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THE REQUISITES

Emergency
Radiology
SERIES EDITOR OTHER VOLUMES IN THE REQUISITES
RADIOLOGY SERIES
James H. Thrall, MD
Radiologist-in-Chief Emeritus Breast Imaging
Department of Radiology Cardiac Imaging
Massachusetts General Hospital Gastrointestinal Imaging
Distinguished Juan M.Taveras Professor of Radiology Genitourinary Imaging
Harvard Medical School Musculoskeletal Imaging
Boston, Massachusetts Neuroradiology
Nuclear Medicine
Pediatric Radiology
Thoracic Radiology
Ultrasound
Vascular and Interventional Radiology
 THE REQUISITES

Emergency
Radiology
SECOND EDITION
Jorge A. Soto, MD
Professor of Radiology
Department of Radiology
Boston University School of Medicine;
Vice Chairman
Department of Radiology
Boston Medical Center
Boston, Massachusetts

Brian C. Lucey, MD
Associate Professor
Department of Radiology
Boston University School of Medicine
Boston, Massachusetts;
Clinical Director
Department of Radiology
The Galway Clinic
Doughiska, County Galway, Ireland
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899

EMERGENCY RADIOLOGY:THE REQUISITES, SECOND EDITION ISBN: 978-0-323-37640-2

Copyright © 2017 by Elsevier, Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
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With respect to any drug or pharmaceutical products identified, readers are advised to check the
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Previous edition copyright © 2009 by Mosby, Inc., an affiliate of Elsevier, Inc.

Library of Congress Cataloging-in-Publication Data

Soto, Jorge A., editor.

Lucey, Brian C., editor.
Emergency radiology / [edited by] Jorge A. Soto, Brian C. Lucey.
Emergency radiology (Soto) | Requisites in radiology. | Requisites series.
Second edition. | Philadelphia, PA : Elsevier, [2017] | Requisites |Requisites radiology series
Includes bibliographical references and index.
LCCN 2015037285
ISBN 9780323376402 (hardcover : alk. paper)
MESH: Diagnostic Imaging. | Emergency Medical Services.
LCC RC78 | NLM WN 180 | DDC 616.07/572--dc23 LC record available at http://lccn.loc.gov/2015037285

Executive Content Strategist: Robin Carter

Content Development Specialist: Amy Meros
Publishing Services Manager: Patricia Tannian
Project Manager: Stephanie Turza
Senior Book Designer: Amy Buxton

Printed in China

Last digit is the print number: 9 8 7 6 5 4 3 2 1

To my parents, Jorge Sr. and Socorro, for their example and guidance, and to my
wife, Ana, and children, Andrea and Alejandro, for their sustained support and
patience as I devote my time to academic radiology.
J.A.S.

To my parents, James and Anne; sister, Suzanne; wife, Ciara; and son, James.
Thanks for the unconditional support.
B.C.L.
This page intentionally left blank

     
Contributors
Carlos A. Anaya, MD Ana Maria Gomez, MD
Medical Director Department of Radiology
Cardiovascular Interventional Institute Manati Medical Center
Department of Radiology Manati, Puerto Rico
Manati Medical Center
Manati, Puerto Rico Rathachai Kaewlai, MD
Instructor
Stephan W. Anderson, MD Division of Emergency Radiology
Associate Professor of Radiology Department of Diagnostic and Therapeutic Radiology
Boston University Medical Center Ramathibodi Hospital
Boston, Massachusetts Faculty of Medicine
Mahidol University
Laura L. Avery, MD Bangkok,Thailand
Assistant Professor
Massachusetts General Hospital Russ Kuker, MD
Harvard Medical School Department of Radiology
Boston, Massachusetts University of Miami Hospital
Miami, Florida
Glenn D. Barest, MD
Assistant Professor of Radiology Christina A. LeBedis, MD
Boston Medical Center Assistant Professor
Boston, Massachusetts Boston University Medical Center
Boston, Massachusetts
Sarah D. Bixby, MD
Assistant Professor of Radiology Brian C. Lucey, MD
Harvard Medical School; Associate Professor
Pediatric Radiologist Department of Radiology
Department of Radiology Boston University School of Medicine
Boston Children’s Hospital Boston, Massachusetts;
Boston, Massachusetts Clinical Director
Department of Radiology
Anna K. Chacko, MD The Galway Clinic
Adjunct Professor of Radiology Doughiska, County Galway, Ireland
Boston University
Boston, Massachusetts; Asim Z. Mian, MD
Professor of Telemedicine Assistant Professor of Radiology
John A. Burns School of Medicine Boston Medical Center
University of Hawaii Boston University
Honolulu, Hawaii Boston, Massachusetts

Margaret N. Chapman, MD Sarah S. Milla, MD

Chief of Neuroradiology Associate Professor
Boston VA Healthcare System; Department of Radiology and Imaging Sciences
Assistant Professor of Radiology Emory University;
Boston Medical Center Attending Pediatric Radiologist and Neuroradiologist
Boston University School of Medicine Children’s Healthcare of Atlanta
Boston, Massachusetts Egleston Hospital
Atlanta, Georgia
Luis E. Diaz, MD
Associate Chief of Radiology Felipe Munera, MD
VA Boston Health Care System; Department of Radiology
Associate Professor of Radiology University of Miami Hospital
Boston University Miami, Florida
Boston, Massachusetts
Rohini N. Nadgir, MD
Alejandra Duran-Mendicuti, MD Assistant Professor of Radiology and Radiological Science
Department of Radiology Johns Hopkins Medical Institutions
Brigham and Women’s Hospital Baltimore, Maryland
Boston, Massachusetts
vii
viii Contributors

Osamu Sakai, MD, PhD Joshua W. Stuhlfaut, MD

Chief of Neuroradiology Beth Israel Deaconess Hospital
Professor of Radiology, Otolaryngology–Head and Neck Plymouth, Massachusetts
Surgery and Radiation Oncology
Boston Medical Center Jennifer C. Talmadge, MD
Boston University School of Medicine Department of Radiology
Boston, Massachusetts Children’s Hospital Boston
Boston, Massachusetts
Rashmikant B. Shah, MD
Diagnostic Radiology Salvatore G. Viscomi, MD
St. James Healthcare Clinical Instructor
Butte, Montana Harvard Medical School;
Attending Radiologist
Ajay Singh, MD Department of Radiology
Department of Radiology Brigham and Women’s Hospital
Massachusetts General Hospital Boston, Massachusetts;
Boston, Massachusetts Chairman
Department of Radiology
Aaron D. Sodickson, MD, PhD Cape Cod Hospital
Department of Radiology Hyannis, Massachusetts
Brigham and Women’s Hospital
Boston, Massachusetts Scott White, MD
Department of Radiology
Jorge A. Soto, MD Brigham and Women’s Hospital
Professor of Radiology Boston, Massachusetts
Department of Radiology
Boston University School of Medicine; Ryan T. Whitesell, MD
Vice Chairman St. Paul Radiology
Department of Radiology Regions Hospital
Boston Medical Center St. Paul, Minnesota
Boston, Massachusetts

Michael Stella, MD
Department of Radiology
Brigham and Women’s Hospital
Boston, Massachusetts
Foreword
Time passes quickly, and it is now time to introduce the THE REQUISITES books have become old friends to
second edition of Emergency Radiology: THE REQUI- imagers for over 25 years. We have tried to remain true
SITES. Drs. Soto and Lucey, along with their coauthors, to the original philosophy of the series, which was to pro-
have once again created an excellent text that captures vide residents, fellows, and practicing radiologists with
the fundamental building blocks of emergency radiology a text that might be read within several days. From feed-
practice. back I have received, many residents do exactly that at
Drs. Soto and Lucey have maintained the logical division the ­beginning of each rotation. During first rotations this
of their book by both body part and indication—trauma ­allows them to acquire enough knowledge to really ben-
versus nontrauma with separate chapters for special con- efit from their day-to-day exposure to clinical material and
siderations in children and for nuclear medicine applica- the conditions about which they have just read. During
tions.This allows the reader of Emergency Radiology: THE subsequent rotations, a rereading imprints the knowledge
REQUISITES to go immediately to the material of interest. they will need subsequently for upcoming certification
As a side note, only two or so decades ago, nontrauma emer- exams. For the practicing radiologist, it serves as a useful
gency patients were not imaged nearly as often as they are refresher, like a booster shot.At the workstation, the books
today.Today, emergency applications for the nontrauma pa- in THE REQUISITES series are useful as a first reference
tient are just as important as the historic role of imaging source and guide to differential diagnosis.
in trauma. Imaging is truly the “guiding hand” of medical THE REQUISITES books are not intended to be exhaus-
practice, making possible rapid diagnosis, triage, and dispo- tive. There are other large reference books to catalog rare
sition, which are vitally important given the time and re- and unusual cases and to present different sides of con-
source constraints faced by busy emergency departments. troversies. Rather, THE REQUISITES books are intended
In the years between the preparation of the first edition to provide information on the vast majority of conditions
and the current work, much has happened to enhance that radiologists see every day, the ones that are at the core
the role of radiology in the emergency department and of radiology practice. In fact, one of the requests to authors
to reshape our thinking. These changes affect every area is to not look up anything they do not know but to put
of application and include, among many others, optimiza- in the book what they teach their own residents at the
tion of computed tomographic (CT ) protocols in every workstation. Since the authors are experienced experts in
organ system for lower radiation exposure, taking advan- their respective areas, this is predictably the most impor-
tage of fast CT scanning capabilities to reduce contrast us- tant material.
age and an increasing appreciation for the potential roles Drs. Soto and Lucey and their coauthors have again
of MRI for both traumatic and nontraumatic indications. done an outstanding job in sustaining the philosophy
Conventional radiography continues to play an important and excellence of THE REQUISITES series and deserve
role, especially for extremity trauma and some thoracic congratulations. Their book reflects the contemporary
imaging applications such as pneumonia and congestive practice of emergency imaging and should serve radiolo-
heart failure. However, for most applications, radiography gists, emergency medicine specialists, and other physi-
is being inexorably replaced by cross-sectional imaging. cians who deal with emergencies as a concise and useful
Drs. Soto and Lucey have again assembled an outstand- foundation for understanding the indications for imaging
ing team of coauthors to help ensure that Emergency and the significance of imaging findings in the emergency
Radiology: THE REQUISITES is as up to date as possible. setting.
Thanks to all the authors for their contributions.
Each chapter presents a different challenge in present- James H. Thrall, MD
ing material. All share a rich opportunity for illustrations, Chairman Emeritus
and Emergency Radiology: THE REQUISITES is extremely Department of Radiology
well illustrated. Otherwise the use of outline lists, boxes, Massachusetts General Hospital
and tables has been dictated by the material requiring Distinguished Taveras Professor of Radiology
presentation. Harvard Medical School

ix
This page intentionally left blank

     
Preface
Emergency Radiology is a unique title in THE REQUI- including CT angiography in the emergency department
SITES series. Although both the organ system–based and for coronary, aorta, brain/neck, visceral, and extremity ar-
modality-based divisions of radiology have existed for
­ teries, updated CT protocols in trauma and nontraumatic
some time, this REQUISITES title is the first to embrace a emergencies, and new and better quality images obtained
multimodality, multisystem approach to radiology. There with the latest imaging technology. Stepping away from
is an ongoing paradigm shift in medical management over the organ- and modality-based divisions, we acknowledge
the past 25 years or so, away from inpatient-oriented health that there is potential for overlap among this text and
care toward an increasingly outpatient-based system. No- others in THE REQUISITES series. However, to avoid this,
where is this more apparent than in emergency depart- we have endeavored to confine the text to medical and
ments across the United States and around the world. The surgical conditions that commonly present through the
reliance on imaging for diagnosis and guiding management emergency department rather than including every imag-
decisions throughout medicine has been increasing, and ing possibility that may present. We apologize in advance
this is exemplified in the emergency setting. All imaging if any overlap is identified—it was included for complete-
modalities are available to the emergency physician. More ness—or for any deficiencies; some rare entities may have
than in any other modality, the massive increase in the use been omitted for the sake of brevity.The fundamental divi-
of computed tomograpy (CT ) has led to the development sion of the book is in two parts, one dealing with acute
and growth of the specialty of emergency radiology. The trauma and the other with nontraumatic acute processes,
value of CT in the setting of trauma, investigation of severe and the division of the chapters reflects this. This makes it
headache, abdominal pain, and the evaluation of patients possible to easily select those chapters relevant to an in-
with suspected pulmonary embolus forms the bedrock of dividual radiology practice. Some departments, especially
emergency imaging, although there is an increasing role large academic departments with residency programs, will
for MR and ultrasound imaging in the emergency setting, have trauma units, whereas some community practices
particularly for the rapid evaluation of musculoskeletal in- may run an emergency department without dealing with
jury and emergent neurologic evaluation. The book is an acute trauma.
attempt to collate all the radiology information required We are pleased with how this revision has developed
in today’s emergency department setting into one suc- from an abstract concept into reality and built upon the
cinct, practical, and current text that can be used by both first edition. It has taken substantial effort, and we fully ap-
residents in training and general radiologists in practice, preciate the contributions from the authors, all of whom
as well as emergency department physicians and trauma have considerable experience in emergency imaging. We
surgeons. hope that the revision will be as well received as the first
The goal of this revision is to provide updates to address edition and will act as an integral resource for all radiology
the rapid changes in emergency imaging requirements, departments and training programs.

xi
This page intentionally left blank

     
Acknowledgments
We would like to thank many people who helped trans- are experienced radiologists with extensive knowledge
form the concept of this book into a reality. First, we owe in the various aspects of emergency radiology. Each au-
thanks to innumerable individuals (staff, residents, fel- thor has added his or her own subspecialty e­xpertise
lows, technologists, and nurses) at the Boston University to the chapters, which has resulted in the final product,
Medical Center who helped us and our colleagues build a textbook that we believe they should all be proud of.
multidisciplinary groups for the care of the acutely ill Finally, thanks to all the staff at Elsevier, especially Amy
patient. This was the principal driving force behind our Meros and Robin Carter, who waited patiently for us to
growing interest in the field of emergency ­radiology. We deliver the various parts of the book, sometimes at a
would also like to thank Dr. James Thrall for insisting on slower-than-hoped-for pace.
the timeliness and necessity of this text to add to THE J.A.S.
REQUISITES series. We would also like to extend a sin- B.C.L.
cere thank you to the contributing authors, all of whom

xiii
This page intentionally left blank

     
Contents
Chapter 1 Chapter 8
Traumatic and Nontraumatic Emergencies of the Nontraumatic Emergency Radiology of the
Brain, Head, and Neck 1 Thorax 243
Glenn D. Barest, Asim Z. Mian, Rohini N. Nadgir, and Osamu Sakai Alejandra Duran-Mendicuti, Scott White, Salvatore G. Viscomi,
Michael Stella, and Aaron D. Sodickson
Chapter 2
Chest Trauma 61 Chapter 9
Ryan T. Whitesell and Laura L. Avery Nontrauma Abdomen 281
Stephan W. Anderson, Brian C. Lucey, and Jorge A. Soto
Chapter 3
Abdomen Trauma 81 Chapter 10
Joshua W. Stuhlfaut, Christina A. LeBedis, and Jorge A. Soto Pelvic Emergencies 316
Brian C. Lucey
Chapter 4
Extremity Trauma 115 Chapter 11
Rathachai Kaewlai and Ajay Singh Vascular Emergencies 327
Russ Kuker, Carlos A. Anaya, Ana Maria Gomez, and Felipe Munera
Chapter 5
Extremities: Nontrauma 165 Chapter 12
Luis E. Diaz Emergency Nuclear Radiology 369
Anna K. Chacko and Rashmikant B. Shah
Chapter 6
Imaging Evaluation of Common Pediatric Index 395
Emergencies 186
Jennifer C. Talmadge, Sarah S. Milla, and Sarah D. Bixby

Chapter 7
Traumatic and Nontraumatic Spine
Emergencies 221
Glenn D. Barest and Margaret N. Chapman

xv
This page intentionally left blank

     
THE REQUISITES

Emergency
Radiology
This page intentionally left blank
     
Chapter 1
Traumatic and Nontraumatic
Emergencies of the Brain,
Head, and Neck
Glenn D. Barest, Asim Z. Mian, Rohini N. Nadgir, and Osamu Sakai

Imagine you are asked to create a list of the disorders of to study the other volumes in the Requisites series (es-
the brain, head, and neck that one might commonly expect pecially Neuroradiology, Musculoskeletal Imaging, and
to encounter at an emergency department (ED) and de- Pediatric Radiology), which cover this material in great
scribe the typical imaging features. At first, this challenge detail. In this attempt at condensing so much material
seems straightforward enough. However, upon beginning into one useful volume, important topics inevitably have
the task, it soon becomes clear that almost every disorder been neglected. We hope that this volume can serve as
within the realm of neuroradiology/head and neck radi- a starting point for further study and become a valuable
ology might at one time or another present as an acute reference to on-call radiologists, emergency department
emergency. Inclusion of certain diagnoses such as stroke, physicians, and residents of both specialties.
fractures, and epiglottitis is a must. Other diagnoses, such
as oligodendroglioma or perhaps a slowly growing le- INTRACRANIAL HEMORRHAGE AND
sion, might seem less clear-cut. Ultimately, it is important TRAUMATIC BRAIN INJURY
to realize that a wide variety of processes will result in
an alteration in mental status leading to an ED visit, with Whether in the setting of head trauma, spontaneous de-
imaging playing a key role in diagnosis and appropriate velopment of headache, or alteration of mental status, the
management. ability to diagnose intracranial hemorrhage (ICH) is of
Upon admission, inpatient workups now occur on a primary importance for all practitioners. These presenta-
24/7 basis, with many complex examinations completed tions are some of the most common indications for brain
during the night shift. On-call radiologists (often residents imaging in the emergency setting. Almost invariably, the
or fellows) are expected to provide “wet readings” or requisition will read, “Rule out bleed.” An understanding
complete interpretations for complex cases covering the of traumatic and nontraumatic causes of ICH, the usual
full spectrum of medicine, pediatrics, surgery, and related workup, and recognition of ICH is therefore important
subspecialties. It was not that many years ago that the ra- and seems like a natural starting point. A discussion of the
diologist was faced with a seemingly never-ending stack important types of mass effect resulting from ICH and
of plain films from the ED, inpatient wards, and intensive traumatic brain injury is also included in this section. An
care units requiring rapid interpretations. This work was understanding of hemorrhage and herniation syndromes
interrupted by an occasional computed tomography (CT) is central to the discussion of other topics that follow, such
scan. In this new millennium, during a typical shift the radi- as stroke and neoplasms.
ologist must maintain a rapid pace to review thousands of The word hemorrhage has Greek origins: the prefix
cross-sectional CT and magnetic resonance images (MRI) haima-, meaning “blood,” and the suffix -rrhage, meaning
with two-dimensional (2D) and three-dimensional (3D) re- “to gush or burst forth.” Incidence of ICH is approximate-
formats. For this reason, the majority of the discussion and ly 25 to 30 per 100,000 adults in the United States, with a
most of the examples in this chapter are based on these higher incidence in elderly hypertensive patients. ICH is
modalities and the latest techniques. typically more common in the African American and Asian
The most daunting part of preparing this chapter was populations. Bleeding may take place within the substance
to boil down all of the disorders and details to a set of req- of the brain (intraaxial) or along the surface of the brain
uisites. Division of this chapter into sections is not quite (extraaxial). Intraaxial hemorrhage implies parenchymal
as neat as one might think. For example, it is not possible hemorrhage located in the cerebrum, cerebellum, or brain-
to separate the vascular system from discussion of the stem. Extraaxial hemorrhages include epidural, subdural,
brain, head and neck, or spine, and the imaging methods and subarachnoid hemorrhages, and intraventricular hem-
applied to the extracranial vessels in the setting of stroke orrhage can be considered in this group as well. Hem-
are similar to those used for blunt or penetrating trauma orrhages can lead to different types of brain herniation,
to the neck. One may therefore notice mention of similar from direct mass effect and associated edema or develop-
techniques and findings in several places with examples ment of hydrocephalus, causing significant morbidity and
appropriate to the context. All readers would do well mortality.
1
2 Chapter 1 Traumatic and Nontraumatic Emergencies of the Brain, Head, and Neck

TABLE 1-1 Usual Magnetic Resonance Signal Characteristics of Hemorrhage

Stage Time Component T1 T2

Hyperacute (0-12 h) Oxyhemoglobin Isointense Hyperintense

Acute (12 h-3 days) Deoxyhemoglobin Isointense Hypointense
Early subacute (3-7 days) Methemoglobin Hyperintense Hypointense
(intracellular)
Late subacute (1 wk-1 mo) Methemoglobin Hyperintense Hyperintense
(extracellular)
Chronic (>1 mo) Hemosiderin Hypointense Hypointense

General Imaging Characteristics of the injury. Although it is beyond the scope of this
of Hemorrhage chapter, a description of the physics of the signal char-
acteristics of blood products on MRI is generally based
The appearance of ICH on a CT scan can vary depending on the paramagnetic effects of iron and the diamagnetic
on the age of the hemorrhage and the hemoglobin level. effects of protein in the hemoglobin molecule. The usual
The attenuation of blood is typically based on the protein signal characteristics of hemorrhage and the general time
content, of which hemoglobin contributes a major por- course over which hemorrhages evolve are summarized
tion. Therefore the appearance of hyperacute/acute blood in Table 1-1.
is easily detected on a CT scan in patients with normal
hemoglobin levels (approximately 15 g/dL) and typically EXTRAAXIAL HEMORRHAGE
appears as a hyperattenuating mass. This appearance is
typical because, immediately after extravasation, clot for- Extraaxial hemorrhage occurs within the cranial vault but
mation occurs with a progressive increase in attenuation outside of brain tissue. Hemorrhage can collect in the epi-
over 72 hours as a result of increased hemoglobin concen- dural, subdural, or subarachnoid spaces and may be trau-
tration and separation of low-density serum. On the other matic or spontaneous. It is important to recognize these
hand, in anemic patients with a hemoglobin level less than entities because of their potential for significant morbidity
10 g/dL, acute hemorrhage can appear isoattenuating to and mortality. Poor clinical outcomes are usually the result
the brain and can make detection difficult. Subsequently, of mass effect from the hemorrhage, which can lead to
after breakdown and hemolysis, the attenuation of the clot herniation, increased intracranial pressure, and ischemia.
decreases until it becomes nearly isoattenuating to cere- Intraventricular hemorrhage will be considered with these
brospinal fluid (CSF) by approximately 2 months. In the other types of extracerebral hemorrhage.
emergency setting, one should be aware of the “swirl” sign
with an unretracted clot that appears to be hypoattenuat-
Epidural Hemorrhage
ing and resembles a whirlpool; this sign may indicate ac-
tive bleeding and typically occurs in a posttraumatic set- Epidural hematoma is the term generally applied to a
ting. It is important to recognize this sign, because prompt hemorrhage that forms between the inner table of the cal-
surgical evacuation may be required. The amount of mass varium and the outer layer of the dura because of its mass-
effect on nearby tissues will depend on the size and loca- like behavior. More than 90% of epidural hematomas are
tion of the hemorrhage, as well as the amount of second- associated with fractures in the temporoparietal, frontal,
ary vasogenic edema that develops. and parieto-occipital regions. CT is usually the most effi-
Use of an intravenous contrast agent usually is not nec- cient method for evaluation of this type of hemorrhage.An
essary for CT detection of ICH. If a contrast agent is used, epidural hematoma typically has a hyperdense, biconvex
an intraaxial hemorrhage can demonstrate an enhancing appearance. It may cross the midline but generally does
ring that is usually due to reactive changes and formation not cross sutures (because the dura has its attachment at
of a vascularized capsule, which typically occurs 5 to 7 the sutures), although this might not hold true if a fracture
days after the event and can last up to 6 months. Subacute disrupts the suture. Epidural hematomas usually have an
and chronic extraaxial hematomas also can demonstrate arterial source, commonly a tear of the middle meningeal
peripheral enhancement, usually because of reactive artery, and much less commonly (in less than 10% of cases)
changes and formation of granulation tissue. Unexpected a tear of the middle meningeal vein, diploic vein, or ve-
areas of enhancement should raise concern, because ac- nous sinus (Figs. 1-1 and 1-2). The classic clinical presenta-
tive bleeding can appear as contrast pooling. Refer to the tion describes a patient with a “lucid” interval, although
section on aneurysms and vascular malformations in this the incidence of this finding varies from 5% to 50% in the
chapter for a discussion of CT angiography in the setting literature. Prompt identification of an epidural hematoma
of acute ICH. is critical, because evacuation or early reevaluation may
MRI has greatly revolutionized the evaluation of ICH. be required. Management is based on clinical status, and
The evolution of hemorrhage from the hyperacute to therefore alert and oriented patients with small hemato-
the chronic stage will have corresponding signal chang- mas may be safely observed. The timing of follow-up CT
es on T1-weighted images (T1WIs), T2-weighted images depends on the patient’s condition, but generally the first
(T2WIs), fluid-attenuated inversion recovery (FLAIR) im- follow-up CT scan may be obtained after 6 to 8 hours and,
ages, and gradient-echo sequences. These properties can if the patient is stable, follow-up may be extended to 24
assist in detection and understanding of the time course hours or more afterward.
 Another Random Document on
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again invaded France with an army of sixty thousand men. He went
through the south of the country.
 EDWARD THE THIRD 1 75 burning and plundering
wheresoever he went ; while his father, who had still the tScottish
war upon his hands, did the like in Scotland, but was harassed and
worried in his retreat from that country by the Scottish men, who
repaid his cruelties with interest. The French King, Philip, was now
dead, and was succeeded by his son John. The Black Prince, called
by that name from the colour of the armour he wore to set off his
fair complexion, continuing to burn and destroy in France, roused
John into determined opposition ; and so cruel had the Black Prince
been in his campaign, and so severely had the French peasants
suffered, that he could not find one who, for love, or money, or the
fear of death, would tell him what the French King was doing, or
where he was. Thus it happened that he came • upon the French
King's forces, all of a sudden, near the town of Poitiers, and found
that the whole neighbouring country was occupied by a vast French
army. " God help us ! " said the Black Prince, '• we must make the
best of it." So, on a Sunday morning, the eighteenth of September,
the Prince — whose army was now reduced to ten thousand men in
all — prepared to give battle to the French King, who had sixty
thousand horse alone. While he was so engaged, there came riding
from the French camp, a Cardinal, who had persuaded John to let
him offer terms, and try to save the shedding of Christian blood.
"Save my honour," said the Prince to this good priest, " and save the
honour of my army, and I will make any reasonable terms." He
offered to give up all the towns, castles, and prisoners, he had
taken, and to swear to make no war in France for seven years ; but,
as John would hear of nothing but his surrender, with a hundred of
his chief knights, the treaty was broken off, and the Prince said
quietly — "God defend the right; we shall fight to-morrow."
Therefore, on the Monday morning, at break of day, the two armies
prepared for battle. The English were posted in a strong place,
which could only be approached by one narrow lane, skirted by
hedges on both sides. The French attacked them by this lane ; but
were so galled and slain by English arrows from behind the hedges,
that they were forced to retreat. Then went six hundred English
bowmen round about, and, coming upon the rear of the French
army, rained arrows on them thick and fast. The French knights,
 176 A CHILD'S HISTORY OF ENGLAND thrown into
confusion, quitted their banners and dispersed in all directions. Said
Sir John Chandos to the Prince, " Ride forward, noble Prince, and the
day is yours. The King of France is so valiant a gentleman, that I
know he will never fly, and may be taken prisoner." Said the Prince
to this, ''Advance, English banners, in the name of God and St.
George ! " and on they pressed until they came up with the French
King, fighting fiercely with his battle-axe, and, when all his nobles
had forsaken him, attended faithfully to the last by his youngest son
Philip, only sixteen years of age. Father and son fought well, and the
King had already two wounds in his face, and had been beaten
down, when he at last delivered himself to a banished French knight,
and gave him his right-hand glove in token that he had done so. The
Black Prince was generous as well as brave, and he invited his royal
prisoner to supper in his tent, and waited upon him at table, and,
when they afterwards rode into London in a gorgeous procession,
mounted the French King on a fine cream-coloured horse, and rode
at his side on a little pony. This was all very kind, but I think it was,
perhaps, a little theatrical too, and has been made more meritorious
than it deserved to be ; especially as I am inclined to think that the
greatest kindness to the King of France would have been not to have
shown him to the people at all. However, it must be said, for these
acts of politeness, that, in course of time, they did much to soften
the horrors of war and the passions of conquerors. It was a long,
long time before the common soldiers began to have the benefit of
such courtly deeds ; but they did at last ; and thus it is possible that
a poor soldier who asked for quarter at the battle of Waterloo, or
any other such great fight, may have owed his life indirectly to
Edward the Black Prince. At this time there stood in the Strand, in
London, a palace called the Savoy, which was given up to the
captive King of France and his son for their residence. As the King of
Scotland had now been King Edward's captive for eleven years too,
his success was, at this time, tolerably complete. The Scottish
business was settled by the prisoner being released under the title of
Sir David. King of Scotland, and by his engaging to pay a large
ransom. The state of France encouraged England to propose harder
terms to that country, where the people
 EDWARD THE THIRD 1 77 rose against the unspeakable
cruelty and barbarity of its nobles ; where the nobles rose in turn
against the people ; where the most frightful outrages were
committed on all sides ; and where the insurrection of the peasants,
called the insurrection of the Jacquerie, from Jacques, a common
Christian name among the country people of France, awakened
terrors and hatreds that have scarcely yet passed away. A treaty
called the Great Peace, was at last signed, under which King Edward
agreed to give up the greater part of his conquests, and King John
to pay, within six years, a ransom of three million crowns of gold. He
was so beset by his own nobles and courtiers for having yielded to
these conditions — though they could help him to no better — that
he came back of his own will to his old palaceprison of the Savoy,
and there died. Thei'e was a Sovereign of Castile at that time, called
Pedro the Cruel, who deserved the name remarkably well : having
committed, among other cruelties, a variety of murders. This
amiable monarch being driven from his throne for his crimes, went
to the province of Bordeaux, where the Black Prince — now married
to his cousin Joan, a pretty widow — was residing, and besought his
help. The Prince, who took to him much more kindly than a prince of
such fame ought to have taken to such a ruffian, readily listened to
his fair promises, and agreeing to help him, sent secret orders to
some troublesome disbanded soldiers of his and his father's, who
called themselves the Free Companions, and who had been a pest to
the French people, for some time, to aid this Pedro. The Prince,
himself, going into Spain to head the army of relief, soon set Pedro
on his throne again — where he no sooner found himself, than, of
course, he behaved like the villain he was, broke his word without
the least shame, and abandoned all the pi'omises he had made to
the Black Prince. Now, it had cost the Prince a good deal of money
to pay soldiers to support this murderous King ; and finding himself,
when he came back disgusted to Bordeaux, not only in bad health,
but deeply in debt, he began to tax his French subjects to pay his
creditoi-s. They appealed to the French King, Charles ; war again
broke out; and the French town of Limoges, which the Prince had
greatly benefited, went over to the French King. Upon this he
ravaged the province of which it was the capital ; burnt, and
plundered, and
 178 A CHILD'S HISTORY OF ENGLAND killed in the old
sickening way ; and refused mercy to the prisoners, men, women,
and children taken in the offending town, though he was so ill and
so much in need of pity himself from Heaven, that he was carried in
a litter. He lived to come home and make himself popular with the
people and Parliament, and he died on Trinity Sunday, the eighth of
June, one thousand three hundred and seventy-six, at forty-six years
old. The whole nation mourned for him as one of the most
renowned and beloved princes it had ever had ; and he was buried
with great lamentations in Canterbury Cathedral. Near to the tomb
of Edward the Confessor, his monument, with his figure, carved in
stone, and represented in the old black armour, lying on its back,
may be seen at this day, with an ancient coat of mail, a helmet, and
a pair of gauntlets hanging from a beam above it, which most
people like to believe were once worn by the Black Prince. King
Edward did not outlive his renowned son, long. He was old, and one
Alice Perrers, a beautiful lady, had contrived to make him so fond of
her in his old age, that he could refuse her nothing, and made
himself ridiculous. She little deserved his love, or — what I dare say
she valued a great deal more — the jewels of the late Queen, which
he gave her among other rich presents. She took the very ring from
his finger on the morning of the day when he died, and left him to
be pillaged by his faithless servants. Only one good priest was true
to him, and attended him to the last. Besides being famous for the
great victories I have related, the reign of King Edward the Third
was rendered memorable in better ways, by the growth of
architecture and the erection of Windsor Castle. In better ways still,
by the rising up of Wickliffe, originally a poor parish priest : who
devoted himself to exposing, with wonderful power and success, the
ambition and corruption of the Pope, and of the whole church of
which he was the head. Some of those Flemings were induced to
come to England in this reign too, and to settle in Norfolk, where
they made better woollen cloths than the English had ever had
before. The Order of the Garter (a very fine tiling in its way. but
hardly so important as good clothes for the nation) also dates from
this period. The King is said to have picked up a lady's garter at a
ball, and to have said. Honi soit qui
The text on this page is estimated to be only 23.51%
accurate

EDWARD THE THIRD 1 79 mal y pense — in English, "Evil

be to him who evil thinks of it." The courtiers were usually glad to
imitate what the King said or did, and hence from a slight incident
the Order of the Garter was instituted, and became a great dignity.
So the story goes.
The text on this page is estimated to be only 29.09%
accurate

CHAPTER XIX ENGLAND UNDER RICHARD THE SECOND

Richard, son of the Black Prince, a boy eleven years of age,
succeeded to the Crown under the title of King Richard the Second.
The whole English nation were ready to admire him for the sake of
his brave father. As to the lords and ladies about the Court, they
declared l.im to be the most beautiful, the wisest, and the best —
even of princes — whom the lords and ladies about the Court,
generally declare to be the most beautiful, the wisest, and the best
of mankind. To natter a poor boy in this base manner was not a very
likely way to develop whatever good was in him ; and it brought him
to anything but a good or happy end. The Duke of Lancaster, the
young King's uncle — commonly called John of Gaunt, from having
been born at Ghent, which the common people so pronounced —
was supposed to have some thoughts of the throne himself ; but, as
he was not popular, and the memory of the Black Prince was. he
submitted to his nephew. The war with France being still unsettled,
the Government of England wanted money to provide for the
expenses that might arise out of it ; accordingly a certain tax. called
the Pull-tax. which had originated in the last reign, was ordered to
be levied on the people. This was a tax on every person in the
kingdom, male and female, above the age of fourteen, of three
groats (or three fourpenny pieces) a year; clergymen were charged
more, and only beggars were exempt. I have no need to repeat that
the common people of England had long been suffering under great
oppression. They were still the mere slaves of the lords of the land
on which they lived, and were on most occasions harshly and
unjustly treated. But, they had begun by this time to think very
seriously of not bearing
 RICHARD THE SECOND l8l probably, were emboldened by
that French insurrection I mentioned in the last chapter. The people
of Essex rose against the Poll-tax, and being severely handled by the
government officers, killed some of them. At this very time one of
the tax-collectors, going his rounds from house to house, at Dartford
in Kent came to the cottage of one Wat, a tiler by trade, and claimed
the tax upon his daughter. Her mother, who was at home, declared
that she was under the age of fourteen ; upon that, the collector (as
other collectors had already done in different parts of England)
behaved in a savage way, and brutally insulted Wat Tyler's daughter.
The daughter screamed, the mother screamed. Wat the Tiler, who
was at work not far off, ran to the spot, and did what any honest
father under such provocation might have done — struck the
collector dead at a blow. Instantly the people of that town uprose as
one man. They made Wat Tyler their leader ; they joined with the
people of Essex, who were in arms under a priest called Jack Straw ;
they took out of prison another priest named John Ball ; and
gathering in numbers as they went along, advanced, in a great
confused army of poor men, to Blackheath. It is said that they
wanted to abolish all property, and to declare all men equal. I do not
think this very likely ; because they stopped the travellers on the
roads and made them swear to be true to King Kichard and the
people. Nor were they at all disposed to injure those who had done
them no harm, merely because thpy were of high station ; for, the
King's mother, who had to pass through their camp at Blackheath,
on her way to her young son, lying for safety in the Tower of
London, had merely to kiss a few dirty-faced rough-bearded men
who were noisily fond of royalty, and so got away in perfect safety.
Next day the whole mass marched on to London Bridge. There was
a drawbridge in the middle, which William Walworth the Mayor
caused to be raised to prevent their coming into the city ; but they
soon terrified the citizens into lowering it again, and spread
themselves, with great uproar, over the streets. They broke open the
prisons ; they burned the papers in Lambeth Palace ; they destroyed
the Duke of Lancaster's Palace, the Savoy, in the Strand, said to be
the most beautiful and splendid in England ; they set lire to the
books and documents in the Temple ;
 182 A CHILUS HISTORY OF ENGLAND and made a great
riot. Many of these outrages were committed in drunkenness ; since
those citizens, who had wellfilled cellars, were only too glad to throw
them open to save the rest of their property ; but even the drunken
rioters were very careful to steal nothing. They were so angry with
one man, who was seen to take a silver cup at the Savoy Palace,
and put it in his breast, that they drowned him in the river, cup and
all. The young King had been taken out to treat with them before
they committed these excesses; but, he and the people about him
were so frightened by the riotous shouts, that they got back to the
Tower in the best way they could. This made the insurgents bolder ;
so they went on rioting away, striking off the heads of those who did
not, at a moment's notice, declare for King Kichard and the people ;
and killing as many of the unpopular persons whom they supposed
to be their enemies as they could by any means lay hold of. In this
manner they passed one very violent day, and then proclamation
was made that the King would meet them at Mile-end, and grant
their requests. The rioters went to Mile-end to the number of sixty
thousand, and the King met them there, and to the King the rioters
peaceably proposed four conditions. First, that neither they, nor their
children, nor any coming after them, should be made slaves any
more. Secondly, that the rent of land should be fixed at a certain
price in money, instead of being paid in service. Thirdly, that they
should have liberty to buy and sell in all markets and public places,
like other free men. Fourthly, that they should be pardoned for past
offences. Heaven knows, there was nothing very unreasonable in
these proposals ! The young King deceitfully pretended to think so,
and kept thirty" clerks up. all night, writing out a charter accordingly.
Now. Wat Tyler himself wanted more than this. He wanted the entire
abolition of the forest laws. He was not at Mile-end with the rest,
but, while that meeting was being held, broke into the Tower of
London and slew the archbishop and the treasurer, for whose heads
the people had cried out loudly the day before. He and his men even
thrust their swords into the bed of the Princess of Wales while the
Princess was in it. to make certain that none of their enemies were
concealed there. So, Wat and his men still continued armed, and
rode
 RICHARD THE SECOND i8q O about the city. Next morning,
the King with a small train of some sixty gentlemen — among whom
was Walworth the Mayor— rode into Smithfield, and saw Wat and
his people at a little distance. Says Wat to his men, " There is the
King. I will go speak with him, and tell him what we want."
Straightway Wat rode up to him, and began to talk. " King," says
Wat, " dost thou see all my men there ? " " Ah," says the King. "
Why ? " ''Because," says Wat, "they are all at my command, and
have sworn to do whatever I bid them." Some declared afterwards
that as Wat said this, he laid his hand on the King's bridle. Others
declared that he was seen to play with his own dagger. I think,
myself, that he just spoke to the King like a rough, angry man as he
was, and did nothing more. At any rate he was expecting no attack,
and preparing for no resistance, when Walworth the Mayor did the
not very valiant deed of drawing a short sword and stabbing him in
the throat. He dropped from his horse, and one of the King's people
speedily finished him. So fell Wat Tyler. Fawmers and flatterers made
a mighty triumph of it, and set up a cry which will occasionally find
an echo to this day. But Wat was a hard-working man, who had
suffered much, and had been foully outraged ; and it is probable
that he was a man of a much higher nature and a much braver spirit
than any of the parasites who exulted then, or have exulted since,
over his defeat. Seeing Wat down, his men immediately bent their
bows to avenge his fall. If the young King had not had presence of
mind at that dangerous moment, both he and the Mayor to boot,
might have followed Tyler pretty fast. But the King riding up to the
crowd, cried out that Tyler was a traitor, and that he would be their
leader. They were so taken by surprise, that they set up a great
shouting, and followed the boy until he was met at Islington by a
large body of soldiers. The end of this rising was the then usual end.
As soon as the King found himself safe, he unsaid all he had said,
and undid all he had done ; some fifteen hundred of the rioters were
tried (mostly in Essex) with great rigour, and executed with great
cruelty. Many of them were hanged on gibbets, and left there as a
terror to the country people ;
 184 A CHILD'S HISTORY OF ENGLAND and. because their
miserable friends took some of the bodies down to bury, the King
ordered the rest to be chained up — ■which was the beginning of
the barbarous custom of hanging in chains. The King's falsehood in
this business makes such a pitiful figure, that I think Wat Tyler
appears in history as beyond comparison the truer and more
respectable man of the two. Richard was now sixteen years of age,
and married Anne of Bohemia, an excellent princess, who was called
" the good Queen Anne." She deserved a better husband ; for the
King had been fawned and nattered into a treacherous, wasteful,
dissolute, bad young man. There were two Popes at this time (as if
one were not enough !), and their quarrels involved Europe in a
great deal of trouble. Scotland was still troublesome too ; and at
home there was much jealousy and distrust, and plotting and
counter-plotting, because the King feared the ambition of his
relations, and particularly of his uncle, the Duke of Lancaster, and
the duke had his party against the King, and the King had his party
against the duke. Nor were these home troubles lessened when the
duke went to Castile to urge his claim to the crown of that kingdom ;
for then the Duke of Gloucester, another of Richard's uncles,
opposed him, and influenced the Parliament to demand the dismissal
of the King's favourite ministers. The King said in reply, that he
would not for such men dismiss the meanest servant in his kitchen.
But, it had begun to signify little what a King said when a Parliament
was determined ; so Richard was at last obliged to give way, and to
agree to another Government of the kingdom, under a commission
of fourteen nobles, for a year. His uncle of Gloucester was at the
head of this commission, and, in fact, appointed everybody
composing it. Having done all this, the King declared as soon as he
saw an opportunity that he had never meant to do it, and that it was
all illegal ; and he got the judges secretly to sign a declaration to
that effect. The secret oozed out directly, and was carried to the
Duke of Gloucester. The Duke of Gloucester, at the head of forty
thousand men, met the King on his entering into London to enforce
his authority ; the King was helpless against him ; his favourites and
ministers were impeached and were mercilessly executed. Among
them were two men whom the people regarded with very different
 RICHARD THE SECOND 1 85 feelings ; one, Robert
Tresilian, Chief Justice, who was hated for having made what was
called " the bloody circuit " to try the rioters ; the other, Sir Simon
Burley, an honourable knight, who had been the dear friend of the
Black Prince, and the governor and guardian of the King. For this
gentleman's life the good Queen even begged of Gloucester on her
knees ; but Gloucester (with or without reason) feared and hated
him, and replied, that if she valued her husband's crown, she had
better beg no more. All this was done under what was called by
some the wonderful — and by others, with better reason, the
merciless — Parliament. But Gloucester's power was not to last for
ever. He held it for only a year longer ; in which year the famous
battle of Otterbourne, sung in the old ballad of Chevy Chase, was
fought. When the year was out, the King, turning suddenly to
Gloucester, in the midst of a great council said, "Uncle, how old am I
? " " Your highness," returned the Duke, " is in your twenty- second
year." "Am I so much?" said the King; "then I will manage my own
affairs! I am much obliged to you, my good lords, for your past
services, but I need them no more." He followed this up, by
appointing a new Chancellor and a new Treasurer, and announced to
the people that he had resumed the Government. He held it for
eight years without opposition. Through all that time, he kept his
determination to revenge himself some day upon his uncle
Gloucester, in his own breast. At last the good Queen died, and then
the King, desiring to take a second wife, proposed to his council that
he should marry Isabella, of France, the daughter of Charles the
Sixth : who, the French courtiers said (as the English courtiers had
said of Richard), was a marvel of beauty and wit, and quite a
phenomenon — of seven years old. The council were divided about
this marriage, but it took place. It secured peace between England
and France for a quarter of a century ; but it was strongly opposed
to the prejudices of the English people. The Duke of Gloucester, who
was anxious to take the occasion of making himself popular,
declaimed against it loudly, and this at length decided the King to
execute the vengeance he had been nursing so long. He went with a
gay company to the Duke of Gloucester's house, Pleshey Castle, in
Essex, where the Duke, suspecting nothing, came out into the court-
yard to receive his royal visitor. While the King conversed hi a
friendly manner
 l86 A CHILD'S HISTORY OF ENGLAND with the Duchess,
the Duke was quietly seized, hurried away, shipped for Calais, and
lodged in the castle there. His friends, the Earls of Arundel and
Warwick, were taken in the same treacherous manner, and confined
to their castles. A few days after, at Nottingham, they were
impeached of high treason. The Earl of Arundel was condemned and
beheaded, and the Earl of Warwick was banished. Then, a writ was
sent by a messenger to the Governor of Calais, requiring him to send
the Duke of Gloucester over to be tried. In three days he returned
an answer that he could not do that, because the Duke of Gloucester
had died in prison. The Duke was declared a traitor, his property was
confiscated to the King, a real or pretended confession he had made
in prison to one of the Justices of the Common Pleas was produced
against him, and there was an end of the matter. How the
unfortunate duke died, very few cared to know. Whether he really
died naturally ; whether he killed himself; whether, by the King's
order, he was strangled, or smothered between two beds (as a
servingman of the Governor's named Hall, did afterwards declare),
cannot be discovered. There is not much doubt that he was killed,
somehow or other, by his nephew's orders. Among the most active
nobles in these proceedings were the King's cousin, Henry
Bolingbroke, whom the King had made Duke of Hereford to smooth
down the old family quarrels, and some others : who had in the
family-plotting times done just such acts themselves as they now
condemned in the duke. They seem to have been a corrupt set of
men ; but such men were easily found about the court in such days.
The people murmured at all this, and were still very sore about the
French marriage. The nobles saw how little the King cared for law,
and how crafty he was, and began to be somewhat afraid of
themselves. The King's life was a life of continued feasting and
excess ; his retinue, down to the meanest servants, were dressed in
the most costly manner, and caroused at his tables, it is related, to
the number of ten thousand persons every day. He himself,
surrounded by a body of ten thousand archers, and enriched by a
duty on wool which the Commons had granted him for life, saw no
danger of ever being otherwise than powerful and absolute, and was
as fierce and haughty as a King could be. He had two of his old
enemies left, in the persons of the Dukes, of Hereford and Norfolk.
Sparing these no more
 RICHARD THE SECOND 187 than the others, he tampered
with the Duke of Hereford until he got him to declare before the
Council that the Duke of Norfolk had lately held some treasonable
talk with him, as he was riding near Brentford ; and that he had told
him, among other things, that he could not believe the King's oath
— which nobody could, I should think. For this treachery he
obtained a pardon, and the Duke of Norfolk was summoned to
appear and defend himself. As he denied the charge and said his
accuser was a liar and a traitor, both noblemen, according to the
manner of those times, were held in custody, and the truth was
ordered to be decided by wager of battle at Coventry. This wager of
battle meant that whosoever won the combat was to be considered
in the right ; which nonsense meant in effect, that no strong man
could ever be wrong. A great holiday was made ; a great crowd
assembled, with much parade and show ; and the two combatants
were about to rush at each other with their lances, when the King,
sitting in a pavilion to see fair, threw down the truncheon he carried
in his hand, and forbade the battle. The Duke of Hereford was to be
banished for ten years, and the Duke of Norfolk was to be banished
for life. So said the King. The Duke of Hereford went to France, and
went no farther. The Duke of Norfolk made a pilgrimage to the Holy
Land, and afterwards died at Venice of a broken heart. Faster and
fiercer, after this, the King went on in his career. The Duke of
Lancaster, who was the father of the Duke of Hereford, died soon
alter the departure of his son ; and, the King, although he had
solemnly granted to that son leave to inherit his father's property, if
it should come to him during his banishment, immediately seized it
all, like a robber. The judges were so afraid of him, that they
disgraced themselves by declaring this theft to be just and lawful.
His avarice knew no bounds. He outlawed seventeen counties at
once, on a frivolous pretence, merely to raise money by way of fines
for misconduct. In short, he did as many dishonest things as he
could ; and cared so little for the discontent of his subjects —
though even the spaniel favourites began to whisper to him that
there was such a thing as discontent afloat — that he took that time,
of all others, for leaving England and making an expedition against
the Irish. He was scarcely gone, leaving the Duke of York Regent
 1 88 A CHILD'S HISTORY OF ENGLAND in his absence,
when his cousin, Henry of Hereford, came over from France to claim
the rights of which he had been so monstrously deprived. He was
immediately joined by the two great Earls of Northumberland and
Westmoreland ; and his uncle, the Regent, finding the King's cause
unpopular, and the disinclination of the army to act against Henry,
very strong, withdrew with the Eoyal forces towards Bristol. Henry,
at the head of an army, came from Yorkshire (where he had landed)
to London and followed him. They joined their forces— how they
brought that about, is not distinctly understood— and proceeded to
Bristol Castle, whither three noblemen had taken the young Queen.
The castle surrendering, they presently put those three noblemen to
death. The Regent then remained there, and Henry went on to
Chester. All this time, the boisterous weather had prevented the King
from receiving intelligence of what had occurred. At length it was
conveyed to him in Ireland, and he sent over the Earl of Salisbury,
who, landing at Conway, rallied the Welshmen, and waited for the
King a whole fortnight ; at the end of that time the Welshmen, who
were perhaps not very warm for him in the beginning, quite cooled
down and went home. When the King did land on the coast at last,
he came with a pretty good power, but his men cared nothing for
him, and quickly deserted. Supposing the Welshmen to be still at
Conway, he disguised himself as a priest, and made for that place in
company with his two brothers and some few of their adherents.
But, there were no Welshmen left— only Salisbury and a hundred
soldiers. In this distress, the King's two brothers, Exeter and Surrey,
offered to go to Henry to learn what his intentions were. Surrey, who
was true to Richard, was put into prison. Exeter, who was false, took
the royal badge, which was a hart, off his shield, and assumed the
rose, the badge of Henry. After this, it was pretty plain to the King
what Henry's intentions were, without sending any more messengers
to ask. The fallen King, thus deserted— hemmed in on all sides, and
pressed with hunger— rode here and rode there, and went to this
castle, and went to that castle, endeavouring to obtain some
provisions, but could find none. He rode wretchedly back to Conway,
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