleigh. The
ladies, comfortably arrayed in sealskin cloaks and hats, were helped
into the sleigh, the warm buffalo robes were tucked around them,
and taking the reins in hand, Lance started out at a dashing pace
over the smooth and shining crust of snow.
The moon shone gloriously, making the ground look as if paved with
sparkling gems, the silver bells rang out a merry chime, and the
hearts of all three seemed to fill with pleasure at the joyous sound,
and the breath of winter seemed like a caress as it sighed past their
warm and glowing cheeks.
Numbers of merry pleasure-seekers were out enjoying the fine
sleighing and the beautiful night. Gay words and happy laughter
rang out from youthful voices, and many a heart beat high with
hope and love.
Mrs. Vance and Ada enjoyed their moonlight ride very much, and
found their appetite sharpened for the delicious supper which was
ready for them when they arrived at their destination.
They met several of their friends at Dabney's hotel on the same
pleasant mission as themselves, and enjoyed an hour of social
converse before starting on their homeward way. They were the last
to leave.
"It has been very pleasant," said Ada, impulsively, as Lance tucked
the buffalo robes around them preparatory to starting.
"I am glad you have enjoyed it," answered the young man, touching
up his spirited horses and starting off in gallant style.
They had gone about half a mile when, in turning a corner, the
mettlesome young horses became suddenly frightened at something,
and reared upward, nearly upsetting the sleigh and its occupants.
With a grasp of steel, Lance tried to bring them down upon their
feet, but succeeded only to see them start away at a maddened and
furious pace, entirely beyond his control, while shriek after shriek of
terror burst from the two ladies as they clung to Lance.
Impeded by the clinging arms of the two, and distressed beyond
measure by their frightened screams, it was impossible for Lance to
do anything to help them. Though he held on to the reins so tightly
that his hands were wounded and bleeding, his utmost strength was
insufficient to arrest the speed of the horses. They ran faster and
faster, as though incited to greater speed by the screams of the
women. At length, with a frantic effort, they cleared themselves of
the sleigh and bounded away, leaving the dainty vehicle overturned
and broken, and its occupants reposing in a snow-drift.
Lance was the first to lift himself up and look about. He felt as if
every bone in his body were broken, so swift had been the impetus
that hurled him out; but repressing his own pain he hastened to his
two companions.
"Ada, Mrs. Vance, are either of you hurt?" he inquired, anxiously.
Mrs. Vance was already on her feet, shaking the loose snow from
her hair and dress.
"I believe I am quite uninjured beyond the shock of the fall," said
she. "Are you, Lance?"
"Oh! I am all right," said he; "but, Ada, my dear girl, are you hurt?"
Ada answered his query with a moan of pain, but made no effort to
rise. He bent over her and lifted the slight form in his strong arms.
"Can you stand?" he inquired, anxiously.
"Oh, no—no!" she moaned. "My ankle seems to be twisted or
sprained, and my head struck something hard like a rock in falling. It
aches dreadfully."
She burst into tears, sobbing aloud in her pain. Lance looked about
him in despair.
There he was in the road, several miles from the city, with two
helpless females to take care of, and his broken sleigh lying useless,
the horses quite out of sight. Worse than all, Ada lying helpless in
his arms, unable to stand or walk, and moaning like a child in her
acute suffering.
"This is terrible," he said. "What can we do, Mrs. Vance?"
"Nothing," said she, coldly, maddened by the sight of Ada's head
resting against his shoulder, "except to remain here and freeze to
death waiting for some other vehicle to happen along and take us
home."
"Something may happen along at any minute," he answered,
encouragingly. "There are numbers of people out to-night as well as
ourselves."
"It is quite probable that we are the last on the road," said she
doubtfully. "Indeed, I believe that we are. If Ada were unhurt I
should suggest that we walk home, or back to the hotel at least.
Ada, my dear, rouse yourself and do not weep so childishly. Do you
not see what a plight you are putting us in? I am quite sure you can
walk a little if you will only try to make an effort."
Thus adjured, Ada lifted herself and tried to put her foot on the
ground and stand up.
"It is useless," said she, falling back with a sharp cry. "My ankle is
too badly hurt. I cannot stand upon it."
Ere she ceased to speak, the welcome tinkle of sleigh-bells in the
distance saluted their ears.
"Thank Heaven!" ejaculated Lance, "we have but a moment to wait.
Relief is at hand."
"How fortunate!" chimed in Mrs. Vance, recovering her good humor
at the prospect of help in their extremity.
Directly a splendid little sleigh drove up to them, stopped, and the
single occupant, a handsome young man, jumped out.
"What is the trouble here?" he inquired, in a genial, friendly voice.
"Why, upon my word," with a start of surprise, "it's you, Lance, is it
not?"
"Yes, it is I, Phil, and I was never so glad to see you before in my
life," answered Lance, in a tone of relief. "Mrs. Vance, Miss
Lawrence, this is my best friend, Philip St. John."
"You have met with an accident?" said Mr. St. John, after briefly
acknowledging this off-hand presentation to the ladies.
"Yes, my horses ran off and overturned the sleigh, pitching us into
the road. Mrs. Vance and myself luckily escaped unhurt, but Miss
Lawrence has sustained an injury that incapacitates her for walking."
"Perhaps I can help you," said the new-comer, cordially. "My sleigh is
very small, but it will be roomy enough to accommodate one of
these ladies, I am sure. Now, if Miss Lawrence will trust herself to
my care, I will take her home immediately. And, Lance, if you and
Mrs. Vance can stand a walk of a mile back to Dabney's hotel, you
will find that they keep a good trap there and you can get it to
return in."
"What do you say to my friend's plan, Ada?" asked Lance, looking
down at her as she leaned upon his arm. "Will you allow Mr. St. John
to take you home? I assure you he will take the kindest care of you."
"I accept his offer with thanks," said Ada, gratefully, "but it seems
selfish to leave Mrs. Vance and you to trudge back to the hotel on
foot."
"My dear child, pray do not distress yourself on that score," said Mrs.
Vance, in her kindest tone. "I feel so thankful for this timely
assistance in your behalf that I shall not mind the long walk at all."
"It is the best thing they can do, Miss Lawrence," said Mr. St. John,
respectfully. "They would freeze if they remained here waiting till I
sent a conveyance out from the city, but if they walk back to the
hotel they can get Dabney's sleigh and follow us directly."
Ada was accordingly lifted into the very small sleigh of Mr. St. John;
the robes from Lance's useless sleigh were brought and tucked
around her, and in a minute she was off like the wind for home,
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