Acquired Brain Injury An Integrative

Neuro Rehabilitation Approach Jean

Elbaum
Visit to download the full and correct content document:
https://textbookfull.com/product/acquired-brain-injury-an-integrative-neuro-rehabilitatio
n-approach-jean-elbaum/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Traumatic Brain Injury: Rehabilitation, Treatment, and

Case Management, Fourth Edition Mark J. Ashley

https://textbookfull.com/product/traumatic-brain-injury-
rehabilitation-treatment-and-case-management-fourth-edition-mark-
j-ashley/

Psychological Therapy for Paediatric Acquired Brain

Injury Innovations for Children Young People and
Families 1st Edition Jenny Jim

https://textbookfull.com/product/psychological-therapy-for-
paediatric-acquired-brain-injury-innovations-for-children-young-
people-and-families-1st-edition-jenny-jim/

Restoring the brain neurofeedback as an integrative

approach to health 2 edition. Edition Hanno W. Kirk
(Editor)

https://textbookfull.com/product/restoring-the-brain-
neurofeedback-as-an-integrative-approach-to-health-2-edition-
edition-hanno-w-kirk-editor/

Statistics Using Stata An Integrative Approach Sharon

Lawner Weinberg

https://textbookfull.com/product/statistics-using-stata-an-
integrative-approach-sharon-lawner-weinberg/
Acquired Neurogenic Communication Disorders An
Integrated Clinical Approach 1st Edition Jerry K.
Hoepner

https://textbookfull.com/product/acquired-neurogenic-
communication-disorders-an-integrated-clinical-approach-1st-
edition-jerry-k-hoepner/

Abnormal Psychology An Integrative Approach Eighth

Edition David H. Barlow

https://textbookfull.com/product/abnormal-psychology-an-
integrative-approach-eighth-edition-david-h-barlow/

The Psychology of Humor An Integrative Approach Rod A.

Martin

https://textbookfull.com/product/the-psychology-of-humor-an-
integrative-approach-rod-a-martin/

Anatomy & physiology : an integrative approach 3rd

Edition Theresa Stouter Bidle

https://textbookfull.com/product/anatomy-physiology-an-
integrative-approach-3rd-edition-theresa-stouter-bidle/

Traumatic Brain Injury 2nd Edition Peter C. Whitfield

https://textbookfull.com/product/traumatic-brain-injury-2nd-
edition-peter-c-whitfield/
Jean Elbaum Editor

Acquired
Brain Injury
An Integrative Neuro-Rehabilitation
Approach
Second Edition
Acquired Brain Injury
Jean Elbaum
Editor

Acquired Brain Injury

An Integrative Neuro-Rehabilitation
Approach

Second Edition
Editor
Jean Elbaum
Transitions of Long Island
Northwell Health
Manhasset, NY, USA

ISBN 978-3-030-16612-0    ISBN 978-3-030-16613-7 (eBook)

https://doi.org/10.1007/978-3-030-16613-7

© Springer Nature Switzerland AG 2007, 2019

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 publication
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. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Contents

  1 Introduction����������������������������������������������������������������������������������������������    1
Jean Elbaum
  2 Neurosurgery and Acquired Brain Injury��������������������������������������������    3
Kevin Kwan, Julia Schneider, Raj K. Narayan, and Jamie S. Ullman
  3 The Role of the Neurologist in the Assessment
and Management of Individuals with Acquired Brain Injury������������   15
Robert A. Duarte and Neisha Patel
  4 Physiatry and Acquired Brain Injury����������������������������������������������������   41
Sarah Khan, Komal Patel, and Gonzalo Vazquez-Cascals
  5 Practical Review of Robotics in the Treatment of Chronic
Impairment After Acquired Brain Injury ��������������������������������������������   71
Johanna L. Chang, Maira Saul, and Bruce T. Volpe
  6 The Role of Neuro-Optometric Rehabilitation��������������������������������������   89
M. H. Esther Han
  7 The Role of Occupational Therapy in Neurorehabilitation ���������������� 135
Donna Napoleone, Taylor Silberglied, Gina L’Abbate,
and Dana Fried
  8 The Role of the Physical Therapist on the Neuro-Rehabilitation
Team���������������������������������������������������������������������������������������������������������� 163
Kristen Murray, Nicole Aquino, and Julianne Nugent
  9 Rehabilitation of Speech, Language, and Swallowing
Disorders in Clients with Acquired Brain Injury �������������������������������� 201
Deena Henderson, Melissa Jensen, Jennifer Drucker,
and Amanda Lutz
10 Neuropsychiatry and Traumatic Brain Injury�������������������������������������� 227
Angela Scicutella

v
vi Contents

11 Neuropsychology in the Outpatient Rehabilitation Setting ���������������� 303

Rosanne Pachilakis and Kathryn Mirra
12 Counseling Individuals Post Acquired Brain Injury:
Considerations and Objectives �������������������������������������������������������������� 315
Jean Elbaum
13 Acquired Brain Injury and the Family: Challenges
and Interventions ������������������������������������������������������������������������������������ 335
Jean Elbaum
14 Postrehabilitation After Acquired Brain Injury������������������������������������ 349
Allison Muscatello and Jean Elbaum
15 Successful Transitions After Acquired Brain Injuries�������������������������� 355
Jessica Moskowitz

������������������������������������������������������������������������������������������������������������������ 359
Contributors

Nicole Aquino Transitions of Long Island, Northwell Health, Manhasset, NY,

USA
South Shore Neurologic Associates, Patchogue, NY, USA
Johanna L. Chang Laboratory for Clinical Neurorehabilitation Research,
Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY,
USA
Jennifer Drucker Transitions of Long Island, Northwell Health, Manhasset, NY,
USA
Robert A. Duarte Department of Neurology, Northwell Health, Manhasset, NY,
USA
Jean Elbaum Transitions of Long Island, Northwell Health, Manhasset, NY, USA
Dana Fried Transitions of Long Island, Northwell Health, Manhasset, NY, USA
M. H. Esther Han SUNY College of Optometry, Vision Rehabilitation Service,
New York, NY, USA
Deena Henderson Transitions of Long Island, Northwell Health, Manhasset, NY,
USA
Melissa Jensen Transitions of Long Island, Northwell Health, Manhasset, NY,
USA
Sarah Khan Department of Physical Medicine and Rehabilitation, Northwell
Health, Manhasset, NY, USA
Kevin Kwan Department of Neurosurgery, Donald and Barbara Zucker School of
Medicine at Hofstra/Northwell, Hempstead, NY, USA
Gina L’Abbate Transitions of Long Island, Northwell Health, Manhasset, NY,
USA

vii
viii Contributors

Amanda Lutz Transitions of Long Island, Northwell Health, Manhasset, NY,

USA
Kathryn Mirra Transitions of Long Island, Northwell Health, Manhasset, NY,
USA
Jessica Moskowitz Broadcast Journalist, New York, NY, USA
Kristen Murray Transitions of Long Island, Northwell Health, Manhasset, NY,
USA
Allison Muscatello Transitions of Long Island, Northwell Health, Manhasset, NY,
USA
Donna Napoleone Transitions of Long Island, Northwell Health, Manhasset, NY,
USA
Raj K. Narayan Department of Neurosurgery, Donald and Barbara Zucker School
of Medicine at Hofstra/Northwell, Hempstead, NY, USA
Julianne Nugent Transitions of Long Island, Northwell Health, Manhasset, NY,
USA
Rosanne Pachilakis Transitions of Long Island, Northwell Health, Manhasset,
NY, USA
Komal Patel Department of Physical Medicine and Rehabilitation, Northwell
Health, Manhasset, NY, USA
Neisha Patel Department of Neurology, Northwell Health, Manhasset, NY, USA
Maira Saul Laboratory for Clinical Neurorehabilitation Research, Feinstein
Institutes for Medical Research at Northwell Health, Manhasset, NY, USA
Julia Schneider Department of Neurosurgery, Donald and Barbara Zucker School
of Medicine at Hofstra/Northwell, Hempstead, NY, USA
Angela Scicutella Department of Psychiatry, Donald and Barbara Zucker School
of Medicine at Hofstra/Northwell, Hempstead, NY, USA
Department of Psychiatry and Behavioral Health, NYC Health + Hospitals/Kings
County, Brooklyn, NY, USA
Taylor Silberglied Transitions of Long Island, Northwell Health, Manhasset, NY,
USA
Jamie S. Ullman Department of Neurosurgery, Donald and Barbara Zucker School
of Medicine at Hofstra/Northwell, Hempstead, NY, USA
Department of Neurosurgery, North Shore University Hospital, Manhasset, NY,
USA
Gonzalo Vazquez-Cascals Department of Neuropsychology, Glen Cove Hospital,
Northwell Health, Manhasset, NY, USA
Bruce T. Volpe Laboratory for Clinical Neurorehabilitation Research, Feinstein
Institutes for Medical Research at Northwell Health, Manhasset, NY, USA
Chapter 1
Introduction

Jean Elbaum

Thirty plus years in the field of neuro-rehabilitation, and each day still brings new
challenges and new learning. The resilience of the brain and the exciting recoveries
that are facilitated in survivors of acquired brain injuries (ABIs) reinforce the value
and power of an integrated team effort. Shifting survivors from states of brokenness
to productive, meaningful lives continues to be the chief reward.
The best way to achieve excellent outcomes for our clients and families is by
ensuring a comprehensive, integrated approach that covers the continuum of care,
allowing clients to be supported from the earliest stages of recovery throughout
their rehabilitation, providing programming that is evidence based, purposeful and
functional, as well as offering post rehabilitation options well matched to clients’
needs.
A specialized team approach to neuro-rehabilitation with each member assuming
a different, yet interconnected role is vital. The survivor and family must know that
their care is being coordinated as well as the function of each of their clinicians. All
rehabilitation team members must be knowledgeable about the different roles of
their colleagues and maintain open communication that crosses interdisciplinary
borders.
Much has changed over the last decade, primarily in concussion management as
well as in the use of ever developing technology to facilitate recoveries. What has
stayed the same is the criticality of helping clients remove barriers towards progress
and teaching compensatory strategies to work around residual challenges. The true
team effort includes not only the therapy team, client, and family, but may include
the employer or school/university to which the client is reintegrating.
Thus, the goal of this text is to provide an introduction to many of the key
members of the neuro-rehabilitation team, including their roles, approaches to
evaluation, and treatment. The book was written for interdisciplinary students of

J. Elbaum (*)
Transitions of Long Island, Northwell Health, Manhasset, NY, USA
e-mail: jelbaum@northwell.edu

© Springer Nature Switzerland AG 2019 1

J. Elbaum (ed.), Acquired Brain Injury,
https://doi.org/10.1007/978-3-030-16613-7_1
2 J. Elbaum

neuro-rehabilitation as well as practicing clinicians interested in developing their

knowledge in both their field as well as other discipline areas. It can also be useful
for survivors and families to help untangle and clarify the complexities of the reha-
bilitation process. Case examples were included to help illustrate real life
challenges.
Based on feedback from colleagues and students, the second edition excluded
certain chapters and added others. Existing chapters were updated to include new
research and current technologies. Kwan, Schneider, Narayan, and Ullman (Chap.
2) describe the role of the neurosurgeon in treating clients post acquired brain inju-
ries. Duarte and Patel (Chap. 3) and Khan, Patel, and Vasquez-Cascals (Chap. 4)
describe the central roles of neurology and physiatry in diagnosing and treating cli-
ents post-ABI. They highlight the importance of team collaboration and discuss
topics such as neuroplasticity, spasticity management, concussion management,
headaches, seizures, sleep disorders, and new areas of study such as stem cell
research in acquired brain injury. Chang, Saul, and Volpe (Chap. 5) provide a state-­
of-­the-art review of the efficacy of robotics in neuro-rehabilitation. Han (Chap. 6)
describes common visual difficulties post-ABI and the role of the neuro-­optometrist.
Napoleone, Silberglied, L’Abbate, and Fried (Chap. 7) and Henderson, Jensen,
Drucker, and Lutz (Chap. 9) discuss the essential roles of the occupational therapist
and the speech/language pathologist on the neuro-rehabilitation team. Murray,
Aquino, and Nugent (Chap. 8) provide a comprehensive review of physical chal-
lenges post acquired brain injury which was missing from our first edition. Scicutella
(Chap. 10), Pachilakis and Mirra (Chap. 11), and Elbaum (Chap. 12) discuss the
emotional, behavioral, and neuropsychological challenges post-ABI and the impor-
tance of addressing these difficulties through an integration of evaluation, proper
medication management, and counseling. Specific family challenges and ways to
meet their needs effectively through appropriate interventions are reviewed in a
separate chapter (Chap. 13). Muscatello and Elbaum (Chap. 14) review the value of
post-rehabilitation programs for clients who aren’t ready or able to return to work
or school. Outstanding recoveries are highlighted in the final chapter by a former
client and current Broadcast Journalist, Jessica Moskowitz.
I’d like to thank all the clients and families that have been part of the Transitions’
family over the last three decades. I’m impressed on a daily basis by the persistence,
devotion, sacrifices, and constructive attitudes we see in the face of highly difficult
and complicated situations.
I’d also like to thank my colleagues that worked on this new edition and
approached the task with interest and enthusiasm. The goal was to assemble the key
components of the neuro-rehabilitation team in an organized, meaningful, and
engaging manner.
Chapter 2
Neurosurgery and Acquired Brain Injury

Kevin Kwan, Julia Schneider, Raj K. Narayan, and Jamie S. Ullman

Introduction

An integrated neuro-rehabilitation approach toward the treatment of acquired brain

injuries begins with a fundamental understanding of neurosurgical pathologies.
Improvements in the neurosurgical knowledge of not only the neuro-rehabilitation
team but also the patient family unit allow more cohesive participation and improve-
ments in patient’s outcomes. The purpose of this chapter is to provide a framework
for the epidemiology, symptoms, diagnoses, treatment paradigm, and outcomes of
the most frequently encountered operative neurosurgical pathologies in the con-
temporary era. It is expected that this information can be utilized by the integrated
neuro-rehabilitation team and family unit to improve patient outcomes.

Brain Anatomy and Physiology

The brain provides numerous essential functions. Besides providing information

about the environment from our five senses, the brain also mediates cognition, rec-
ollection, speech, movement, touch, and systemic homeostasis. The brain is an
organized structure, divided into three main components: the cerebrum, the

K. Kwan · J. Schneider · R. K. Narayan

Department of Neurosurgery, Donald and Barbara Zucker School of Medicine
at Hofstra/Northwell, Hempstead, NY, USA
e-mail: kkwan1@northwell.edu; Jschneider6@northwell.edu; rnarayan@northwell.edu
J. S. Ullman (*)
Department of Neurosurgery, Donald and Barbara Zucker School of Medicine
at Hofstra/Northwell, Hempstead, NY, USA
Department of Neurosurgery, North Shore University Hospital, Manhasset, NY, USA
e-mail: Jullman1@northwell.edu

© Springer Nature Switzerland AG 2019 3

J. Elbaum (ed.), Acquired Brain Injury,
https://doi.org/10.1007/978-3-030-16613-7_2
4 K. Kwan et al.

cerebellum, and the brain stem. These vital structures are encased by the bones of
the skull known as the cranium, protecting it from injury.
The cerebrum, which forms the major portion of the brain, is divided into two
major parts: the right and left cerebral hemispheres. Each hemisphere is subse-
quently divided into different sections or lobes: the frontal, parietal, temporal, and
occipital lobes. The frontal lobe is responsible for thinking, making judgments,
planning, decision-making, and conscious emotions. The parietal lobe is mainly
associated with spatial computation, body orientation, and attention. The temporal
lobe is concerned with hearing, language, and memory. The occipital lobe is dedi-
cated to visual processing. Any damage to a particular part of the brain may result
in a relative loss of function dedicated to that area.
The cerebellum is located at the back of the brain beneath the occipital lobes. The
cerebellum fine tunes motor activity or movement. It helps maintain central posture
and fine tunes the movements of the peripheral limbs. The cerebellum is important
in one’s ability to perform rapid and repetitive actions such as playing a piano.
The brain stem is the lower extension of the brain, located in front of the cerebel-
lum and connected to the spinal cord. It consists of three structures: the midbrain,
pons, and medulla oblongata. The midbrain is an important center for ocular motion,
while the pons is involved with coordinating eye and facial movements, facial sen-
sation, hearing, and balance. The medulla oblongata controls breathing, blood pres-
sure, heart rhythms, and swallowing. Messages from the cortex to the spinal cord
and nerves that branch from the spinal cord are sent through the brain stem. Damage
of this essential and primitive region of the brain, i.e., due to a stroke, may result in
sudden death (AANS, 2018).

Initial Neurosurgical Evaluation

Upon presentation of a patient with acquired brain injury, often emergently, the
priority for the multidisciplinary trauma team is for airway stabilization and cardio-
vascular circulatory optimization. Securing the airway may require the insertion of
an endotracheal tube with ventilator support. Blood pressure stabilization may also
require adjuvant pharmacological support. The team must also quickly assess the
patient’s neurologic exam using an abridged format, which is often denoted using
the Glasgow Coma Scale (GCS). Noted in Fig. 2.1, this scale is divided into three
segments, including eye opening (4 points), verbal response (5 points), and motor
response (6 points) to stimuli, for a total of 15 points (Bateman, 2001). Any patient
with evidence of trauma or with an impaired GCS score must have a computed
tomography (CT) scan completed following initial stabilization. The CT scan of the
head is sensitive for demonstrating the presence of hemorrhage or edema in the
brain, as well as any evidence of a fracture within the cranium. Emergent neurosur-
gical management is subsequently dictated by the patient’s history, physical exam,
and radiographic findings.
2 Neurosurgery and Acquired Brain Injury 5

Fig. 2.1 Glasgow Coma Scale (Bateman, 2001)

Acquired Brain Injury

Acquired brain injury (ABI) refers to post-natal cerebral damage, rather than an
insult occurring as part of a hereditary disorder (Ontario Brain Injury Association,
2018). ABI is classically subdivided into traumatic and nontraumatic subtypes
(Prins, Greco, Alexander, & Giza, 2013). Consequences of ABI often require a
major life alteration around the patient’s new conditions, and making that modifica-
tion has a critical influence on recovery and rehabilitation (Tate et al., 2014). This
alteration, however, depends mainly upon the nature and severity of the specific
neurologic injury.

Chapter Outline
This chapter will seek to illustrate the symptoms, diagnosis, treatment, and
outcomes from ABI as a result of traumatic brain injury (concussion, epi-
dural hematoma, subdural hematoma, and penetrating injury) or nontrau-
matic brain injury (spontaneous intracranial hemorrhage, malignant cerebral
infarction, brain tumor, and aneurysmal subarachnoid hemorrhage).

Traumatic Brain Injury

Concussion (Mild Traumatic Brain Injury)

Concussion is a diffuse subtype of mild traumatic brain injury and afflicts an esti-
mated 1.4–3.8 million people in the United States per year (Laker, 2011). The
diagnosis of a patient with a concussion is mainly clinical, with patients presenting
6 K. Kwan et al.

with nonspecific symptoms such as headache, dizziness, nausea, imbalance, or

incoordination. Often patients may present in a delayed fashion, days, weeks, or
even months after the initial traumatic event with persistent symptomatology
(Kushner, 1998). Radiographic evaluation, usually with computed tomography
(CT) or magnetic resonance imaging (MRI), is classically normal in nature.
Patients with mild traumatic brain injury are often managed conservatively with
medication for their symptomatology. Routine re-imaging may be necessary if
symptoms persist or delayed focal neurologic deficits occur. Early involvement of
rehabilitation specialists who focus on traumatic brain injury is essential to expe-
dite patient recovery and resumption of activities of daily life (Fraser, Matsuzawa,
Lee, & Minen, 2017).

Epidural Hematoma

Epidural hematomas (EDHs) represent 3% of head injuries, occurring mostly

between 10 and 30 years of age as the dura is more attached to the cranium as one
ages. EDHs may occur secondary to tearing of the middle meningeal artery, middle
meningeal vein, or dural sinus (Bullock, 2006). Presentation can be acute, subacute,
or chronic, but classically patients present with a lucid interval before deterioration.
EDHs are often diagnosed on initial computed tomography (CT) scans on patient
presentation, which often manifest with a lentiform biconvex appearance that does
not cross suture lines due to dural attachments. Craniotomy or craniectomy for sur-
gical evacuation of the hematoma is necessitated if patients have a neurologic deficit
as a result of the mass effect (Williams, Levin, & Eisenberg, 1990).

Subdural Hematoma

Subdural hematomas (SDH) can occur in 10–35% of severe head injuries. SDH
develop from ruptured bridging veins following acceleration, deceleration, and rota-
tional forces to the cranium. Risk factors can include use of anticoagulation, alco-
holism, or cerebral atrophy. Presentation can be acute, subacute, or chronic in
nature. When diagnosed initially on CT, they tend to be crescent shaped and cross
suture lines but not dural attachments. Surgical evacuation of the hematoma is
necessitated if patients have a neurologic deficit as a result of the mass effect.
Generally, if the SDH is acute in nature, a larger craniotomy is utilized for the surgi-
cal evacuation. Conversely, if the SDH is chronic in nature, a smaller burr hole or
craniotomy is utilized for the surgical evacuation (Karibe et al., 2014).
2 Neurosurgery and Acquired Brain Injury 7

Case Study: Subdural Hematoma

Clinical Presentation: A 75-year-old female with past medical history of mod-
erate/severe Alzheimer’s disease (nursing home resident with full assistance of
activities of daily living) was found down by nursing staff with a left forehead
abrasion. Upon arrival, patient was initially oriented to person and conversant,
then deteriorated and became minimally responsive. Pt exam deteriorated to a
Glasgow coma score of 7 (no eye opening, no verbal response, localized to
painful stimuli), and she was intubated for respiratory protection.
Diagnostic Imaging: CT head initially showed a left SDH (blue arrow),
with a left temporal parietal parenchymal hematoma (red arrow) with sur-
rounding edema (Fig. 2.2). On a subsequent scan, there was greater than 1 cm
midline shift with compression of the lateral ventricle.
Management: The patient was taken emergently to the operating room for
a left craniotomy with placement of an intracranial pressure (ICP) monitor.
Clinical Course: Patient was started on video electroencephalography
which showed increased risk for focal onset seizure bi-frontally. Patient was
started on anti-epileptics. Intracranial pressures continued to be low and the
ICP monitor was discontinued. The patient received a tracheostomy, percuta-
neous endoscopic gastrostomy tube and was transferred to a long-term reha-
bilitation facility. On long-term follow up, the patient still requires full
assistance with activities of daily living.

Fig. 2.2 Initial computed tomography scan of head, coronal slice (left) and axial slice (right),
demonstrating a left temporal subdural hematoma and parenchymal hemorrhage

Penetrating Brain Injury

Penetrating brain injuries (PBI) are fortunately rare occurrences among the civilian
populations and can be the result of violence, accidents, or even suicide attempts
(Gutiérrez-González, Boto, Rivero-Garvía, Pérez-Zamarrón, & Gómez, 2008).
8 K. Kwan et al.

Following the initial stabilization of the patient in regard to the trauma guidelines, the
neurosurgical evaluation begins with conducting a clinical exam with signs of
increased ICP documented prudently. CT scan is the initial imaging modality of
choice, with vascular imaging included if there is a suspicion for arterial or venous
injury. Surgical treatment is recommended within 12 h (Helling, McNabney, Whittaker,
Schultz, & Watkins, 1992), especially in the context of a neurologic deficit or deterio-
ration, with the goal toward the safe removal of the object, if at all possible, followed
by appropriate antibiotic prophylaxis to improve outcomes. The risk of post-traumatic
epilepsy after PBI is between 45% and 53%, and therefore, the use of prophylactic
anticonvulsants is recommended (Raymont et al., 2010; Salazar et al., 1985).

Case Study: Penetrating Brain Injury

Clinical Presentation: A 42-year-old male walks into the emergency room
after shooting himself with a nail gun in the head and chest. The patient did
not have any neurologic deficits. The patient received prophylactic broad-­
spectrum antibiotics and a tetanus vaccine.
Diagnostic Imaging: CT head showed a foreign object within the frontal
interhemispheric fissure (Fig. 2.3). Vascular imaging was obtained and did not
show evidence of arterial or venous injury.
Management: The patient was taken emergently to the OR for a bi-frontal
craniotomy with removal of the foreign body.
Clinical Course: The patient had an uneventful postoperative recovery in
the intensive care unit. The patient was subsequently transferred to the psychi-
atric department for management.

Fig. 2.3 Computed tomography scan of head, sagittal slice (left) and axial slice (right), demon-
strating a left temporal subdural hematoma and parenchymal hemorrhage
2 Neurosurgery and Acquired Brain Injury 9

Operative Nontraumatic Brain Injury

Spontaneous Intracranial Hemorrhage

Spontaneous nontraumatic intracerebral hemorrhage (ICH) is the second most preva-

lent subtype of stroke and is associated with high mortality and morbidity throughout
the world (Kim & Bae, 2017). The pathogenesis of spontaneous ICH is diverse,
including vascular disorders, amyloid angiopathy, tumor, vasculitis, hypertension, or
reperfusion following a cerebral vascular accident. Initial workup entails a CT scan,
with vascular imaging added on, especially in younger patients. Initial management
of ICH is directed toward optimization of risk factors and control of ICPs. Surgical
management of ICH remains controversial based on outcomes from randomized clin-
ical trials (Broderick, 2005), but can be considered for superficial or cerebellar
lesions, especially in the younger patient population (Alerhand & Lay, 2017). Results
of a trial applying minimally invasive thrombolysis of spontaneous intracerebral
hemorrhage showed no significant difference in outcome in 506 patients, but did sug-
gest an advantage towards better outcomes in patients whose ICH was reduced to
15 ml in volume (Hanley, Thompson, Rosenblum, et al., 2019). Preliminary results
for an endoscopic-guided, minimally invasive evacuation of basal ganglia ICH are
promising, reducing in-house mortality (Goyal, Tzigoulis, Malhotra, et al., 2019).

Malignant Cerebral Infarction

Malignant cerebral infarction (MCI) is characterized by the compromise of the

entire territory supplied by the middle cerebral artery (MCA) with accompanying
mass effect resulting from acute brain swelling. Peak swelling and symptomatology
usually occur within the first 48 h after stroke. MRI can be utilized to visualize acute
infarcts on diffusion weighted imaging sequences. Initial management involves
optimization of risk factors and control of ICPs. No definitive surgical guidelines
exist, but the general recommendation is to perform a hemicraniectomy within 48 h
if the patient is less than 60 years of age. There is an 80% mortality associated with
MCI (Simard, Sahuquillo, Sheth, Kahle, & Walcott, 2011).

Brain Tumors: Meningiomas

Meningiomas are the most common primary brain tumor, with an incidence of
3–3.5 per 100,000 persons (Hoffman, Propp, & McCarthy, 2006). They tend to
occur more commonly in patients with genetic predispositions, including neurofi-
bromatosis type 2 or multiple endocrine neoplasia type 1 (Asgharian et al., 2004;
Perry et al., 2001). The majority are histologically benign and asymptomatic and
incidentally found on radiographic imaging (Chamoun, Krisht, & Couldwell, 2011).
3 The Role of the Neurologist in the Assessment and Management of Individuals… 21

as the MRI examination will typically require the patient to stay still in a relatively
closed space for 30–40 min at a time. Nonetheless, image quality obtained with an
MRI is superior to that obtained with CT and therefore justifies its preference by
most physicians and remains the gold standard in non-emergent evaluation of
brain injury.
Additional testing modalities that are frequently employed by neurologists include
transcranial and carotid Doppler ultrasound, which will be discussed in the “Stroke”
section of this chapter, and electroencephalography (EEG), which is discussed in the
“Epilepsy” section.

Seizures

Patient is a 49-year-old male who presented to the hospital after a motor vehicle
accident at 40 miles/h, in which the patient was unrestrained and his head struck
the windshield. On initial examination, the patient’s GCS is 8 (best eye score 2/4,
best verbal score 2/5, best motor score 4/6) Chap. 2 there is marked bruising of the
forehead with multiple facial lacerations. During evaluation in the emergency
room, the patient is observed to have a single generalized tonic–clonic seizure last-
ing 45 s, associated with tongue biting. CT scan of the head revealed frontal and
occipital hemorrhagic contusions. Patient was loaded with intravenous phenytoin
(Dilantin) and transferred to the intensive care unit for monitoring and neurologi-
cal checks.
Seizures are a common complication of traumatic brain injury (TBI). A seizure
is defined as a disturbance or disruption in the electrical activity of the brain, which
results in uncontrollable changes to behavior, motor functions, or a change in
­sensory perception. The presence of intracranial pathology predisposes a patient to
having seizures and consequently developing a seizure disorder. Epilepsy, as
opposed to seizures, is usually defined as two or more unprovoked seizures on sepa-
rate days, generally 24 h apart. An unprovoked seizure refers to a seizure that occurs
in the absence of an acute brain insult or systemic disorder. Early seizures are
thereby defined as acute symptomatic, but they are not representative of epilepsy, as
seizures are provoked by the presence of an acute lesion. Post-traumatic epilepsy
(PTE) refers to epilepsy that develops after TBI. Most investigators agree that PTE
is to be distinguished from repeated seizures in the early stage following TBI, while
the brain is acutely traumatized, inflamed, and metabolically disrupted. Therefore,
a common set of definitions adopted by many researchers is the following: (1)
immediate seizures usually defined as those occurring within 24 h after the injury,
(2) early seizures which occur less than 1 week after the injury, and (3) late seizures
which occur more than a week after the injury. Since the risk of recurrence after a
single late post-traumatic seizure is over 70%, most investigators consider a single
late post-traumatic seizure as being sufficient for the diagnosis of PTE. Although
these are the most widely accepted definitions, there is controversy. Some narrow
the definition of immediate seizures to those occurring at impact or within minutes
Another random document with
no related content on Scribd:
The Project Gutenberg eBook of Ninon
de l'Enclos and her century
 This ebook is for the use of anyone anywhere in the United
States and most other parts of the world at no cost and with
almost no restrictions whatsoever. You may copy it, give it away
or re-use it under the terms of the Project Gutenberg License
included with this ebook or online at www.gutenberg.org. If you
are not located in the United States, you will have to check the
laws of the country where you are located before using this
eBook.

Title: Ninon de l'Enclos and her century

Author: Mary C. Rowsell

Release date: October 24, 2023 [eBook #71953]

Language: English

Original publication: New York: Brentano's, 1910

Credits: Susan Skinner, John Campbell and the Online

Distributed Proofreading Team at https://www.pgdp.net
(This file was produced from images generously made
available by The Internet Archive)

*** START OF THE PROJECT GUTENBERG EBOOK NINON DE

L'ENCLOS AND HER CENTURY ***
TRANSCRIBER’S NOTE
Footnote anchors are denoted by [number], and the footnotes have been placed at
the end of the book.
New original cover art included with this eBook is granted to the public domain.
Some minor changes to the text are noted at the end of the book.
 NINON DE L’ENCLOS.
From an Original Picture given by herself to the
Countess of Sandwich and by the present Earl of
Sandwich to Mr Walpole 1757
 N I N O N D E L’ E N C L O S
AND HER CENTURY

BY

M. C. ROWSELL
AUTHOR OF
“THE FRIEND OF THE PEOPLE,” “TRAITOR OR PATRIOT,” “THORNDYKE
MANOR,” “MONSIEUR DE PARIS,” ETC. ETC.

WITH ILLUSTRATIONS

B R E N TA N O ’ S
NEW YORK

H U R S T & B L A C K E T T, L I M I T E D
LONDON
1910
Printed in Great Britain
 CONTENTS
PAGE
Chapter I 1
Birth—Parentage—“Arms and the Man”—A Vain Hope—Contraband Novels—A
Change of Educational System—Ninon’s Endowments—The Wrinkle—A Letter
to M. de L’Enclos and What Came of it—A Glorious Time—“Troublesome
Huguenots”—The Château at Loches, and a New Acquaintance—“When Greek
meets Greek”—The Prisoners—“Liberty”—The Shades of Night—Vagabonds?
or Two Young Gentlemen of Consequence?—Tired Out—A Dilemma—Ninon
Herself Again—Consolation.

Chapter II 14
Troublesome Huguenots—Madame de L’Enclos—An Escapade and Nurse
Madeleine—Their Majesties—The Hôtel Bourgogne—The End of the Adventure
—St Vincent de Paul and his Charities—Dying Paternal Counsel—Ninon’s New
Home—Duelling—Richelieu and the Times.

Chapter III 27
A Life-long Friend—St Evrémond’s Courtly Mot—Rabelais v. Petronius—Society
and the Salons—The Golden Days—The Man in Black.

Chapter IV 36
A “Delicious Person”—Voiture’s Jealousy—A Tardy Recognition—Coward
Conscience—A Protestant Pope—The Hôtel de Rambouillet—St Evrémond—
The Duel—Nurse Madeleine—Cloistral Seclusion and Jacques Callot—“Merry
Companions Every One”—and One in Particular.

Chapter V 51
An Excursion to Gentilly—“Uraniæ Sacrum”—César and Ruggieri—The rue
d’Enfer and the Capucins—Perditor—The Love-philtre—Seeing the Devil
—“Now You are Mine!”

Chapter VI 61
Nemesis—Ninon’s Theories—Wits and Beaux of the Salons—Found at Last
—“The Smart Set”—A Domestic Ménage—Scarron—The Fatal Carnival—The
Bond of Ninon—Corneille and The Cid—The Cardinal’s Jealousy—Enlarging
the Borders—Monsieur l’Abbé and the Capon Leg—The Grey Cardinal—A
Faithful Servant.

Chapter VII 81
Mélusine—Cinq-Mars—An Ill-advised Marriage—The Conspiracy—The
 Revenge—The Scaffold—A Cry from the Bastille—The Lady’s Man—“The
Cardinal’s Hangman”—Finis—Louis’s Evensong—A Little Oversight—The
King’s Nightcap—Mazarin—Ninon’s Hero.

Chapter VIII 91
“Loving like a Madman”—A Great Transformation—The Unjust Tax—Parted
Lovers—A Gay Court and A School for Scandal, and Mazarin’s Policy—The
Regent’s Caprices—The King’s Upholsterer’s Young Son—The Théâtre Illustre
—The Company of Monsieur and Molière.

Chapter IX 103
The Rift in the Lute—In the Vexin—The Miracle of the Gardener’s Cottage—
Italian Opera in Paris—Parted Lovers—“Ninum”—Scarron and Françoise
d’Aubigné—Treachery—A Journey to Naples—Masaniello—Renewing
Acquaintances—Mazarin’s Mandate.

Chapter X 115
The Fronde and Mazarin—A Brittany Manor—Borrowed Locks—The Flight to St
Germains—A Gouty Duke—Across the Channel—The Evil Genius—The
Scaffold at Whitehall—Starving in the Louvre—The Mazarinade—Poverty—
Condé’s Indignation—The Cannon of the Bastille—The Young King.

Chapter XI 124
Invalids in the rue des Tournelles—On the Battlements—“La Grande
Mademoiselle”—Casting Lots—The Sacrifice—The Bag of Gold—“Get Thee to
a Convent”—The Battle of the Sonnets—A Curl-paper—The Triumph and
Defeat of Bacchus—A Secret Door—Cross Questions and Crooked Answers—
The Youthful Autocrat.

Chapter XII 135

The Whirligig of Time, and an Old Friend—Going to the Fair—A Terrible
Experience—The Young Abbé—“The Brigands of La Trappe”—The New
Ordering—An Enduring Memory—The King over the Water—Unfulfilled
Aspirations—“Not Good-looking.”

Chapter XIII 144

Christina’s Modes and Robes—Encumbering Favour—A Comedy at the Petit-
Bourbon—The Liberty of the Queen and the Liberty of the Subject—Tears and
Absolutions—The Tragedy in the Galérie des Cerfs—Disillusions.

Chapter XIV 154

Les Précieuses Ridicules—Sappho and Le Grand Cyrus—The Poets of the
Latin Quarter—The Satire which Kills—A Lost Child—Periwigs and New Modes
—The Royal Marriage and a Grand Entry.
Chapter XV 163
Réunions—The Scarrons—The Fête at Vaux—The Little Old Man in the
Dressing-gown—Louise de la Vallière—How the Mice Play when the Cat’s
Away—“Pauvre Scarron”—An Atrocious Crime.

Chapter XVI 175

A Lettre de Cachet—Mazarin’s Dying Counsel—Madame Scarron Continues to
Receive—Fouquet’s Intentions and What Came of Them—The Squirrel and the
Snake—The Man in the Iron Mask—An Incommoding Admirer—“Calice cher, ou
le parfum n’est plus”—The Roses’ Sepulchre.

Chapter XVII 185

A Fashionable Water-cure Resort—M. de Roquelaure and his Friends—Louis le
Grand—“A Favourite with the Ladies”—The Broken Sword—A Billet-doux—La
Vallière and la Montespan—The Rebukes from the Pulpit—Putting to the Test—
Le Tartufe—The Triumphs of Molière—The Story of Clotilde.

Chapter XVIII 199

A Disastrous Wooing—Fénelon—“Mademoiselle de L’Enclos”—The Pride that
had a Fall—The Death of the Duchesse d’Orléans—Intrigue—The Sun-King
and the Shadows—The Clermont Scholar’s Crime—Monsieur de Montespan—
Tardy Indignation—The Encounter—The Filles Répenties—What the Cards
Foretold.

Chapter XIX 212

“In Durance Vile”—Molière’s Mot—The Malade Imaginaire—“Rogues and
Vagabonds”—The Passing of Molière—The Narrowing Circle—Fontenelle—Lulli
—Racine—The Little Marquis—A Tardy Pardon—The Charming Widow Scarron
—A Journey to the Vosges, and the Haunted Chamber.

Chapter XX 228
The Crime of Madame Tiquet—A Charming Little Hand—Aqua Toffana—The
Casket—A Devout Criminal—The Sinner and the Saint—Monsieur de Lauzun’s
Boots—“Sister Louise”—La Fontange—“Madame de Maintenant”—The Blanks
in the Circle—The Vatican Fishes and their Good Example—Piety at Versailles
—The Periwigs and the Paniers—Père la Chaise—A Dull Court—Monsieur de
St Evrémond’s Decision.

Chapter XXI 241

A Distinguished Salon—The Duke’s Homage—Quietism—The Disastrous Edict
—The Writing on the Window-pane—The Persecution of the Huguenots—The
Pamphleteers—The Story of Jean Larcher and The Ghost of M. Scarron—The
Two Policies.

251
Chapter XXII
Mademoiselle de L’Enclos’ Cercle—Madeleine de Scudéri—The Abbé Dubois
—“The French Calliope,” and the Romance of her Life—“Revenons à nos
Moutons”—A Resurrection?—Racine and his Detractors—“Esther”—Athalie and
St Cyr—Madame Guyon and the Quietists.

Chapter XXIII 263

A Grave Question—The Troublesome Brother-in-Law—“No Vocation”—The
Duke’s Choice—Peace for “La Grande Mademoiselle”—An Invitation to
Versailles—Behind the Arras—Between the Alternatives—D’Aubigné’s Shadow
—A Broken Friendship.

Chapter XXIV 275

The Falling of the Leaves—Gallican Rights—“The Eagle of Meaux”—Condé’s
Funeral Oration—The Abbé Gedouin’s Theory—A Bag of Bones—Marriage and
Sugar-plums—The Valour of Monsieur du Maine—The King’s Repentance—
The next Campaign—La Fontaine and Madame de Sablière—MM. de Port
Royal—The Fate of Madame Guyon—“Mademoiselle Balbien.”

Chapter XXV 288

The Melancholy King—The Portents of the Storm—The Ambition of Madame
Louise Quatorze—The Farrier of Provence—The Ghost in the Wood—Ninon’s
Objection—The King’s Conscience—A Dreary Court—Racine’s Slip of the
Tongue—The Passing of a Great Poet, and a Busy Pen Laid Down.

Chapter XXVI 301

Leaving the Old Home—“Wrinkles”—Young Years and Old Friends—“A Bad
Cook and a Little Bit of Hot Coal”—Voltaire—Irène—Making a Library—“Adieu,
Mes Amis”—The Man in Black.
 L I S T O F I L L U S T R AT I O N S

Ninon de L’Enclos Frontispiece

Cardinal Richelieu To face page 24

De la Rochefoucauld ” 48

Molière ” 100

St Evrémond ” 112

Ninon de L’Enclos ” 127

NINON DE L’ENCLOS
AND HER CENTURY
NINON DE L’ENCLOS
AND HER CENTURY
 CHAPTER I
Birth—Parentage—“Arms and the Man”—A Vain Hope—Contraband Novels—A
Change of Educational System—Ninon’s Endowments—The Wrinkle—A
Letter to M. de L’Enclos and What Came of it—A Glorious Time
—“Troublesome Huguenots”—The Château at Loches, and a New
Acquaintance—“When Greek meets Greek”—The Prisoners—“Liberty”—The
Shades of Night—Vagabonds? or Two Young Gentlemen of Consequence?—
Tired Out—A Dilemma—Ninon Herself Again—Consolation.

Anne de L’Enclos was born in Paris in 1615. She was the daughter
of Monsieur de L’Enclos, a gentleman of Touraine, and of his wife, a
member of the family of the Abra de Raconis of the Orléanois.
It would not be easy to find characteristics more diverse than
those distinguishing this pair. Their union was an alliance arranged
for them—a mariage de convenance. Diametrically opposite in
temperament, Monsieur was handsome and distinguished-looking;
while the face and figure of Madame were ordinary. She was
constitutionally timid, and intellectually narrow, devoted to
asceticism, and reserved in manner. She passed her time in
seclusion, dividing it between charitable works, the reading of pious
books, and attendance at Mass and the other services of the
Church. Monsieur de L’Enclos, on the other hand, was a votary of
every pleasure and delightful distraction the world could afford him.
Among them he counted duelling; he was a skilled swordsman, and
his rapier play was of the finest. A brave and gallant soldier, he had
served the royal cause during the later years of Henri IV., and so on
into the reign of Louis XIII. He was a bon vivant, and arms and
intrigue, which were as the breath of life to him, he sought after
wherever the choicest opportunities of those were likely to be found.
Notwithstanding, the rule of life-long bickering and mutual
reproach attending such ill-assorted unions, would seem to be
proved by its exception in the case of Ninon’s parents; since no
record of any such domestic strife stands against them. Bearing and
forbearing, they agreed to differ, and went their several ways—
Madame de L’Enclos undertaking the training and instruction of
Ninon in those earliest years, in the fond hope that there would be a
day when she should take the veil and become a nun. Before,
however, she attained to the years of as much discretion as she ever
possessed, she had arrived at the standpoint of the way she
intended to take of the life before her, which was to roll into years
that did not end until the dawning of the eighteenth century; and it in
no way included any such intention. So sturdily opposed to it,
indeed, was she, that it irresistibly suggests the possibility of her
being the inspiration of the old song—“Ninon wouldn’t be a nun”—
“I shan’t be a nun, I won’t be a nun,
I am so fond of pleasure that I won’t be a nun!”

For Ninon was her father’s child; almost all her inherited instincts
were from him. The endeavours of Madame de L’Enclos failed
disastrously. The monotony and rigid routine of the young girl’s life
repelled the bright, frank spirit, and drove it to opposite extreme,
resulting in sentiments of disgust for the pious observances of her
church; and taken there under compulsion day in, day out, she
usually contrived to substitute some plump little volume of romance,
or other light literature, at the function, for her Mass-book and
breviary, to while away the tedium.
In no very long time Monsieur de L’Enclos, noting the bent of his
daughter’s nature, himself took over her training. He carried it on, it
is scarcely necessary to say, upon a plane widely apart from the
mother’s. A man of refined intellect, he had studied the books and
philosophy of the renaissance of literature; and before Ninon was
eleven years old, while imbuing her with the love of reading such
books as the essays of Montaigne and the works of Charon, he
accustomed her to think and to reason for herself, an art of which
she very soon became a past-mistress, the result being an ardent
recognition of the law of liberty, and the Franciscan counsel of
perfection: “Fay ce qu’et voudray.” Ninon possessed an excellent gift
of tongues, cultivating it to the extent of acquiring fluently, Italian,
Spanish, and English, rendered the more easy of mastery from her
knowledge of Latin, which she so frequently quotes in her
correspondence.
Her love of music was great; she sang well, and was a proficient
on the lute, in which her father himself, a fine player, instructed her.
She conversed with facility, and doubtless took care to cultivate her
natural gifts in those days when the arts of conversation and
causerie were indispensable for shining in society, and she loved to
tell a good story; but she drew a distinct line at reciting. One day
when Mignard, the painter, deplored his handsome daughter’s
defective memory, she consoled him—“How fortunate you are,” she
said, “she cannot recite.”
The popular acceptation of Ninon de L’Enclos’ claims to celebrity
would appear to be her beauty, which she retained to almost the end
of her long life—a beauty that was notable; but it lay less in
perfection of the contours of her face, than in the glorious freshness
of her complexion, and the expression of her magnificent eyes, at
once vivacious and sympathetic, gentle and modest-glancing, yet
brilliant with voluptuous languor. Any defects of feature were
probably those which crowned their grace—and when as in the
matter of a slight wrinkle, which in advanced years she said had
rudely planted itself on her forehead, the courtly comment on this of
Monsieur de St Evrémond was to the effect that “Love had placed it
there to nestle in.” Her well-proportioned figure was a little above
middle height, and her dancing was infinitely graceful.
Provincial by descent, Mademoiselle de L’Enclos was a born
Parisian, in that word’s every sense. Her bright eyes first opened in a
small house lying within the shadows of Notre-Dame, the old Cité
itself, the heart of hearts of Paris, still at that time fair with green
spaces and leafy hedgerows, though these were to endure only a
few years longer. Her occasionally uttered wish that she had been
born a man, hardly calls for grave consideration. The desire to don
masculine garments and to ride and fence and shoot, and to indulge
generally in manly pursuits, occurred to her when she was still short
of twelve years old, by which time she was able to write well; and her
earliest epistolary correspondence included a letter addressed to her
father. It ran as follows:—

“My Very Honoured Father,—I am eleven years old. I am big and

strong; but I shall certainly fall ill, if I continue to assist at three masses
every day, especially on account of one performed by a great, gouty, fat
canon, who takes at least twelve minutes to get through the Epistle and
the Gospel, and whom the choir boys are obliged to put back again on
his feet after each genuflexion. I would as soon see one of the towers of
Notre Dame on the altar-steps; they would move quite as quickly, and
not keep me so long from breakfast. This is not at all cheering I can tell
you. In the interest of the health of your only child, it is time to put an
end to this state of things. But in what manner, you will ask, and how is it
to be set about? Nothing more simple. Let us suppose that instead of
me, Heaven had given you a son: I should have been brought up by you,
and not by my mother; already you would have begun to instruct me in
arms, and mounted me on horseback, which would have much better
pleased me than twiddling along the beads of a rosary to Aves, Paters,
and Credos. The present moment is the one for me to inform you that I
decide to be no longer a girl, and to become a boy.
“Will you therefore arrange to send for me to come to you, in order to
give me an education suitable to my new sex? I am with respect, my
very honoured father,—Your little
Ninon.”

This missive, which Ninon contrived to get posted without her

mother’s knowledge, met with her father’s hearty approval. No more
time was lost than it took to make her a handsome suit of clothes, of
the latest mode, the one bearing the palm for grace and
picturesqueness, far and away from all the fashions of men’s attire,
speaking for itself in the canvases of Vandyck; and Ninon stands
forth in the gallant bravery of silken doublet, with large loose sleeves
slashed to the shoulder; her collar a falling band of richest point lace;
the short velvet cloak hanging to the shoulder; the fringed breeches
meeting the wide-topped boots frilled about with fine lawn; the
plumed, broad-brimmed Flemish beaver hat, well-cocked to one side
upon the graceful head, covered with waves of dark hair falling to the
neck; gauntleted gloves of Spanish leather; her rapier hanging from
the richly-embroidered baldric crossing down from the right shoulder
—a picture that thrilled the heart of Monsieur de L’Enclos with
ecstasy; and when, splendidly mounted, she rode forth, ruffling it
gallantly beside him, he was the proud recipient of many a
compliment and encomium on the son of whose existence until now
nobody had been as much as aware.
These delightful days were destined, however, to come quickly to
an end. Fresh disturbances arose with the Huguenots of La Rochelle
and Loudun, and Monsieur de L’Enclos was summoned to join his
regiment. Ninon would doubtless have liked of all things to go with
him; but while this was impossible, she was spared the dreaded
alternative of the fat canon and the three Masses a day, by her father
accepting for her an invitation from his sister, the Baroness
Montaigu, who lived on her estate near Loches, on the borders of the
Indre. This lady, a widow and childless, had long been desirous of
making the acquaintance of her young niece, and on his way north-
west, Monsieur de L’Enclos left Ninon at the château. “And when we
have settled these wretched Huguenots,” said Monsieur de L’Enclos,
as he bade her farewell, and slipped a double louis into her hands, “I
will return for you.”
Madame de Montaigu was a charming lady, of the same spirited,
gay temperament as her brother. She received her niece with the
utmost kindness, and having been initiated into the girl’s whim for
playing the boy, she laughingly fell in with it, and addressed her with
the greatest gravity as “my pretty nephew,” introducing to her, a—
shall it be said?—another young gentleman, by name François de la
Rochefoucauld, Prince de Marsillac, the son of her intimate friend,
the Duchesse de la Rochefoucauld. The lad was a pupil at the
celebrated Jesuits’ College of La Flêche, founded by Henri IV., and
usually spent part of his holidays at the Loches château.
A year or two older than Ninon, Marsillac was a shy and retiring
boy, and at first rather shrank from his robustious new companion,
who, however, soon contrived to draw him out, putting him on his