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2016
Annual Update
in Intensive Care
and Emergency
Medicine 2016

Edited by J.-L.Vincent

123
Annual Update in Intensive Care and
Emergency Medicine 2016
The series Annual Update in Intensive Care and Emergency Medicine is the con-
tinuation of the series entitled Yearbook of Intensive Care Medicine in Europe and
Intensive Care Medicine: Annual Update in the United States.
Jean-Louis Vincent
Editor

Annual Update in
Intensive Care and
Emergency Medicine 2016
Editor
Prof. Jean-Louis Vincent
Université libre de Bruxelles
Dept. of Intensive Care
Erasme Hospital
Brussels, Belgium
[email protected]

ISSN 2191-5709 ISSN 2191-5717 (electronic)

Annual Update in Intensive Care and Emergency Medicine
ISBN 978-3-319-27348-8 ISBN 978-3-319-27349-5 (eBook)
DOI 10.1007/978-3-319-27349-5

© Springer International Publishing Switzerland 2016

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part
of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or
information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica-
tion does not imply, even in the absence of a specific statement, that such names are exempt from the
relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or
the editors give a warranty, express or implied, with respect to the material contained herein or for any
errors or omissions that may have been made.

Cover design: WMXDesign GmbH, Heidelberg

Printed on acid-free paper

This Springer imprint is published by Springer Nature

The registered company is Springer International Publishing AG Switzerland.
Contents

Common Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Part I Infections and Antibiotics

Interpreting Procalcitonin at the Bedside . . . . . . . . . . . . . . . . . . . . . 3

J. Fazakas, D. Trásy, and Z. Molnár

Reducing Antibiotic Use in the ICU: A Time-Based Approach

to Rational Antimicrobial Use . . . . . . . . . . . . . . . . . . . . . . . . . 15
P. O. Depuydt, L. De Bus, and J. J. De Waele

Plasmacytoid Dendritic Cells in Severe Influenza Infection . . . . . . . . . . 25

B. M. Tang, M. Shojaei, and A. S. McLean

Critically Ill Patients with Middle East Respiratory Syndrome

Coronavirus Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
H. M. Al-Dorzi, S. Alsolamy, and Y. M. Arabi

Part II Sepsis

Immunomodulation: The Future for Sepsis? . . . . . . . . . . . . . . . . . . . 49

T. Girardot, F. Venet, and T. Rimmelé

Norepinephrine in Septic Shock: Five Reasons to Initiate it Early . . . . . 61

M. Jozwiak, X. Monnet, and J.-L. Teboul

Myths and Facts Regarding Lactate in Sepsis . . . . . . . . . . . . . . . . . . 69

M. Nalos, A. S. McLean, and B. Tang

v
vi Contents

Part III Renal Issues

Creatinine-Based Definitions: From Baseline Creatinine

to Serum Creatinine Adjustment in Intensive Care . . . . . . . . . . . 81
S. De Rosa, S. Samoni, and C. Ronco

Detrimental Cross-Talk Between Sepsis and Acute Kidney Injury:

New Pathogenic Mechanisms, Early Biomarkers
and Targeted Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
S. Dellepiane, M. Marengo, and V. Cantaluppi

Timing of Acute Renal Replacement Therapy . . . . . . . . . . . . . . . . . . 111

A. Jörres

(Multiple) Organ Support Therapy Beyond AKI . . . . . . . . . . . . . . . . 117

Z. Ricci, S. Romagnoli, and C. Ronco

Part IV Fluid Therapy

Crystalloid Fluid Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

S. Reddy, L. Weinberg, and P. Young

Part V Bleeding

Emergency Reversal Strategies for Anticoagulants

and Antiplatelet Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
M. Levi

Part VI Cardiovascular System

Bedside Myocardial Perfusion Assessment

with Contrast Echocardiography . . . . . . . . . . . . . . . . . . . . . . . 165
S. Orde and A. McLean

Pathophysiological Determinants of Cardiovascular Dysfunction

in Septic Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
F. Guarracino, R. Baldassarri, and M. R. Pinsky

Cardiovascular Response to ECMO . . . . . . . . . . . . . . . . . . . . . . . . . 185

S. Akin, C. Ince, and D. dos Reis Miranda

Mechanical Circulatory Support in the New Era: An Overview . . . . . . 195

K. Shekar, S. D. Gregory, and J. F. Fraser
Contents vii

Part VII Cardiac Arrest

Cardiac Arrest in the Elderly: Epidemiology and Outcome . . . . . . . . . 219

C. Sandroni, S. D’Arrigo, and M. Antonelli

Regional Systems of Care: The Final Link in the “Chain of Survival”

Concept for Out-of-Hospital Cardiac Arrest . . . . . . . . . . . . . . . . 231
T. Tagami, H. Yasunaga, and H. Yokota

Cardiac Arrest Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

E. L. Riley, M. Thomas, and J. P. Nolan

Part VIII Oxygenation and Respiratory Failure

High-Flow Nasal Cannula Oxygen Therapy: Physiological Effects

and Clinical Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
D. Chiumello, M. Gotti, and C. Chiurazzi

The Potential Value of Monitoring the Oxygen Reserve Index

in Patients Receiving Oxygen . . . . . . . . . . . . . . . . . . . . . . . . . 271
A. Perel

Variable Ventilation from Bench to Bedside . . . . . . . . . . . . . . . . . . . . 281

R. Huhle, P. Pelosi, and M. G. de Abreu

Monitoring Respiratory Effort by Means of the Electrical Activity

of the Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
G. Grasselli, M. Pozzi, and G. Bellani

Dissipated Energy is a Key Mediator of VILI: Rationale for Using

Low Driving Pressures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
A. Serpa Neto, M. B. P. Amato, and M. J. Schultz

Corticosteroids as Adjunctive Therapy in Severe Community-

Acquired Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
C. Cillóniz, A. San José, and A. Torres

Part IX Abdominal Issues

The Neglected Role of Abdominal Compliance

in Organ-Organ Interactions . . . . . . . . . . . . . . . . . . . . . . . . . . 331
M. L. N. G. Malbrain, Y. Peeters, and R. Wise
viii Contents

Part X Metabolic Support

Metabonomics and Intensive Care . . . . . . . . . . . . . . . . . . . . . . . . . . 353

D. Antcliffe and A. C. Gordon

The Rationale for Permissive Hyperglycemia in Critically Ill Patients

with Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
J. Mårtensson and R. Bellomo

Indirect Calorimetry in Critically Ill Patients: Concept, Current Use,

and Future Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
E. De Waele, P. M. Honoré, and H. D. Spapen

Part XI Ethical Issues

Managing Intensive Care Supply-Demand Imbalance . . . . . . . . . . . . . 385

C. C. H. Leung, W. T. Wong, and C. D. Gomersall

Advances in the Management of the Potential Organ Donor

After Neurologic Determination of Death . . . . . . . . . . . . . . . . . . 393
A. Confalonieri, M. Smith, and G. Citerio

Humanizing Intensive Care: Theory, Evidence, and Possibilities . . . . . . 405

S. M. Brown, S. J. Beesley, and R. O. Hopkins

Part XII Applying New Technology

Ultrasound Simulation Education for Intensive Care

and Emergency Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423
F. Clau-Terré, A. Vegas, and N. Fletcher

Virtual Patients and Virtual Cohorts: A New Way to Think About

the Design and Implementation of Personalized ICU Treatments . . 435
J. G. Chase, T. Desaive, and J.-C. Preiser

Part XIII Intensive Care Unit Trajectories: The Bigger Picture

Predicting Cardiorespiratory Instability . . . . . . . . . . . . . . . . . . . . . . 451

M. R. Pinsky, G. Clermont, and M. Hravnak

Long-Term Outcomes After Critical Illness Relevant

to Randomized Clinical Trials . . . . . . . . . . . . . . . . . . . . . . . . . 465
C. L. Hodgson, N. R. Watts, and T. J. Iwashyna
Contents ix

Long-Term Consequences of Acute Inflammation in the Surgical Patient:

New Findings and Perspectives . . . . . . . . . . . . . . . . . . . . . . . . 475
P. Forget

Kairotropy: Discovering Critical Illness Trajectories

Using Clinical Phenotypes with Big Data . . . . . . . . . . . . . . . . . . 483
G. E. Weissman and S. D. Halpern

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497
Common Abbreviations

AKI Acute kidney injury

ARDS Acute respiratory distress syndrome
BMI Body mass index
CAP Community-acquired pneumonia
CI Confidence interval/cardiac index
COPD Chronic obstructive pulmonary disease
CPB Cardiopulmonary bypass
CPR Cardiopulmonary resuscitation
CRP C-reactive protein
CRRT Continuous renal replacement therapy
CT Computed tomography
CVP Central venous pressure
ECMO Extracorporeal membrane oxygenation
EKG Electrocardiogram
ICU Intensive care unit
IL Interleukin
LPS Lipopolysaccharide
LV Left ventricular
MAP Mean arterial pressure
MRI Magnetic resonance imaging
OR Odds ratio
PEEP Positive end-expiratory pressure
PCR Polymerase chain reaction
RCT Randomized controlled trial
RRT Renal replacement therapy
RV Right ventricular
SvO2 Mixed venous oxygen saturation
SOFA Sequential organ failure assessment
TNF Tumor necrosis factor
VILI Ventilator-induced lung injury

xi
 Part I
Infections and Antibiotics
Interpreting Procalcitonin at the Bedside

J. Fazakas, D. Trásy, and Z. Molnár

Introduction

One of the most challenging tasks in critical care medicine is the treatment of seri-
ous infection-related multiple organ dysfunction. Early detection of infection and
the immediate start of resuscitation paralleled with adequate antimicrobial therapy
undoubtedly give the best possible chance for survival and are strongly recom-
mended in the Surviving Sepsis Campaign guidelines [1]. However, although rec-
ognizing organ failure via objective signs is relatively easy, diagnosing infection as
a possible underlying cause remains a challenge. Because of the non-specific prop-
erties of conventional signs of infection, such as body temperature and white blood
cell (WBC) count, biomarkers to aid diagnosis have been looked for for decades.
One of the most studied biomarkers is procalcitonin (PCT) [2]. Its role in assisting
antibiotic therapy has been studied extensively, with contradicting results. There are
positive studies [3, 4] showing that PCT-guided patient management reduced antibi-
otic exposure and length of antibiotic therapy without affecting patient outcomes.
There are also negative studies, which did not show this benefit [5–7]. However, to
understand the values and limitations of inflammatory biomarkers it is necessary to
understand the immunological background of critical illness determined mainly by
the host response. Putting the results of these studies into context, based on new
insights of the pathomechanisms of sepsis and systemic inflammation generated
mainly by the individual’s host response, may help explain the differences between
the reported results and help the clinician to interpret PCT data with more confi-
dence at the bedside.

J. Fazakas
Department of Transplantation and Surgery, Semmelweis University
Budapest, Hungary
D. Trásy ! Z. Molnár (!)
Department of Anesthesiology and Intensive Therapy, University of Szeged
Budapest, Hungary
email: [email protected]

© Springer International Publishing Switzerland 2016 3

J.-L. Vincent (ed.), Annual Update in Intensive Care and Emergency Medicine 2016,
DOI 10.1007/978-3-319-27349-5_1
4 J. Fazakas et al.

Sepsis Is not a ‘Definitive’ Disease

In classical medicine, for example, in most fields of surgery and internal medicine,
after taking a medical history, performing physical examination and diagnostic tests,
the diagnosis is often straightforward, and patients can receive treatment, which is
by-and-large well defined around the world. As examples, in stroke, myocardial in-
farction, bone fractures, intracranial hemorrhage, etc., we have diagnostic tests with
very high sensitivity and specificity. However, defining sepsis is not that simple.
The term “sepsis syndrome” was conceived in a hotel in Las Vegas in 1980, dur-
ing the designing of the protocol of one of the first prospective randomized trials in
sepsis, performed by a group of scientists led by the late Roger Bone [8]. The study
ended with non-significant results, but a statement paper was later published by the
same authors entitled “Sepsis syndrome: a valid clinical entity” [9], after which
medical society started to deal with sepsis as a definitive disease. As a definitive
disease, physicians wanted a single test with high sensitivity and specificity to di-
agnose sepsis, and there was an urge to find an ‘anti-sepsis magic bullet’. Neither
of these wishes has or will ever come true.
Regarding the definition and diagnosis of sepsis, the classical signs of the “sepsis
syndrome”, such as fever/hypothermia, leukocytosis/leukopenia, tachycardia and
hypotension, were met by a very large and non-specific cohort of patients. For this
reason, a consensus conference was convened and defined ‘consensus criteria’ of
sepsis, which have been used for decades in research and clinical practice [10]. In
the most recent Surviving Sepsis Campaign guidelines more robust, more detailed
criteria were used as definition [1], but these were almost immediately questioned
by experts who had also taken part in the Surviving Sepsis Campaign process [11].
These efforts clearly show that finding the appropriate definition of sepsis has
been a continuous challenge for more than 30 years. The difficulty in defining
sepsis originates from its complex pathophysiology, which is affected by numer-
ous individual variations of the host response. Furthermore, in most specialties,
diagnostic laboratory or radiological tests have very high sensitivity and specificity,
often reaching almost 95–100% [12]. However, in the case of sepsis, as we will
see in the subsequent paragraphs, the situation is different, which makes not just
diagnosis, but also interpretation of the results of clinical trials and epidemiological
data very difficult.

From Localized Insult to Cytokine Storm

The immune system is a complex network and the immune response to pathogens
relies on both innate and adaptive components, dynamically defined as the pro-
and anti-inflammatory forces. The innate immune system (including the comple-
ment system, sentinel phagocytic and natural killer cells), is responsible for the
eradication of the invaders, whereas the adaptive immune system’s role is to con-
trol the process and keep it localized to the site of the insult [13]. Under normal
circumstances, these mechanisms remain in balance. The innate system acts by
Interpreting Procalcitonin at the Bedside 5

broad recognition of antigens, mainly by triggering pathogen-associated molecular

patterns (PAMPs) of lipopolysaccharide (LPS) elements of the surfaces of invad-
ing pathogens. When there is an imbalance due to dysregulation of the pro- and
anti-inflammatory forces, the local response escalates into a systemic host response
also termed a “cytokine storm” [14]. It was a surprising finding that after trauma,
burns, ischemia-reperfusion, pancreatitis, major surgery, etc., the same or similar
molecules that are found in PAMPs are released, mainly from the mitochondria of
the injured or stressed cells, and can also cause a cytokine storm. This process ac-
companying tissue injury is called damage-associated molecular patterns (DAMPs).
This similarity is due to the fact that the bacteria and the mitochondria (which are
more-or-less encapsulated bacteria) share very similar genetic backgrounds, and ex-
plains why tissue injury-induced DAMPs and bacterial infection-induced PAMPs
manifest as similar host responses and clinical manifestations [15].

The Role of PCT in Diagnosing Infection

The question “Is this patient septic?” is frequently asked on intensive care unit
(ICU) rounds. However, this may be an irrelevant issue. Why? Because, first,
we should recognize a critically ill patient via objective signs of organ dysfunction,
which determines the immediate start of basic and organ-specific resuscitation, re-
gardless of the actual diagnosis. And, second, what is of pivotal importance is not
that the patient is septic or not, but whether the onset of critical illness is due to in-
fection or not? Because, if it is due to infection, then we should start antibiotics or
perform another form of source control. But if there is no infection, then antibiotic
therapy should not be commenced, because of its undesired effects. Therefore, it is
not ‘sepsis’ that we treat, but organ dysfunction and infection.
Diagnosing infection on the ICU is not easy and requires a multimodal ap-
proach. Clinical signs are obviously the most important in recognizing critical
illness and suspecting infection and even the source of infection, but they cannot
prove it on their own. Conventional indicators, such as fever/hypothermia, leukocy-
tosis/leukopenia, tachypnea, tachycardia, hypotension, taken from the classical sep-
sis-syndrome criteria are non-specific, and in fact poor indicators of infection. To
fill this gap, inflammatory biomarker measurements have been developed [2]. Ev-
ery biomarker has its own merits and limitations, but there is no ‘ideal’ biomarker,
and there may never be one. Biomarkers can support decision-making but they will
never be able to differentiate between the inflammatory response to infection and
the host response to non-infectious insults with 100% sensitivity and specificity be-
cause of the complex, overlapping pathomechanism of PAMPs and DAMPs. This
situation is in sharp contrast with the diagnostic power of certain biomarkers used
in the world of ‘definitive’ diseases, where several laboratory parameters have this
ability. Furthermore, learning how to use biomarkers is not easy either.
The two markers most commonly used in infection/sepsis diagnostics and for
guiding therapeutic interventions are PCT and C-reactive protein (CRP) [2]. One
of the main limitations of CRP is that it moves ‘slowly’, and after a certain insult
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 XIV
The Pleached Alley
The "Pleached Alley," another typical feature of the Elizabethan
garden (from the French plessir, to weave), is nothing more nor less
than a thickly covered walk. In Shakespeare's time this was
constructed of woven boughs and climbing vines and flowers, or a
series of arbors. The old prints and pictures show them to be
complete tunnels of greenery. We can make a pleached alley to-day
by setting up a pergola and smothering it with flowers and vines.
Ironwork arches covered with roses, honeysuckle, and other
creepers will produce the proper effect. A latticework trellis covered
with vines and flowers will, if properly constructed, produce the
appearance of a pleached alley.
When the pleached alley is not used to enclose the garden, then a
brick wall or, still better, a fine hedge should be planted.
 XV
Hedges
Box makes a perfect hedge. The hedge must be clipped at the upper
part narrower than at the base, otherwise the base will become
bare. Privet makes an excellent hedge and so does the Osage
orange, which grows luxuriantly in some parts of the United States.
It is decorative to trim the hedge so that tall pyramids ornament
either side of the gate, or an arch can be made to grow over the
gate. A small lavender hedge is very attractive. Each autumn, after
the flower-spikes have gone, trim plants for the dwarf hedge.
Roses, particularly the sweetbrier, make a charming hedge.
Honeysuckle is another delightful flower for a hedge; and nothing
could be more beautiful than the two combined.
If the rose and honeysuckle hedge is desired, have the carpenter
make a lattice screen of the desired height, or simply construct a
rustic fence and plant the creepers near it and train them so that
they will make a wall of flowers and leaves.
 XVI
Paths
"There is no pleasanter path than that of grass, and even the small
garden ought to have a little grass-walk between the flower borders
and rose beds. It adds immensely to the attractiveness of the garden
and none other is so pleasant to the tread. Constant mowing and
rolling are necessary and the edges must be kept neat and trim; for
while a well-kept grass-path is most attractive of all, its charm is
never fully realized unless it is carefully attended to."[92]
[92] H. H. Thomas.
Gravel-paths must be frequently rolled and the surface of the walk
made a little higher in the center than the sides with a curving
outline, so that water may drain away to the sides.
The brick pathway is capable of much variety. Bricks may be laid in
many patterns; and the little garden, if very small, may be entirely
paved with bricks, leaving the formal flower-beds only of earth. A
fountain or sun-dial looks well in the center.
Flagged pathways are effective in certain garden arrangements. Old
paving-stones are suitable, but they should first be broken up into
irregular pieces.
"Build a good foundation, cover it with a thin layer of sandy loam,
then lay the larger pieces flat on this. Fill the interstices with the
fragments, but leave crevices filled with soil, two inches or so wide,
here and there. Make up a compost of equal parts of loam, sand and
leaf-mould, sweep this over the path and let it settle in the joints.
Many plants can be established in the joints and a pretty effect
obtained."[93]
[93] H. H. Thomas.
Among the plants practical for this purpose are thrift, thyme, and
camomile, and the more they are trodden on the sweeter they smell
and the better they grow.
"The Gardener's Labyrinth" gives three or four feet as the width for
paths between beds and one foot to one foot six inches for the
cross-path.
 XVII
Borders
Borders should not be confused with edgings.
"Border is the name applied to the narrow division of the garden
which usually accompanies each side of a walk. In fact, any bed
which acts as a boundary to a walk or grass-plot, or the main
quarters of a garden may be properly described as a border.
"Flower-borders should be well drained. In plotting them it must be
remembered that if narrow no art will impart to them an air of
boldness. If the pleasure grounds are small, narrow borders are
permissible. All flower-borders should be made in proportion to the
size of the garden and other surroundings. Neatness must be the
presiding deity over flower-borders; and no application of the hoe
and rake, no removal of decayed leaves, no tying up of straggling
members can be too unremitting."[94]
[94] Johnson's "Gardener's Dictionary and Cultural Instructor,"
edited by Fraser and Hemsley (London, 1917).

According to Lawson, the borders "should be roses, thyme, lavender,

rosemary, hyssop, sage and such like and filled with cowslips,
primroses, violets, Daffy-down-dillies, sweet Sissely, Go-to-bed-at-
noon, and all sweet flowers; and, chief of all, with gilliflowers, July-
flowers, commonly called gilliflowers or clove July-flowers (I call
them so because they flower in July); they have the names of cloves
of their scent. I may well call them the King of Flowers (except the
rose). Of all flowers save the Damask Rose they are the most
pleasant to sight and smell."
 XVIII
Edgings
Edging is the material used for dividing beds and borders from the
paths, or grass leading up to the bed, if the bed is alongside a wall,
or terrace, or veranda.
Box is a formal, but charming, edging. "The growth must be
regularly clipped each year. Stretch a line the whole length of the
edging, so as to show the correct height; then cut evenly and neatly
both at top and sides. When relaying, take up the plants, pull them
to pieces and use the strong young growths, which must be clipped
to one level. Box is easily grown and stands pruning with impunity."
Such is the advice of an authority. Another practical gardener says:
"Most amateurs clip box-edgings early in the Spring. This causes an
early growth, which is just in the condition to be nipped by a sharp,
late frost. The safeguard is to delay clipping until the end of August.
Then comes free, healthy growth, which renders box-lined garden
paths cheerful and pleasant to the eye through times of heat and
drought."
Thrift (Armeria) is one of the best edgings as it is green all the year
round and in summer is covered with bright pink flowers. A flower-
lover says:
"Thrift is seen as an edging in many old English gardens. To
preserve its beauty the plants must be lifted, divided and replanted
once in at least four years: a rich even growth is then the reward.
The tufted habit, fresh green growth and rose-purple flowers in
Summer are enjoyable to look at."
Thrift requires frequent trimming.
London-pride (Saxifraga umbrosa) is very pretty when in flower and,
therefore, makes an attractive edging.
Pansies also form a decorative edging for flower beds, large and
small.
Another charming edging is the carnation, especially the white
varieties. The gray-green foliage makes a beautiful border for flower-
beds. Pinks are pretty, too, for bed edgings, and the sweet-william is
also attractive for this purpose.
 XIX
Knots
The knot should occupy a piece of ground from twenty-five to one
hundred feet square. According to "The Gardener's Labyrinth" "the
flower-bed should be kept to the size that the weeder's hands may
well reach into the middest of the bed." The size given in this
manual is twelve feet by six, "each bed raised one foot above the
ground (two feet in marshy ground) and the edge cased in with
short planks framed into square posts with finials at the angles with
intermediate supports." A prettier method, however, is to border the
flower-bed with an edging of box, thrift, pansies, or pinks. This
border outlines the shape of the knot. Within the edging, or border,
"the flowers are all planted in some proportion as near one into
another as it is fit for them, which will give such grace to the garden
that the place will seem like a tapestry of flowers."
It would seem from the hundreds of designs for knots in the old
garden-books that every possible combination of scroll and line and
curve had been exhausted; but ingenious persons liked to invent
their own. Markham tells us that "the pattern of the design cannot
be decided by rule; the one whereof is led by the hops and skips,
turnings and windings of his brain; the other, by the pleasing of his
eye, according to his best fantasie."
Lawson gives the following nine designs for knots:

Cinkfoyle
Flower-de-luce[95]
Trefoyle
Frette
Lozenges
Cross-bow
 Diamond
Oval
Maze.

[95] Fleur-de-lis.
Here the maze is not intended as a labyrinth to walk in, but is a
design for the planting of flowers.
Markham's knots are:

Straight line knots

Diamond knots, single and double
Single knots
Mixed knots
Single impleate of straight line
Plain and mixed
Direct and Circular.

Knots, formed with "a border of box, lavender, or rosemary, are

eighteen inches broad at bottom and clipped so close a level at the
top as to form a table for the housewife to spread clothes to dry on,"
are Lawson's idea.
The old garden books contain many designs for knots, some of
which are astonishingly intricate. Examples occur in Markham's and
Lawson's books and in Didymus Mountain's "Gardener's Labyrinth"
(editions of 1557, 1594, and 1608), which are perfectly practical for
use to-day.
In David Loggan's "Oxonia Illustrata" (Oxford, 1675, folio) several
large plates show formal gardens. Among them New College
Gardens and those of Jesus are extremely interesting. Loggan's
companion book on Cambridge, "Cantabrigia Illustrata" (Cambridge,
1688), has splendid views of architecture and formal gardens with
knots.
Typical flower-beds are also represented in Vredeman de Vries's
"Hortorum Viridariorumque" (Antwerp, 1583) and Crispin de Passe's
"Hortus Floridus" (Arnhem, 1614).
Theobald's as late as 1650 preserved the Tudor arrangement.
"In the great garden are nine large complete squares, or knots, lying
upon a level in the middle of the said garden, whereof one is set
forth with box-borders in the likeness of the King's Arms, one other
plot is planted with choice flowers; the other seven knots are all
grass-knots, handsomely turfed in the intervals, or little walks. A
quickset hedge of white thorn, or privet, cut into a handsome
fashion at every angle, a fair cherry tree and a cypress in the middle
of the knots—also a marble fountain."
 XX
The Rock-Garden
It is well to build a little unostentatious rock-garden in some
appropriate spot where a few flowers, which you may not want in
the beds, can grow. Flowers that find a congenial home in a loosely
arranged pile of rocks and turf are anemones, columbines, thrift,
thyme, rosemary, violets, buttercups, harebells, ferns, fennel, ivy,
myrtle, pansies, and the ragged-robin (gentian).
Select weather-worn stones and pile them carelessly one above
another, placing some of them as shelves. Leave plenty of room for
the earth and let your flowers grow as they please.
 XXI
Flowers
As I do not pretend to be a practical gardener, having had no
experience, I have culled these hints from several authorities,
including E. T. Cook's "The Century Book of Gardening" (London,
1901); Johnson's "Gardener's Dictionary and Cultural Instructor,"
edited by Fraser and Hemsley (London, 1917); H. H. Thomas's "The
Complete Gardener" (London, 1912); and Mabel Cabot Sedgwick's
"The Garden Month by Month" (New York, 1907).
ANEMONE STELLATA requires a sheltered, warm position
and light, sandy soil, well drained. It grows about ten inches high
with star-like flowers, purple, rose-color, and white. Generally
speaking, it requires the same treatment as the tulip. Anemones also
flourish in the rock-garden.

BOX can be grown in almost any soil, but prefers light soil with
gravelly subsoil. See page 297.
BROOM-FLOWER (Cytisus scoparius), a splendid flowering
shrub with yellow flowers of handsome color, succeeds in dry, sandy
places where most other plants fail. It can, therefore, be planted on
rough dry banks. It grows from seed; and this can be sown in any
sheltered place out of doors. Cuttings placed in a frame are also
easy to strike.

CAMOMILE will grow in any garden soil. It is a creeping plant

and grows freely in dense masses. The flowers are white and
blossom from June to August. The height attained is from twelve to
eighteen inches. The foliage is finely divided and has a feathery
appearance. The plant makes a good border, for it loves the sun.
Propagate by division and cuttings. Camomile may be allowed to run
over paving-stones, for it grows when trodden upon.

CARNATIONS. A carnation specialist says:

"A great number of amateur cultivators of the Carnation have an
idea that if they obtain seed from a variety of Carnation, the
seedlings produced from such seed will be reproductions of the
parent plant. This, of course, is wrong, and it is well to mention it.
Now to grow Carnations well they must have a good soil, or the
plants will not produce flowers, or layers, for another season. For the
open garden, I strongly recommend seedlings. The cultivator must
not expect all the flowers to be as good as the parent, or even all
double. There will be from ten to fifteen per cent with single flowers,
all the others having double flowers, some as good as, or even
better than their parents; but the majority will be of uncertain
quantity.

SUNKEN GARDEN, SUNDERLAND HALL, WITH UNUSUAL TREATMENT OF HEDGES

"The seed will germinate in a hothouse well within a week from the
time of sowing, and the seedlings should be pricked out in boxes as
soon as large enough. Plant in good soil and let the plants be fifteen
inches apart and two feet between the rows. Seedlings are not
nearly so particular in regard to soil as-named varieties. The seedling
is more robust; and, given the same cultural conditions, grows more
vigorously. It is always best to dig a trench some time before the
seedling is planted. This admits of the soil being aerated. The plants
should be put out after a shower of good rain. I trench it eighteen
inches deep, put a layer of manure at the bottom and another layer
six or eight inches below the surface.
"A warning is necessary to those unacquainted with the nature of
soils. It will not do to trench up soil that has not been there before.
New subsoil is not adapted to grow anything until it has been well
turned over two or three times and mixed with decayed manure.
"After planting, give a light dressing of manure: it keeps the roots in
better condition and the plant starts more freely into growth.
Carnations must not be left to themselves after planting."
Gilliflowers, pinks, and sweet-williams belong to this family.

COLUMBINES prefer a situation where the roots can obtain

moisture. They also do well and look at home in a rock-garden.
"Gather ripe seeds in July and sow them so that the seedlings are
well established before winter," an authority says. "Such plants will
bloom the next year. Aquilegias often die out after their second year,
although they are classed as perennials, and should therefore be
treated as biennials and raised annually from seed. Seed is produced
in abundance and should be sown as soon as ripe in a shady place
in the garden, or in pans in a cold frame, care being taken to sow
the seed very thinly. When the seedlings are large enough to handle
they should be lifted and planted out in their permanent quarters.
Aquilegias growing in a garden are almost invariably cross-fertilized;
and it is therefore necessary, where more than one variety is in
bloom at the same time, to procure the seed from some other
dependable source."
COWSLIP. This flower needs a rich, light soil, not dry. Its small,
yellow cup-like flowers with ruby spots in the center blossom in the
late April and late May. It grows to six or twelve inches and prefers
half-shade. It must be protected in the winter. Propagate by seed.
Cowslips make a charming border plant and are happy, also, in rock-
gardens.
CROCUS SATIVUS, the beautiful purple flower that blooms in
autumn, should be planted near trees. "The cultivation of the garden
crocus is so simple a matter that the merest novice may plant the
bulbs with the assurance that he, or she, will reap a bright reward in
the near future, provided the burrowing mouse and flower-picking
sparrow do not interfere with nature. Crocuses may be propagated
from seed sown as soon as ripe in light, sandy soil in pans, or pots.
They reach their flowering stage in three years."

CROW-FLOWERS. Some authorities, as we have seen,

identify crow-flowers as the buttercup; others, as Scilla nutans. The
buttercup is easy to raise in almost any soil. As it should be
represented, it is well to put it in the rock-garden. See Harebell.

CROWN-IMPERIAL. This plant, which the people of

Shakespeare's time valued so highly, is rare in our gardens. The
popularity of the flower decreased because of its unpleasant odor;
but no Shakespeare garden can be without at least one
representative because of Perdita's words. The Crown-Imperial is a
very showy plant and makes a splendid effect if planted in groups. It
also looks well among shrubs and in a border. The blossoms appear
in March, April, and May, and are very handsome as to shape and
color. The bell-shaped flowers, orange-red or reddish-orange, droop
gracefully beneath an upright crown of leaves. When the foliage
turns brown, the plant can be cut down. Propagate by offsets in
deep, rich, well-drained soil, and divide every two or three years.
CUCKOO-FLOWERS (Lychnis Flos cuculi), or the Ragged-
Robin, with its deeply cut petals of rich blue, makes a pretty border
plant as it is an abundant bloomer. (See page 214.)
CUPID'S FLOWER. See Pansy.
DAFFODILS do better in half-shade than in full sunlight. The
earlier the buds can be procured and planted the better: August is
none too soon.
"Late planted bulbs must necessarily lose much of their vigor by
being kept out of the ground too long, and the longer the period of
root-growth the stronger the flower-spikes. As regards soil one that
is fairly retentive of moisture is more suited to the requirements than
a light staple that soon dries up. They should be covered to the
depth of one and a half times the depth of the bulb measured from
base to shoulder. A bulb two inches deep can be covered to a depth
of three inches, and so on in proportion. In light soil the bulbs
should be placed a little deeper and in heavy soil not quite so deep."
DAISY. In the spring florists have plenty of English daisies to sell
in little pots. Propagate by seed in spring or division in September.
This daisy is pink and white; the little rays tipped with pink
sometimes almost cover the yellow center. The plant requires rich
soil and plenty of sunshine. It blooms in mid-April to mid-June and
grows to a height of three to six inches. The daisy must be protected
in the winter. It is most desirable for borders and makes a charming
edging.
DIAN'S BUD, Artemesia, or wormwood, is a bushy foliage plant
of small globe-shaped, drooping flowers of whitish yellow. The
leaves are finely divided. Propagate by division. This grows in a poor
soil and likes sunshine.

FENNEL, though regarded as a weed, can be utilized so that it

makes a decorative appearance, for its foliage is light and a brilliant
green. The tiny flowers are yellow and grow in flat-tipped clusters on
branching stalks. They blossom in July. The plant rises to a good
height and prefers rich, deep, open soil and plenty of sunlight. Plant
fresh seeds and make the plants grow in bold groups.

FERNS are effective planted in pots, jars, or tubs, and look well at
the sides of the steps and on the newel-posts of the steps. They
look well in a rock-garden.
FLOWER-DE-LUCE (fleur-de-lis). There are many native
American flags, or irises; but the plants nearest to those described
by Parkinson are the Iris florentina, the Iris pseudacorus, and the
great purple Turkey flag.
The Iris florentina grows from one to two feet, blooms in May and
June, with large, delicately scented white flowers tinted blue and
streaked with purple veins and having orange-yellow beards. The
fragrant rootstock is the orris-root. Propagate by division in soil not
too dry. This is an excellent border plant and prefers half-shade.
Iris pseudacorus grows from one and a half to three feet and
blossoms in late May and late June. It forms luxuriant clumps,
having many stems, which bear large broad-petaled flowers, yellow
veined with brown. The leaves—long, stiff, and gray-green—are
handsome. This is a beautiful plant for the margin of water, and is
very pretty around a bird-bath. Propagate by division. This iris likes
the sun.
The great purple Turkey flag will grow in either sun, or half-shade.
The height is from two to four feet. The large fragrant flowers bloom
in May, June, and July. This iris is very handsome in large groups
and in the border. Propagate by division. It is a gross feeder, but
grows well in any garden soil.
GILLIFLOWERS. See Carnations.
HAREBELL. This lovely jewel of the English woodland has
drooping bell-shaped flowers, fragrant, and blue in color. The bells
hang from tall stems. The leaves are long and grass-like. The height
is from eight to twelve inches. It is bulbous. Propagate by offsets
and give it occasionally a top dressing of manure. Scilla nutans
blooms in May and June and prefers half-shade. There are varieties,
white, pink, and purple.
HOLLY should be used for hedges and ornamental bushes. Some
varieties grow very well in certain parts of the United States.
HONEYSUCKLE grows easily in any garden. It is a luxuriant
creeper and is generous with its blossoms and lavish in fragrance.
Use it for hedges and to climb over walls, arbors, trellises, gates and
wire screens.

IVY. English ivy is a climbing and trailing evergreen sub-shrub,

with beautiful large, dark-green leaves, richly veined, and of graceful
heart-shape. The flowers are inconspicuous, but the berries, almost
jet-black, are decorative. Propagate by half-ripe cuttings in rich,
damp soil and protect in winter. Ivy prefers shade. It blossoms in
June and July.

LADY'S-SMOCK (Cardamine pretensis) will grow in sun, or

shade, but prefers a moist soil. Propagate by division. Its blossoms
are pinkish lilac in terminal clusters and appear in June. The foliage
is deeply cut. Lady's-smocks will grow in rock-gardens and are
excellent border-plants.

LARK'S-HEELS. See Nasturtium.

LARKSPUR is a glorious flower, noble in masses of bloom and
fine in growth, highly decorative, and lasts well besides.
"Delphiniums are very easy to grow and can be planted at almost
any time, but the best seasons are early autumn and spring when
new growth commences. The great point is to plant them in rich
well-dug and manured soil and strew coal-ashes about for the
reason that slugs are very partial to these plants. Ample space must
be left for full development as with age the roots increase greatly, so
that two and a half feet apart is none too much. The plant needs a
rather rich ground, for its growth is strong. Larkspur looks well
planted in the back row of the mixed border."
LAVENDER is a precious, fragrant, hardy bush. Its sweet-
smelling leaves and blue flowers are ever welcome, whether in the
border, or as a low hedge, or standing alone. A very light soil and
sunshine are essential. Propagate by cuttings in early autumn out of
doors in a sheltered, but not shady, place and plant out when
rooted, or divide in March, planting out the rooted slips one foot
apart in light soil. Lavender may be used to beautify walks. Bushes
in some sunny corner of the garden are pretty for picturesque
growth and color. Lavender can be grouped so as to give a touch of
silvery gray to the border. It permits itself to be clipped, and it must
be cared for, or it will grow twisted and gnarled. If flower-spikes are
desired, the lavender must be clipped in autumn; if the gray leaf is
all that is desired then it must be clipped in the spring before the
young twigs have begun to grow.

LILIES. The lily bed should be deep—three feet if possible,—the

soil open and porous without being light. There cannot be a better
material than sound fibrous loam with which leaf-mold has been
mixed. Lilies are rarely benefited by animal manure. The bed should
be sheltered from boisterous winds, for lilies lose half their beauty if
it becomes necessary to stake their graceful stems, and partially
shaded so that the sun does not parch the ground, or prematurely
wither their dainty petals. In times of drought the beds should be
given a copious soaking of an hour or two's duration.
The Madonna Lily is a great favorite and is very effective in small
clumps against a background of shrubs and in borders.
Unfortunately it is subject to disease. It is bulbous. Propagate by
offsets, scales, or very slowly by seed. It likes rich, well-dressed soil
and half-shade. Avoid contact with manure. The Madonna Lily
flowers in June and July with white blossoms.
The Martagon has much reflexed flowers on long spire-like racemes
and is light-purple with darker spots. The Martagon dalmaticum
grows from six to seven feet. It has dark purple flowers. There is
also a white kind. Both are very hardy and succeed in open borders.
The Chalcedonicum, or Scarlet Turk's-Cap, grows from three to four
feet high and has waxy flowers of bright vermilion. This is the
brightest of all lilies. It is very hardy and easy to cultivate.
Lily-of-the-Valley flourishes in the shade and also where there is a
little (but not too much) sunlight. It thrives beneath shade trees and
near a wall. Room for development it must have; otherwise it
becomes crowded to such an extent that the plants deteriorate and
fail to bloom. The Lily-of-the-Valley should be planted in September
or October. Prepare the soil by deep digging and mix in a plentiful
supply of decayed manure. Leaf-soil and road sweepings may be
added to heavy soil. Plant crowns about three inches apart to allow
room for future development. Bury the crowns just below the
surface and make them moderately firm. When all are planted mulch
with rolled manure and leaf-soil in equal parts, covering the bed to a
depth of two inches.

LONG PURPLES. This Arum, being a plant of the woods, does

well in the rock-garden. The best plan is to remove a Jack-in-the-
Pulpit from the woods with some of its native soil and transplant it in
the garden. It grows in shade and sun alike.

MARIGOLD. For marigolds choose a light, dry, poor soil and a

sunny spot. Sow seed any time from February to June. Seeds sown
in the spring will produce flowers in June. Sow in drills ten inches
apart and water moderately. Thin the seedlings and remove into
rows ten inches apart. In rich soil the plant grows too large and fails
to blossom well. H. H. Thomas in "The Complete Gardener" says:
"The ordinary reader understands Marigold to refer to the French,
African and Pot Marigolds. The botanical name Calendula is said to
imply that the plant keeps pace with the calendar. In other words
that it is nearly always in bloom. And really this is not very far from
the truth. Once introduce the Pot Marigold into your garden and you
will rarely be without flowers. It is hardy and seeds itself very freely.
Seed may be sown out of doors where the plants are to bloom,
choosing for preference poor ground, otherwise the plants will grow
freely enough, but blooms will be scarce."
The French marigold is deep yellow, orange, or pale yellow striped or
marked with brown, and crinkled. It grows from twelve to fifteen
inches high. "The Gentleman's Labyrinth" gives quaint instructions
for the growth of the Marigold:
"The seeds of this flower are commonly bestowed in a husbandly
and well-dressed earth, but this rather done by the counsel of the
skilful in the increase of the Moon, whereby the flowers may grow
the bigger and broader. But to procure the flowers to grow the
doubler, bigger and broader the owner ought to remove the plants
and set them in new beds, lying in sunny places herein considering
at those times of removing that the Moon be increasing so nigh as
you can. These, after certain leaves spring up, if they be often
removed and clipped by the course of the Moon, yield a better,
broader and fairer flower, and they yield always more flowers in the
harvest than in the spring time."

MARJORAM is a branching plant with flowers in clusters,

purplish pink. Propagate by seed and division in early spring in any
garden soil. Sweet marjoram must be treated as an annual, for
winter kills it. The leaves are deliciously fragrant and are useful in
cookery.

MINT (Mentha spicata, spearmint) has purplish flowers that bloom

in July and August. These blossoms appear in slender spikes. The
leaves have a pleasant taste and are used for flavoring. Spearmint
will grow in any ordinary soil, but it likes the sun. It grows from one
to two feet high.
Mentha rotundifolia has round leaves, variegated, and pale yellow
flowers that appear in June and July. Propagate by division. The
height is from one to two feet. The flowers are unimportant; but the
foliage is sufficiently interesting to use as an edging, and this variety
is useful to cover waste places.
MONK'S-HOOD has large showy helmet-shaped flowers of
deep purple-blue growing on racemes on erect stems. The leaves
are deeply cut. The plant is suited to borders and rough places.
Propagate by division in rich soil. Monk's-hood likes sun or shade. It
blooms in late summer or early autumn. The roots and flowers are
poisonous. It grows from three to four feet.
MYRTLE (Myrtus latifolia). This plant has charming foliage and
pure white flowers. Both leaves and flowers are fragrant. The
fragrance of the foliage is caused by an oil, which is secreted in the
leaves. Myrtle is quite hardy. Propagate by cuttings, or partially
ripened shoots. Myrtle looks well in large pots.
NASTURTIUM. Tropæolum is the botanical name, meaning
trophy, for the leaves suggest a buckler and the flowers a helmet.
Treat as a hardy annual. Sow seeds in the spring. Nasturtium is a
splendid climber over rocks, stones, or latticework, and a prolific
bloomer.

OXLIP. Propagate by fresh seed, divisions, or cuttings in rich,

light soil, not dry. Protect in winter. The oxlip grows from eight to
twelve inches and likes half-shade. It resembles the primrose, but
has larger flowers. These open in May and are yellow. The leaves
are broad and flat and wrinkled.

PANSY. Heart's-ease and Johnny-Jump-Up are other names for

the Viola tricolor, which has a wonderful length of blossoming, for
the flowers continue from mid-April to mid-September. The flowers
must be constantly picked, or the plant deteriorates. This precious
little plant is very easy to raise, provided it is protected from the
noonday sun. Propagate by seed or division in any garden soil, and
in half-shade or morning sunlight. Protect it from the hot noon-day
sun. Pansies look well in a bed by themselves and make a beautiful
border plant.

PINKS. See Carnations.

POMEGRANATE is a highly decorative shrub, particularly the
beautiful double scarlet variety (Punica rubrum florepleno), which
flowers in August. Plant cutting in a big pot, jar, or tub, or buy
plants. Stand these plants in pairs in some conspicuous place in the
garden and they will add great elegance.

POPPY. The common garden herbaceous poppy flowers in May

and June, in sun or half-shade, rising from two to three feet. It has
large flowers and handsome divided foliage. For a Shakespeare
garden select the white. Propagate by dividing in early autumn. The
poppy is a gross feeder and likes rather moist loam enriched with
cow manure.

PRIMROSE. This flower blooms from mid-April to mid-June. It

has several solitary pale yellow blossoms on naked stem. It grows
from six to nine inches high. Protect in winter. Propagate by seeds
and offsets in rich, light soil, not dry.

ROSE. "How to plant a rose may seem a simple matter, but many
have laid the foundation of failure through bad planting," writes a
rose cultivator. "Never plant in a very wet soil, nor allow crude
manures to come into direct contact with the roots. See that the
roots are spread out properly and naturally, not pressed into a small
hole and cramped or distorted from the first. Plant dwarf kinds two
inches deeper than the junction of the rose and stock, and standards
three inches below the original root. To place a small grower side by
side with one of three or four times the strength is a great mistake;
the weaker grower has no chance whatever. For medium growers
three feet is a good distance, while plants of greater vigor will need
to be from four feet to six feet apart. Do not plant against a wall;
but leave some four or six inches between the wall and the base of
the plant. It should not be difficult to obtain the roses familiar to
Shakespeare. The old Hundred-Leaved and Damask are easy to
procure. The Rosa alba, or white rose, has two familiar varieties
called "Maiden's Blush" and "Madame Plantier."
KNOTS FROM MARKHAM

SIMPLE GARDEN BEDS

The Musk-Rose may give some trouble, but E. T. Cook gives us a
good clue as well as instructions for growing it. He says:
"These are very old roses, certainly known in England three hundred
years ago. The flowers are insignificant individually, but collectively
are pleasing and appear late in August. They require good culture,
and very little, if any, pruning. As pillar roses they are seen at their
best. 'Fringed' is very pretty and strikes freely from cuttings. Its color
is white shaded sulphur. All the Musk-Roses have a peculiar musk-
like odor, but this is distilled only on still damp mornings or evenings.
'Eliza Verry' is white, very free, the flowers appearing in large
corymbs. 'Rivers Musk' is a pretty pink variety, well worth cultivating.
Of the Hybrid Musks the 'Garland' is of rampant growth. It has
immense corymbs of tiny white flowers with innumerable little buff
colored buds, peering out among them. 'Madame d' Arblay' is
another. 'Nivea' is a beautiful kind for a pergola, or fence."
The "Noisette" is also a hybrid musk, named for a French gardener
of Charleston, South Carolina, who took the seed from the musk-
rose in 1817.
There is a difference between the Eglantine, or Sweetbrier, and the
Dog-rose, although they are difficult to distinguish.
"The 'Dog Rose' sends up long arching branches some six to nine
feet high and perhaps more; the 'Sweetbrier' is content with
branches three or four feet in length. And whereas in the 'Dog Rose'
the branch continues single the 'Sweetbrier' sends out side growths,
or branchlets quickly forming a dense bush. Note also the prickles.
To a certain extent they are stout and hooked like those of the 'Dog
Rose,' but more irregularly placed. On the young root-shoots there is
a marked difference, for whilst on the 'Sweetbrier' this young growth
is covered with setæ, some of them very small, tipped with glands,
in the 'Dog Rose' they are totally absent."[96]
[96] Pemberton, "Roses" (London, 1908).

ROSEMARY. Tender, aromatic sub-shrub with small flowers in

short racemes. Propagate by seeds, cuttings, or layers in dry, light
soil. The flowers are purple and bluish. Rosemary is valued in
cookery as a flavoring. It can be allowed to wander all over the
garden. It was always a favorite border-plant in old-fashioned
gardens.

RUE. The "herb of grace" is not very pretty. It has much divided
leaves and panicles of small fragrant flowers, yellowish-green, or
greenish-yellow. Propagate by seed and division. Rue needs a
sheltered position and protection in winter. Its height is about two
feet.

SAVORY. Sow in open ground at the end of March, or early April,

in light, rich soil. Thin the seedlings moderately; they may remain
where they are, or be transplanted. Sown along the outside of beds,
savory makes a good edging. It is useful in cookery.

SWEET BALM. Melissa officinalis is the botanical name. Sweet

balm is loved for its fragrance. The yellowish white flowers bloom in
June, July, and August. It grows about two feet and loves the sun.
Propagate by seed and division.

SWEET-WILLIAM is a valuable little garden plant, for it

blooms profusely in June and July and is vigorous and rapidly
spreading. The flowers are in double clusters, pink, white, red, and
party-colored, single and double. Propagate by seed in any soil. See
Carnations.

THYME. This aromatic herb is of dense growth with small, pale-

lilac flowers in terminal spikes. Its pale, bright-green foliage makes it
an attractive creeper for banks. Thyme also grows well in a rock-
garden and makes a good border-plant also. Propagate by seed and
division. The plant grows in any soil. It attains a height of from one
to two inches and blossoms in June and July. Every one knows the
value of dried thyme for flavoring in cookery.
VIOLETS prefer shady places. They are at home in the rock-
garden, and they are very charming if planted on a little bank. They
can be sown on the grassy slope of a terrace. In that case, let them
come up of their own sweet will. The graceful heart-shaped leaves of
the Viola odorata and its purple blossoms that open in late April and
May are known and loved by every one. Propagate by seed or
division, selecting a loose, rich, sandy soil.
 XXII
Potpourri
As the ladies of Shakespeare's time were so fond of making
potpourri, I think it may be of value to place here an old recipe,
which any one who has a garden can follow:
"Many fragrant flowers and leaves can be used in the making of an
old-fashioned bowl of potpourri. Those usually employed are rose-
petals, lavender, lemon-plant, verbena, myrtle, rosemary, bay,
mignonette, violets, pinks and syringa. Thyme, mint and other sweet
herbs should be used, if available. Shred the larger leaves and dry all
in the sun. Mix an ounce of orris-root, allspice, bay-salt and cloves
and mix freely with about twelve handfuls of the dried petals and
leaves and store in a jar, or bowl. A small quantity of essence of
lemon and spirits of lavender may be added, but are not necessary.
Should the mixture become too moist, add more powdered orris-
root."
 A MASKE OF FLOWERS

I T seems to me that nothing more appropriate could be placed here

as an epilogue to this book on the Shakespeare garden than the
contemporary description of "A Maske of Flowers by the Gentlemen
of Gray's Inn at Whitehall on Twelfth Night, 1613, being the last of
the solemnities and magnificences which were performed at the
marriage of the Earl of Somerset and Lady Frances, daughter of the
Earl of Suffolk, Lord Chamberlain."
This was printed in 1614; and I have quoted it from the "History of
Gardening in England" by the Hon. Alicia Amherst (London, 1895),
who copied it from a very rare original.
This description not only presents a perfect picture of a
Shakespearian garden but will be a revelation to those persons who
think that only crude stage-setting existed in Elizabethan and
Jacobean days. Although elaborate stage-setting was restricted to
private entertainments, the designers of the period knew how to
produce splendid effects. There is nothing more elaborate in the
theater today than this ornate and brilliantly lighted scene:
"When the Dance ended, the loud music sounded. The curtains
being drawn was seen a Garden of a glorious and strange beauty,
cast into four Quarters with a cross-walk and alleys compassing each
Quarter. In the middle of the cross-walk stood a goodly Fountain,
raised on four columns of silver. On the tops whereof strode four
statues of silver which supported a bowl in circuit containing four
and twenty foot and was raised from the ground nine foot in height,
in the middle whereof, upon scrolls of silver and gold, was placed a
globe garnished with four golden mask heads, out of which issued
water into the bowl; above stood a golden Neptune, in height three
foot, holding in his hand a trident.
"The Garden walls were of brick, artificially painted in perspective, all
along which were placed fruit-trees with artificial leaves and fruits.
The Garden within the walls was railed about with rails of three foot
high, adorned with balusters of silver, between which were placed
pedestals beautified with transparent lights of variable colors. Upon
the pedestals stood silver columns, upon the tops whereof were
personages of gold, lions of gold and unicorns of silver. Every
personage and beast did hold a torchet burning, that gave light and
luster to the whole fabric.
"Every Quarter of the Garden was finely hedged about with a low
hedge of cypress and juniper; the Knots within set with artificial
flowers. In the two first Quarters were two Pyramids, garnished with
gold and silver and glittering with transparent lights resembling
carbuncles, sapphires and rubies.
"In every corner of each Quarter were great pots of gilliflowers
which shadowed certain lights placed behind them and made
resplendent and admirable luster. The two farther Quarters were
beautified with tulips of divers colors, and in the middle and in the
corners of the said Quarters were set great tufts of several kinds of
flowers receiving luster from secret lights placed behind them.
"At the farther end of the Garden was a Mount, raised by degrees
resembling banks of earth covered with grass. On the top of the
Mount stood a goodly Arbor, substantially made and covered with
artificial trees and with arbor flowers such as eglantine,
honeysuckles and the like. The Arbor was in length three and thirty
foot, in height one and twenty, supported with termes of gold and
silver. It was divided into six arches and three doors answerable to
the three walks of the Garden.
"In the middle of the Arbor rose a goodly large turret and at either
end a smaller. Upon the top of the Mount in the front thereof was a
bank of flowers, curiously painted behind, while within the arches
the maskers sat unseen.
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