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 DENTAL
PUBLIC HEALTH

Nathe
& RESEARCH

DENTAL PUBLIC HEALTH & RESEARCH

Textbook Resources
for Dental Public Health & Research
Fourth Edition

resources to enhance
your learning are just a click away! Contemporary Practice
for the Dental Hygienist
Fourth Edition

Go to: www.pearsonhighered.com/healthprofessionsresources
Select the appropriate discipline
Find your book and click to enter

Fourth Edition

ISBN-13: 978-0-13-425546-0
ISBN-10: 0-13-425546-1
Christine Nielsen Nathe

9 780134 255460
www.pearsonhighered.com

Nathe 11/20/15.indd 1 11/23/15 10:56 AM

 Contents

Foreword xi 5 Financing of Dental Care 65

Preface xiii Payment Methods 70
Acknowledgments xiv
Insurance Plans 71
Reviewers xv
Dental Provider Billing 71
Governmental Roles in Funding Dental Care 75
UNIT
INTRODUCTION TO DENTAL PUBLIC
I HEALTH 1
6 Federal and State Legislation Affecting Dental
Hygiene Practice 82
Historical Perspective of Practice Issues 83
1 Dental Public Health: An Overview 2 State Government Overview 85
Public Health Defined 3 State Laws and Their Passage 86
Historical Perspective of Public Health 6 State Dental Boards 87
Dental Public Health Defined 7 Supervision of Dental Hygienists 88
Factors Affecting Dental Public Health 10
7 Advocacy for Dental Care 92
2 The Prevention Movement 17 Understanding Change and its Agents 93
Historical Development 18 Making Governmental Policy 99
Evolution of Organized Dental Hygiene 20 Working in Collaboration and Through
Dental Health Preventive Modalities 22 Partnerships 101
Building Coalitions 102
3 Dental Care Delivery in the United States 34
Professional Collaborations in Practice 103
Delivery of Dental Care in the United States 35
Writing Grants 104
Federal Structure of Dental Public Health 35
Structure of State Dental Public Health 41
Dental Health Care Workforce 41 UNIT
DENTAL HYGIENE PUBLIC HEALTH
4 Dental Hygiene Care Delivery in the Global II PROGRAMS 107
Community 47
Access to Information on Global Oral Health 8 Dental Health Education and Promotion 108
Needs 48 Principles of Health 109
International Dental Hygiene 50 Health Education and Motivation Theories 110
Current Status of Dental Hygiene Education 53
9 Lesson Plan Development 119
Professional Regulation 54
Dental Hygiene Process of Care 120
Movement Toward Autonomy 55
Assessment 121
Challenges to the Profession 57
Dental Hygiene Diagnosis 121
Successful Public Health Initiatives Involving Dental
Hygienists 59 Planning 121
Future of Dental Hygiene Worldwide 61 Implementation 126
Key International Organizations 62 Evaluation 127
Documentation 127

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 viii CONTENTS

10 Target Populations 130 Statistical Decision Making 221

Target Populations 131 Inferential Statistics 224
Target Population Profiles 139 Interpretation of Data and Research Results 226
Faith-Based Initiatives 140
18 Oral Epidemiology 233
Barriers to Dental Care 141
Epidemiology Defined 234
11 Cultural Competency 144 What Is Oral Epidemiology? 235
Cultural Diversity in the United States 146 The Multifactorial Nature Of Disease 235
Culture Issues in Health Care 147 Measurement In Epidemiology 235
Cultural Competency and Dental Hygienists 148 Oral Epidemiology Surveillance and Reports 239
Concepts of Epidemiologic Studies 249
12 Program Planning 154
Validity of Epidemiologic Studies 254
Common Dental Health Program Planning
Paradigms 155 19 Current Oral Epidemiological Findings 263
Dental Hygiene Public Health Programs 157 The Epidemiology of Oral Diseases and
Dental Hygiene Public Health Program Planning Conditions 264
Paradigm 161 Prevention by Dental Care Utilization 277
13 Program Evaluation 164 20 Evaluation of Scientific Literature and Dental
Evaluation Techniques 165 Products 283
Dental Indexes 166 Regulation of Dental Care Products 284
Governmental Evaluation Of Oral Health 175 Research Sources for Dental Care Products 285
Evaluation of Advertisements 286
UNIT Evaluation of Scientific Literature 288
DENTAL HYGIENE RESEARCH 179
III Data Sources and Publications 290

UNIT
14 Research in Dental Hygiene 180 PRACTICAL STRATEGIES FOR DENTAL
Research and Dental Public Health 181 IV PUBLIC HEALTH 293
Historical Aspects of Research in Dental Hygiene 183
Dental Hygiene: A Developing Discipline 184 21 Careers in Dental Public Health 294
Federal/National Public Health Career
15 Ethical Principles in Research 187 Opportunities 295
Ethical Considerations in Research 188 Independent Contractors 298
Research Roles of Government and Private Dental Staffing Agency Employee 298
Entities 192
Health Systems Opportunities 298
16 The Research Process 195 Student Dental Public Health Opportunities 299
Historical Approach 199 State Opportunities 300
Descriptive Approach 199 Local Opportunities 300
Retrospective (Ex Post Facto) Approach 201 International Opportunities 301
Experimental (Prospective) Approach 201
22 Strategies for Creating Dental Hygiene Positions in
Quasi-Experimental Approach 204 Dental Public Health Settings 302
17 Biostatistics 210 Legislative Perspective 303
Data Categorization 212 Proposed Plan for Action 303
Descriptive Statistics 213 Documentation and Practice Management 307
Graphing Data 216 Proposal Development and Presentation 307
Correlation 220 Dental Hygiene Consultation and Policies 307

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 CONTENTS ix

23 Dental Public Health Review 310 C Dental Terms and Phrases Translated into Spanish
Study Guide 312 and Vietnamese with Spanish Pronunciation
Guide A-4
Sample Questions 314
D Standards for Dental Hygienists in Dental Public
Health Education A-6
APPENDICES E Guide to Scientific Writing A-7

A Table Clinic Presentation A-1 F Answers to Self-Study Test Items A-8

B Poster Session Preparation A-3 Glossary G-1

Index I-1

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 Foreword

When Alfred Civilion Fones followed his dream to create women knew Dr. Fones personally. During lunch hours,
within the dental staff a dental therapist whose focus would they had a captive audience and would relate to us how it
be the prevention of dental disease, his intention was all began: the first school in the carriage house adjacent to
not merely to have this person perform in dental offices. Dr. Fones’ and his father’s dental building; his persever-
He recognized from the start that the most effective way ance and determination in convincing city fathers, the
to ”spread the word” was to provide direct services, educa- board of education, and the dental society to allow the
tional and clinical, to groups of people—to the masses. early dental hygienists to conduct programs within the
Ideally, those groups would be composed of children who schools.
would be taught at an early age the importance of dental I know how proud and delighted they would be— Dr.
health and prevention of dental disease. Where better to Fones and “the pioneers”—to see how dental hygienists
interface with children than in grammar schools? And so have positioned themselves today in various public health
in time, what was known as the Bridgeport, Connecticut, settings, and how impressed they would be with Christine
School Dental Hygiene Corps was established, composed Nathe’s Dental Public Health and Research: Contemporary
of members of Dr. Fones’ classes of 1914, 1915, and 1916. Practice for the Dental Hygienist. It is a remarkable testi-
Ergo the first dental hygiene public health program. mony to the premise that public health dental hygienists
I will fast-forward to the early 1950s when thirtythree have the ability to play a valuable and critical role in the
young women and I were enrolled at the University of dental health of people everywhere.
Bridgeport’s Fones School of Dental Hygiene. As part of
our fieldwork rotation, we traveled to longestablished
dental clinics throughout the city’s schools. I remember Janet Carroll Memoli, RDH, MS
being extremely fond of that assignment because I liked Retired Director, Fones School of Dental Hygiene
interacting with the children. But the real thrill of those Professor Emeritus, University of Bridgeport,
trips was coming face-to-face with members of those first Bridgeport, CT
classes who were still in charge of the various clinics. These

xi

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 This page intentionally left blank

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 Preface

The guiding principles that served as the impetus for the Follow this URL and select Dental Hygiene as your
first three editions of Dental Public Health and Research discipline. Click on this title to view extra practice
remain consistent with an added emphasis on the dental questions and information for students to use outside of
hygienist’s understanding of research principles. The class to test their knowledge or for additional review of
twenty-first century mandates a change in the practice and topics covered in each chapter.
understanding of dental public health concepts. The dental
hygiene practitioners who will be practicing in this century Instructor’s Resource Manual
need information on how to effectively practice and con- The Instructor’s Resource Manual contains a wealth of
duct dental hygiene research in the dental public health material to help faculty plan and manage their course. This
setting. manual includes:
The fourth edition expands on public health science
• A test bank of more than 550 questions
from its inception and further explains the essence of den-
• Discussion items to provide ideas for classroom
tal public health. The chapter on dental care funding is
discussion
expanded to focus on the current issues in dental care
• Laboratory or field experiences with process evalua-
financing and the government’s role in this area. Moreover,
tions for student and faculty member use
a chapter on the importance of collaboration in dental
care, building coalitions to help advocate for the oral • Laboratory exercises
health of all people, and an introductory discussion on This Instructor’s Resource Manual is available for
grant writing are included. download from www.pearsonhighered.com from the
The second unit focuses on learning theories, popula- Instructor’s Resource Center. Instructors should register
tions, and programs. The cultural diversity chapter empha- at the site to obtain a username and password.
sizes the effect culture has on dental health, and the
chapter on target populations has been expanded and Instructor Resources
diversified. This focus is necessary in a public health book Additional instructor resources are available at
because it helps future providers understand how cultures, www.pearsonhighered.com. These include the complete
populations, and health relate. The program planning test bank that allows instructors to design customized
chapter is significantly updated and expanded with regard quizzes and exams. The TestGen wizard guides instructors
to benchmarks and effective programs presently in place. through the steps in creating a simple test with drag-and-
The research unit is greatly expanded to provide drop or point-and-click transfer. Faculty members can
detailed information on the study of dental hygiene select test questions either manually or randomly and use
research. The focus of this unit is to comprehensively dis- online spell checking and other tools to quickly polish
cuss the reasons research is necessary in dental hygiene the test content and presentation. The question formats
and how research impacts the practicing dental hygienist. include multiple choice, fill in the blank, true/false,
Areas of expansion include discussions on the pivotal role and essay. Tests can be saved in a variety of formats both
research plays in dental hygiene, ethics in research, evi- locally and on a network, organized in as many as twenty-
denced-based principles of practice, the roles of govern- five variations of a single test, and published in an
ment and private entities in dental research, oral online format. For more information, please visit
epidemiology, and the measurement of oral diseases and www.pearsonhighered.com/testgen.
conditions. Expansion of this unit should help colleges that The Instructor Resources also include a PowerPoint
teach research within the community dental/public health lecture package that contains key discussion points for
courses. Additionally, this unit may be useful in conjunc- each chapter. This feature provides dynamic, fully
tion with other materials in stand-alone research courses. designed, integrated lectures that are ready to use and
allows instructors to customize the materials to meet their
specific course needs.
Teaching and Learning Package
Ad d i t i o n a l s t u d e n t re s o u rc e s c a n b e f o u n d a t
www.pearsonhighered.com/healthprofessionsrecources.

xiii

A01_NATH5460_04_SE_FM_pp00i-xvi.indd 13 16/11/15 10:57 AM

 Acknowledgments

The author wishes to acknowledge the contributing editorial support and advice from John Goucher,
authors for their work to enhance the fourth edition. Executive Editor, and Nicole Ragonese, Program Manager,
Important academic support was provided by Demetra Pearson. Also, the copyeditor, Michael Rossa, and Susan
Logothetis, Professor Emeritus, and Cynthia Guillen, McNally, the production editor at Cenveo® Publisher
Supervisor, Administrative Support, Division of Dental Services. The book would not be possible without support
Hygiene, University of New Mexico. And, of course, from these individuals.

xiv

A01_NATH5460_04_SE_FM_pp00i-xvi.indd 14 16/11/15 10:57 AM

 Reviewers

Susan Barnard, DHSc, RDH Beverly Hardee, RDH

Bergen Community College Cape Fear Community College
Paramus, NJ Wilmington, NC

Julie Bencosme, RDH Joanna Harris, RDH, MSDH

Hostos Community College Clayton State University
Bronx, NY Morrow, GA

Peg Boyce, RDH, MA Joyce Hudson, RDH, MS

Parkland College Ivy Tech Community College
Champaign, IL Anderson, IN

April Catlett, RDH, BHSA, MDH, PhD Mindy Jay, RDH, AAS, BHS, Med
Central Georgia Technical College Pensacola State College
Macon, GA Pensacola, FL

Kathy Conrad, RDH, BS Susan Kass, EdD

Columbia Basin College Miami Dade College
Pasco, WA Miami, FL

Brenda Fisher, RDH, BSDH Amy Krueger, CRDH, BSDH, MS

AB Tech Community College St. Petersburg College
Asheville, NC St. Petersburg, FL

xv

A01_NATH5460_04_SE_FM_pp00i-xvi.indd 15 16/11/15 10:57 AM

 xvi REVIEWERS

Previous Editions

Sheila Bannister, Vermont Technical College Jamar M. Jackson, Hostos Community College

Eugenia B. Bearden, Clayton College and State Tara L. Johnson, Idaho State University
University
Mary E. Jorstad, Lake Land College
Maryellen Beaulieu, University of New England
Nancy K. Mann, Indiana University–Purdue University
Lynn Ann Bethel, Mount Ida College Fort Wayne

Jacqueline N. Brian, Indiana University–Purdue Patricia Mannie, St. Cloud Technical College
University
Jill Mason, Oregon Health Sciences University
Fort Wayne
Aamna Nayyar, Santa Fe Community College
Janice Brinson, BSDH, MS, Tennessee State University
Robert F. Nelson, University of South Dakota
Diane L. Bourque, Community College of Rhode Island
Marian Williams Patton, Tennessee State University
Sandra George Burns, Ferris State University
Mary S. Pelletier, Indian River State College
Valerie L. Carter, St. Petersburg College
Connie M. E. Preiser, Catawba Valley Community College
Kenneth A. Eaton, University College London
Barbara Ringle, Cuyahoga Community College
Michele M. Edwards, Tallahassee Community College
Martha H. Roberson, Virginia Western Community
Kerry Flynn, Palm Beach Community College College

Jacque Freudenthal, Idaho State University Judith Romano, Hudson Valley Community College

Theresa M. Grady, Community College of Philadelphia Kari Steinbock, Mt. Hood Community College

Beverly H. Hardee, Cape Fear Community College Edith Tynan, Northern Virginia Community College

Sheranita Hemphill, Sinclair Community College

A01_NATH5460_04_SE_FM_pp00i-xvi.indd 16 16/11/15 10:57 AM

 UNIT

I
Introduction to
Dental Public Health

Science photo/Shutterstock
Chapter 1 Dental Public Health: An Overview
Chapter 2 The Prevention Movement
Chapter 3 Dental Care Delivery in the United States
Chapter 4 Dental Hygiene Care Delivery in the Global Community
Chapter 5 Financing of Dental Care
Chapter 6 Federal and State Legislation Affecting Dental Hygiene
Practice
Chapter 7 Advocacy for Dental Care

The following excerpt eloquently states the need for edu- Unfortunately, this statement reflects a problem that
cating dental hygienists about the need for dental public exists throughout the world. Dental problems cause pain,
health: infection, disease, and disability and can easily be pre-
vented. And, although this paragraph was written over
Children live for months with pain that grown-ups would
twenty years ago, it is still paramount to the overall goal of
find unendurable. The gradual attrition of accepted pain
the dental hygiene discipline. For over one hundred years,
erodes their energy and aspirations. I have seen children
dental hygienists have had the skills necessary to help alle-
in New York with teeth that look like brownish, broken
viate this problem. This introductory unit focuses on the
sticks. I have also seen teenagers who were missing half
definition of public health, its historical development as a
their teeth. But, to me, most shocking is to see a child
true public health profession, and evidence-based preven-
with an abscess that has been inflamed for weeks and
tive health modalities that are practiced in public health.
that he has simply lived with and accepts as part of the
This unit also discusses the current status of dental care
routine of life.*
delivery in the United States and abroad with an emphasis
* Kozol J. Savage Inequalities: Children in America’s Schools. New York, on government structures, financing, laws and initiatives
NY: Crown Publishers; 1991. affecting dental hygiene care.

M01_NATH5460_04_SE_P01.indd 1 16/11/15 10:59 AM

 1
Dental Public Health:
An Overview
O BJ E C T I V E S C OMP E TENC IES
After studying this chapter, the dental hygiene student After studying this chapter and participating in
should be able to: accompanying course activities, the dental hygiene
• Define public health student should be competent to do the following:
• Describe the evolution of public health science and • Promote positive values of oral and general health
practice and wellness to the public and organizations within
and outside the profession
• Define dental public health
• Evaluate factors that can be used to promote
• Describe factors affecting dental public health
patient adherence to disease prevention and/or
health maintenance strategies
• Evaluate and utilize methods to ensure the health
and safety of the patient and the dental hygienists
in the delivery of dental hygiene
• Pursue career options within the health care industry,
education research and other roles as they evolve for
the dental hygienist.
• Access professional and social networks to pursue
professional goals

KEY TERMS
Assessment 4
Assurance 4
Community dental health 9
Dental public health 9
Malpractice 14
Policy development 4
Primary prevention 3
Public health 3
Public health goals 5
Public health services 5
Secondary prevention 3
Serving all functions 4
Socioeconomic status
(SES) 13
Tertiary prevention 3

Science photo/Shutterstock
2

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 CHAPTER 1 • DENTAL PUBLIC HEALTH: AN OVERVIEW 3

Public health is concerned with the health care of all peo- fluoride to remineralize tooth surfaces that have been
ple. It focuses on the health of a population as a whole demineralized.
rather than on the treatment of an individual. The goal of
public health is to protect and promote the health of the
public across three essential domains: health protection, Did You Know?
disease prevention, and health promotion.1 Health protec-
tion is protecting society from disease, illness, and acci- Fluoride can be a primary preventive agent or a secondary
dents, whereas disease prevention is actually preventing preventive agent depending on the use of fluoride.
disease from occurring. Promoting health is the work that
is accomplished when healthy ideas and concepts are Another dental example is periodontal debridement
encouraged. to reduce periodontal pocketing. Tertiary prevention
Public health has become an essential component of employs strategies to replace lost tissues through rehabili-
developed societies. Many of the major improvements in tation. The use of prosthetics to replace missing limbs is an
the health of populations have resulted from public health example. Using dental materials to restore demineralized
measures such as ensuring safe food and water, controlling tooth surfaces to stop an infection and prevent the loss of
epidemics, and protecting workers from injury.2 Most peo- a tooth due to tooth decay is an example of tertiary dental
ple, however, do not give much thought to the public prevention. See Table 1-1 for more examples of the levels
health until a crisis occurs or the system fails.2 Infectious of dental prevention.
disease outbreaks, the incidence of cancer, and the increas- Dental public health is only one component of public
ing number of working people unable to afford health care health. An understanding of the foundation of public
services draw attention to the infrastructure that protects health is important when discussing the topic of dental
the health of the public.2 public health.
Public health initially involved caring for a population
with a disease, but the focus shifted to controlling the dis-
ease itself. It has subsequently evolved to emphasize dis- Public Health Defined
ease prevention (Figure 1-1 ), which enhances quality of The World Health Organization (WHO) defines health as
life, helps deter illness or outbreaks, and is cost effective. a state of complete physical, mental, and social well-being
Primary prevention is the employment of strategies and and not merely the absence of disease or infirmity. 3
agents to forestall the onset of disease, reverse its progress,
or arrest its process before treatment becomes necessary.
An example of primary prevention would be the provision Table 1–1 Levels of Dental Preventive Care
of immunizations to children. Dental hygiene is a form of Levels of Prevention Therapies and Services
primary dental prevention as is the use of fluoride to pre-
vent tooth demineralization. Primary prevention Oral evaluation
Most people recognize the efficacy of primary levels
Dental prophylaxis
of prevention, but they are less likely to think of second-
ary prevention as being effective at preventing disease. Fluoride as a preventive agent
Secondary prevention employs routine treatment meth- Dental sealants
ods to terminate the disease process and/or restore tissues
to as nearly normal as possible; this can also be called Health education
restorative care. Setting a broken arm so that the bone Health promotion
heals correctly is an example of secondary prevention. Secondary prevention Dental restorations
One dental example of secondary prevention is the use of
Periodontal debridement
Fluoride use on incipient caries
Secondary Dental sealants on incipient caries
Prevention
ART, alternative restorative
treatment
Primary Tertiary
Prevention Prevention Endodontics
Tertiary prevention Prosthodontics
Health Implants
Oromaxillofacial surgery
Source: Based on Harris, NO, Garcia-Godoy, F and Nathe, CN. Primary
FIGURE 1–1 Disease Prevention Levels
Preventive Dentistry, 8th edition. Upper Saddle River, NJ: Pearson,
Source: © Pearson Education, Inc. 2013, page 6.

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 4 UNIT I • INTRODUCTION TO DENTAL PUBLIC HEALTH

Further, the WHO and others have defined public health • Serving all functions is the research for new insights
as the effort to promote physical and mental health and and innovative solutions to health problems.6
prevent disease, injury, and disability at the population
These functions can facilitate public health policy and
level. This involves a wide range of products, activities, and
decision making and further enhance planning public
services aimed at the entire population although it is
health programs (Figure 1-2 ). As stated, these functions
sometimes delivered to the individual.3,4 Many postulate
ensure that the public’s health should be assessed, so that
that public health is the approach to health care that con-
policies can be developed to address needs and mecha-
cerns the health of the community as a whole. The first
nisms can be enacted to ensure that these policies are
dentist to be president of the American Public Health
meeting the needs. Researching new innovations, titled
Association, John W. Knutson, originally defined public
serving all functions, ensures that this cycle of needs assess-
health as:
ments, policy development, and assurance is constantly
Public health is people’s health. It is concerned with and consistently occurring.
the aggregate health of a group, a community, a state, The IOM subsequently published For the Public’s
or a nation. Public health in accordance with this broad Health: Investing in a Healthier Future, which addressed
definition is not limited to the health of the poor, or to three topics related to population health in the United
rendering health services or to the nature of the health States: measurement, law and policy, and funding in the
problems. Nor is it defined by the method of payment for context of health care changes.7
health services or by the type of agency responsible for
supplying those services. It is simply a concern for and
activity directed toward the improvement and protection Did You Know?
of the health of a population group and the aggregate.5
Population health means the health of the population,
This definition appropriately places value on the or the public’s health and focuses on public health efforts.
description of public health to address the public’s health, Many times, public health is thought of as health care
regardless of financial resources, the provision of clinical, for those without financial means, but public health is
educational or social services nor the particular health much broader, essentially encompassing the public’s
health in totality.
issue. Public health in totality addresses all aspects of the
public’s health. Examples of public health could be clinical
care provided in a government-funding or private clinic,
Data collection, reporting, and action—including pub-
research conducted to treat disease, data collected to moni-
lic policy and laws informed by data and quality metrics—
tor health or social services provided to access care.
were felt needed to support activities that will alter the
In the report The Future of the Public’s Health in the
physical and social environment for better health.7 The
21st Century, the Institute of Medicine (IOM) defined
report cited failure of the health system, including both
public health as “what we, as a society, do collectively to
assure the conditions in which people can be healthy.” The
IOM identified core functions that were to be conducted
by government public health agencies: assessment, policy
development, assurance, and serving all functions.6 Assessment

• Assessment involves monitoring the health of com-

munities and populations to identify health problems
and priorities. It includes activities such as performing
public health surveillance, collecting and interpreting
data, finding case applications, and evaluating out-
comes of programs and policies. Core
Policy
• Policy development is the process by which society Health Assurance
Development
makes decisions about problems, chooses goals and Functions
strategies to address the problems, and allocates re-
sources to reach them. Formulation of public policies
usually occurs through collaboration among commu-
nity, private sector, and government leaders.
• Assurance involves making certain that all popula- Serving All
Functions:
tions have access to appropriate and cost-effective Research for
services to reach agreed-on public health goals. In New
Innovations
addition to treatment services for individuals, assur-
ance activities include health promotion and disease-
prevention services. FIGURE 1–2 Core Functions of Public Health

M02_NATH5460_04_SE_C01_pp002-016.indd 4 23/11/15 11:48 AM

 CHAPTER 1 • DENTAL PUBLIC HEALTH: AN OVERVIEW 5

medical care and governmental public health, as evidenced

in the poor performance of the United States in life expec-
tancy and other major health outcomes and the increasing
Box 1–1 Public Health Goals
financial issues associated with medical care. Solutions
proposed included controlling administrative waste; reme- • Prevent epidemics and the spread of disease
dying sources of excess cost and other inefficiencies in the • Protect against environmental hazards
clinical care, while improving quality; achieving universal • Prevent injuries
coverage; and implementing population-based health • Promote and encourage healthy behaviors
• Respond to disasters and assist communities in recovery
improvement strategies.7 This report focused on the areas
• Ensure the quality and accessibility of health services
that could be improved in health care delivery.
Source: Based on Public Health Functions Steering Committee,
Goals and Challenges Members (July 1995): American Public Health Association; Association
The American Public Health Association states that the of Schools of Public Health; Association of State and Territorial Health
practice of public health should reduce human suffering, Officials; Environmental Council of the States; National Association of
County and City Health Officials; National Association of State Alcohol
help children thrive, improve the quality of life, and save and Drug Abuse Directors; National Association of State Mental
money.8 They emphasize that public health is prevention, Health Program Directors; Public Health Foundation; US Public Health
policy development, and population health surveillance. Service—Agency for Health Care Policy and Research; Centers for
Disease Control and Prevention; Food and Drug Administration; Health
Policy development should continually be developing and Resources and Services Administration; Indian Health Service; National
amending infrastructure so that prevention is practiced and Institutes of Health; Office of the Assistant Secretary for Health; Substance
public health is easily accessed. Surveillance is continually Abuse and Mental Health Services Administration, http://www.health
.gov/phfunctions/public.htm
needed to adequately assess the public’s health and needs,
which interventions are deemed successful or not successful,
and cost effectiveness of prevention and/or interventions.
Box 1–2 Public Health Services
Did You Know?
• Monitor health status to identify community health
Former US Surgeon General C. Everett Koop once stated problems
that health care matters to all of us some of the time; how- • Diagnose and investigate health problems and health
ever, public health matters to all of us all of the time. hazards in the community
• Inform, educate, and empower people about health
issues
• Mobilize community partnerships to identify and solve
Public health goals are goals that guide all public health problems
health activities. They dictate the services needed to ensure • Develop policies and plans that support individual and
the promotion of health and prevention of disease and community health efforts
injury (see Boxes 1-1 and 1-2 ). An example of a public • Enforce laws and regulations that protect health and
health goal that promotes healthy behaviors is the distri- ensure safety
bution of mouth guards to student athletes. Screening for • Link people to needed personal health services and
dental decay illustrates the monitoring of health status to ensure the provision of health care when otherwise
identify community health problems. unavailable
• Ensure a competent public health and personal health
Public health services are those interventions that
care workforce
help attain public health goals. Preventing illness and pro-
• Evaluate effectiveness, accessibility, and quality of per-
moting health through the delivery of efficient and effec- sonal and population-based health services
tive public health services lie at the core of society’s ability • Research for new insights and innovative solutions to
to create an exemplary circle of better health, more pro- health problems
ductive citizens, and affordable health care.1 At a time of
renewed concern about communicable diseases, such as Source: Based on Fall 1994. Public Health Functions Steering Committee.
Ebola virus disease, tuberculosis, and HIV, as well as new Public Health Functions Steering Committee, Members (July 1995):
anxieties about events such as bioterrorism, people in American Public Health Association; Association of Schools of
Public Health; Association of State and Territorial Health Officials;
many countries also face the challenges of lifestyle-related Environmental Council of the States; National Association of County
diseases, such as obesity, diabetes, cancer, and cardiovascu- and City Health Officials; National Association of State Alcohol and
lar disease, which are significantly influenced by diet, phys- Drug Abuse Directors; National Association of State Mental Health
Program Directors; Public Health Foundation; US Public Health
ical activity, tobacco use, and alcohol abuse.1 Public health Service—Agency for Health Care Policy and Research; Centers for
services aid in educating the public about preventive mea- Disease Control and Prevention; Food and Drug Administration; Health
sures to decrease the risk of some diseases. Resources and Services Administration; Indian Health Service; National
Institutes of Health; Office of the Assistant Secretary for Health; Substance
With health care services placing more and more pres- Abuse and Mental Health Services Administration. http://www.health
sures on budgets as well as a financial burden for .gov/phfunctions/public.htm

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 6 UNIT I • INTRODUCTION TO DENTAL PUBLIC HEALTH

individuals and families, the practice of public health has In England in 1777, a Gloucestershire milkmaid told
become a cause of great concern for governments and her physician, Dr. Edward Jenner, that she was fortunate
health systems. The World Health Organization (WHO) to have contracted cowpox because it conferred protection
operates in an increasingly complex and rapidly changing against smallpox. Dr. Jenner, in turn, collaborated with
landscape, and the boundaries of public health action other providers to study the relationship and establish the
extend into other sectors that influence health opportuni- scientific principle of immunization that eventually
ties and outcomes.1 WHO responds to these challenges resulted in eliminating smallpox.11
using a six-point agenda to help navigate the health of the In 1798, the United States passed an act that provided
public (see Box 1-3 ). for the relief of sick and disabled seamen, which established
a federal network of hospitals for the care of merchant
seaman, the precursor of the US Public Health Service,
Historical Perspective of Public Health which was initiated in 1902.12 Recall that many times
Learning from history cannot be underestimated when communicable diseases were spread country to country by
developing effective solutions to current public health seamen. In today’s world intercontinental travel is common,
issues. Widespread outbreaks of communicable disease and many people travel to many countries, as opposed to a
can be traced back to the plague, including the infamous century earlier when seamen were often the only
Black Death, which had devastating effects on populations international travelers. Interestingly, the first supervising
in many nations and continents for decades (Figure 1-3 ). surgeon of this network was the predecessor to today’s US
Public health activities such as quarantines, mass burials, Surgeon General.
and ship inspections were subsequently developed to pre- The identification of a polluted public water well as
vent such horrendous epidemics. the source of an 1854 cholera outbreak in London resulted
Public health preventive measures have been seen in in a major advancement in public health.13 Dr. John Snow
tribal customs of primitive societies.9 These measures were used a logical, epidemiological approach to study the out-
probably developed to serve as a survival mechanism. break. At the time, many suspected pollution as the cause
These measures included hygiene and cleanliness customs. of the cholera, but by studying the geographical relation of
This is, of course, interesting since dental hygienists hope the sick to a water pump, he was able to help control the
that the current population feels the same way about outbreak.
hygiene and cleanliness of the oral cavity.
The first significant recording of public health measures
in the United States occurred in South Carolina in 1671
when a water protection measure was enacted to prevent
diseases caused by water supplies.10 Specifically, it stated: Box 1–3 World Health Organization’s
Should any person cause to flow into or be cast into any of Six-Point Agenda
the creeks, streams or inland waters of this State any im-
purities that are poisonous to fish or destructive to their
1. Promoting development The ethical principle of
spawn, such person shall, upon conviction, be punished.10 ­equity directs health development: Access to life-saving
or health-promoting interventions should not be denied
for unfair reasons, including those with economic or
­social roots.
2. Fostering health security One of the greatest threats
to international health security is from outbreaks of
emerging and epidemic-prone diseases.
3. Strengthening health systems For health ­improvement
to operate as a poverty-reduction strategy, health
­services must reach poor and underserved populations.
4. Harnessing research, information, and evidence ­
Evidence provides the foundation for setting priorities,
defining strategies, and measuring results.
5. Enhancing partnerships WHO carries out its
work with the support and collaboration of many
partners, including UN agencies and other interna-
tional organizations, donors, civil society, and the
private sector.
6. Improving performance WHO participates in ongo-
ing reforms to improve its efficiency and effectiveness
at both the international level and within countries.
FIGURE 1–3 Triumph of Death: Black Death
Source: Scala/Art Resource, NY Retrieved September 23, 2014 from http://www.who.int.

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 CHAPTER 1 • DENTAL PUBLIC HEALTH: AN OVERVIEW 7

Did You Know? Did You Know?

Epidemiology is the study of the amount, distribution, In 1914, New York City Health Commissioner Herman
determinant, and control of disease and health conditions M. Bigges remarked that “public health is purchasable,”
among a given population. adding that “within natural limitations, a community can
determine its own death rate.”16

The first one-room laboratory for public health was

With the advent of accredited medical academic insti-
opened in 1887 on Staten Island, New York, and was the
tutions, advanced education, and documented clinical stan-
forerunner to the National Institutes of Health, which still
dards, the country now places a socially accepted respect
is the main health care research institution in the United
and prestige for physicians and a much higher expectation
States.12
for medical care than in the past. Additionally, when public
During the first years of the 1900s, Dr. Sara Baker, a
health issues arise, there now are professional physician
physician, led teams of nurses into the crowded neighbor-
associations that are the voice for the science and practice
hoods of Hell’s Kitchen in New York City and taught
of medicine. Physicians’ opinions and recommendations
mothers how to dress, feed, and bathe their babies. Baker
have significant credibility and are a powerful influence in
established many programs to help the poor in that city
dealing with public health issues in today’s America.
keep their infants healthy. After World War I, many states
The dramatic increase in the average life span during
and countries followed her example to lower infant mor-
the 1900s is widely credited to public health achievements,
tality rates.14
such as vaccination programs and control of infectious dis-
eases; effective policies such as motor vehicle and occupa-
tional safety; improved family planning; antismoking mea-
Did You Know? sures; and programs designed to decrease chronic disease.
The US Department of Health and Human Services
Archeologists reported that two molar teeth about 63,400 (HHS) has incorporated dental public health into many of
years old show that the presence of grooves on the teeth the more than 300 programs it offers (see Box 1-4 ).
formed by the passage of a pointed object, thought to be Actually, a dental public health preventive effort, commu-
a small stick, indicates that Neanderthals may have cleaned nity water fluoridation, is one of the ten great public health
their teeth.15 measures adopted during the past century (see Box 1-5 ).
More recent public health efforts include the response
to crises such as the September 11, 2001, terrorist attacks
Pickett and Hanlon described the historical evolution and the aftermath of recent hurricanes, tsunamis, torna-
of public health as a science and practice and the role of does, mudslides, and wildfires. The emergence of diseases
the medical profession in public health from past to pres- of the past, in part as a result of the public’s resistance to
ent. History recorded the gross inadequacies of medical prevention through vaccinations, is being witnessed
care in the early 1800s. Physicians were not educated in throughout the world. Public health is now being focused
academic institutions as they are today. In fact, back then, on violence witnessed in all areas of society, which seems
the prestige of the medical profession was at its lowest to be increasingly common, as is the intentional acts of ter-
and medical practice lacked uniform educational and ror witnessed throughout the world.
practice standards. Medical education was largely propri- Campaigns to promote healthy habits, such as exercising,
etary in nature or based on apprenticeships, resulting in and decrease unhealthy habits such as chewing smokeless
physicians who were poorly prepared, and the services tobacco are routinely used to improve the public’s health.
they provided were frequently of poor quality, not uni- Specific to oral health are innovative public health preventive
form, and cheap.9 efforts including the increased utilization of dental hygienists
Although there were public health laws enacted to in school settings to reduce dental decay. See Box 1-6 for
ensure basic sanitation and prevention of communicable historic events involving the US Public Health Service.
diseases, there were no mechanisms to recognize noncom-
pliance with requirements. Further, because of the greatly Dental Public Health Defined
expanded population and subsequent issues this created,
Dental health is a wide-reaching field of study, but it is
public health measures were not a priority, so that other
grounded in distinct concepts within public health. The
seemingly more pressing problems could be addressed.
American Board of Dental Public Health (ABDPH)
Adding to this mix was the low public expectation of med-
defines dental public health as:
ical care and the lack of a unified voice for physicians to
advocate for solutions aimed at essential public health the science and art of preventing and controlling dental
issues.9 diseases and promoting dental health through organized

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 8 UNIT I • INTRODUCTION TO DENTAL PUBLIC HEALTH

Box 1–4 Historical Highlights

The roots of the US Department of Health and Human 1966: The International Smallpox Eradication program
Services go back to the early days of the nation: led by the US Public Health Service was established;
1798: An act for the relief of sick and disabled seamen was the worldwide eradication of smallpox was accomplished
passed, establishing a federal network of hospitals for the in 1977.
care of merchant seamen; forerunner of today’s US Public 1970: The National Health Service Corps was established.
Health Service. 1990: The Human Genome Project was established, and
1871: The first supervising surgeon (later called Surgeon the Nutrition Labeling and Education Act was passed to
General) was appointed for the Marine Hospital Service, authorize nutritional labeling of food.
which had been organized the prior year. 1993: The Vaccines for Children Program was established,
1887: The federal government opened a one-room laboratory providing free immunizations to all children in low-income
on Staten Island for research on disease, thereby planting the families.
seed that was to grow into the National Institutes of Health. 1995: The Social Security Administration became an
1906: Congress passed the Pure Food and Drugs Act, ­independent agency.
authorizing the government to monitor the purity of foods 1996: The Health Insurance Portability and Accountability
and the safety of medicines, now the responsibility of the Act (HIPAA) was enacted.
Food and Drug Administration. 1997: The State Children’s Health Insurance Program
1921: The Bureau of Indian Affairs Health Division, the (SCHIP) was created, which enables states to extend
forerunner to the Indian Health Service, was created. health coverage to more uninsured children.
1946: The Communicable Disease Center, forerunner of the 1999: The initiative on combating bioterrorism was
Centers for Disease Control and Prevention, was established. launched.
1955: The Salk polio vaccine was licensed. 2002: The Office of Public Health Emergency Preparedness
1961: The First White House Conference on Aging was held. was created to coordinate efforts against bioterrorism and
1964: The first Surgeon General’s Report on Smoking and other emergency health threats.
Health was released. 2003: The Medicare Prescription Drug Improvement and
1965: The Medicare and Medicaid programs were created, Modernization Act of 2003 was enacted—the most signifi-
making comprehensive health care available to millions of cant expansion of Medicare since its enactment, including
Americans. In addition, the Older Americans Act created the a prescription drug benefit.
nutritional and social programs administered by HHS Admin- 2010: The Affordable Care Act was signed into law, put-
istration on Aging, and the Head Start program was created. ting in place comprehensive US health insurance reforms.

Source: Historical Highlights: US Department of Health and Human Services. http://www.hhs.gov/about/hhshist.html.

Accessed September 16, 2014.

community efforts. It is that form of dental practice diseases on a community basis. Implicit in this defini-
that serves the community as a patient rather than tion is the requirement that the specialist have broad
the individual. It is concerned with the dental health knowledge and skills in public health administration, re-
education of the public, with applied dental research, search methodology, the prevention and control of oral
and with the administration of group dental care pro- diseases, and the delivery and financing of oral health
grams, as well as the prevention and control of dental care.17

Box 1–5 Great Public Health Achievements of the Twentieth Century

• Vaccination • Safer and healthier food

• Motor vehicle safety • Healthier mothers and babies
• Workplace safety • Family planning
• Control of infectious diseases • Community water fluoridation
• Decline in deaths from coronary heart disease and stroke • Recognition of tobacco as a hazard

Source: Ten Great Public Health Achievements—United States, 1900–1999. MMWR Morb Mortal Wkly Rpt. 1999;8(12):241–243.

M02_NATH5460_04_SE_C01_pp002-016.indd 8 23/11/15 11:48 AM

Another Random Scribd Document
with Unrelated Content
from their eyes the self-betraying consciousness of hidden terrors;
each striving to forget the peat-stack on the moor where some
hunted creature was lying, the scrub in the hollow that sheltered
some wounded body, the cranny in the hill to which she must
journey painfully after dark with the crusts in her apron.
The shot still rattled out over the countryside where the search
was going on, and where, when it had been successful, a few
maimed and haggard men stood along some shieling wall in front of
a platoon of Cumberland’s musketry. All down the shores of Loch
Ness and among the hills above the Nairn water south-west of
Culloden, the dark rocks raised their broken heads to the sky over
God knows what agonies of suffering and hunger. The carrion-crow
was busy in the land. One-fifth of Prince Charles’s army was dead
upon the battle-field, and the church and tolbooth of Inverness were
full of wounded prisoners, to whom none—not even the surgeons of
their own party—were suffered to attend.
And so April passed, and May was near her passing. Cumberland
lay at Fort Augustus, to which place he had retired with Kingston’s
Horse and eleven battalions of foot. The victorious army was the
richer by much spoil, and money was free; the Duke’s camp was
merry with festivities and races, and in the midst of it he enjoyed a
well-earned leisure, enlivened by women and dice. He had
performed his task of stamping out the danger that threatened his
family with admirable thoroughness, and he had, besides, the
comfortable prospect of a glorious return to London, where he would
be the hero of the general rejoicing that was to follow. He was
rooted at Fort Augustus, a rock of success and convivial self-
satisfaction in the flood of tears and anguish and broken aspiration
that had drowned half Scotland.
The Prince had begun his wanderings in the West, hiding among
the hills and corries of the islands, followed by a few faithful souls,
and with a price of thirty thousand pounds on his head, whilst
Cumberland’s emissaries, chief among whom was John Campbell of
Mamore, Commandant of the West Highland garrisons, searched the
country in every direction. The rank and file of his army—such of his
men as were not dead or in prison—were scattered to the four
winds; and those officers who had escaped after Culloden were in
hiding, too, some despairing, some holding yet to the forlorn hope of
raising his standard anew when the evil day should be over. Among
these last was James Logie.
He had come unhurt through the battle. Complete indifference
about personal issues had wrapped him round in a protecting
atmosphere, as it seems to enwrap and protect the unconcerned
among men. He had left the field in company with the Prince and a
few friends, with whom he reached the Ford of Falie on the Nairn
River. They had held a rapid council at this place, Prince Charles
desiring that the remnant of his army should rendezvous at Ruthven,
in Badenoch, whilst he made his way to France; for his hopes were
living still, and he still looked for support and supplies from the
French king. He had taken leave of his companions at the ford, and
had set off with half a dozen followers for the coast.
Logie turned his face towards Angus. He had been a conspicuous
figure in the Prince’s immediate circle, and he knew that he had no
time to lose if he was to cross the Grampians alive. He thirsted to
get back, and to test the temper of the east coast after the news of
the reverse; like his master, he was not beaten yet. He did not know
what had become of Ferrier and the Angus men, for he had been on
the Prince’s staff; but the friends had met on the night before the
battle, and it was a compact between them, that, should the day go
against them, and should either or both survive the fight, they were
to make for the neighbourhood of Forfar, where they would be
ready, in case of necessity, to begin on their task of raising new
levies for the cause.
He had reached the Spey, and had gained Deeside in safety by
the shores of the Avon, crossing the Grampians near the sources of
the Isla.
In the long winter that had passed since he joined the Prince in
the field, James had not forgotten Flemington. His own labours in
Angus and at the taking of the Venture, completely as they had filled
his mind in the autumn, had sunk back into the limbo of insignificant
things, but Archie was often in his thoughts, and some time before
the advance on Inverness he had heard with indescribable feelings
that he was intelligence officer to the Duke of Cumberland. The
terrible thing to Logie was that Archie’s treachery seemed to have
poisoned the sacred places in his own past; when he turned back to
it now, it was as though the figure of the young man stood blocking
his view, looking at him with those eyes that were so like the eyes of
Diane, and were yet the eyes of a traitor.
He could not bear to think of that October morning by the Basin
of Montrose. Perhaps the story that a fatal impulse had made him
lay bare to his companion had been tossed about—a subject of
ridicule on Flemington’s lips, its telling but one more proof to him of
the folly of men. He could scarcely believe that Archie would treat
the record of his anguish in such a way; but then, neither could he
have believed that the sympathy in Archie’s face, the break in his
voice, the tension of his listening attitude, were only the stock-in-
trade of a practised spy. And yet this horror had been true. In spite
of the unhealed wound that he carried, in spite of the batterings of
his thirty-eight years, Logie had continued to love life, but now he
had begun to tell himself that he was sick of it.
And for another very practical reason his generous impulses and
his belief in Flemington had undone him. Perhaps if the young
painter had come to Balnillo announcing an ostentatious adherence
to the Stuarts, he might have hesitated before taking him at his own
value; but his apparent caution and his unwillingness to speak, and
the words about his father at St. Germain, which he had let fall with
all the quiet dignity of a man too upright to pass under false colours,
had done more to put the brothers on the wrong track than the
most violent protestations. Balnillo had been careful, in spite of his
confidence in his guest; but in the sympathy of his soul James had
given Flemington the means of future access to himself. Now the
tavern in the Castle Wynd at Stirling could be of use to him no
longer, and he knew that only the last extremity must find him in any
of the secret haunts known to him in the Muir of Pert.
 Madam Flemington had never reopened the subject of James
Logie with Archie. In her wisdom she had left well alone. Installed in
her little lodging in Hyndford’s Close, with her woman Mysie, she had
made up her mind to remain where she was. There was much to
keep her in Edinburgh, and she could not bring herself to leave the
centre of information and to bury herself again in the old white
house among the ash-trees, whilst every post and every horseman
brought word of some new turn in the country’s fortunes.
News of the Highland army’s retreat to Scotland, of the Battle of
Falkirk, of the despatch of the Duke of Cumberland to the North,
followed one another as the year went by, and still she stayed on.
With her emergence from the seclusion of the country came her
emergence from the seclusion she had made for herself; and on the
Duke’s thirty hours’ occupation of Holyrood, she threw off all
pretence of neutrality, and repaired with other Whig ladies to the
palace to pay her respects to the stout, ill-mannered young General
whose unbeguiling person followed so awkwardly upon the attractive
figure of his predecessor.
Now that Archie was restored to her, Christian found herself with
plenty of occupation. The contempt she had hitherto professed for
Edinburgh society seemed to have melted away, and every card-
party, every assembly and rout, knew her chair at its door, her
arresting presence in its midst. Madam Flemington’s name was on a
good many tongues that winter. Many feared her, some maligned
her, but no one overlooked her. The fact that she was the widow of
an exiled Jacobite lent her an additional interest; and as the polite
world set itself to invent a motley choice of reasons for her
adherence to the House of Hanover—which it discovered before her
reception by the Duke at Holyrood made it public—it ended by
stumbling on the old story of a bygone liaison with Prince Charles’s
father. The idea was so much to its taste that it was generally
accepted; and Christian, unknown to herself, became the cast-off
and alienated mistress of that Prince whom her party had begun to
call ‘The Old Pretender.’ It was scarcely a legend that would have
conciliated her had it come to her ears, but, as rumour is seldom on
speaking terms with its victims, she was ignorant of the interested
whispers which followed her through the wynds and up the
staircases of the Old Town.
But the reflected halo of royalty, while it casts deep shadows,
reaches far. The character of royal light of love stood her in good
stead, even among those to whom her supposed former lover was
an abhorred spectre of Popery and political danger. The path that
her own personality would surely open for her in any community was
illumined and made smooth by the baleful interest that hangs about
all kingly irregularities, and there was that in her bearing which
made people think more of the royal and less of the irregular part of
the business. Also, among the Whigs, she was a brand plucked from
the burning, one who had turned from the wrong party to embrace
the right. Edinburgh, Whig at heart, in spite of its backslidings,
admired Madam Flemington.
And not only Edinburgh, but that curious fraction of it, David
Balnillo.
The impression that Christian had made upon the judge had
deepened as the weeks went by. By the time he discovered her true
principles, and realized that she was no dupe of Archie’s, but his
partisan, he had advanced so far in his acquaintance with her, had
become so much her servant, that he could not bring himself to
draw back. She had dazzled his wits and played on his vanity, and
that vanity was not only warmed and cosseted by her manner to
him, not only was he delighted with herself and her notice, but he
had begun to find in his position of favoured cavalier to one of the
most prominent figures in society a distinction that it would go hard
with him to miss.
He had begun their conversation at Lady Anne Maxwell’s party by
the mention of Archie Flemington, but his name had not come up
between them again, and when his enlightenment about her was
complete, and the talk which he heard in every house that he
frequented revealed her in her real colours, he had no further wish
to discuss the man into whose trap he had fallen.
 David Balnillo’s discoveries were extremely unpalatable to him. If
Christian had cherished his vanity, she had made it smart, too. No
man, least of all one like the self-appreciative judge, can find without
resentment that he has been, even indirectly, the dupe of a person
to whom he has attached himself; but when that person is a woman,
determined not to let him escape from her influence, the case is not
always desperate. For three unblessed days it was wellnigh
desperate with Balnillo, and he avoided her completely, but at the
end of that time a summons from her was brought to him that his
inclination for her company and the chance sight of Lord Grange
holding open the door of her chair forbade him to disobey. She had
worded her command as though she were conferring a favour;
nevertheless, after an hour’s hesitation, David had taken his hat and
repaired to Hyndford’s Close, dragging his dignity after him like a
dog on a leash.
If she guessed the reason of his absence from her side she made
no remark, receiving him as if she had just parted from him, with
that omission of greeting which implies so much. She had sent for
him, she said, because her man of business had given her a legal
paper that she would not sign without his advice. She looked him in
the face as fearlessly as ever, and her glance sparkled with its
wonted fire. For some tormented minutes he could not decide
whether or no to charge her with knowledge of the fraud that had
been carried on under his roof, but he had not the courage to do so.
Also, he was acute enough to see that she might well reply to his
reproaches by reminding him that he had only himself to thank for
their acquaintance. She had not made the advances; his own zeal
had brought about their situation. He felt like a fool, but he saw that
in speaking he might look like one, which some consider worse.
He left her, assuring himself that all was fair in love and politics;
that he could not, in common good breeding, withhold his help from
her in her legal difficulty; that, should wind of Archie’s dealings with
him get abroad in the town, he would be saving appearances in
avoiding a rupture with the lady whose shadow he had been since
he arrived in Edinburgh, and that it was his duty as a well-wisher of
Prince Charles to keep open any channel that might yield information
about Flemington’s movements. Whatsoever may have been the
quality of his reasons, their quantity was remarkable. He did not like
the little voice that whispered to him that he would not have dared
to offer them to James.
There was no further risk of a meeting with Archie, for within a
few days of the latter’s appearance in Hyndford’s Close he had been
sent to the Border with instructions to watch Jedburgh and the
neighbourhood of Liddesdale, through which the Prince’s army had
passed on its march to England. Madam Flemington knew that the
coast was clear, and David had no suspicion that it had been
otherwise. Very few people in Edinburgh were aware of Flemington’s
visit to it; it was an event of which even the caddies were ignorant.
And so Balnillo lingered on, putting off his return to Angus from
week to week. His mouse-coloured velvet began to show signs of
wear and was replaced by a suit of dark purple; his funds were
dwindling a little, for he was not a rich man, and a new set of verses
about him was going the round of the town. Then, with January,
came the battle of Falkirk and the siege of Stirling Castle, and the
end of the month brought Cumberland and the mustering of loyal
Whigs to wait upon him at Holyrood Palace.
David departed quietly. He had come to Edinburgh to avoid
playing a marked part in Angus, and he now returned to Angus to
avoid playing a marked part in Edinburgh. He was behaving like the
last remaining king in a game of draughts when he skips from
square to square in the safe corner of the board; but he did not
know that Government had kept its eye on all his doings during the
time of his stay. Perhaps it was on account of her usefulness in this
and in other delicate matters that Madam Flemington augured well
for her grandson, for when the Whig army crossed the Forth, Archie
went with it as intelligence officer to the Duke of Cumberland.
 CHAPTER XX
THE PARTING OF THE WAYS

JULY spread a mantle of heather over the Grampians. In Glen Esk,

the rough road into the Lowlands, little better than a sheep-track,
ran down the shore of Loch Lee, to come out at last into the large
spaces at the foot of the hills. The greyness of the summer haze lay
over everything, and the short grass and the roots of bog-myrtle and
thyme smelt warm and heady, for the wind was still. The sun
seemed to have sucked up some of the heather-colour out of the
earth; the lower atmosphere was suffused with a dusty lilac where,
high overhead, it softened the contours of the scattered rocks.
Amongst carpets of rush and deep moss, dappled with wet patches,
the ruddy stems of the bog-asphodel raised slim, golden heads that
drooped a little, as though for faintness, in the scented warmth. An
occasional bumble-bee passed down wind, purposeful and
ostentatious, like a respectable citizen zealous on the business of
life.
No one looking along the windings of the Glen, and drawing in the
ardent quietness of the summer warmth, would have supposed that
fire and sword had been through it so lately. Its vastness of outline
hid the ruined huts and black fragments of skeleton gable-ends that
had smoked up into the mountain stillness. Homeless women and
children had fled down its secret tracks; hunted men had given up
their souls under its heights. The rich plainland of Angus had sent its
sons to fight for the Prince in the North, and of those who survived
to make their way back to their homes, many had been overtaken by
the pursuit that had swept down behind them through the hills. No
place had a darker record than Glen Esk.
 Archie Flemington rode down the Glen with his companion some
little way in front of the corporal and the three men who followed
them. His left arm was in a sling, for he had received a sabre-cut at
Culloden; also, he had been rolled on by his horse, which was killed
under him, and had broken a rib. His wound, though not serious had
taken a long time to heal, for the steel had cut into the arm bone;
he looked thin, too, for the winter had been a time of strenuous
work.
One of the three private soldiers, the last of the small string of
horsemen, had a rope knotted into his reins, the other end of which
was secured round the middle of a short, thickset man who paced
sullenly along beside the horse. The prisoner’s arms were bound at
his back, his reddish beard was unkempt, and his clothes ragged; he
made a sorry figure in the surrounding beauty.
Nearly two months had gone by since the Battle of Culloden, and
the search for fugitives was still going on in remote places.
Cumberland, who was on the point of leaving Fort Augustus for
Edinburgh on his way to London, had given orders for a last scouring
of Glen Esk. The party had almost reached its mouth, and its efforts
had resulted only in the capture of this one rebel; but, as there was
some slight doubt of his identity, and as the officer who rode beside
Archie was one whose conscience ranked a great way above his
convenience, the red-bearded man had fared better than many of
those taken by Cumberland’s man-hunters. If he were the person
they supposed him to be, he was an Angus farmer distantly related
to David Ferrier, and he was now being brought to his own country
for identification.
Captain Callandar, the officer in command, was a long, lean, bony
man with a dark face, a silent, hard-bitten fellow from Ligonier’s
regiment. He and Archie had met very little before they started
south together, and they had scarcely progressed in acquaintance in
the few days during which they had ridden side by side. They had
shared their food on the bare turf by day, lain down within a few
yards of each other at night; they had gone through many of the
same experiences in the North, and they belonged to the same
victorious army, yet they knew little more of each other than when
they started. But there was no dislike between them, certainly none
on Archie’s side, and if the other was a little critical of the foreign roll
of his companion’s r’s, he did not show it.
Archie’s tongue had been quiet enough. He was riding listlessly
along, and, though he looked from side to side, taking in the details
of what he saw from force of habit, they seemed to give him no
interest. He puzzled Callandar a good deal, for he had proved to be
totally different from anything that he had expected. The soldier was
apt to study his fellow-men, when not entirely swallowed up by his
duty, and he had been rather pleased when he found that
Cumberland’s brilliant intelligence officer was to accompany him
down Glen Esk. He had heard much about him. Archie’s quick
answers and racy talk had amused the Duke, who, uncompanionable
himself, felt the awkward man’s amazement at the readiness of
others, and scraps of Flemington’s sayings had gone from lip to lip,
hall-marked by his approval. Callandar was taciturn and grave, but
he was not stupid, and he had begun to wonder what was amiss
with his companion. He decided that his own society must be
uncongenial to him, and, being a very modest man, he did not
marvel at it.
But the sources of Archie’s discomfort lay far, far deeper than any
passing irritation. It seemed to him now, as he reached the mouth of
the Glen, that there was nothing left in life to fear, because the
worst that could come upon him was looming ahead, waiting for
him, counting his horse’s steps as he left the hills behind.
An apprehension, a mere suggestion of what might be remotely
possible, a skeleton that had shown its face to him in sleepless or
overwrought moments since Cumberland’s victory, had become real.
To most people who are haunted by a particular dread, Fate plays
one of the tricks she loves so much. She is an expert boxer, and
whilst each man stands up to her in his long, defensive fight, his eye
upon hers, guarding himself from the blow he expects to receive in
the face, she hits him in the wind and he finds himself knocked out.
 But she had dealt otherwise with Archie; for a week ago he had
been specially detailed to proceed to Angus to hunt for that
important rebel, Captain James Logie, who was believed to have
made his way southward to his native parts.
At Fort Augustus it was felt that Flemington was exactly the right
man to be entrusted with the business. He was familiar with the
country he had to search, he was a man of infinite resource and
infinite intelligence; and Cumberland meant to be pleasant in his
harsh, ungraceful manner, when he gave him his commission in
person, with a hint that he expected more from Mr. Flemington than
he did from anybody else. He was to accompany Captain Callandar
and his three men. The officer, having made a last sweep of Glen
Esk, was to go on by Brechin to Forfar, where he would be joined by
another and larger party of troops that was on its way down Glen
Clova from Braemar, for Cumberland was drafting small forces into
Angus by way of the Grampians, and the country was filling with
them.
He had dealt drastically with Montrose. The rebellion in the town
had been suppressed, and the neighbourhood put under military
law. This bit of the east coast had played a part that was not
forgotten by the little German general, and he was determined that
the hornet’s nest he had smoked out should not re-collect. Whilst
James Logie was at large there could be no security.
Of all the rebels in Scotland, Logie was the man whom
Cumberland was most desirous to get. The great nobles who had
taken part in the rising were large quarry indeed, but this commoner
who had worked so quietly in the eastern end of Angus, who had
been on the Prince’s staff, who had the experience of many
campaigns at his back, whose ally was the notorious Ferrier, who
had seized the harbour of Montrose under the very guns of a
Government sloop of war, was as dangerous as any Highland
chieftain, and the news that he had been allowed to get back to his
own haunts made the Whig generals curse. Though he might be
quiet for the moment, he would be ready to stir up the same
mischief on the first recrudescence of Stuart energy. It was not
known what had happened to Ferrier, for although he was a marked
man and would be a rich haul for anybody who could deliver him up
to Cumberland, he was considered a less important influence than
James; and Government had scarcely estimated his valuable services
to the Jacobites, which were every whit as great as those of his
friend.
Lord Balnillo was a puzzle to the intelligence department. His
name had gone in to headquarters as that of a strongly suspected
rebel; he was James’s brother; yet, while Archie had included him in
the report he had entrusted to the beggar, he had been able to say
little that was definite about him. The very definite information he
had given about James and Ferrier, the details of his pursuit of the
two men and his warning of the attack on the Venture, had mattered
more to the authorities than the politics of the peaceable old judge,
and Balnillo’s subsequent conduct had been so little in accordance
with that of his brother that he was felt to be a source of small
danger. He had been no great power on the bench, where his
character was so easy that prisoners were known to think
themselves lucky in appearing before him. No one could quite
account for his success in the law, and the mention of his name in
the legal circles of Edinburgh raised nothing worse than a smile. He
had taken no part in the rejoicing that followed James’s feat at
Montrose, but had taken the opportunity of leaving the
neighbourhood, and during his long stay in Edinburgh he had
frequented Whig houses and had been the satellite of a conspicuous
Whig lady, one who had been received by Cumberland with some
distinction, the grandmother of the man who had denounced Logie.
The authorities decided to leave him alone.
When the hills were behind the riders and the levels of the
country had sunk and widened out on either hand, they crossed the
North Esk, which made a shallow curve by the village of Edzell. The
bank rose on its western side, and the shade of the trees was
delightful to the travellers, and particularly to the prisoner they
carried with them. As the horses snuffed at the water they could
hardly be urged through it, and Callandar and Archie dismounted on
the farther shore and sat on a boulder whilst they drank. They
watched them as they drew the draught up their long throats and
raised their heads when satisfied, to stare, with dripping muzzles, at
distant nothings, after the fashion of their kind. The prisoner’s
aching arms were unbound that he might drink too.
“Egad, I have pitied that poor devil these last miles,” said Archie,
as the man knelt at the brink and extended his stiffened arms into a
pool.
The other nodded. Theoretically he pitied him, but a rebel was a
rebel.
“You have no bowels of compassion. They are not in your
instructions, Callandar. They should be served out, like ammunition.”
Callandar turned his grave eyes on him.
“The idea displeases you?” said Archie.
“It would complicate our duty.”
He spoke like a humourless man, but one side of his mouth
twitched downwards a little, and Flemington, who had the eye of a
lynx for another man’s face, decided that the mere accident of habit
had prevented it from twitching up. He struck him as the most
repressed person he had ever seen.
“There would not be enough at headquarters to go round,”
observed Archie.
Callandar’s mouth straightened, and, like the horses, he looked at
nothing. Criticism was another thing not in his instructions.
“They have drunk well,” he said at last. “An hour will bring us to
the foot of Huntly Hill. We can halt and feed them at the top before
we turn off towards Brechin. You know this country better than I
do.”
“Wait a little,” said Archie. “I am no rebel, and you may have
mercy on me with a clear conscience.”
He had slipped his arm out of the sling and was resting it on his
knee.
 “You are in pain?” exclaimed Callandar, astonished.
Archie laughed.
“Why, man, do you think I ride for pleasure with the top half of a
bone working east and the bottom half working west?”
“I thought——” began Callandar.
“You thought me churlish company, and maybe I have been so.
But this ride has been no holiday for me.”
“I did not mean that. I would have said that I thought your wound
was mended.”
“My flesh-wound is mended and so is my rib,” said Flemington,
“but there are two handsome splinters hobnobbing above my elbow,
and I can tell you that they dance to the tune of my horse’s jog.”
Callandar’s opinion of him rose. He had found him disappointing
as a companion, but Archie had hid his pain, and he understood
people who did that.
The Edzell villagers turned out to stare at them as they passed a
short time later, when they took the road again. After the riders left
its row of houses their way ran from the river-level through fields
that had begun to oust the moor, rising to the crest of Huntly Hill, on
the farther side of which the southern part of Angus spread its
partial cultivation down to the Basin of Montrose. Archie’s discomfort
seemed to grow; he shifted his sling again and again, and Callandar
could see his mouth set in a hard line. Now and then an impatient
sound of pain broke from him. They rode on, silent, the long rise of
the hill barring their road like a wall, and the stems of the fir-strip
that crowned it beginning to turn to a dusky black against the sky,
which was cooling off for evening. Flemington’s horse was a slow
walker, and he had begun to jog persistently. His rider, holding him
back, had fallen behind. Callandar rode on, preoccupied, and when,
roused from his thoughts, he turned his head, Archie waved him on,
shouting that he would follow more slowly, for the troopers moved at
a foot’s pace because of their prisoner, and he stayed abreast of
them.
 As Callandar passed a green sea of invading bracken that had
struggled on to the road his jaw dropped and he pulled up. Behind
the feathering waves an individual was sitting in a wooden box on
wheels, and four dogs, harnessed to the rude vehicle, were lying on
the ground in their leathern traces. He noticed with astonishment
that the man had lost the lower parts of his legs.
“You’ll be Captain Callandar,” said Wattie, his twinkling eyes on the
other’s uniform; “you’re terrible late.”
“What do you want?” said the officer, amazed.
The beggar peered through the fern and saw the knot of riders
and their prisoner coming along the road some little way behind.
“Whaur’s yon lad Flemington?” he demanded.
“What do you want?” exclaimed Callandar again. “If you are a
beggar you have chosen a strange place to beg in.”
For answer Wattie pulled up his sliding panel and took out two
sealed letters, holding them low in the shelter of the fern, as if the
midges, dancing their evening dance above the bracken-tops, should
not look upon them. Callandar saw that one of the letters bore his
own name.
“Whisht,” said the beggar, thrusting them back quickly, “come
doon here an’ hae a crack wi’ me.”
As Callandar had been concerned exclusively with troops and
fighting, he knew little about the channels of information working in
the country, and it took him a moment to explain the situation to
himself. He dismounted under the fixed glare of the yellow dog. He
was a man to whom small obstacles were invisible when he had a
purpose, and he almost trod on the animal, without noticing the
suppressed hostility gathering about his heels. But, so long as his
master’s voice was friendly, the cur was still, for his unwavering mind
answered to its every tone. Probably no spot in all Angus contained
two such steadfast living creatures as did this green place by the
bracken when Callandar and the yellow dog stood side by side.
 The soldier tethered his horse and sat down on the moss. Wattie
laid the letters before him; the second was addressed to Archie.
Callandar broke the seal of the first and read it slowly through; then
he sat silent, examining the signature, which was the same that
Flemington had showed to the beggar on the day when he met him
for the first time, months ago, by the mill of Balnillo.
He was directed to advance no farther towards Brechin, but to
keep himself out of sight among the woods round Huntly Hill, and to
watch the Muir of Pert, for it was known that the rebel, James Logie,
was concealed somewhere between Brechin and the river. He was
not upon the Balnillo estate, which, with Balnillo House, had been
searched from end to end, but he was believed to be in the
neighbourhood of the Muir.
“You know the contents of this?” asked Callandar, as he put away
the paper inside the breast of his coat.
“Dod, a ken it’ll be aboot Logie. He’s a fell man, yon. Have ye na
got Flemington wi’ ye?”
Callandar looked upon his companion with disapproval. He had
never seen him, never heard of him before, and he felt his manner
and his way of speaking of his superiors to be an outrage upon
discipline and order, which were two things very near his heart.
He did not reply.
“Whaur’s Flemington?” demanded the beggar again.
“You make very free with Mr. Flemington’s name.”
“Tuts!” exclaimed Wattie, ignoring the rebuke, “a’ve got ma orders
the same as yersel’, an’ a’m to gie yon thing to him an’ to nae ither
body. Foo will a dae that if a dinna ken whaur he is?”
His argument was indisputable.
“Mr. Flemington will be with me in a moment,” said Callandar
stiffly. “He is following.”
The sound of horses’ feet was nearing them upon the road, and
Callandar rose and beckoned to Archie to come on.
 “Go to the top of the hill and halt until I join you,” he told the
corporal as the men passed.
As Archie dismounted and saw who was behind the bracken, he
recoiled. It was to him as if all that he most loathed in the past came
to meet him in the beggar’s face. Here, at the confines of the
Lowland country, the same hateful influences were waiting to engulf
him. His soul was weary within him.
He barely replied to Wattie’s familiar greeting.
“Do you know this person?” inquired Callandar.
He assented.
“Ay, does he. Him and me’s weel acquaint,” said Wattie, closing an
eye. “Hae, tak’ yon.”
He held out the letter to Flemington.
The young man opened it slowly, turning his back to the cart, and
his brows drew together as he read.
His destiny did not mean him to escape. Logie had been marked
down, and the circle of his enemies was narrowing round him.
Flemington was to go no farther, and he was to remain with
Callandar to await another message that would be brought to their
bivouac on Huntly Hill, before approaching nearer to Brechin.
He stood aside, the paper in his hand. Here was the turning-point;
he was face to face with it at last. He could not take part in Logie’s
capture; on that he was completely, unalterably determined. What
would be the end of it all for himself he could not think. Nothing was
clear, nothing plain, but the settled strength of his determination. He
looked into the mellowing light round him, and saw everything as
though it were unreal; the only reality was that he had chosen his
way. Heaven was pitiless, but it should not shake him. Far above him
a solitary bird was winging its way into the spaces beyond the hills;
the measured beat of its wings growing invisible as it grew smaller
and smaller and was finally lost to sight. He watched it, fascinated,
with the strange detachment of those whose senses and
consciousness are numbed by some crisis. What was it carrying
away, that tiny thing that was being swallowed by the vastness? His
mind could only grasp the idea of distance . . . of space. . . .
Callandar was at his elbow, and his voice broke on him as the
voice of someone awakening him from sleep.
“These are my orders,” he was saying, as he held out his own
letter; “you know them, for I am informed here that they are the
duplicate of yours.”
There was no escape. Callandar knew the exact contents of both
papers. Archie might have kept his own orders to himself, and have
given him to suppose that he was summoned to Forfar or Perth, and
must leave him; but that was impossible. He must either join in
hunting Logie, or leave the party on this side of Huntly Hill.
“We had better get on,” said Callandar.
They mounted, and as they did so, Wattie also got under way. His
team was now reduced to four, for the terrier which had formerly run
alone in the lead had died about the new year.
He took up his switch, and the yellow cur and his companions
whirled him with a mighty tug on to the road. He had been waiting
for some time in the bracken for the expected horseman, and as the
dogs had enjoyed a long rest, they followed the horses at a steady
trot. Callandar and Flemington trotted too, and the cart soon fell
behind. Beyond the crest of Huntly Hill the Muir of Pert sloped
eastwards towards the coast, its edges resting upon the Esk, but
before the road began to ascend it forked in two, one part running
upwards, and the other breaking away west towards Brechin.
“Callandar, I am going to leave you,” said Archie, pulling up his
horse.
“To leave?” exclaimed the other blankly. “In God’s name, where
are you going?”
“Here is the shortest way to Brechin, and I shall take it. I must
find a surgeon to attend to this arm. There is no use for me to go on
with you when I can hardly sit in my saddle for pain.”
 “But your orders?” gasped Callandar.
“I will make that right. You must go on alone. Probably I shall join
you in a few days, but that will depend on what instructions I get
later. If you hear nothing from me you will understand that I am
busy out of sight. My hands may be full—that is, if the surgeon
leaves me with both of them. Good-bye, Callandar.”
He turned his horse and left him. The other opened his mouth to
shout after him, ordering him to come back, but remembered that
he had no authority to do so. Flemington was independent of him;
he belonged to a different branch of the King’s service, and although
he had fought at Culloden he was under different orders. He had
merely accompanied his party, and Callandar knew very well that,
though his junior in years, he was a much more important person
than himself. The nature of Archie’s duties demanded that he should
be given a free hand in his movements, and no doubt he knew what
he was about. But had he been Callandar’s subordinate, and had
there been a surgeon round the nearest corner, his arm might have
dropped from his shoulder before the officer would have permitted
him to fall out of the little troop. Callandar had never in all his
service seen a man receive definite orders only to disobey them
openly.
He watched him go, petrified. His brain was a good one, but it
worked slowly, and Archie’s decision and departure had been as
sudden as a thunderbolt. Also, there was contempt in his heart for
his softness, and he was sorry.
Archie turned round and saw him still looking after him. He sent
back a gibe to him.
“If you don’t go on I will report you for neglect of duty!” he
shouted, laughing.
 CHAPTER XXI
HUNTLY HILL

CALLANDAR rode up Huntly Hill. The rose-red of the blossoming briar

that decks all Angus with its rubies glowed in the failing sunlight,
and the scent of its leaf came in puffs from the wayside ditches; the
blurred heads of the meadow-sweet were being turned into clouds
of gold as the sun grew lower and the road climbed higher. In front
the trees began to mantle Huntly Hill.
He had just begun the ascent at a foot’s pace when he heard the
whirr of the beggar’s chariot-wheels behind him, then at his side,
and he turned in his saddle and looked down on his pursuer’s bald
crown. Wattie had cast off his bonnet, and the light breeze springing
up lifted the fringe of his grizzled hair.
“Whaur awa’s Flemington?” he cried, as he came up.
The other answered by another question; his thoughts had come
back to the red-haired prisoner at the top of the hill, and it struck
him that the man in the cart might recognize him.
“What’s your name?” he asked abruptly.
“Wattie Caird.”
“You belong to these parts?”
He nodded.
“Then come on; I have not done with you yet.”
“A’m asking ye whaur’s Flemington?”
If Callandar had pleased himself he would have driven Wattie
down the hill at the point of the sword, his persistence and his
pestilent, unashamed curiosity were so distasteful to him. But he
had a second use for him now. He was that uncommon thing, a
disciplinarian with tact, and by virtue of the combination in himself
he understood that the troopers in front of him, who had been
looking forward eagerly to getting their heads once more under a
roof that night, would be disgusted by the orders he was bringing.
He had noticed the chanter sticking out from under Wattie’s leathern
bag, and he thought that a stirring tune or two might ease matters
for them. He did not see his way to dispensing with him at present,
so he tolerated his company.
“Mr. Flemington has a bad wound,” he answered. “He has gone to
Brechin to have it attended to.”
“Whaur did he get it?”
“At Culloden Moor.”
“They didna tell me onything aboot that.”
“Who tells you anything about Mr. Flemington? What do you know
about him?”
“Heuch!” exclaimed Wattie, with contempt, “it’s mysel’ that should
tell them! A ken mair aboot Flemington than ony ither body—a ken
fine what’s brocht yon lad here. He’s seeking Logie, like a’body else,
but he kens fine he’ll na get him—ay, does he!”
Callandar looked down from his tall horse upon the grotesque
figure so close to the ground. He was furious at the creature’s
assumption of knowledge.
“You are a piper?” said he.
“The best in Scotland.”
“Then keep your breath for piping and let other people’s business
be,” he said sternly.
“Man, dinna fash. It’s King Geordie’s business and syne it’s mine.
Him and me’s billies. Ay, he’s awa’, is he, Flemington?”
Callandar quickened his horse’s pace; he was not going to endure
this offensive talk. But Wattie urged on his dogs too, and followed
hard on his heels.
All through the winter, whilst the fortunes of Scotland were
deciding themselves in the North, he had been idle but for his piping
and singing, and he had had little to do with the higher matters on
which he had been engaged in the autumn, whilst the forces of the
coming storm were seething south of the Grampians. He had not set
eyes on Flemington since their parting by the farm on Rossie Moor,
but many a night, lying among his dogs, he had thought of Archie’s
voice calling to Logie as he tossed and babbled in his broken
dreams.
He had long since drawn his conclusion and made up his mind
that he admired Archie as a mighty clever fellow, but he was
convinced that he was more astute than anybody supposed, and it
gave him great delight to think that, probably, no one but himself
had a notion of the part Flemington was playing. Wattie was well
aware of his advancement, for his name was in everybody’s mouth.
He knew that he was on Cumberland’s staff, just as Logie was on the
staff of the Prince, and he wagged his head as he thought how
Archie must have enriched himself at the expense of both Whig and
Jacobite. It was his opinion that, knowledge being marketable, it
was time that somebody else should enrich himself too. He would
have given a great deal to know whether Flemington, as a well-
known man, had continued his traffic with the other side, and as he
went up the hill beside the dark Whig officer he was turning the
question over in his mind.
He had kept his suspicions jealously to himself. Whilst Flemington
was far away in the North, and all men’s eyes were looking across
the Grampians, he knew that he could command no attention, and
he had cursed because he believed his chance of profit to be lost.
Archie had gone out of range, and he could not reach him; yet he
kept his knowledge close, like a prudent man, in case the time
should come when he might use it. And now Flemington had
returned, and he had been sent out to meet him.
 The way had grown steep, and as Callandar’s horse began to
stumble, the soldier swung himself off the tired beast and walked
beside him, his hand on the mane.
Wattie was considering whether he should speak. If his
information were believed, it would be especially valuable at this
time, when the authorities were agog to catch Logie, and the reward
for his services must be considerable if there was any justice in the
world. They would never catch Logie, because Flemington was in
league with him. Wattie knew what many knew—that the rebel was
believed to be somewhere about the great Muir of Pert, now just in
front of them, but so far as he could make out, the only person who
was aware of how the wind set with Archie was himself.
What he had seen at the foot of Huntly Hill had astonished him till
he had read its meaning by the light of his own suspicions. Though
he had not been close enough to the two men to hear exactly what
passed between them when they parted, he had seen them part. He
had seen Callandar standing to look after the other as though
uncertain how to act, and he had heard Archie’s derisive shout.
There was no sign of a quarrel between them, yet Callandar’s face
suggested they had disagreed; there was perplexity in it and
underlying disapproval. He had seen his gesture of astonishment,
and the way in which he had sat looking after Flemington at the
cross roads, reining back his horse, which would have followed its
companion, was eloquent to the beggar. Callandar had not expected
the young man to go.
Wattie did not know the nature of the orders he had brought, but
he knew that they referred to Logie. He understood that those who
received them were hastening to meet those who had despatched
them, and would be with them that night; and this proved to him
how important it was that the letters should be in the hand of the
riders before they advanced farther on their way. He had been
directed to wait on the northern side of Huntly Hill, and had been
specially charged to deliver them before Callandar crossed it. He told
himself that only a fool would fail to guess that they referred to this
particular place. But the illuminating part to Wattie was the speech
he had heard by the bracken: it was all that was needed to explain
the officer’s stormy looks.
“These are my orders,” Callandar had said, “but you know them,
for I am informed that they are the duplicate of yours.”
Archie had disobeyed them, and Wattie was sure that he had
gone, because the risk of meeting Logie was too great to be run.
Now was the time for him to speak.
He had no nicety, but he had shrewdness in plenty. He was
sudden and persistent in his address, and divining the obstacles in
Callandar’s mind, he charged them like a bull.
“Flemington ’ll na let ye get Logie,” said he.
He made his announcement with so much emphasis that the man
walking beside him was impressed in spite of his prejudices. He was
annoyed too. He turned on him angrily.
“Once and for all, what do you mean by this infernal talk about
Mr. Flemington?” he cried, stopping short. “You will either speak out,
or I will take it upon myself to make you. I have three men in the
wood up yonder who will be very willing to help me. I believe you to
be a meddlesome liar, and if I find that I am right you shall smart for
it.”
But the beggar needed no urging, and he was not in the least
afraid of Callandar.
“It’s no me that’s sweer to speak, it’s yersel’ that’s sweer to
listen,” said he, with some truth. “Dod, a’ve tell’t ye afore an’ a’m
telling ye again—Flemington ’ll no let ye get him! He’s dancin’ wi’
George, but he’s takin’ the tune frae Chairlie. Heuch! dinna tell me!
There’s mony hae done the same afore an’ ’ll dae it yet!”
The officer was standing in the middle of the road, a picture of
perplexity.
“It’s no the oxter of him that gars him gang,” said Wattie,
breaking into the broad smile of one who is successfully letting the
light of reason into another’s mind. “It’s no his airm. Maybe it gies
him a pucklie twist, whiles, and maybe it doesna, but it’s no that that
gars the like o’ him greet. He wouldna come up Huntly Hill wi’ you,
for he ken’t he was ower near Logie. It’s that, an’ nae mair!”
Callandar began to think back. He had not heard one complaint
from Archie since the day they rode out of Fort Augustus together,
and he remembered his own astonishment at hearing he was in pain
from his wound. It seemed only to have become painful in the last
couple of hours.
“It is easy to make accusations,” he said grimly, “but you will have
to prove them. What proof have you?”
“Is it pruifs ye’re needin’? Fegs, a dinna gang aboot wi’ them in
ma poke! A can tell ye ma pruifs fine, but maybe ye’ll no listen.”
He made as though to drive on.
Callandar stepped in front of the dogs, and stood in his path.
“You will speak out before I take another step,” said he. “I will
have no shuffling. Come, out with what you know! I will stay here till
I get it.”
 CHAPTER XXII
HUNTLY HILL (continued)

CALLANDAR sat a little apart from his men on the fringe of the fir-
wood; on the other side of the clearing on which the party had
bivouacked Wattie formed the centre of a group. It was past sunset,
and the troop-horses, having been watered and fed, were picketed
together. Callandar’s own horse snatched at the straggling bramble-
shoots behind a tree.
The officer sat on a log, his chin in his hand, pondering on the
amazing story that the beggar had divulged. It was impossible to
know what to make of it, but, in spite of himself, he was inclined to
believe it. He had questioned and cross-questioned him, but he had
been able to form no definite opinion. Wattie had described his
meeting with Archie on the day of the taking of the ship; he had told
him how he had accompanied him on his way, how he had been
forced to ask shelter for him at the farm, how he had lain and
listened in the darkness to his feverish wanderings and his appeals
to Logie. If the beggar’s tale had been true, there seemed to be no
doubt that the intelligence officer whose services were so much
valued by Cumberland, had taken money from the rebels, though it
seemed that he had hesitated over the business. His conscience
must have smitten him even in his dreams. “I will say nothing, but I
will tell you all!” he had cried to Logie. “I shall know where you are,
but they shall never know!” In his delirium, he had taken the beggar
for the man whose fellow-conspirator he was proving himself to be,
and when consciousness was fighting to return, and he had sense
enough to know that he was not speaking to Logie, it was his
companion’s promise to deliver a message of reassurance that had
given him peace and sleep. “Tell him that he can trust me,” he had
said. What puzzled Callandar was the same thing that had puzzled
Wattie: Why had these two men, linked together by a hidden
understanding, fought? Perhaps Flemington had repented of the part
he was playing, and had tried to cut himself adrift. “Let me go!” he
had exclaimed. It was all past Callandar’s comprehension. At one
moment he was inclined to look on Wattie as an understudy for the
father of lies; at another, he asked himself how he could have had
courage to invent such a calumny—how he had dared to choose a
man for his victim who had reached the position that Archie had
gained. But he realized that, had Wattie been inventing, he would
hardly have invented the idea of a fight between Flemington and
Captain Logie. That little incongruous touch seemed to Callandar’s
reasonable mind to support the truth of his companion’s tongue.
And then there was Flemington’s sudden departure. It did not look
so strange since he had heard what the beggar had to say. He
began to think of his own surprise at finding Archie in pain from a
wound which seemed to have troubled him little, so far, and to
suspect that his reliable wits had been stimulated to find a new use
for his injured arm by the sight of Huntly Hill combined with the
news in his pocket. His gorge rose at the thought that he had been
riding all these days side by side with a very prince among traitors.
His face hardened. His own duty was not plain to him, and that
perturbed him so much that his habitual outward self-repression
gave way. He could not sit still while he was driven by his
perplexities. He sprang up, walking up and down between the trees.
Ought he to send a man straight off to Brechin with a summary of
the beggar’s statement? He could not vouch for the truth of his
information, and there was every chance of it being disregarded,
and himself marked as the discoverer of a mare’s nest. There was
scarcely anything more repugnant to Callandar than the thought of
himself in this character, and for that reason, if for no other, he
inclined to the risk; for he had the overwhelmingly conscientious
man’s instinct for martyrdom.
 His mind was made up. He took out his pocket-book and wrote
what he had to say in the fewest and shortest words. Then he called
the corporal, and, to his extreme astonishment, ordered him to ride
to Brechin. When the man had saddled his horse, he gave him the
slip of paper. He had no means of sealing it, here in the fir-wood,
but the messenger was a trusted man, one to whom he would have
committed anything with absolute conviction. He was sorry that he
had to lose him, for he could not tell how long he might be kept on
the edge of the Muir, nor how much country he would have to
search with his tiny force; but there was no help for it, and he
trusted that the corporal would be sent back to him before the
morrow. He was the only person to whom he could give the open
letter. When the soldier had mounted, Callandar accompanied him to
the confines of the wood, giving him instructions from the map he
carried.
Wattie sat on the ground beside his cart; his back was against a
little raised bank. Where his feet should have been, the yellow dog
was stretched, asleep. As Callandar and his corporal disappeared
among the trees, he began to sing ‘The Tod’ in his rich voice,
throwing an atmosphere of dramatic slyness into the words that
made his hearers shout with delight at the end of each verse.
When he had finished the song, he was barely suffered to take
breath before being compelled to begin again; even the prisoner,
who lay resting, still bound, within sight of the soldiers, listened,
laughing into his red beard. But suddenly he stopped, rising to his
feet:

“A lang-leggit deevil wi’ his hand upon the gate,

An’ aye the Guidwife cries to him——”

Wattie’s voice fell, cutting the line short, for a rush of steps was
bursting through the trees—was close on them, dulled by the pine-
needles underfoot—sweeping over the stumps and the naked roots.
The beggar stared, clutching at the bank. His three companions
sprang up.
 The wood rang with shots, and one of the soldiers rolled over on
his face, gasping as he tried to rise, struggling and snatching at the
ground with convulsed fingers. The remaining two ran, one towards
the prisoner, and one towards the horses which were plunging
against each other in terror; the latter man dropped midway, with a
bullet through his head.
The swiftness of the undreamed-of misfortune struck panic into
Wattie, as he sat alone, helpless, incapable either of flight or of
resistance. One of his dogs was caught by the leaden hail and lay
fighting its life out a couple of paces from where he was left, a
defenceless thing in this sudden storm of death. Two of the
remaining three went rushing through the trees, yelping as the
stampeding horses added their share to the danger and riot. These
had torn up their heel-pegs, which, wrenched easily from a
resistance made for the most part of moss and pine-needles, swung
and whipped at the ends of the flying ropes behind the crazy
animals as they dashed about. The surviving trooper had contrived
to catch his own horse, and was riding for his life towards the road
by which they had come from Edzell. The only quiet thing besides
the beggar was the yellow cur who stood at his master’s side, stiff
and stubborn and ugly, the coarse hair rising on his back.
Wattie’s panic grew as the drumming of hoofs increased and the
horses dashed hither and thither. He was more afraid of them than
of the ragged enemy that had descended on the wood. The dead
troopers lay huddled, one on his face and the other on his side; the
wounded dog’s last struggles had ceased. Half a dozen men were
pursuing the horses with outstretched arms, and Callandar’s charger
had broken loose with its comrades, and was thundering this way
and that, snorting and leaping, with cocked ears and flying mane.
The beggar watched them with a horror which his dislike and fear
of horses made agonizing, the menace of these irresponsible
creatures, mad with excitement and terror, so heavy, so colossal
when seen from his own helpless nearness to the earth that was
shaking under their tread, paralyzed him. His impotence enwrapped
him, tragic, horrible, a nightmare woven of death’s terrors; he could
not escape; there was no shelter from the thrashing hoofs, the
gleaming iron of the shoes. The cumbrous perspective of the great
animals blocked out the sky with its bulk as their rocking bodies
went by, plunging, slipping, recovering themselves within the
cramped circle of the open space. He knew nothing of what was
happening, nor did he see that the prisoner stood freed from his
bonds. He knew James Logie by sight, and he knew Ferrier, but,
though both were standing by the red-bearded man, he recognized
neither. He had just enough wits left to understand that Callandar’s
bivouac had been attacked, but he recked of nothing but the
thundering horses that were being chased to and fro as the circle of
men closed in. He felt sick as it narrowed and he could only flatten
himself, stupefied, against the bank. The last thing he saw was the
yellow coat of his dog, as the beast cowered and snapped, keeping
his post with desperate tenacity in the din.
The bank against which he crouched cut the clearing diagonally,
and as the men pressed in nearer round the horses, Callandar’s
charger broke out of the circle followed by the two others. A cry
from the direction in which they galloped, and the sound of frantic
nearing hoofs, told that they had been headed back once more. The
bank was high enough to hide Wattie from them as they returned,
but he could feel the earth shake with their approach, which rang in
his ears like the roar of some dread, implacable fate. He could see
nothing now, as he lay half-blind with fear, but he was aware that his
dog had leaped upon the bank behind him, and he heard the well-
known voice, hoarse and brutal with defiant agony, just above his
head. All the qualities that have gone to make the dog the outcast of
the East seemed to show in the cur’s attitude as he raised himself,
an insignificant, common beast, in the path of the great, noble,
stampeding creatures. It was the curse of his curship that in this
moment of his life, when he hurled all that was his in the world—his
low-bred body—against the danger that swooped on his master, he
should take on no nobility of aspect, nothing to picture forth the
heart that smote against his panting ribs. Another moment and the