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 DIGITAL
VERSION
Included

DIALYSIS THERAPY

Allen R. Nissenson | Richard N. Fine

Rajnish Mehrotra | Joshua Zaritsky
2
HANDBOOK OF
DIALYSIS THERAPY
SIXTH EDITION

HANDBOOK OF
DIALYSIS THERAPY

Allen R. Nissenson, MD, FACP Rajnish Mehrotra, MD, MS

Emeritus Professor of Medicine Belding H. Scribner Endowed Chair
David Geffen School of Medicine at UCLA Professor of Medicine
Los Angeles, CA, United States Head, Division of Nephrology
Department of Medicine
Richard N. Fine, MD University of Washington
Professor of Pediatrics Seattle, WA, United States
Renaissance School of Medicine at Stony Brook
University Joshua Zaritsky, MD, PhD
Stony Brook, NY, United States Chief Pediatric Nephrology
St. Chris Hospital for Children
Professor of Pediatrics
Drexel University College of Medicine
Philadelphia, PA, United States
Elsevier
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899

HANDBOOK OF DIALYSIS THERAPY, SIXTH EDITION  ISBN: 978-0-323-79135-9

Copyright © 2023 by Elsevier, Inc. All rights reserved.
Ch. 9, “Safety Monitors in Hemodialysis,” copyrighted by Joanne D. Pittard
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations, such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found on our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. Because of rapid
advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors,
or contributors for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.

Previous editions copyrighted 2002, 2008, and 2017.

Senior Content Strategist: Nancy Anastasi Duffy

Senior Content Development Specialist: Priyadarshini Pandey
Publishing Services Manager: Deepthi Unni
Senior Project Manager: Manchu Mohan
Book Designer: Ryan Cook
Printed in The United States of America.
Last digit is the print number: 9 8 7 6 5 4 3 2 1
 This book is dedicated to the heroic patients and care givers who showed courage
and perseverance during the COVID-19 pandemic and inspired us all.
Allen R. Nissenson, MD

I would like to dedicate this edition of Handbook of Dialysis to my wife of ALMOST

50 years, Shawney, whose encouragement, support, and advice have made the journey to
facilitate access to ESRD care for children of all ages possible, as well as our 4 children,
one of whom (Jeffrey) is no longer with us, 11 grandchildren, 2 of whom aspire to
become physicians AND 3 GREAT-GRANDCHILDREN. They have tolerated my
conflicting priorities over the years. I appreciate their continued understanding.
Richard N. Fine, MD

This book is dedicated to my wife, Kushi Mehrotra, who has stood patiently by
my side for 29 years, to our two children, Kunaal and Ria, who have grown into
amazing young adults in the blink of an eye, and to my parents, Trijugi and
Kamini Mehrotra, who are no longer with us but forever in our hearts.
Rajnish Mehrotra, MD, MS

I would like to dedicate this book to my children, Sarah and Ella.

Joshua J. Zaritsky, MD, PhD
Contributors

Cahyani Gita Ambarsari, MD, FIPNA, FISPD Carlos E. Araya, MD

Clinical Nephrology Fellow Associate Professor
Princess Alexandra Hospital and Queensland Children’s Department of Pediatrics, Division of Pediatric Nephrology
Hospital, Brisbane, QLD, Australia Nemours Children’s Hospital, Orlando
Member of Medical Technology Indonesia Medical FL
Education and Research Institute (IMERI) United States
Consultant Paediatric Nephrologist Associate Professor
Paediatric Nephrology Division Department of Pediatrics
Department of Child Health University of Central Florida, Orlando
Faculty of Medicine, Universitas Indonesia FL
Cipto Mangunkusumo Hospital, Jakarta United States
DKI Jakarta
Indonesia
Rossella Attini, MD, PhD
Physician
Rachel A. Annunziato, PhD Department of Obstetrics and Gynecology
Professor Città della Salute e della Scienza, Ospedale
Psychology Sant’Anna
Fordham University Turin
Bronx, NY Italy
United States
Associate Professor
Pediatrics Rose Mary Ayoob, MD
Icahn School of Medicine at Mount Sinai, New York Associate Professor of Pediatrics
NY, United States Division of Pediatric Nephrology
Hoops Family Children’s Hospital at Cabell
Huntington Hospital
Evamaria Anvari, MD Joan C. Edwards School of Medicine at Marshall
Assistant Professor of Medicine University
Cleveland Clinic Lerner College of Medicine of Case Huntington, WV, United States
Western Reserve University
Department of Kidney Medicine
Glickman Urological & Kidney Institute Justine Bacchetta, MD, PhD
Cleveland Clinic Professor of Pediatrics
Cleveland, OH Pediatric Nephrology, Reference Center for Rare Renal
United States Diseases
Hospices Civils de Lyon, Bron
France

vii
viii Contributors

Rossana Baracco, MD Mei Lin Z. Bissonnette, MD, PhD, FRCPC

Associate Professor Clinical Associate Professor
Pediatrics, Division of Pediatric Nephrology Department of Pathology and Laboratory Medicine
Central Michigan University College of Medicine, University of British Columbia, St. Paul’s Hospital
Detroit Vancouver
MI BC
United States Canada

Joanne M. Bargman, MD, FRCPC Geoffrey A. Block, MD

Director Associate Chief Medical Officer
Peritoneal Dialysis Program Medical Office
University Health Network, Toronto US Renal Care, Plano
ON TX
Canada United States
Professor
University of Toronto, Toronto
ON Brendan Bowman, MD
Canada Associate Professor
Department of Medicine
University of Virginia School of Medicine, Charlottesville
Antonio Bellasi, MD VA
Research, Innovation and Brand Reputation United States
Ospedale di Bergamo, ASST-Papa Giovanni XXIII,
Bergamo
Italy Patrick D. Brophy, MD, MHCDS
Chairman
Pediatrics
Ezequiel Bellorin-Font, MD University of Rochester, Rochester
Instructor of Medicine NY
Division of Nephrology United States
Saint Louis University, Saint Louis
MO
United States Deborah J. Brouwer-Maier, RN, CNN
Vascular Access Marketing Manager
Marketing
William M. Bennett, MD Transonic, Lansdale
Medical Director PA
Legacy Transplant Services United States
Legacy Health Systems, Portland
OR
United States Steven Brunelli, MD, MSCE
Professor of Medicine (Retired) Vice President for Research
Oregon Health & Science University, Portland DaVita Clinical Research
OR DaVita, Inc, Minneapolis
United States MN
United States

Scott Bieber, DO
Physician David Bushinsky, MD
Nephrology Professor of Medicine and of Pharmacology and Physiology
Kootenai Health, Coeur d’Alene Medicine
ID University of Rochester School of Medicine and Dentistry,
United States Rochester
NY, New York
United States
 Contributors ix

Jonathan Casavant, PharmD, BCPS Anthony Chang, MD

Antimicrobial Stewardship Pharmacist Professor
Pharmacy Clinical Services Department of Pathology
VA Puget Sound HealthCare System, Seattle University of Chicago, Chicago
WA IL
United States United States

Roberta Cerutti, MD Chaim Charytan, MD

Nephrology Chief Renal Division
IRCCS Ospedale Maggiore Policlinico, Milan Renal
Italy New York-Presbyterian Med Ctr of Queens, Flushing,
Queens
NY
Vimal Chadha, MD United States
Professor of Pediatrics Clinical Professor of Medicine
Department of Pediatrics Weill Cornell College of Medicine, New York
School of Medicine, University of Missouri-Kansas City, NY
Kansas City United States
MO
United States
Director, Acute Kidney Injury Program Joline L.T. Chen, MD, MS
MO Health Sciences Associate Clinical Professor
United States Division of Nephrology and Hypertension
Associate Director, Dialysis and Transplantation University of California, Irvine, Irvine
Division of Nephrology CA
Children’s Mercy Kansas City, Kansas City United States
MO
United States
Wei Chen, MD
Associate Professor
Christopher T. Chan, MD, FRCPC Department of Medicine
Director of Nephrology Albert Einstein College of Medicine, Bronx
Nephrology NY
University Health Network, Toronto United States
ON Adjunct Professor
Canada Department of Medicine
University of Rochester School of Medicine and Dentistry,
Rochester
Bipan Chand, MD, MBA NY
Department of Surgery United States
Loyola University, Maywood, IL,
United States
Andrew I. Chin, MD
Health Science Clinical Professor
Deepa H. Chand, MD, MHSA Division of Nephrology, Department of Internal
Executive Medical Director Medicine
Global Patient Safety University of California, Davis School of Medicine,
Novartis Gene Therapies, Bannockburn Sacramento
IL CA
United States United States
Attending Pediatric Nephrologist
Pediatrics
Washington University School of Medicine, St. Louis
MO
United States
x Contributors

Yeoungjee Cho, MBBS (Hons), FRACP, PhD Stephanie L. Donahue, MSN, FNP-BC
Consultant Nephrologist Nurse Practitioner Medicine and Behavioral Health
Associate Professor of Medicine, University of Queensland The Rogosin Institute New York, New York
Clinical Trialist (Australian Kidney Trials Network) NY, United States
Department of Nephrology
Division of Medicine
Metro South Health Ramanath Dukkipati, MD
Princess Alexandra Hospital Associate Professor of Medicine
Brisbane, QLD Nephrology and hypertension
Australia Harbor-UCLA Medical Center, Torrance
CA
United States
William R. Clark, MD
Professor of Engineering Practice
Davidson School of Chemical Engineering Claire Dunphy, PhD
Purdue University, W Lafayette Postdoctoral Fellow
IN Pediatrics
United States Icahn School of Medicine at Mount Sinai
New York, NY
John H. Crabtree, MD United States
Visiting Clinical Faculty
Division of Nephrology and Hypertension
Harbor-University of California Los Angeles Medical Mohamed Elbokl, MBBCH
Center, Torrance Clinical Fellow
CA Nova Scotia Health Authority
United States Nephrology
Dalhousie University
Halifax, NS
Daniel Cukor, PhD Canada
Director
Behavioral Health
The Rogosin Institute, New York Fabrizio Fabrizi, MD
NY Staff Nephrologist
United States Division of Nephrology
Maggiore Policlinico Hospital and Ca’ Granda IRCCS
Foundation, Milano
Serpil Muge Deger, MD, FISN Italy
Associate Professor
Department of Nephrology
Dokuz Eylul University Faculty of Medicine Mohammed K. Faizan, MD
Izmir, Turkey Associate Professor
Department of Pediatrics
The Warren Alpert Medical School of Brown University,
Lucia Del Vecchio, MD Providence, RI, United States
Department of Nephrology and Dialysis, Sant’Anna Division Director
Hospital, ASST Lariana Pediatric Nephrology
Como Hasbro Children’s Hospital, Providence
Italy RI, United States

Alonso R. Diaz, MD
Nephrology Fellow
Division of Nephrology, Department of Internal Medicine
University of California, Davis School of Medicine,
Sacramento
CA
United States
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 Contributors xi

Steven Fishbane, MD Pediatric Nephrologist

Chief Pediatrics
Division of Kidney Diseases & Hypertension Montreal Children’s Hospital, Montreal
Zucker School of Medicine at Hofstra/Northwell, QC
Uniondale Canada
NY
United States
Professor Seth B. Furgeson, MD
Medicine Associate Professor
Zucker School of Medicine at Hofstra/Northwell, Medicine
Uniondale University of Colorado, Aurora
NY CO
United States United States
Vice President Staff Nephrologist
Northwell Health Network Dialysis Services Medicine
NY Denver Health, Denver
United States CO
United States

Molly Fisher, DO
Assistant Professor of Medicine Ashley M. Gefen, MD
Medicine Fellow
Montefiore Medical Center, Bronx Department of Pediatrics, Division of Nephrology
NY Cohen Children’s Medical Center
United States New Hyde Park, NY
United States

William Henry Fissell IV, MD

Associate Professor Guido Gembillo, MD
Nephrology and Hypertension Department of Clinical and Experimental Medicine, Unit
Vanderbilt University Medical Center, Nashville of Nephrology and Dialysis
TN Policlinic G. Martino, Messina
United States Italy

Jorge Ignacio Fonseca-Correa, MD F. John Gennari, MD

Geriatric Nephrology Fellow Professor Emeritus
Division of Nephrology Medicine
University Health Network, Toronto University of Vermont College of Medicine, Burlington
ON VT
Canada United States
Nephrologist
Department of Nephrology and Mineral Metabolism
Instituto Nacional de Ciencias Médicas y Nutrición Marc Ghannoum, MD
Salvador Zubirán Associate Professor
Mexico City Specialized Medicine
Mexico University of Montreal, Verdun Hospital, Montreal
QC
Canada
Bethany J. Foster, MD, MSCE
Professor
Department of Pediatrics, Division of Nephrology Griet Glorieux, PhD
McGill University, Montreal Professor
QC Internal Medicine and Pediatrics, Nephrology Division
Canada Ghent University Hospital, Ghent
Belgium
xii Contributors

Sharlene Anuska Greenwood, PhD, BSc Sarbjit Vanita Jassal, MD, MB, MRCP(UK),
Consultant Physiotherapist FRCPC
Renal Staff Nephrologist and Director, Geriatric Dialysis
King’s College Hospital, London Program
United Kingdom Division of Nephrology
Honorary Senior Lecturer University Health Network, Toronto
Renal Sciences ON
King’s College London, London Canada
United Kingdom Professor
Medicine
University of Toronto, Toronto
Dieter Haffner, MD ON
Professor Canada
Pediatric Kidney, Liver and Metabolic Diseases
Hannover Medical School, Hannover
Lower Saxony Kirsten L. Johansen, MD
Germany Professor of Medicine
Department of Medicine
University of Minnesota School of Medicine
Rainer Himmele, MD, MSSH Director
Head of Global Medical Information & Education Division of Nephrology
Fresenius Medical Care Hennepin Healthcare
Charlotte Minneapolis, MN
NC United Sates
United States

David W. Johnson, PSM MBBS, FRACP,

Jean L. Holley, AB, MD DMed (Res), FASN, FAHMS, PhD
Clinical Professor of Medicine Director of Metro South Integrated Nephrology and
Medicine Transplant Services (MINTS)
University of Illinois, Urbana-Champaign, Medical Director, Queensland Kidney Transplant Service
Urbana Professor of Medicine (University of Queensland)
IL Professor of Population Health (University of
United States Queensland)
Clinical Professor of Medicine Co-Director of Centre for Kidney Disease Research,
Medicine Translational Research Institute
Carle Illinois College of Medicine, Urbana NHMRC Leadership Fellow
IL Department of Nephrology
United States Division of Medicine
Princess Alexandra Hospital
Metro South Health
Daljit K. Hothi, MBBS, MRCPCH, MD Brisbane, QLD
Consultant Pediatric Nephrologist Australia
Great Ormond Street Hospital for Children, London
United Kingdom
Kamyar Kalantar-Zadeh, MD, MPH, PhD
Professor and Chief
T. Alp Ikizler, MD, FASN Nephrology
Catherine McLaughlin Hakim Chair in Vascular Biology University of California Irvine, Orange
Professor of Medicine CA
Vanderbilt University Medical Center, Nashville United States
TN
United States
 Contributors xiii

Pranay Kathuria, MD, FACP, FASN Pelagia Koufaki, PhD

Director, Division of Nephrology and Professor of Reader in Exercise and Rehabilitation Sciences
Medicine School of Health Sciences
Division of Nephrology and Hypertension Queen Margaret University, Edinburgh
University of Oklahoma School of Medicine, Tulsa Scotland
OK United Kingdom
United States

Eugene C. Kovalik, MD, CM, FRCP(C),

Irfan Khan, MD FACP, FASN
Board Certified in Pediatrics and Pediatric Critical Care Profesor of Medicine
Medical Director of PICU/CVICU/ECMO Medicine/Nephrology
Pediatrics Duke University Medical Center, Durham
Presbyterian Hospital, Albuquerque NC
NM United States
United States

Robin A. Kremsdorf, MD
Paul L. Kimmel, MD, MACP, FRCP, FASN Assistant Professor
Clinical Professor of Medicine Department of Pediatrics
Emeritus George Washington University The Warren Alpert Medical School of Brown University
Washington Providence, RI
DC United States
United States

Martin Kreuzer, MD
Alan S. Kliger, MD Department of Pediatrics II
Clinical Professor of Medicine Essen University Hospital, Essen
Medicine North Rhine-Westphalia
Yale School of Medicine, New Haven Germany
CT
United States
Mahesh Krishnan, MD, MPH, MBA, FASN
Group Vice President
Timothy Koh Jee Kam, MBBS, MMed(Int Med), Research and Development
MRCP(UK) DaVita Venture Group, Washington
Senior Consultant DC
Renal Medicine United States
Tan Tock Seng Hospital, Singapore
Singapore
Martin K. Kuhlmann, MD
Department of Internal Medicine—Nephrology
Berfu Korucu, MD Vivantes Klinikum im Friedrichshain, Berlin
Nephrology and Hypertension Germany
Vanderbilt University School of Medicine,
Nashville
TN Danica Lam, BASc, MD
United States Division of Nephrology
Nephrology Humber River Hospital, Toronto
Gazi University Faculty of Medicine, Ankara ON
Turkey Canada
xiv Contributors

Yu-Chi Lapid, MBBS Harold J. Manley, PharmD, FASN, FCCP

Nephrology Fellow Senior Pharmacy Director
NewYork-Presbyterian Queens Pharmacy
Flushing Queens, NY Dialysis Clinic Inc, Nashville
United States TN
United States

Francesco Locatelli, MD
Past Director MD Kevin J. Martin, MB, BCh, FASN
Department of Nephrology and Dialysis Professor of Internal Medicine
A. Manzoni Hospital ASST Lecco Division of Nephrology
Lecco Saint Louis University, Saint Louis
Italy MO
United States

Joseph B. Lockridge, MD
Associate Professor Nicola Matthews, FRCP(C)
Nephrology Staff Nephrologist
Oregon Health and Sciences University, Portland Division of Nephrology
OR Mackenzie Health
United States Richmond Hill, ON
Medical Director for Kidney Transplantaion Canada
Department of Hospital and Specialty Medicine
VA Portland, Portland
OR Juliet Mayes, BSc (Hons) Physiotherapy
United States Specialist Renal Physiotherapist
Therapies Department
King’s College Hospital, London
Charmaine E. Lok, BSc(PT), MD, MSc, FRCPC United Kingdom
Professor of Medicine
Department of Medicine, Division of Nephrology
University of Toronto, Toronto Ian E. McCoy, MD, MS
ON Assistant Professor
Canada Department of Medicine, Division of Nephrology
University of California, San Francisco
San Francisco, CA
Etienne Macedo, MD, PhD United States
Assistant Professor
Medicine
UCSD, San Diego Christopher W. Mcintyre, MD, PhD
CA Professor of Medicine, Medical Biophysics
United States and Pediatrics
Department of Medicine
University of Western Ontario, London
John D. Mahan, MD ON
Professor of Pediatrics Canada
Department of Pediatrics Robert Lindsay Chair of Dialysis Research
Nationwide Children’s Hospital/The Ohio and Innovation
State University College of Medicine University of Western Ontario, London, ON
Columbus, OH Canada
United States
 Contributors xv

Rajnish Mehrotra, MD, MS Alvin H. Moss, MD, FACP, FAAHPM

Belding H. Scribner Endowed Chair Director
Professor of Medicine Center for Health Ethics and Law
Head, Division of Nephrology West Virginia University, Morgantown
Department of Medicine WV
University of Washington, Seattle United States
WA Professor of Medicine
United States Medicine, Sections of Nephrology and Geriatrics and
Palliative Medicine
West Virginia University, Morgantown
Ravindra L. Mehta, MBBS, MD, DM WV
Professor Emeritus of Clinical Medicine United States
Medicine
University of California San Diego, San Diego
CA Vinay Narasimha Krishna, MBBS
United States Assistant Professor
Department of Medicine, Division of Nephrology
The University of Alabama at Birmingham, Birmingham
Mark M. Mitsnefes, MD, MS AL
Division of Nephrology and Hypertension United States
Cincinnati Children’s Hospital Medical Center,
Cincinnati
OH Sharon J. Nessim, MD, MSc
United States Nephrologist
Department of Medicine, Division of Nephrology
Jewish General Hospital, Montreal
Michele H. Mokrzycki, MD QC
Professor Canada
Department of Medicine, Division of Nephrology Associate Professor
Albert Einstein College of Medicine, Montefiore Medical Medicine
Center, Bronx McGill University, Montreal, QC
NY Canada
United States

Allen R. Nissenson, MD, FACP

Bogdan Momciu, MD, FRCPC Emeritus Professor of Medicine
Assistant Professor David Geffen School of Medicine at UCLA,
Division of Nephrology Los Angeles, CA
Queen’s University California
Kingston, ON United States
Canada

Vandana Dua Niyyar, MD

Liz Mooney, BA, MPA Professor
Director of IT Strategy & Innovation Department of Medicine
Information Technology Division of Nephrology
DaVita, Denver Emory University
CO Atlanta, GA
United States United States
xvi Contributors

Ali Olyaei, PharmD Jeffery Perl, MD, SM, FRCP(C)

Professor Associate Professor of Medicine
Medicine and Pharmacy Division of Nephrology
OSU/OHSU, Portland University of Toronto, Toronto, ON
OR Canada
United States

Giorgina B. Piccoli, MD
Alejandra Orozco-Guillén, MD, PhD Néphrologie et Dialyse
Nephrologist Centre Hospitalier Le Mans
Unit Intensive Adult Care Le Mans
National Institute of Perinatology, Mexico City France
Mexico
Internal Medicine
Unit Intensive Adult Care Joanne D. Pittard, MS, RN
National Institute of Perinatology, Mexico City Nursing Education Consultant
Mexico Hemodialysis, Inc.
Professor Emerita of Allied Health
Glendale College
David I. Ortiz-Melo, MD Glendale, CA
Assistant Professor United States
Medicine-Nephrology
Duke University, Durham
NC Connie M. Rhee, MD, MSc
United States Associate Professor of Medicine
Department of Medicine, Division of Nephrology,
Hypertension and Kidney Transplantation
Biff F. Palmer, MD University of California Irvine School of Medicine,
Professor of Internal Medicine Orange
Internal Medicine CA
University of Texas Southwestern Medical Center, Dallas United States
TX
United States
Professor of Internal Medicine Ezequiel Ridruejo, MD
Medicine Chief
Univserity of Texas Southwestern Medical Center, Dallas Hepatology Section, Department of Medicine
TX Centro de Educación Médica e Investigaciones Clínicas
United States Norberto Quirno “CEMIC”, Ciudad Autónoma de
Buenos Aires
Argentina
Suetonia C. Palmer, MB, ChB, PhD
Medicine
University of Otago Christchurch, Christchurch Claudio Rigatto, MD, MSc
New Zealand Associate Professor of Medicine
University of Manitoba, Winnipeg
MB
Patrick S. Parfrey, MD, FRCPC, FRSC Canada
Distinguished University Professor
Faculty of Medicine
Memorial University of Newfoundland, St. John’s
NL
Canada
 Contributors xvii

Matthew B. Rivara, MD Rudolph A. Rodriguez, MD

Assistant Professor Professor
Division of Nephrology Pediatrics, Division of Pediatric Nephrology
University of Washington, Seattle Central Michigan University College of Medicine,
WA Detroit
United States MI
Investigator United States
Kidney Research Institute, Seattle Chief Medical Officer
WA Administration
United States Children’s Hospital of Michigan, Detroit
MI
United States
Darren M. Roberts, MBBS, PhD, FRACP, FAChAM
Staff Specialist
Clinical Pharmacology and Toxicology Claudio Ronco, MD
Royal Prince Alfred Hospital, Sydney Full Professor of Nephrology
NSW School of Medicine, Department of Medicine
Australia Università degli Studi di Padova, Padova
Medical Director Italy
NSW Poisons Information Centre Director
Sydney Children’s Hospital Network, Sydney Department of Cardiovascular Medicine
NSW Division of Nephrology Dialysis & Transplantation
Australia International Renal Research Institute (IRRIV) San
Staff Specialist Bortolo Hospital, Vicenza
Clinical Pharmacology and Toxicology Italy
St Vincent’s Hospital, St Vincent’s
Hospital
NSW Mitchell H. Rosner, MD
Australia Professor of Medicine
Medicine
University of Virginia Health System, Charlottesville
AnnaMarie Rodriguez, RDN, LD, FAND VA
Dietitian/Nutrition Consultant United States
Consultation/Education
Nutrition Directions LLC, Sturtevant
WI John H. Sadler, MD
United States Associate Professor (retired)
Renal Clinical Retention Specialist Medicine-Nephrology
Contracting University of Maryland, Baltimore
Pentec Health, Inc, Glen Mills MD
PA United States
United States President & CEO
Independent Dialysis Foundation, Baltimore
MD
Mariano Rodriguez, MD, PhD United States
Professor of Medicine
Nephrology, Hospital Universitario Reina Sofia
Maimonides Institute of Biomedical Research (IMIBIC) Valeria Saglimbene, PhD
University of Cordoba School of Public Health
Cordoba University of Sydney, Sydney
Spain NSW
Australia
xviii Contributors

Fabio R. Salerno, MD Professor of Medicine

PhD Candidate Donald and Barbara Zucker School of Medicine at
Department of Medical Biophysics Hofstra/Northwell, Hempstead
Western University, London NY
ON United States
Canada

Jenny I. Shen, MD, MS

Domenico Santoro, MD Assistant Professor
Chief Department of Medicine, Division of Nephrology and
School of Nephrology Hypertension
Internal Medicine—Unit of Nephrology and Dialysis Harbor-UCLA Medical Center, Torrance
G. Martino University Hospital, Messina CA
Italy United States
Professor
Internal Medicine and Pharmacology—Division of
Nephrology Jeffrey Silberzweig, MD
University of Messina, Messina Associate Professor of Clinical Medicine
Italy Medicine
Weill Cornell Medical College, New York
NY
Franz Schaefer, MD, PhD United States
Professor of Pediatrics Chief Medical Officer
Division of Pediatric Nephrology, Center for Pediatrics and The Rogosin Institute, New York
Adolescent Medicine NY
Heidelberg University Hospital, Heidelberg United States
Germany Medical Director
Hemodialysis
New York-Presbyterian Hospital/Weill Cornell, New York
Christine B. Sethna, MD, EdM NY
Division Director United States
Department of Pediatrics, Division of Nephrology
Cohen Children’s Medical Center
New Hyde Park, NY Rossella Siligato, MD
United States Department of Clinical and Experimental Medicine
Associate Professor University of Messina, Messina
Department of Pediatrics Italy
Zucker School of Medicine at Hofstra/Northwell
Uniondale, NY
United States Pamela S. Singer, MD, MS
Associate Professor Medical Director
Institute of Molecular Medicine Pediatric Kidney Transplant Center
Feinstein Institutes for Medical Research Department of Pediatrics, Division of Nephrology
Manhasset, NY Cohen Children’s Medical Center
United States New Hyde Park, NY
United States
Assistant Professor
Hitesh H. Shah, MD Department of Pediatrics
Director, Nephrology Fellowship Program Zucker School of Medicine at Hofstra/Northwell
Division of Kidney Diseases and Hypertension, Uniondale, NY
Department of Medicine United States
Donald and Barbara Zucker School of Medicine at
Hofstra/Northwell, Great Neck
NY
United States
 Contributors xix

Michael J.G. Somers, MD Giovanni F.M. Strippoli, MD, PhD, MPH, MM

Associate Chief Professor of Nephrology
Division of Nephrology Emergency and Organ Transplantation
Boston Children’s Hospital, Boston University of Bari, Bari
MA Italy
United States
Associate Professor
Harvard Medical School, Boston Cheuk-Chun Szeto, MD, FRCP
MA Professor
United States Department of Medicine & Therapeutics
The Chinese University of Hong Kong, Shatin
Hong Kong
Euan Soo, MBBS, MRCPCH, FHKAM (Paed),
FHKCPaed, DCH, PDipMDPath
Associate Consultant Isaac Teitelbaum, MD
Paediatric Nephrology Center Professor
Hong Kong Children’s Hospital, Kowloon Medicine
Hong Kong University of Colorado School of Medicine, Aurora
Paediatrician CO
Central Health Medical Practice, Central United States
Hong Kong Medical Director
Home Dialysis Program
University of Colorado Hospital, Aurora
Bruce Spinowitz, MD, FACP CO
Vice Chair United States
Medicine
New York Presbyterian Queens, Flushing
NY Rebecca Thomas-Chen, MBBS, DM
United States Paediatric Nephrologist
Professor of Clinical Medicine Nephrology
Medicine University Hospital of the West Indies, Kingston
Weill Cornell Medical College, New York Jamaica
NY Associate Lecturer, Clerkship Coordinator
United States Child and Adolescent Health
University of the West Indies, Kingston
Jamaica
Deborah Stein, MD
Assistant Professor of Pediatrics
Department of Pediatrics Ashita J. Tolwani, MD
Harvard Medical School, Boston Professor
MA Department of Medicine, Division of Nephrology
United States University of Alabama at Birmingham, Birmingham
Attending AL
Division of Nephrology United States
Boston Children’s Hospital, Boston
MA
United States Massimo Torreggiani, MD, PhD
Centre Hospitalier Le Mans
Néphrologie et Dialyse
Emily Stonebrook, MD Centre Hospitalier Le Mans, Le Mans
Fellow France
Division of Pediatric Nephrology
Nationwide Children’s Hospital/The Ohio State University
College of Medicine
Columbus, OH
United States
xx Contributors

Avram Z. Traum, MD Detroit Medical Center, Detroit

Director of Quality Management MI
Division of Nephrology United States
Boston Children’s Hospital, Boston
MA
United States Peter Noel Van Buren, MD
Associate Professor
Internal Medicine, Division of Nephrology
Luis G. Tulloch-Palomino, MD University of Texas Southwestern Medical Center,
Clinical Assistant Professor Dallas
Department of Medicine, Division of Allergy and TX
Infectious Diseases United States
University of Washington School of Medicine, Seattle Chief
WA Nephrology Section, Medical Service
United States Dallas Veterans Affairs Medical Center, Dallas
Attending Physician TX
Hospital and Specialty Medicine Service, Infectious United States
Diseases Section
VA Puget Sound Health Care System, Seattle
WA René G. VanDeVoorde III, MD
United States Associate Professor
Pediatrics
Vanderbilt University Medical Center, Nashville
Tushar J. Vachharajani, MD, FASN TN
Professor United States
Internal Medicine
Cleveland Clinic Lerner College of Medicine of Case
Western Reserve University, Cleveland Raymond Vanholder, MD, PhD
OH Professor
United States Internal Medicine and Pediatrics
Director of Interventional Nephrology University Hospital Ghent, Ghent
Department of Kidney Medicine Select State
Glickman Urological & Kidney Institute, Cleveland Belgium
OH
United States
Director of Global Nephrology Thanh-Mai Vo, MD
Department of Kidney Medicine Training Program Director
Glickman Urological & Kidney Institute Division of Nephrology
OH Saint Louis University, St. Louis, MO
United States United States

Rudolph P. Valentini, MD Bradley A. Warady, MD

Professor Professor of Pediatrics
Pediatrics, Division of Pediatric Nephrology Department of Pediatrics
Central Michigan University College of Medicine, Detroit University of Missouri-Kansas City School of Medicine,
MI Kansas City
United States MO
Chief Medical Officer United States
Administration Director, Division of Pediatric Nephrology
Children’s Hospital of Michigan, Detroit Director, Dialysis and Transplantation
MI Department of Pediatrics
United States Children’s Mercy Kansas City, Kansas City
Group Chief Medical Officer MO
Administration United States
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Exploring the Variety of Random
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daughter she had insisted upon their paying for their board, in this
respect wishing to annoy Marc, who consequently had to make his
wife a considerable allowance out of his meagre salary. Perhaps
Madame Duparque—advised in this matter as in others by her good
friends, those masters of intrigue, whose unseen hands pulled every
string—had hoped that Marc would respond by a refusal, and that a
scandal would ensue. But he could live on very little, and he
consented immediately, as if indeed he were well pleased to remain
the paterfamilias, the worker, and supporter of those who belonged
to him. And although straitened circumstances aggravated his
solitude, the meals he shared with Mignot becoming extremely
frugal, he did not suffer, for it was sufficient for him to know that
Geneviève had appeared moved by his willingness to provide for her,
and that she found in this pecuniary question a motive to approve of
Louise's resolution to pursue her studies in order to ensure her
future. Thus the girl, who had already obtained her elementary
certificate, continued to take lessons from Mademoiselle Mazeline,
preparing herself for the superior certificate examination, which
circumstance gave rise to further disputes with Madame Duparque,
who was exasperated by all the science which it had become the
fashion to impart to young girls, when, in her opinion, the catechism
ought to have sufficed them. And as Louise always answered every
protest in her extremely deferential manner: 'Yes, grandmamma;
certainly, grandmamma,' the old lady grew more exasperated than
ever, and ended by picking quarrels with Geneviève, who, losing
patience, occasionally answered back.
One day while Marc was listening to the news his daughter gave
him, he became quite astonished. 'Does mamma quarrel with
grandmother then?' he inquired.
'Oh, yes, papa. This was even the second or third time. And
mamma, you know, does not beat about the bush. She loses her
temper at once, answers back in a loud voice, and then goes to sulk
in her room as she used to do here before she left.'
Marc listened, unwilling to give utterance to the secret delight, the
hope, which was rising within him.
'And does Madame Berthereau take part in these discussions?' he
resumed.
'Oh, grandmamma Berthereau never says anything. She sides with
mamma and me, I think; but she does not dare to support us openly
for fear of worries.... She looks very sad and very ailing.'
However, months went by, and Marc saw none of his hopes fulfilled.
It must be said that he observed great discretion in questioning his
daughter, for it was repugnant to him to turn her into a kind of spy
for the purpose of keeping himself informed of everything that
occurred in the dismal little house on the Place des Capucins. For
weeks at a time when Louise ceased to speak of her own accord,
Marc relapsed into anxious ignorance, again losing all hope of
Geneviève's return. His only consolation then lay in his daughter's
presence beside him for a few hours on Thursdays and Sundays. On
those days also it occasionally happened that the two chums of the
Beaumont Training College, Joseph Simon and Sébastien Milhomme,
arrived at the Maillebois school about three o'clock, and remained
there until six, happy to meet their friend Louise, who like
themselves was all aglow with youth and courage and faith. Their
long chats were enlivened by merry laughter, which left some gaiety
in the mournful home throughout the ensuing week. Marc, who felt
comforted by these meetings, at times requested Joseph to bring his
sister Sarah from the Lehmanns', and likewise told Sébastien that he
would be happy to see his mother, Madame Alexandre, accompany
him. The schoolmaster would have been delighted to gather a
number of worthy folk, all the forces of the future, around him. At
those affectionate meetings the sympathies of former times revived,
acquiring a strength full of gentleness and gaiety, drawing Sébastien
and Sarah, Joseph and Louise together; while the master, smiling
and content to await victory at the hands of those who represented
to-morrow, allowed good Mother Nature, beneficent love, to do their
work.
All at once, amidst the disheartening delays of the Court of
Cassation, at a moment when courage was forsaking David and
Marc, they received a letter from Delbos acquainting them with
some great news and requesting them to call on him. They did so in
all haste. The great news—destined to burst on Beaumont like a
thunderclap—was that, after a long and cruel struggle, Jacquin, the
diocesan architect and foreman of the jury which had convicted
Simon, had at last felt it absolutely necessary to relieve his
conscience. Very pious, attending confession and Communion, strict
in his faith, and in all respects an upright man, Jacquin had ended
by feeling anxious with respect to his salvation, asking himself
whether, as he was in possession of the truth, it was possible for him
to keep silent any longer without incurring the risk of damnation. It
was said that his confessor, feeling extremely perplexed, not daring
to decide the question himself, had advised him to consult Father
Crabot, and that if the architect had remained silent several months
longer it was on account of the great pressure brought to bear on
him by the Jesuit, who, in the name of the Church's political
interests, had prevented him from speaking out. If, however, Jacquin
was unable to keep his terrible secret any longer, it was precisely by
reason of the anguish he felt as a Christian, one who believed that
the Christ had descended upon earth to ensure the triumph of truth
and justice. And the knowledge which consumed him was that of
Judge Gragnon's illegal communication to the jury in the Simon case
of a document unknown either to the prisoner or to his counsel.
Summoned to the retiring room to enlighten the jurymen respecting
the penalty which might attach to their verdict, the judge had shown
them a letter received by him a moment previously, a letter from
Simon to a friend, followed by a postscript and a paraph, which last
was similar to the one on the copy-slip tendered as evidence. It was
to this same letter and this paraph that Father Philibin had alluded in
his sensational evidence; and now it had been established that if the
body of the letter was indeed in Simon's handwriting, the postscript
and the paraph were assuredly impudent forgeries, in fact gross
ones, by which a child even would hardly have been deceived.
Thus David and Marc found Delbos triumphant: 'Ah! didn't I tell you
so?' he exclaimed. 'That illegal communication is now proved!
Jacquin has written to the President of the Court of Cassation,
confessing the truth, and asking to be heard.... I knew that the
letter was among the papers of the case, for Gragnon had not dared
to destroy it. But how difficult it was to have it produced and
submitted to the examination of experts! I scented a forgery; I felt
that we were confronted by some more of the handiwork of that
terrible Father Philibin! Ah! that man, how heavy and common he
looked! But the more I fathom the affair the greater do his talents,
his suppleness, artfulness, and audacity appear. He was not content
with tearing off the stamped corner of the copy-slip, he also falsified
one of Simon's letters, so arranging matters that this letter might
prevail over the jury at the last moment. Yes, assuredly that forgery
was his work!'
However, David, who had met with so many deceptions, retained
some fears. 'But are you sure,' he asked, 'that Jacquin, who is the
diocesan architect and at the mercy of the priests, will remain firm
to the end?'
'Quite sure. You don't know Jacquin. He is not at the mercy of the
priests; he is one of the few Christians who are governed solely by
their consciences. Some extraordinary things have been told me
respecting his interviews with Father Crabot. At first the Jesuit spoke
in a domineering way, in the name of his imperative Deity, who
forgives and even glorifies the worst deeds when the salvation of the
Church is in question. But Jacquin answered back in the name of a
good and equitable God, the God of the innocent and the just, who
tolerates neither error, nor falsehood, nor crime. I wish I had been
present; that battle between the mere believer and the political
agent of a crumbling religion must have been a fine spectacle.
However, I have been told that it was the Jesuit who ended by
humbling himself, and entreating Jacquin, though he failed to
prevent him from doing his duty——'
'All the same,' Marc interrupted, 'it took Jacquin a very long time to
relieve his conscience.'
'Oh! no doubt; I don't say that his duty became manifest to him at
once. For years, however, he did not know that President Gragnon's
communication was illegal. Almost all jurors are similarly situated;
they know nothing of the law, and take as correct whatever the chief
magistrates may say to them. When Jacquin learnt the truth he
hesitated evidently, and for years and years went about with a
burden on his conscience, saying nothing, however, for fear of
scandal. We shall never know the sufferings and the struggles of
that man, who went regularly to confession and Communion, ever
terrified by the thought that he was perhaps damning himself for all
eternity. However, I can assure you that when he became certain
that the document was a forgery, he no longer hesitated; he
resolved to speak out, even if by doing so he should cause the
cathedral of Saint Maxence to fall, for on no account was he
disposed to disregard what he deemed to be his duty towards God.'
Then Delbos, like a man who, after long efforts, was at last reaching
his goal, gaily summed up the situation, and David and Marc went
off radiant with hope.
But how great was the commotion in Beaumont when Jacquin's
letter to the Court of Cassation, his confession and his offer of
evidence became known. Judge Gragnon hastily closed his doors,
refusing to answer the journalists who applied to him, wrapping
himself, as it were, in haughty silence. He was no longer a jovial,
sarcastic sportsman and pursuer of pretty girls. People said that he
was quite overwhelmed by the blow which had thus fallen on him on
the eve of his retirement from the bench, at the moment when he
was expecting to receive the collar of a Commandership in the
Legion of Honour. Of recent years his wife, the once beautiful
Madame Gragnon, having passed the age for reading poetry with
General Jarousse's young officers, had decided to occupy herself in
converting him, pointing out to him no doubt all the advantages of a
pious old age; and he followed her to confession and Communion,
giving a lofty example of fervent Catholicism, which explained the
passionate zeal with which Father Crabot had tried to prevent
Jacquin from relieving his conscience. The Jesuit, indeed, wished to
save Gragnon, a believer of great importance and influence, of
whom the Church was very proud.
Moreover, the whole judicial world of Beaumont sided with the
presiding judge, defending the conviction and condemnation of
Simon as its own work, its masterpiece, which none might touch
without committing high treason against the country. Behind that
fine assumption of indignation, however, there was base, shivering
dread—dread of the galleys, dread lest the gendarmes should set
their heavy hands some evening on the black or red robes, furred
with ermine, whose wearers had imagined themselves to be above
the laws. The handsome Raoul de La Bissonnière was no longer
public prosecutor at Beaumont, he had been transferred to the
neighbouring Appeal Court of Mornay, where he was growing
embittered by his failure to secure a post in Paris, in spite of all his
suppleness and skill under every succeeding government. On the
other hand, Investigating Magistrate Daix had not quitted the town,
where he had been promoted to the rank of counsellor; but he was
still tortured by his terrible wife, whose ambition and craving for
luxury made his home a hell. It was said that Daix, seized with
remorse like Jacquin, was on the point of throwing off his wife's
acrimonious authority, and relating how he had cowardly yielded to
her representations, and sent Simon for trial, at the very moment
when, from lack of proof, he was about to stay further proceedings.
Thus the Palais de Justice was all agog, swept by gusts of fear and
anger, pending the advent of the cataclysm which would at last
annihilate the ancient worm-eaten framework of so-called human
justice.
The political world of Beaumont was no less shaken, no less
distracted. Lemarrois, the Deputy and Mayor, felt that the Radical
Republican views he had long professed were losing their hold on
the electorate, and that he might be swept away in this supreme
crisis which was bringing the living strength of the people forward.
Thus, in the much-frequented salon of his intelligent wife, the
evolution towards reactionary courses became more pronounced.
Among those now often seen there was Marcilly, once the
representative of the intellectual young men, the hope of the French
mind, but now reduced to a kind of political paralysis, bewildered by
his inability to detect in which direction lay his personal interests,
and forced to inaction by the haunting fear that if he should act in
any particular way he might not be re-elected. Then another visitor
was General Jarousse, who, though a mere cipher, now showed
himself aggressive, spurred on, it seemed, by the perpetual nagging
of his little, dusky, withered wife. And Prefect Hennebise also called
at times, accompanied by the placid Madame Hennebise, each
desiring to live at peace with everybody, such being indeed the wish
of the government, whose motto was: 'No difficulties, only
handshakes and smiles.' There was great fear of 'bad' elections, as
the department was so enfevered by the revival of the Simon affair;
and Marcilly and even Lemarrois, though they did not own it, had
resolved to ally themselves secretly with Hector de Sanglebœuf and
their other reactionary colleagues in order to overcome the Socialist
candidates, particularly Delbos, whose success would become
certain should he succeed in his efforts on behalf of the innocent
prisoner.
All this tended to the confusion which broke out directly people
heard of the intervention of Jacquin, by which the revision of the
case was rendered inevitable. The Simonists triumphed, and for a
few days the anti-Simonists seemed crushed. Nothing else was
talked about on the aristocratic promenade of Les Jaffres; and
though Le Petit Beaumontais, in order to inspirit its readers, declared
every morning that the revision of the case would be refused by a
majority of two to one, the friends of the Church remained plunged
in desolation, for private estimates indicated quite a different result.
Meantime the delight shown among the University men was very
temperate. Nearly all of them were Simonists, but they had hoped in
vain so often that they now scarcely dared to rejoice. Rector Forbes
was relieved to think that he would soon be rid of the case of that
Maillebois schoolmaster, Marc Froment, about whom he was so
frequently assailed by the reactionary forces. In spite of his desire to
meddle with nothing, Forbes had been obliged to confer with Le
Barazer respecting the necessity of an execution; and Le Barazer,
whose own powers of resistance were exhausted, foresaw the
moment when policy would compel him to sacrifice Marc. He had
even mentioned it to Salvan, who had shown deep grief at the
announcement. When, however, Marc came to him with the great
news that made revision certain, the kind-hearted man revived to
gaiety and gave his friend quite a triumphal greeting. He embraced
him and then told him of the threatening danger from which the
favourable decision of the Court of Cassation alone would save him.
'If revision should not be granted, my dear fellow,' he said, 'you
would certainly be revoked, for this time you are deeply involved in
the affair, and all the reactionaries demand your head.... However,
the news you bring pleases me, for you are at last victorious, and
our secular schools triumph.'
'They need to do so,' Marc replied; 'our conquests over error and
ignorance are still so slight in spite of all your efforts to endow the
region with good masters.'
'Certainly a good many lives will be needed; but, no matter, we are
marching on, and we shall reach the goal,' Salvan responded with
his usual gesture expressive of unshakable hope.
Perhaps the best proof that Marc was really victorious was found by
him in the eager manner with which handsome Mauraisin, the
Elementary Inspector, rushed towards him, that same day, just as he
had quitted Salvan.
'Ah! my dear Monsieur Froment, I am very pleased to meet you,' the
Inspector exclaimed. 'We see each other so seldom apart from the
requirements of our duties.'
Since the revival of the affair, mortal anxiety had taken possession of
Mauraisin, who at an earlier stage had openly sided with the anti-
Simonists, convinced as he then was that the priests never allowed
themselves to be beaten. But now, if they should lose the game,
how would he be able to save himself? The idea of not being on the
winning side distressed him greatly.
Though nobody was passing in the street, he leant towards Marc to
whisper in his ear: 'For my part, you know, my dear Froment, I
never doubted Simon's innocence. I was convinced of it at bottom.
Only it is so necessary for public men like ourselves to remain
prudent—is that not so?'
For a long time past Mauraisin had been keeping his eye on Salvan's
post, hoping to secure it in due course; and in view of a possible
triumph of the Simonists he felt it would be as well to side with them
on the eve of victory. But as that victory was not yet quite certain he
did not wish to exhibit himself in their company. So he speedily took
leave of Marc, whispering, as he pressed his hand for the last time,
'Simon's triumph will be a triumph for all of us.'
On returning to Maillebois Marc perceived a change there also.
Darras, the ex-Mayor, whom he chanced to meet, did not rest
content with bowing to him discreetly, according to his wont, but
stopped him in the middle of the high street, and talked and laughed
with him for more than ten minutes. He, Darras, had been a
Simonist at the outset, but since he had lost his position as Mayor he
had put his flag in his pocket, and made it a habit to bolt his door
before divulging what he thought. If, therefore, he now openly
chatted with Marc, it must have been because Simon's acquittal
seemed to him a certainty. As it happened, Philis, the new Mayor,
went by at that moment, gliding swiftly over the pavement with his
head bent and his eyes darting furtive glances around him. This
amused Darras, who with a knowing look at Marc exclaimed: 'What
pleases some displeases others, is it not so, Monsieur Froment? We
all have our turns!'
Indeed a great change in public opinion gradually became manifest.
Day by day for several weeks Marc observed the increasing favour of
the cause he defended. However, the decisive importance of the
success already achieved became most manifest to him when he
received a letter from Baron Nathan, who was again staying at La
Désirade, and who asked him to call there with respect to a prize for
the Communal School, which he, the Baron, desired to found.
Although Nathan, on two or three occasions previously, had given a
hundred francs or so to be distributed in savings-bank deposits
among the best pupils, Marc felt that the offer of a prize at that
juncture was only a pretext. So he repaired to La Désirade full of
wonder and curiosity.
He had not returned thither since the now distant day when he had
accompanied David on his attempt to interest the all-powerful Baron
in the cause of his accused and imprisoned brother. Marc
remembered the most trifling details of that visit, the skilful manner
in which the triumphant Jew, a king of finance and the father-in-law
of a Sanglebœuf, had shaken off the poor Jew, on whom public
execration had fallen. And now, on returning to La Désirade, Marc
found that its majesty and beauty had increased. Recently a million
of francs had been spent on new terraces and new fountains, which
imparted an aspect of sovereign grandeur to the parterres in front of
the château. Encompassed by plashing waters and a galaxy of
marble nymphs, he ended by reaching the steps, where two tall
lackeys, in liveries of green and gold, were waiting. On one of them
conducting him to a little drawing-room, where he was requested to
wait, he remained alone for a moment, and heard a confused
murmur of voices in some neighbouring room. Then two doors were
shut, all became quiet, and finally Baron Nathan entered with
outstretched hand.
'Excuse me for having disturbed you, my dear Monsieur Froment,' he
said, 'but I know how devoted you are to your pupils, and I wish to
double the sum which I have been giving you of recent years. You
are aware that my ideas are broad, that I desire to reward merit
wherever it may be found, apart from all political and religious
questions.... Yes, I make no difference between the congregational
and the secular schools; I am for all France.'
Short and somewhat bent, with a yellow face, a bald cranium, and a
large nose resembling the beak of a bird of prey, Nathan went on
talking, while Marc gazed at him. The schoolmaster knew that of
recent times the Baron had still further enriched himself by stealing
a hundred millions of francs in a colonial affair, a deed of rapine, the
huge booty of which he had been obliged to share with a Catholic
bank. And he had now plunged into fierce reaction, for as new
millions were added to his former ones he became more and more
convinced that priests and soldiers were needed to enable him to
retain his ill-gotten wealth. He was no longer content with having
wormed his way, through his daughter, into the ancient family of the
Sanglebœufs: he now absolutely denied his race, openly displaying a
ferocious anti-Semitism, showing himself a monarchist, a militarist, a
respectful friend of those who in olden time had burnt the Jews.
Nevertheless—and this astonished Marc—Nathan, whatever his
wealth, still retained much of his racial humility. A dread of the
persecutions which had fallen on his ancestors appeared in his
anxious eyes as they glanced at the doors as if he wished to be
ready to slip under a table at the slightest sign of danger.
'So it is settled,' he said, after all sorts of involved explanations, 'and
you will dispose of these two hundred francs yourself, as you please,
for I have perfect confidence in your sagacity.'
Marc thanked him, but still failed to understand the meaning of it all.
Even a politic desire to remain on good terms with everybody, a wish
to be among the Simonists if they should win the battle, did not
explain that flattering and useless appointment, that over-cordial
reception at La Désirade. However, just as the schoolmaster was
retiring, there came an explanation.
Baron Nathan, having accompanied him to the drawing-room door,
detained him there, and with a keen smile, which seemed prompted
by a sudden inspiration, exclaimed: 'My dear Monsieur Froment, I
am going to be very indiscreet.... When I was informed of your
arrival just now, I happened to be with somebody, an important
personage, who exclaimed, "Monsieur Froment! Oh! I should be so
pleased to have a moment's conversation with him!" A cry from the
heart in fact.'
The Baron paused, waiting a few seconds in the hope that he would
be questioned. Then, as Marc remained silent, he laughed and said
in a jesting way: 'You would be greatly surprised if I told you who
the personage was.' And as the schoolmaster still looked grave,
remaining on the defensive, Nathan blurted out everything: 'It was
Father Crabot. You did not expect that, eh?... But he came to lunch
here this morning. As you may know, he honours my daughter with
his affection, and is a frequent visitor here. Well, he expressed to me
a desire to have some conversation with you. Setting aside all
matters of opinion, he is a man of the rarest merit. Why should you
refuse to see him?'
To this Marc, who at last understood the object of the appointment
given him, and whose curiosity was more and more aroused, quietly
responded: 'But I don't refuse to see Father Crabot. If he has
anything to say to me I will listen to him willingly.'
'Very good, very good!' exclaimed the Baron, delighted with the
success of his diplomacy. 'I will go to tell him.'
Again the two doors opened, one after the other, and a confused
murmur of voices once more reached the little drawing-room. Then
all relapsed into silence, and Marc was left waiting for some time.
Having at last drawn near to the window he saw the persons, whose
voices he had heard, step on to the adjoining terrace. And he
recognised Hector de Sanglebœuf and his wife, the still beautiful
Léa, accompanied by their good friend, the Marchioness de Boise,
who, though her fifty-seventh birthday was now past, remained a
buxom blonde, the ruins of whose beauty were magnificent. Nathan
likewise appeared, and one could also divine that Father Crabot was
standing at the glass door of the grand drawing-room, still talking to
his hosts, who left him in possession of the apartment in order that
he might receive the visitor as if he were at home.
The Marchioness de Boise seemed particularly amused by the
incident. Though she had originally resolved to disappear as soon as
she should be fifty, unwilling as she was to impose too old a mistress
on Hector, she had ended by making the château her permanent
home. Besides, people said that she was still adorable, so why
should she not continue to ensure the happiness of the husband
whose marriage she had so wisely negotiated, and of the wife whose
tender friend she was? Thus age might come but happiness still
reigned at La Désirade, amid its luxurious appointments and Father
Crabot's discreet smiles and pious benisons.
As Marc looked out of the window and observed the terrible
Sanglebœuf waving his arms and shaking his carroty head, it
seemed to him that this clerical champion with the heavy face and
the narrow, stubborn brow was deploring the practice of so much
diplomacy, the honour which Father Crabot accorded to a petty
anarchical schoolmaster by thus receiving him. Sanglebœuf had
never once fought in his cuirassier days, but he always talked of
sabring people. Although the Marchioness, after securing his election
as a deputy, had made him rally to the Republic—in accordance with
the Pope's express commands—he still and ever prated about his
regiment, and flew into a passion whenever there was any question
of the flag. Indeed, he would have committed blunder upon blunder
had it not been for that intelligent Marchioness, and this was one of
the reasons she gave for remaining near him, Again, on this
occasion, she had to intervene and lead him and his wife away,
walking slowly between them, in the direction of the park, and
showing the while much gaiety of mien, and motherliness of manner
towards both.
Baron Nathan, however, had quickly returned to the grand drawing-
room, the glass door of which he closed; and almost immediately
afterwards Marc heard himself called:
'Kindly follow me, my dear Monsieur Froment.'
The Baron led him through a billiard-room; then, having opened the
drawing-room door, drew back and ushered him in, delighted, it
seemed, with the strange part he was playing, his body bowed in a
posture which again showed racial humility reviving in the
triumphant king of finance.
'Please enter—you are awaited.'
Nathan himself did not enter, but discreetly closed the door and
disappeared; while Marc, amazed, found himself in the presence of
Father Crabot, who stood, in his long black gown, in the centre of
the spacious and sumptuous room, hung with crimson and gold. A
moment's silence followed.
The Jesuit, whose noble mien, whose lofty and elegant carriage
Marc well remembered, seemed to him to have greatly aged. His
hair had whitened, and his countenance was ravaged by all the
terrible anxiety he had experienced for some time past. But the
caressing charm of his voice, its grave and captivating modulations,
had remained.
'As circumstances have brought us both to this friendly house,
monsieur,' said he, 'you will perhaps excuse me for having prompted
an interview which I have long desired. I am aware of your merits, I
can render homage to all convictions, when they are sincere, loyal,
and courageous.'
He went on speaking in this strain for some minutes, heaping praises
on his adversary as if to daze him and win him over. But the device
was too familiar and too childish to influence Marc, who, after
bowing politely, quietly awaited the rest, striving even to conceal his
curiosity, for only some very grave reason could have induced such a
man as Father Crabot to run the risk of such an interview.
'How deplorable it is,' the Jesuit at last exclaimed, 'that the
misfortunes of the times should separate minds so fit to understand
each other! Some of the victims of our dissensions are really to be
pitied. For instance, there is President Gragnon——'
Then, as a hasty gesture escaped the schoolmaster, he broke off in
order to interpolate a brief explanation. 'I name him,' he said,
'because I know him well. He is a penitent of mine—a friend. A
loftier soul, a more upright and loyal heart could be found nowhere.
You are aware of the frightful position in which he finds himself—
that charge of prevarication,[2] which means the collapse of his
entire judicial career. He no longer sleeps; you would pity him if you
were to witness his sufferings.'
[2] The word 'Prevarication' is used in a legal sense, as signifying
the betrayal of the interests of one party in a lawsuit by collusion
with the other party. The French call this forfaiture.—Trans.

At last Marc understood everything. They wished to save Gragnon,

who only yesterday had been an all-powerful son of the Church,
which felt it would be grievously maimed if he should be struck
down.
'I can understand his torment,' Marc finally answered, 'but he is
paying the penalty of his transgression. A judge must know the laws,
and the illegal communication of which he was guilty had frightful
consequences.'
'No, no, I assure you, he acted in all simplicity,' the Jesuit exclaimed.
'That letter which he received at the last moment seemed to him
without importance. He still had it in his hand when he was
summoned to the jurymen's retiring room, and he no longer
remembers how it happened that he showed it to them.'
Marc gave a little shrug of the shoulders. 'Well,' he responded, 'he
will only have to tell that to the new judges, if there should be a new
trial.... In any case I hardly understand your intervention with me. I
can do nothing.'
'Oh! do not say that, monsieur! We know how great your power is,
however modest your position may seem to be. And that is why I
thought of applying to you. Throughout this affair all thought and
action and willpower have been centred in you. You are the friend of
the Simon family, which will do whatever you advise. So, come, will
you not spare an unfortunate man, whose ruin is by no means
indispensable for your cause?'
Father Crabot joined his hands and entreated his adversary so
fervently that the latter, again all astonishment, wondered what
could be the real reason of such a desperate appeal, such clumsy
and impolitic insistence. Did the Jesuit feel that the cause he
defended was lost? Did he possess private information which made
him regard revision as a certainty? In any case, matters had come to
such a pass, that he was now ready to leave something to the fire in
order to save the rest. He abandoned his former creatures, who
were now too deeply compromised. That poor Brother Fulgence had
a befogged, unbalanced mind, spoilt by excessive pride; disastrous
consequences had attended his actions. That unfortunate Father
Philibin had always been full of faith, no doubt; but then there were
many gaps in his nature. He was deplorably deficient in moral sense.
As for the disastrous Brother Gorgias, Father Crabot cast him off
entirely; he was one of those adventurous, erring sons of the
Church, who become its curse. And if the Jesuit did not go so far as
to admit the possible innocence of Simon, he was, at least, not far
from believing Brother Gorgias capable of every crime.
'You see, my dear sir,' he said, 'I do not deceive myself; but there
are other men whom it would be really cruel to visit too severely for
mere errors. Help us to save them, and we will requite the service
by ceasing to contend with you in other matters.'
Never had Marc so plainly realised his strength, the very strength of
truth. He answered, engaging in quite a long discussion, desirous as
he was of forming a final opinion with respect to the merits of Father
Crabot. And his stupefaction increased as he fathomed the
extraordinary poverty of argument, the arrant clumsiness too, which
accompanied the vanity of this man, accustomed never to be
contradicted. Was this, then, the profound diplomatist whose crafty
genius was feared by everybody, and the presence of whose hand
was suspected in every incident, as if, indeed, he ruled the world? In
this interview, which had been prepared so clumsily, he showed
himself a poor bewildered individual, committing himself far more
than was necessary, even incompetent to defend his faith against
one who was merely possessed of sense and logic. A mediocrity—
that was what he was—a mediocrity, with a façade of social gifts,
which imposed on the man in the street. His real strength lay in the
stupidity of his flock, the submissiveness with which the faithful bent
low before his statements, which they regarded as being beyond
discussion. And Marc ended by understanding that he was
confronted by a mere show Jesuit, one of those who for decorative
purposes were allowed by their Order to thrust themselves forward,
shine, and charm, while, in the rear, other Jesuits—such, for
instance, as Father Poirier, the Provincial installed at Rozan, whose
name was never mentioned—directed everything like unknown
sovereign rulers hidden away in distant places of retreat.
Father Crabot, however, was shrewd enough to understand at last
that he was taking the wrong course with Marc, and he thereupon
did what he could to recover his lost ground. The whole ended by an
exchange of frigid courtesies. Then Baron Nathan, who must have
remained listening outside the door, reappeared, looking also very
discomfited, with only one remaining anxiety, which was to rid La
Désirade as soon as possible of the presence of that petty
schoolmaster, who was such a fool that he could not even
understand his own interests. He escorted him to the terrace and
watched his departure. And Marc, as he went his way among the
parterres, the plashing waters, and the marble nymphs, again
caught a glimpse of the Marchioness de Boise, laughing
affectionately with her good friends Hector and Léa, as all three
strolled slowly under the far-spreading foliage.
On the evening of that same day Marc repaired to the Rue du Trou,
having given David an appointment at the Lehmanns'. He found
them all in a state of delirious joy, for a telegram from a friend in
Paris had just informed them that the Court of Cassation had at last
pronounced an unanimous judgment, quashing the proceedings of
Beaumont, and sending Simon before the Assize Court of Rozan. For
Marc this news was like a flash of light, and what he had regarded
as Father Crabot's folly seemed to him more excusable than before.
The Jesuit had evidently been well informed; that judgment had
been known to him; and, revision becoming a certainty, he had
simply wished to save those whom he thought might still be saved.
And now, at the Lehmanns', all were weeping with joy, for the long
calamity was over. Wildly did Joseph and Sarah kiss Rachel, their
poor, aged, and exhausted mother. Both children and wife were
intoxicated by the thought of the return of the father, the husband,
for whom they had mourned and longed so much. Outrage and
torture were all forgotten, for acquittal was now certain; nobody
doubted it either at Maillebois or at Beaumont. And David and Marc,
those two brave workers in the cause of justice, also embraced each
other, drawn together by a great impulse of affection and hope.
But, as the days went by, anxiety arose once more. At the penal
settlement yonder Simon had fallen so dangerously ill that for a long
time yet it would be impossible to bring him back to France. Months
and months might elapse before the new trial would begin at Rozan.
And thus all necessary time was given to the spirit of injustice to
revive and spread once more in the midst of mendacity and the
multitude's cowardly ignorance.

III

During the year which followed, a year full of anxiety, uneasiness,

and contention, the Church made a supreme effort to regain her
power. Never had her position been more critical, more threatened,
than during that desperate battle, by which the duration of her
empire might be prolonged for a century, or perhaps two centuries,
should she win it. In order to do so it was necessary she should
continue to educate and train the youth of France, retain her sway
over children and women, and avail herself of the ignorance of the
humble in such wise as to mould them and make them all error,
credulity, and submissiveness, even as she needed them to be in
order to reign. The day when she might be forbidden to teach, when
her schools would be closed, and disappear, would prove for her the
beginning of the end, when she would be annihilated amidst a new
and free people, which would have grown up outside the pale of her
falsehoods, cultivating an ideal of reason and humanity. And the
hour was a grave one. That Simon affair, with the expected return
and triumph of the innocent prisoner, might deal a most terrible blow
to the Congregational schools by glorifying the secular ones.
Meantime Father Crabot, who wished to save Judge Gragnon, was so
compromised himself that he had disappeared from society and
hidden himself, pale and trembling, in his lonely cell. Father Philibin,
who had been consigned to an Italian convent, was spending the
remainder of his days in penitence, unless indeed he were already
dead. Brother Fulgence, removed by his superiors in punishment for
the discredit which had fallen on his school, a third of whose pupils
had already quitted it, was said to have fallen dangerously ill in the
distant department whither he had been sent. Finally, Brother
Gorgias had fled, fearing that he might be arrested, and feeling that
his principals were forsaking him, willing to sacrifice him as an
expiatory victim. And this flight had increased the anxiety of the
defenders of the Church, who lived only with the thought of fighting
a last and merciless battle when the Simon affair should come
before the Rozan Assize Court.
Marc also, while lamenting Simon's ill health, which delayed his
return to France, was preparing for that same battle, fully realising
its decisive importance. Almost every Thursday, sometimes with
David, sometimes alone, he repaired to Beaumont, calling first on
Delbos, to whom he made suggestions, and whom he questioned
about the slightest incidents of the week. And afterwards he went to
see Salvan, who kept him informed of the state of public opinion,
every fluctuation of which set all classes in the town agog. In this
wise, then, one Thursday, Marc paid a visit to the Training College,
and on quitting it went down the Avenue des Jaffres, where, close to
the cathedral of St. Maxence, he was upset by a most unexpected
meeting.
On one of the deserted sidewalks of the avenue, at a spot where
scarcely anybody was ever seen after four o'clock, he perceived
Geneviève seated on a bench, and looking very downcast, weary,
and lonely in the cold shadow falling from the cathedral, whose
proximity encouraged the moss to grow on the trunks of the old
elms.
For a moment Marc remained motionless, quite thunderstruck. He
had met his wife in Maillebois at long intervals, but invariably in the
company of Madame Duparque; and on those occasions she had
passed through the streets with absent-minded eyes, on her way, no
doubt, to some devotional exercise. This time, however, they found
themselves face to face, in perfect solitude, parted by none.
Geneviève had seen him, and was looking at him with an expression
in which he fancied he could detect great suffering, and an
unacknowledged craving for help. Thus he went forward, and even
ventured to seat himself on the same bench, though at some little
distance from her, for fear lest he should frighten her and drive her
away.
Deep silence reigned. It was June, and the sun, descending towards
the horizon in a vast stretch of limpid sky, transpierced the
surrounding foliage with slender golden darts; while little wandering
zephyrs already began to cool the warm afternoon atmosphere. And
Marc still looked at his wife, saying nothing, but feeling deeply
moved as he noticed that she had grown thinner and paler, as if
after a serious illness. Her face, crowned by splendid fair hair, and
with large eyes which once had been all passion and gaiety, had not
only become emaciated, but had acquired an expression of ardent
anxiety, the torment of a parching thirst, which nothing could
assuage. Her eyelids quivered, and two tears, which she vainly tried
to force back, coursed down her cheeks. Then Marc began to speak
—in such a way that it seemed as if he had quitted her only the
previous day, such indeed was his desire to reassure her.
'Is our little Clément well?' he asked.
She did not answer immediately, for she feared, no doubt, that she
might reveal the emotion which was choking her. The little boy, who
had lately completed his fourth year, was no longer at Dherbecourt.
Having removed him from his nurse, Geneviève now kept him with
her in spite of all her grandmother's scoldings.
'He is quite well,' she said at last in a slightly tremulous voice,
though on her side also she strove to affect a kind of indifferent
quietude.
'And our Louise,' Marc resumed, 'are you satisfied with her?'
'Yes: she does not comply with my desires; you have remained the
master of her mind; but she is well behaved, she studies, and I do
not complain of her.'
Silence fell again, embarrassment once more stayed their tongues.
That allusion to their daughter's first Communion, and the terrible
quarrel which had parted them, had been sufficient. Yet the
virulence of that quarrel was necessarily abating day by day, the girl
herself having assumed all responsibility by her quiet resolve to
await her twentieth year before making any formal confession of
religious faith. In her gentle way she had exhausted her mother's
resolution; and indeed a gesture of lassitude had escaped the latter
when speaking of her, as if she had referred to some long-desired
happiness, all hope of which had fled. A few moments went by, and
then Marc gently ventured to put another question to her: 'And you,
my friend, you have been so ill: how are you now?'
She shrugged her shoulders in a hopeless way, and was again
obliged to force back her tears. 'I? Oh, I have long ceased to know
how I am! But no matter, I resign myself to live since God gives me
the strength to do so.'
So great was Marc's distress, so deeply was his whole being stirred
by a quiver of loving compassion at the sight of such great suffering,
that a cry of intense anxiety sprang from his lips: 'Geneviève, my
Geneviève, what ails you? what is your torment? Tell me! Ah, if I
could only console you, and cure you!'
Thus speaking, he came nearer to her on the bench, near enough
indeed to touch the folds of her gown, but she hastily drew back.
'No, no, we have nothing more in common,' she exclaimed. 'You can
no longer do anything for me, my friend, for we belong to different
worlds.... Ah! if I were to tell you! But of what use would it be? You
would not understand me!'
Nevertheless, she went on speaking; and in short and feverish
sentences, never noticing that she was confessing herself, she told
him of her torture, her daily increasing anguish, for she had reached
one of those distressful hours when the heart instinctively opens and
overflows. She related how, unknown to Madame Duparque, she had
escaped that afternoon from Maillebois, in order to speak with a
famous missionary, Father Athanase, whose pious counsels were at
that time revolutionising the pious folk of Beaumont. The missionary
was merely sojourning there for a short time, but it was said that he
had already worked some marvellous cures—a blessing, a prayer,
from his lips having restored angelic calmness to the unappeasable
souls of women who were racked by their yearning for Jesus. And
Geneviève had just left the neighbouring cathedral, where for two
hours she had remained in prayer, after confessing to that holy man
her unquenchable thirst for divine happiness. But he had merely
absolved her for what he called excess of pride and human passion,
and by way of penitence had told her to occupy her mind with
humble duties, such as the care of the poor and the sick. In vain
afterwards had she striven to humble, annihilate herself, in the
darkest, the loneliest chapel of St. Maxence; she had not found
peace, she had not satisfied her hunger; she still glowed with the
same craving—a return for the gift of her whole being to the Deity,
that gift which she had tendered again and again, though never
once had it brought real peace and happiness to her flesh and her
heart.
As Marc listened to what she said, he began to suspect the truth,
and whatever might be his sadness at seeing his Geneviève so
wretched, a quiver of hope arose within him. Plainly enough, neither
Abbé Quandieu nor even Father Théodose had satisfied the intense
need of love that existed in her nature. She had known love, and
she must still love the man, the husband, whom she had quitted,
and who adored her. Mere mystical delights had left her unsatisfied
and irritated. She was now but the proud, stubborn daughter of
Catholicism, who turns desperately to harsher and more frantic
religious practices, as to stronger stupefacients, in order to numb the
bitterness and rebellion induced by increasing disillusion. Everything
pointed to it: the revival of motherliness in her nature, for she had
taken little Clément back, and busied herself with him, and she even
found some consolation in Louise, who exercised a gentle healing
influence over her, leading her back a little more each day towards
the father, the husband. Then, also, there were her dissensions with
her terrible grandmother, and her dawning dislike for the little house
on the Place des Capucins, where she at last felt she could no longer
live, for its coldness, silence, and gloom were deathly. And, after
failing with Abbé Quandieu and Father Théodose, her sufferings had
led her to make a supreme attempt with that powerful missionary, to
whom she had transferred her faith, that miracle-working confessor,
whom she had hastened to consult in secret for fear lest she might
be prevented, and who, by way of relief, had only been able to
prescribe practices which, in the circumstances, were childish.
'But, my Geneviève,' Marc cried again, carried away, losing all
thought of prudence, 'if you are thus beset, thus tortured, it is
because you lack our home! You are too unhappy: come back, come
back, I entreat you!'
Her pride bristled up, however, and she answered: 'No, no, I shall
never go back to you. I am not unhappy: it is untrue. I am punished
for having loved you, for having been part of you, for having had a
share in your crime. Grandmother does right to remind me of it
when I am so weak as to complain. I expiate your sin, God strikes
me to punish you, and it is your poison which burns me beyond
hope of relief.'
'But, my poor wife, all that is monstrous. They are driving you mad!
If it is true that I set a new harvest in you, it is precisely on that
harvest that I rely to ensure our happiness some day. Yes, we
became so blended one with the other that we can never be wholly
parted. And you will end by returning to me: our children will bring
you back. The pretended poison which your foolish grandmother
talks about is our love itself; it is working in your heart, and it will
bring you back.'
'Never!... God would strike us down, both of us,' she retorted. 'You
drove me from our home by your blasphemy. If you had really loved
me, you would not have taken my daughter from me, by refusing to
let her make her first Communion. How can I return to a home of
impiety where it would not even be allowable for me to pray? Ah!
how wretched I am; nobody, nobody loves me, and heaven itself will
not open!'
She burst into sobs. Filled with despair by that frightful cry of
distress Marc felt that it would be useless and cruel to torture her
further. The hour for reunion had not yet come. Silence fell between
them once more, while in the distance, on the Avenue des Jaffres,
the cries of some children at play rose into the limpid evening
atmosphere.
During their impassioned converse they had at last drawn nearer to
each other on the lonely bench; and now, seated side by side, they
seemed to be reflecting, their glances wandering away amid the
golden dust of the sunset. At last Marc spoke again, as if finishing
his thoughts aloud: 'I do not think, my friend, that you gave for a
moment any credit to the abominable charges with which certain
people wished to besmirch me à propos of my brotherly intercourse
with Mademoiselle Mazeline.'
'Oh! no,' Geneviève answered quickly, 'I know you, and I know her.
Do not imagine that I have become so foolish as to believe all that
has been said to me.'
Then with some slight embarrassment she continued: 'It is the same
with me. Some people, I know it, have set me among the flock
which Father Théodose is said to have turned into a kind of cour
galante. In the first place I do not admit that anything of the kind
exists. Father Théodose is, perhaps, rather too proud of his person,
but I believe his faith to be sincere. Besides, I should have known
how to defend myself—you do not doubt it, I hope?'
In spite of his sorrow Marc could not help smiling slightly.
Geneviève's evident embarrassment indicated that there had been
some audacity on the part of the Capuchin, and that she had
checked it. Assuming this to be the case Marc felt the better able to
understand why she was so perturbed and embittered.
'I certainly do not doubt it,' he responded. 'I know you, as you know
me, and I am aware that you are incapable of wrong-doing. I have
no anxiety respecting Father Théodose on your account, whatever
another husband of my acquaintance may have to say.... Yet all the
same I regret that you were so badly advised as to quit worthy Abbé
Quandieu for that handsome monk.'
A fugitive blush which appeared on Geneviève's cheeks while her
husband was speaking told him that he had guessed aright. It was
not without a profound knowledge of woman in her earlier years,
when an amorosa may exist within the penitent, that Father Crabot
had advised Madame Duparque to remove her daughter from the
charge of old Abbé Quandieu and place her in that of handsome
Father Théodose. The Catholic doctors are well aware that love
alone can kill love, and that a woman who loves apart from Christ
never wholly belongs to Christ. The return of Geneviève to her
husband and her sin was fatal unless she should cease to love, or
rather unless she should love elsewhere. But, as it happened, Father
Théodose was not expert in analysing human nature, he had
blundered with respect to the passionate yet loyal penitent confided
to his hands, and had thus precipitated the crisis, provoking
repugnance and rebellion in that distracted, suffering woman, who,
without as yet returning to sober reason, saw the glorious, mystical
stage-scenery of the religion of her childhood collapse around her.
Well pleased with the symptoms which he fancied he could detect,
Marc asked somewhat maliciously: 'And so Father Théodose is no
longer your confessor?'
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