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Key Points
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Initial evaluation of a child with noisy breathing involves assessment of phase and character of noisy breathing; distress in relation to states of sleep, wakefulness, and feeding; overall color and oxygen saturation; growth and weight gain; and awake fiberoptic laryngoscopy.
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The most common cause of stridor in infants is laryngomalacia, but not all stridor can be assumed to be due to laryngomalacia.
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Laryngomalacia improves spontaneously with increasing age in most children, but when surgery is needed, aryepiglottoplasty (supraglottoplasty) is highly successful to resolve the symptoms.
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Noniatrogenic neonatal unilateral and bilateral vocal cord paralysis will resolve spontaneously in more than 50% of patients.
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All children with congenital anterior laryngeal webs should undergo genetic testing for abnormalities of chromosome 22q11.
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Patients with subglottic hemangiomas often present with a history of "recurrent croup," because the lesion mimics the subglottic swelling of croup, and the symptoms improve with steroid treatment.
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Laryngeal cysts—including vallecular thyroglossal duct cysts, saccular cysts, and subglottic cysts—are a source of potentially severe airway obstruction.
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In the patient with feeding problems, recurrent aspiration, and stridor, the otolaryngologist must maintain a high index of suspicion that a laryngeal cleft may be present and must maintain a low threshold to perform direct laryngoscopy in the operating room to rule out potential clefts.
Assessment of a Child with Noisy Breathing
Characterization of Noisy Breathing
Noisy breathing in a neonate (birth to 1 month age), infant (1 to 12 months), and child (1 to 12 years) can be characterized in several ways and is a reflection of turbulent airflow at some level of the airway. The word stertor is derived from the Latin word stertere , which means "to snore." The term stertor can be used to describe noisy breathing from the vibration of tissues above the level of the larynx. In contrast, stridor is the hallmark of any laryngeal obstruction and can be described as a high pitched, musical, or harsh sound often mistaken for "wheezing." Stridor and stertor can be heard on exam without auscultation and can be correlated with phase of breathing, wakefulness, sleep, and feeding. On auscultation, noisy breathing can be an indication of tracheal sources of turbulent airflow.
Much can be learned about the nature of the airway obstruction by closely observing the infant and listening to the noise produced as air passes through the obstruction. Stertor can result from obstruction at the level of the nose, nasopharynx, oropharynx, hypopharynx, and/or supraglottis. Stridor that results from glottic obstruction is typically present on inspiration, whereas biphasic stridor originates from obstruction at or below the level of the glottis, in the subglottis and upper trachea; expiratory stridor is the result of lesions in the distal trachea or mainstem bronchi. The differential diagnosis of airway pathology in a child can be divided by characteristics that reflect the level of the airway affected, either above or below the larynx ( Tables 23-1 through 23-3 ).
|Airway Pathology
|Age of Presentation
|Level of Airway Obstruction
|Characteristic Noisy Breathing
|Classic Signs/Symptoms
|Associated Sequences/ Syndromes/Findings
|Piriform aperture stenosis
|Birth, first months of infancy
|Anterior nose
|Stertor, noisy mouth/nose breathing
|Nasal flaring, cyclical cyanosis, mouth breathing, difficulty sleeping or feeding
|Holoprosencephaly, single central incisor
|Nasal saline and suctioning, topical decongestant drops, McGovern nipple, surgical repair
|Nasolacrimal duct cyst
|Birth, first months of infancy
|Anterior nose
|Stertor, noisy mouth/nose breathing
|Nasal flaring, cyclical cyanosis, mouth breathing, difficulty sleeping or feeding; symptoms are more severe if bilateral
|Warm compresses and massage of associated dacrocystocele, nasal saline and suctioning, topical decongestant drops, McGovern nipple, marsupialization with lacrimal duct dilation
|Choanal atresia
|Birth (bilateral), birth through childhood (unilateral)
|Stertor, noisy mouth/nose breathing
|Nasal flaring, cyclical cyanosis, mouth breathing, difficulty sleeping or feeding; symptoms are more severe if bilateral
|CHARGE syndrome, craniosynostosis syndromes (Crouzon, Treacher Collins)
|Oral intubation, McGovern nipple, surgical repair
|Nasal glioma, encephalocele
|Birth, infancy
|Nasal cavity
|Stertor, noisy mouth/nose breathing
|Nasal flaring, cyclical cyanosis, mouth breathing, difficulty sleeping or feeding
|Nasal pit with single hair, nasal dorsal mass, possible intracranial extension
|Endoscopic/open resection
|Midface hypoplasia
|Birth, infancy
|Nasal cavity, choanae
|Stertor, noisy mouth/nose breathing
|Nasal flaring, cyclical cyanosis, mouth breathing, difficulty sleeping or feeding
|Craniosynostosis syndromes
|Nasal saline and suctioning, topical decongestant drops, midface advancement
|Retrognathia, micrognathia, glossoptosis
|Birth, infancy
|Base of tongue
|Stertor, noisy mouth breathing
|Difficulty breathing, sleeping or feeding, retractions, cyanosis
|Pierre Robin sequence, craniosynostosis syndromes (Treacher Collins), laryngomalacia
|Prone positioning, nasal trumpet, tongue-lip adhesion, mandibular distraction, tracheostomy
|Birth, childhood
|Posterior oropharynx/base of tongue
|Stertor, noisy mouth breathing
|Protruding tongue with oral incompetence; difficulty breathing, sleeping, or feeding
|Beckwith-Weidemann syndrome, vascular malformation
|Nasogastric tube feeding, oxygen supplementation, tracheostomy, tongue reduction
|Airway Pathology
|Age of Presentation
|Level of Airway Obstruction
|Characteristic Noisy Breathing
|Classic Signs/Symptoms
|Associated Sequences/ Syndromes/Findings
|Birth, infancy
|Stertor, stridor, "congestion," transmission of sound out of nasal cavity
|Retractions, difficulty sleeping/feeding, failure to thrive
|Micrognathia, retrognathia
|Antireflux medications and precautions, supraglottoplasty
|Laryngeal agenesis
|Prenatally diagnosed on ultrasound with fetal echogenic lungs, hydrops, ascites
|EXIT procedure, tracheostomy
|Laryngeal web
|Birth, infancy
|Stridor, aphonia, hoarseness
|Retractions, difficulty feeding
|Velocardiofacial syndrome
|Surgical repair
|Vocal fold paralysis
|Birth, childhood
|Stridor, aphonia, hoarseness
|Retractions, difficulty feeding/sleeping, aspiration
|Bilateral: central nervous system pathology (Arnold-Chiari malformation), birth trauma, postsurgical (cardiac surgery), mediastinal mass
|Nasogastric tube feedings, oxygen supplementation, tracheostomy, posterior cricoid graft (bilateral); vocal fold injection (unilateral)
|Paradoxic vocal fold motion
|Birth, childhood
|Inspiratory stridor
|Episodic inspiratory stridor with crying, agitation, during feeding (infant), or with anxiety or exercise (child)
|Gastroesophageal reflux, allergic rhinitis with postnasal drip, anxiety
|Reflux treatment, treatment of nasal allergies, soothing/calming measures, speech therapy
|Gastropharyngeal reflux
|Birth, infancy
|Stertor, stridor "congestion"; transmission of sound out of nasal cavity
|Noisy breathing after feeding
|Antireflux medications, Nissen fundoplication
|Posterior glottic stenosis
|Birth, childhood
|Stridor, hoarseness
|Retractions, difficulty sleeping/feeding
|History or intubation
|Reflux treatment, lysis of scar, tracheostomy, posterior cricoid graft
|Laryngeal cleft
|Birth, childhood
|Larynx, trachea
|Stertor, stridor
|Feeding difficulties, recurrent pneumonia
|Tracheoesophageal fistula, esophageal atresia, congenital heart disease, cleft lip and palate, micrognathia, glossoptosis, laryngomalacia, and Opitz-Frias syndrome
|Endoscopic or open repair
|Infancy, childhood
|Supraglottis, larynx, trachea
|Stridor, hoarseness, aphonia
|Retractions, hoarseness progressing to aphonia
|Pulmonary seeding as the disease progresses
|Surgical debridement, cidofovir intralesional injection
|Laryngeal cysts
|Birth, childhood
|Stertor, stridor, hoarseness
|Retractions, difficulty sleeping, feeding
|Laryngocele or saccular cyst
|Endoscopic or open repair
|Subglottic hemangioma
|Retractions, difficulty sleeping/feeding
|Infantile hemangioma in the beard distribution, PHACES syndrome
|Oral steroids, surgical removal, oral propranolol
|Subglottic cyst
|Birth, childhood
|Retractions, difficulty sleeping/feeding
|History of intubation
|Surgical removal
|Subglottic stenosis
|Birth, childhood
|Retractions, difficulty sleeping/ feeding
|History of intubation, congenital stenosis
|Endoscopic dilation or laser treatment, tracheostomy, laryngotracheal reconstruction
|Airway Pathology
|Age of Presentation
|Level of Airway Obstruction
|Characteristic Noisy Breathing
|Classic Signs/Symptoms
|Associated Sequences/ Syndromes/Findings
|Vascular ring/extrinsic tracheal compression
|Birth, childhood
|Stridor, biphasic "washing machine" or "rattling" noise, coarse upper airway sounds on auscultation
|Retractions, exacerbated with exertion or excitement, recurrent pneumonia, difficulty swallowing
|Down syndrome, velocardiofacial syndrome, CHARGE syndrome, TEF
|Cardiothoracic surgical repair
|Tracheal stenosis, complete tracheal rings
|Birth, childhood
|Stridor, biphasic "washing machine" or "rattling" noise, coarse upper airway sounds on auscultation
|Retractions, exacerbated with exertion or excitement, recurrent pneumonia
|Down syndrome, pulmonary and cardiac anomalies
|Infancy, childhood
|Stridor, biphasic "washing machine" or "rattling" noise, coarse upper airway sounds on auscultation, expiratory wheeze
|Retractions, exacerbated with exertion or excitement, persistent cough
|Laryngomalacia, external compression, chronic tracheal inflammation after TEF repair
|CPAP, tracheostomy for severe cases
|Laryngotracheoesophageal clefts, tracheoesophageal fistula
|Infancy, childhood
|Larynx, trachea
|Stridor, biphasic "washing machine" or "rattling" noise, coarse upper airway sounds on auscultation
|Retractions, persistent cough, recurrent pneumonia
|Opitz-Frias syndrome, Townes-Brock syndrome, chromosome 1q43 deletion, and Down syndrome, VACTERL
|Surgical repair
|Foreign body aspiration
|Infancy, childhood
|Larynx, trachea, bronchus
|Stridor, recurrent cough, unilateral wheezing/rattling on auscultation
|Retractions, persistent cough, unilateral pneumonia
|Hyperinflation, lung collapse, mediastinal shift, and/or radiopaque FB on CXR
|Bronchoscopy and removal of foreign body
Noisy breathing is the hallmark symptom that leads to an airway evaluation. Severity of the airway process and need for intervention can be determined by level of distress, cyanosis, hypercapnea, poor weight gain or failure to thrive, difficulty feeding, difficulty sleeping, and obstructive sleep apnea.
Obtaining a history that elicits whether the noisy breathing is positional or related to states of wakefulness, sleep, or feeding is helpful in determining a differential diagnosis. Important features also include age of onset, exacerbating and ameliorating features, presence of progression, and occurrence of cyanosis. History of illness or recurrent pneumonia and comorbidities such as Down syndrome are useful in identifying associated factors. A history of intubation, prematurity status, and history of cardiac surgery increase suspicion for glottic or subglottic processes. History of a choking episode raises the suspicion of foreign body aspiration.
Physical Exam
The exam of the child begins with an overall assessment of size relative to age, level of distress, retractions, posturing, irritability, level of fatigue, and skin color. Evidence of syndromic features should be noted. Severe obstruction may be inferred by the type and anatomic level of retractions, including nasal flaring, suprasternal retractions, subcostal retractions, and intercostal retractions; the latter reflects recruitment of additional chest muscles for respiration. Altered voice quality may lead to a higher suspicion for a laryngeal process, especially if the child is aphonic, has a muffled voice, or does not generate a cough. Phase of stridor with inspiration or expiration is timed with chest motion. A complete head and neck exam and auscultation of the chest should be performed. Nasal and nasopharyngeal patency can be inferred when fog is seen under each nostril with a mirror.
Dynamic evaluation of the larynx by flexible laryngoscopy is best performed in the patient who is awake. Although at least a 2.5-mm diameter fiberoptic laryngoscope is recommended for optimal viewing, fiberoptic laryngoscopes with diameters as small as 1.9 mm allow the neonatal larynx to be viewed with a minimum of trauma to the young patient. Viewing the fiberoptic laryngoscopy from a monitor allows for a magnified view of the pediatric larynx. Technology that provides the ability to record and review the exam with slow motion views, frame by frame views, and stroboscopy may greatly aid in the evaluation of the dynamic pediatric larynx.
Direct laryngoscopy of the neonatal larynx with a telescope or microscope provides the best optics ( Fig. 23-1 ) and requires general anesthesia, often performed by a pediatric anesthetic team familiar with techniques to provide spontaneous respirations that allow for a full evaluation of the airway before intubation or airway manipulation is performed. Techniques of total intravenous anesthesia, using propofol-remifentanyl intravenously, and of sevoflurane volatile induction/maintenance anesthesia have been well described to allow for spontaneous respirations while permitting airway manipulation. The endoscopist should fully evaluate the larynx and note findings in the valleculae, piriform fossae, postcricoid region, arytenoids, interarytenoid area, aryepiglottic folds, epiglottis, false vocal cords, ventricles, true vocal cords, and the subglottis. A bronchoscopy can be completed with a telescope or Hopkins rod, and the trachea and mainstem bronchi can also be evaluated.
Optional Diagnostic Exams
Other studies that may be helpful in the assessment of child with noisy breathing include oxygen saturation monitoring, capnography, arterial blood gas, lateral neck radiography, chest radiography, modified barium swallow, barium esophagogram, vocal fold ultrasound, vocal fold electromyography, pulmonary function testing, pH probe testing, and polysomnography (PSG). Associated imaging studies of the brain or chest may be needed to assess for associated findings such as Arnold-Chiari malformation or vascular rings.
Without question, the most common cause of stridor in infants is laryngomalacia (LM), which has been thought to occur more frequently in term males with a normal birth weight, although recent evidence suggests that it is equally common in females. Premature Hispanic infants and black infants of all gestational ages are at higher risk for this laryngeal anomaly. The newborn with LM typically develops intermittent inspiratory stridor within the first 2 weeks of life, which resolves slowly over several months. For infants who are not managed operatively, the median time to spontaneous resolution of stridor is 7 to 9 months of age, and the vast majority will have no stridor by 18 months of age.
Many authors describe the stridor of LM as high-pitched, but compared with the stridor of vocal cord paralysis, it is relatively low in pitch and does not have a musical quality. The stridor nearly always worsens with feeding, and often the infant will need to take breaks while feeding in order to breathe. The stridor of mild LM often improves with crying, as tone in the pharynx is increased; conversely, in moderate to severe LM, the stridor typically will worsen with crying because of the increased airflow through the severely collapsed larynx. Infants with severe LM have been found to have shorter aryepiglottoic folds compared with infants without LM. Also, LM may be an isolated finding in the otherwise healthy infant, or it may be associated with other neurologic disorders such as cerebral palsy.
The inspiratory stridor of LM results from collapse of the supraglottic larynx, which creates a narrow airway and turbulent airflow ( Fig. 23-2 ). The etiology of this collapse has been elusive, but it appears to be related to neuromuscular hypotonia. Sensorimotor integration of peripheral sensory afferent reflexes, brainstem function, and the motor efferent response are responsible for laryngeal function and tone. The laryngeal adductor reflex (LAR) is a vagal nerve-mediated reflex activated by sensory stimulation of the mechanoreceptors and chemoreceptors of the superior laryngeal nerve located in the region of the aryepiglottic fold. Dysfunction anywhere along the afferent, brainstem, or efferent pathway of the LAR can result in altered laryngeal tone and function. Infants with LM have been found to have elevated laryngopharyngeal sensory testing thresholds, which shows that the sensorimotor integrative function of the larynx is altered, likely leading to the weak laryngeal tones seen in infants with LM. In addition, pathologic specimens of surgically resected supraarytenoid tissue have been found to have nerve hypertrophy compared with controls, which supports the theory of neurologic dysfunction as the etiology of LM.
The diagnosis of LM requires an endoscopic examination; however, the optimal type of endoscopic examination is somewhat controversial. If the patient is sedated and undergoes fiberoptic flexible laryngoscopy (FFL), the topical lidocaine typically used can cause increased collapse of the arytenoids and folding of the epiglottis during inspiration, which could possibly lead to overestimation of the severity of LM. These findings suggest that the optimal way to diagnose LM is with FFL in the awake patient. Conversely, the awake technique has been found to miss mild LM or lead to overdiagnosis in the patient with a normal airway. The advantages of awake FFL compared to FFL under general anesthesia include the ability to perform the examination expediently in the clinic setting with the parents present and avoidance of sedation, which reduces medical expense. The primary disadvantage of the awake FFL is that in nearly all cases, the infant is crying during the examination, which can alter the appearance of the supraglottic structures. Flexible nasolaryngoscopy has been found to be a consistently accurate method of diagnosis. An omega-shaped epiglottis is often associated with LM but can also be found in otherwise normal infants with no airway obstruction. Airway fluoroscopy has been proposed as a screening tool for the infant with stridor; however, although it has been found to have a relatively high specificity, it has a low sensitivity and is thus not recommended if FFL is available.
It is possible for infants with LM to have a second synchronous lesion that may lead to airway difficulties. The reported incidence of secondary lesions varies from 8% to 58%, with a higher incidence in children with more severe LM. The decision to perform a bronchoscopy in patients who present with typical LM is controversial. Some contend that bronchoscopy should be done only in select infants with LM who present with "apnea, failure to thrive, or features inconsistent with isolated LM." Others have recommended a complete evaluation of the tracheobronchial tree in all symptomatic infants.
In several series, a high prevalence of gastroesophageal reflux disease (GERD) has been reported in patients with LM. Theoretically, when GERD is present, it can cause airway edema and thus contribute to the airway compromise. A recent systematic review of 27 studies representing 1295 neonates with LM showed an increased reflux prevalence of 59% in this group; however, reflux was not demonstrated to be more prevalent in infants with LM compared with matched children with other respiratory diagnoses. In this systematic review, an increased prevalence of reflux was seen in infants with severe LM compared with those with mild LM. The review points out that there currently are no controlled studies to correlate pH data to pathologic reflux findings in infants, and further trials of antireflux medication versus placebo are justified. Because no definitive evidence is currently available to suggest that mild LM will be improved with antireflux therapy, some have recommended that routine use of acid-suppressing medications be avoided. However, in children with moderate to severe LM, it is routine practice among pediatric otolaryngologists to consider antireflux therapy, often empirically, particularly when surgical intervention is being contemplated. Treatment of GERD may improve LM by preventing acid-induced irritation of the larynx and by improving laryngeal sensation and airway protection mechanisms. However, some evidence suggests that infants treated with acid-suppression therapy may have an increased incidence of lower respiratory tract infections. In the child with GERD related to airway obstruction, the GERD will often improve significantly after aryepiglottoplasty.
Laryngeal penetration and aspiration are also common in the child with severe LM. Functional endoscopic evaluation of swallowing (FEES) of children with severe LM has shown laryngeal penetration in 88% of infants and aspiration beyond the vocal folds in 72% of infants. Videofluoroscopic swallow studies are helpful preoperatively to assess the extent of aspiration. PSG may be indicated in the child with LM to assess the degree of sleep disturbance.
Various anatomic abnormalities that lead to supraglottic obstruction may cause laryngomalacia in infants. The most common findings are anterior prolapse of the mucosa overlying the arytenoid cartilages (57%), short aryepiglottic folds that tether the epiglottis posteriorly (15%), posterior collapse of the epiglottis (12%), or some combination of these findings (15%). Several classification systems have been proposed, with none being predominant at this time.
Infrequently, the LM is severe and results in feeding difficulties, microaspiration, failure to thrive, apnea, pectus excavatum, or cyanosis. In these cases, surgical intervention is recommended to prevent worsening failure to thrive, cor pulmonale, and cardiac failure. Approximately 10% to 31% of infants seen by a pediatric otolaryngologist require surgical intervention for their LM. The current standard treatment is supraglottoplasty (aryepiglottoplasty; Fig. 23-3 ). The surgical resection can be performed using the carbon-dioxide (CO 2 ) laser, laryngeal microscissors, sinus instruments, or microdébrider.
The simplest type of supraglottoplasty involves division of short aryepiglottic folds. Alternatively, various portions of the prolapsing supraglottis are removed: the tissue overlying the arytenoids, the aryepiglottic folds, or the posterior portion of the epiglottis. It is important to preserve the interarytenoid mucosa to avoid postoperative stenosis. For the child with a severely omega-shaped epiglottis, an epiglottopexy can be performed to unfurl the epiglottis and open up the airway. In this procedure, the mucosa of the lingual surface of the epiglottis and the corresponding mucosa of the base of the tongue are removed with the carbon-dioxide laser, followed by suturing of the epiglottis to the tongue base. Unilateral supraglottoplasty has been advocated by some to reduce the risk of postoperative supraglottic stenosis; however, most surgeons perform a bilateral procedure to obtain the maximum benefit.
The supraglottoplasty procedures are well tolerated by infants and typically require only a short hospital stay of 1 to 3 days. The success of the various forms of supraglottoplasty-epiglottopexy are high, and the vast majority of children obtain relief from their obstruction. Children with severe LM often have a lower-percentile weight on a standardized growth curve, and improvement in growth curve percentile is substantial after supraglottoplasty. Following supraglottoplasty, the incidence of aspiration also improves significantly. Some children have ongoing aspiration for months after surgery and require thickening of feedings or gastrostomy tube placement. Sleep mechanics also improve as evidenced in studies that have compared preoperative and postoperative PSG.
Those children who do not improve with supraglottoplasty often have underlying neurologic or syndromal abnormalities and may require a tracheotomy. Complications are rare, the most concerning of which is supraglottic stenosis, which may occur in up to 4% of cases. Children who do not improve significantly with the initial surgery may require revision supraglottaplasty, which is more commonly needed in children with comorbidities.
Although LM is typically thought of as occurring only in infants, it is occasionally observed in older children and adults and can be a cause of obstructive sleep apnea. Similar to neonates with LM, older children with sleep apnea and LM improve after supraglottoplasty. Neurologically impaired children (i.e., those with cerebral palsy) with poor pharyngeal tone are particularly prone to developing LM. Exercise-induced LM results when enough inspiratory force occurs during exercise to draw the aryepiglottic folds into the larynx and partially obstruct the glottis. In severe cases with redundant aryepiglottic folds, supraglottoplasty can be beneficial. Similarly, if the epiglottis is elongated and flaccid, a partial epiglottidectomy may be effective.
Vocal Fold Dysfunction
Vocal Fold Paralysis
Vocal fold paralysis (VFP) is another common cause of neonatal stridor. The stridor is inspiratory or biphasic with a high-pitched musical quality. VFP in a newborn may result from birth trauma, thoracic diseases or procedures, central or peripheral neurologic diseases, or from idiopathic causes. Birth trauma or forceps delivery results in a traction-type injury to the neck, associated with hematoma, soft tissue swelling, and/or compression injury to the vagus nerve as it descends in the neck. Traumatic intubation or aggressive suctioning may also result in direct laryngeal trauma and VFP.
Iatrogenic left VFP is a known complication of thoracic surgery, particularly patent ductus arteriosus ligation or repair of an interrupted aortic arch, which may be associated with difficulty weaning the infant off ventilator support. The left recurrent laryngeal nerve is susceptible to injury at the point that it passes around the ductus arteriosus, unless a right aortic arch is present. The incidence of recurrent laryngeal nerve injury is estimated at 1% to 7.4% of patent ductus arteriosus ligation cases. Tracheoesophageal fistula repair, pediatric thyroidectomy, and transcervical resection of branchial anomalies have also been associated with VFP.
The diagnosis is best made by FFL in the awake patient so that the effect of anesthesia on vocal fold function is minimized. The combination of a small dynamic glottis and collapsing supraglottic tissues in infants can make the diagnosis of VFP difficult. VFP may be unilateral or bilateral; bilateral VFP of neurogenic origin cannot be differentiated from bilateral vocal fold fixation by FFL alone, direct laryngoscopy with palpation is necessary. Pediatric laryngeal electromyography has been found to be useful in the diagnosis and management of VFP ; when performed under a light plane of anesthesia, it is helpful to differentiate fixation from paralysis and assist with prognosis.
The presenting symptoms for infants with a unilateral VFP include a weak cry or stridor, aspiration, dysphagia, or feeding difficulties. The voice of most infants with a unilateral VFP is quiet but audible and gains strength with time. The patient with unilateral VFP is often able to compensate for purposes of feeding without medical intervention. Sometimes an infant will require nasogastric feeds on a short-term basis or a gastrostomy tube. An occupational or speech pathology feeding consult is helpful with these infants to rule out aspiration (as seen on modified barium swallow) and to counsel the parents on how to feed the patient. Most often, these infants should start with a slow-flow nipple and work up to a regular nipple.
Children with bilateral VFP often have severe airway obstruction, which requires a tracheotomy in up to 73% of children. Bilateral VFP is often the presenting symptom leading to diagnosis of many neuromuscular diseases, including fascioscapulohumeral myopathy, spinal muscular atrophy, and congenital myasthenia gravis. Meningomyelocele and Arnold-Chiari malformation may lead to herniating contents in the posterior fossa and/or hydrocephalus, which causes pressure injury on the vagus nerves as they exit the skull base. Neonatal subdural hemorrhage may also present with bilateral VFP.
Workup of patients with idiopathic bilateral VFP should include a magnetic resonance imaging (MRI) scan of the brain to rule out an Arnold-Chiari malformation or other intracranial cause of brainstem compression ; early decompression is recommended to obtain a better outcome. Genetics consultation to evaluate for chromosomal abnormalities is recommended for patients with idiopathic congenital bilateral VFP.
When unilateral VFP results in severe aspiration and dysphonia, injection of the vocal fold may be helpful. The most commonly injected materials include cadaveric dermis (Cymetra), calcium hydroxyapatite (Radiesse or Radiesse Voice Gel), hydrated porcine gelatin powder (Surgifoam), absorbable gelatin sponge (Gelfoam), or autologous fat. Alternatively, in the older child, a medialization laryngoplasty (thyroplasty) can be performed, taking into consideration that the vocal fold lies in an anatomically lower position in children compared with adults. However, not all children may be able to cooperate intraoperatively with vocal tuning. Vocal fold reinnervation has been described to restore vocal fold tone, thus providing neuromuscular medialization without the use of an implant. Ansa cervicalis to recurrent laryngeal nerve reinnervation has been described, which required 3 to 6 months for results, with improvement in vocal functioning reported.
Approximately 70% of noniatrogenic unilateral vocal fold paralyses will resolve spontaneously, most within the first 6 months of life. In one study of children evaluated by a pediatric otolaryngologist, 35% of those with unilateral vocal fold paralysis after cardiac surgery recovered vocal fold function; at least half of the patients had swallowing dysfunction, usually aspiration or laryngeal penetration evident on modified barium swallow. Although many of the patients with a unilateral vocal fold paralysis were able to feed orally, many initially required a gastrostomy tube.
The vocal folds spontaneously become mobile in up to 65% of patients with bilateral VFP. Prognosis is better if there are no associated anomalies. Most recovery of vocal fold function occurs within 24 to 36 months, although it has been reported in patients up to 11 years of age. If recovery occurs after 2 to 3 years, it is often incomplete because of laryngeal muscle atrophy, cricoarytenoid fixation, and/or synkinesis. The timing of possible surgical intervention is debated. Some authors recommend intervention at a young age, whereas others suggest waiting until adolescence when the patient is able to decide.
Many surgical options are available to improve the airway of a patient with bilateral vocal cord paralysis, which implies that none is uniformly successful, particularly in the young patient. Endoscopically, a lateral cordotomy can be performed to increase the glottic area. Arytenoidectomy may be performed via an endoscopic or external cervical approach or the Woodman approach. Alternatively, an arytenoidopexy can be performed using a laterocervical approach. Triglia and colleagues performed an arytenoidopexy on 34 children with bilateral vocal cord paralysis (mean age, 20 months). Of the 15 children who had a tracheotomy or endotracheal tube before the procedure, 14 were successfully decannulated postoperatively. Another option is to expand the cricoid cartilage by placing a costal cartilage graft posteriorly, thereby separating the arytenoids and increasing the area between the vocal folds. This procedure can be performed with a laryngofissure or endoscopic approach. Finally, lateralization of the paralyzed cord has been described as a potentially reversible approach to vocal cord paralysis.
Hartnick and colleagues described 52 children who underwent surgery for bilateral VFP. The procedures most successful in realizing tracheotomy decannulation were those that included vocal cord lateralization procedures combined with a partial arytenoidectomy (71% decannulation rate). These procedures were more successful than CO 2 laser cordotomy or arytenoidectomy procedures (29% decannulation), isolated arytenoidopexy procedures (25% decannulation), or posterior costal cartilage graft procedures (60% decannulation). No prospective randomized studies have been performed to evaluate the outcomes of these different surgical options, although meta-analysis has suggested that external arytenoidopexy and external arytenoidectomy are more effective than carbon-dioxide ablation procedures.
Paradoxic Vocal Fold Motion
Paradoxic vocal fold motion may result in stridor in the neonate, infant, and child. The classic presentation is a patient with episodic stridor that is loud and high pitched, interspersed with periods of normal breathing. The history and presentation in a neonate vary greatly from that of an older child, although the exam findings are the same. The evaluation for stridor begins with an awake fiberoptic laryngoscopy. Vocal fold motion must be observed and timed with inspiration and expiration; the endoscopist will note that with inspiration, the vocal folds are adducted, especially the anterior vocal folds. Video recording of the endoscopy with slow motion and frame-by-frame views may aid in the diagnosis. Whereas a neonate may present with stridor at birth, the stridor may be more pronounced with crying episodes. This form of stridor in a neonate tends to be short lived and often resolves on its own within a few months of life, or it may be associated with significant gastroesophageal reflux. A child or adolescent may have stridor from paradoxic motion associated with stress, anxiety, or exercise, which is often confused with asthma. There have been reports of paradoxic vocal fold motion causing obstructive sleep apnea. The pathophysiology of paradoxic vocal fold dysfunction is unknown, but laryngeal hyperresponsiveness is suspected to play a role. Treating sources of laryngeal sensitivity such as postnasal drip, gastroesophageal reflux, laryngopharyngeal reflux, and/or psychological conditions may be of benefit. Speech therapy and breathing exercises have also been reported to be helpful.
Laryngeal Web/Atresia
Anterior congenital laryngeal webs are rare anomalies typically diagnosed in the neonatal period after an investigation for the source of aphonia or stridor ( Fig. 23-4 ). Occasionally a minor web will present as hoarseness in an older child. Most commonly, a web will cause partial obstruction of the anterior glottis and will extend into the subglottic area, causing congenital subglottic stenosis. Glottic webs are classified by the degree of glottic obstruction and the degree of extension into the subglottis ( Table 23-4 ).
|Extent of Glottic Obstruction
|Subglottic Involvement
|Type 1
|None or little
|Mild hoarseness
|Type 2
|Thin anterior web with little subglottic extension
|Hoarse, weak cry, stridor with exertion
|Type 3
|Thin-thick web, extends to lower border of cricoid
|Severe hoarseness, moderate airway obstruction
|Type 4
|Thick web, extends to lower cricoid
|Aphonic, severe airway obstruction, requires tracheotomy


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Welcome to Herbert Akins Road Elementary School, Home of the Hawks! As a school community, we strive to build a strong foundation for students to become responsible and productive citizens. School staff, parents, and students collaborate to ensure personal growth and academic achievement for all students. If you are unable to find the information you are seeking on our site, please feel free to call us at (919) 567-4100.
6:00 PM - 7:00 PM School Tour
9:30 AM - 10:45 AM School Tour
9:30 AM - 10:30 AM School Tour
9:30 AM - 10:30 AM School Tour
Overall, only about 1% of Wake County Public School System students will be impacted in each of the two years of this plan.
Our Early College programs help students earn college credit – tuition free! – as they also work toward their high school diploma.
We have scored a great partnership with the Carolina Hurricanes that will encourage elementary students to read more both in and out of school.

subset: commoncrawl


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Waffle House on Dessau Road is now open
Hutto seeks to hire interim city manager from Texas Municipal League
The city of Hutto will seek a retired city manager from the Texas Municipal League to serve as Hutto's interim city manager.
UPDATED: Plans progress for a mix of uses on Quick Farms property in Round Rock
UPDATED: Dec. 5, 2019
18 new jobs, $11M facility upgrades: Michael Angelos Gourmet Foods ups investment in Round Rock
Local manufacturer of frozen foods Michael Angelo's Gourmet Foods plans to upgrade its facilities, hire additional staff with a $290,000 economic incentive boost.
Engineering consulting firm BGE to bring at least 80 new jobs to Round Rock
BGE, Inc. will create at least 80 jobs in Round Rock with an average salary of $80,000, according to an economic development agreement approved by Round Rock City Council Dec. 5.
Nutty Brown Amphitheatre gets 2-year extension to build $10M venue in Round Rock
A highly-anticipated outdoor music venue has delayed its Round Rock opening once again.
Louisiana Crab Shack to open 2 Round Rock locations
The Austin-based seafood chain currently has restaurants in Austin, Georgetown, Cedar Park and Waco.
Spirit of Texas expands Pflugerville distillery, adding brewery
Spirit of Texas officially opened its taproom Nov. 8.
468 new jobs, $30.4M investment in 2019: Round Rock Chamber is 'strong,' CEO says in annual address
Round Rock Chamber President and CEO Jason Ball delivered the 2019 State of the Chamber address Dec. 3.
Travis County 2017-22 bond program remains on track thanks to innovations
Fifty-six of the 60 projects included in the five-year bond program Travis County voters approved in 2017 are in active development, according to a Dec. 3 presentation made to the Commissioners Court.
Williamson County sees one of the largest year-over-year employment increases in the U.S.
Williamson County continues to see its unemployment rate decline.
REAL ESTATE DATA: Homes on the market in Round Rock, Pflugerville, Hutto
Residential real estate listings added to the market between 11/5/19 and 11/26/19 were provided by the Austin Board of Realtors.
Pflugerville officials seek to remedy city's water treatment failure
The city of Pflugerville failed to meet state-mandated water treatment levels from October 2018 through September 2019, excluding December 2018 and April 2019.


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Alex Bregman Poised To Dominate Second Half
5 months agoHouston Astros infielder Alex Bregman will be ready to continue his success in the second half when the team opens up a series with the Rangers on Thursday. In 2017, Bregman slashed .315/.367/.536 with four triples, 11 home runs and 18 doubles in 71 games. In 2018, he posted a line of .283/.402/.520 with 11 home runs and 20 doubles in 61 games. Bregman is having another fantastic offensive season and is positioned to take his game to another level in the second half. One area that needs improvement will be raising his .194 batting average with runners in scoring position but is a must-start in fantasy regardless.
Source: Houston Astros
Source: Houston Astros


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The Trade Union was a very powerful Republic commence guild, trade cartel, megacorporation and lobbying group that was founded in 5 ABY as an association of business and trade groups with it's own commercial trade fleet.
It grew to dominate entire star systems and all major trade routes, and possessed a formidable and private military. Towards the end of the Republic, It would become increasingly dominated by the commence-sawy Twi'leks.
It was dissolved and transformed into the Imperial Workers Union by the Dark Empire.
The Trade Union was a shipping corporation and cartel, it made deals with Czerka Corporation and spice traders in order to form it's own private military to accomplish their Sith-influenced aims, it was originally controlled by a directorate, which was led by a commanding Viceroy.
Tw'leks were very influential in the leadership of the Directorate. though the Union only became a Twi'lek monopoly in 33 BBY when the Trade Union Directorate was murdered, leaving Viceroy Nute Gunray. He proceeded to fill up the vacancies with his Twi'lek puppets, some of whom later comprised the Occupation Council that took control of Pau City after the Utapau invasion.
A trade union (or a labor union) is an organization of workers who have banded together to achieve common goals in key areas, such as working conditions.
The primary role of unions is to represent their members in negotiations for labor contracts with employers. Unions may also provide their members with direct services, such as include: health insurance, unemployment insurance, legal aid, subsidized vacations, education programs, etc.
Some Starports are "closed shop" (employers agree to only hire union members, and employees must remain members of the union at all times in order to remain employed) while others are "open shop" (employees are not required to join a union as a condition of hiring or continued employment). Characters without a union "ticket" (membership card) may find it difficult to obtain work at a Starport with a closed shop. Conversely, union members may find themselves blacklisted at Starports in systems that are strongly anti-union.
Due to the vast size of the Imperium, authority within a union is typically decentralized to subregional councils (1 per subsector), joint councils (1 per system), and individual locals. A single Starport may have more than one local branch, e.g. the IBLT may have one local to represent shuttle crews, another to represent cargo handlers, etc. These local branches come together in joint councils, e.g. IBLT Kinorb Joint Council.
Unions in the Imperium include:


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A Serbian English teacher was "seized and deported" in June in Shenzhen, according to Xinhua, which reported the incident Friday.
The foreign teacher was deported for "taking drugs" and on "suspicion of working illegally," according to the Xinhua article, which also says the the Nanshan-based kindergarten staff reported their own teacher to the authorities. The drug involved was not named.
The unnamed Nanshan kindergarten is said to have about 80 students and only one foreign teacher after two other foreign employees resigned, including the 'headmaster' and 'teaching supervisor,' though it's not clear from the Xinhua report if that is as of June or currently.
The deportation may be symptomatic of a bigger issue, according to one industry insider.
Asking not to be named, the owner of a teaching agency said qualified foreign teachers have become hard to come by after China introduced stricter visa rules.
"This means that many schools – out of desperation for employees – are willing now to hire people they wouldn't have considered two years ago," said the insider. "He must have really pissed someone off to have his own school report him."
READ MORE: New 'Green Cards' for Foreigners Coming This Month
A 2015 Shenzhen Daily article, which was also written by the author of this article, cited sources estimating 80 percent of foreign teachers in the city weren't working on the correct visa.
Legally employed teachers work on a residence permit, but, with the encouragement of training centers, many work on business visas, which are valid for up to 10 years.
Business visas require regular trips outside of mainland China, but at Shenzhen's Futian Checkpoint it takes about 30 minutes to pass into Hong Kong and back into the mainland, technically 'entering and exiting.'
Updates to China visa policy sometimes go unannounced online, with new work-visa policies implemented in mid-2017, according to consulting agency INS.
READ MORE: China Launching a 5-Year Work Permit for Foreigners


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Parallel Verses
New International Version
When you reached this place, Sihon king of Heshbon and Og king of Bashan came out to fight against us, but we defeated them.
King James Bible
And when ye came unto this place, Sihon the king of Heshbon, and Og the king of Bashan, came out against us unto battle, and we smote them:
Darby Bible Translation
And ye came to this place; and Sihon the king of Heshbon and Og the king of Bashan came out against us for battle, and we smote them.
World English Bible
When you came to this place, Sihon the king of Heshbon, and Og the king of Bashan, came out against us to battle, and we struck them:
Young's Literal Translation
'And ye come in unto this place, and Sihon king of Heshbon -- also Og king of Bashan -- doth come out to meet us, to battle, and we smite them,
Deuteronomy 29:7 Parallel
CommentaryClarke's Commentary on the Bible
Ye have not eaten bread, etc. - That is, ye have not been supported in an ordinary providential way; I have been continually working miracles for you, that ye might know that I am the Lord. Thus we find that God had furnished them with all the means of this knowledge, and that the means were ineffectual, not because they were not properly calculated to answer God's gracious purpose, but because the people were not workers with God; consequently they received the grace of God in vain. See 2 Corinthians 6:1.
Treasury of Scripture Knowledge
Deuteronomy 2:24-37 Rise you up, take your journey, and pass over the river Arnon: behold, I have given into your hand Sihon the Amorite, king of Heshbon...
Deuteronomy 3:1-17 Then we turned, and went up the way to Bashan: and Og the king of Bashan came out against us, he and all his people...
Numbers 21:21-35 And Israel sent messengers to Sihon king of the Amorites, saying...
Numbers 32:33-42 And Moses gave to them, even to the children of Gad, and to the children of Reuben, and to half the tribe of Manasseh the son of Joseph...
Psalm 135:10-12 Who smote great nations, and slew mighty kings...
Psalm 136:17-22 To him which smote great kings: for his mercy endures for ever...
LibraryCovenant Duties.
It is here proposed to show, that every incumbent duty ought, in suitable circumstances, to be engaged to in the exercise of Covenanting. The law and covenant of God are co-extensive; and what is enjoined in the one is confirmed in the other. The proposals of that Covenant include its promises and its duties. The former are made and fulfilled by its glorious Originator; the latter are enjoined and obligatory on man. The duties of that Covenant are God's law; and the demands of the law are all made …
John Cunningham—The Ordinance of Covenanting
Promises and Threatenings
Palestine Eighteen Centuries Ago
The Holy Spirit as a Teacher.
Cross References
Numbers 21:21
Israel sent messengers to say to Sihon king of the Amorites:
Numbers 21:33
Then they turned and went up along the road toward Bashan, and Og king of Bashan and his whole army marched out to meet them in battle at Edrei.
Deuteronomy 2:17
the LORD said to me,
Deuteronomy 2:33
the LORD our God delivered him over to us and we struck him down, together with his sons and his whole army.
Psalm 135:11
Sihon king of the Amorites, Og king of Bashan, and all the kings of Canaan--
Psalm 136:18
and killed mighty kings-- His love endures forever.
Jump to PreviousBashan Battle Defeated Heshbon Meet Og Overcame Reached Sihon Smite Smote Struck War
Jump to NextBashan Battle Defeated Heshbon Meet Og Overcame Reached Sihon Smite Smote Struck War
LinksDeuteronomy 29:7 NIV
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Deuteronomy 29:7 Commentaries
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Exacerbação da doença pulmonar obstrutiva crônica : investigação do efeito sobre a modulação autonômica cardíaca e capacidade funcional
Kabbach, Erika Zavaglia
MetadataShow full item record
Chronic obstructive pulmonary disease (COPD) is a major cause of disability, hospital admissions, and the demand for care in health systems. Periods of exacerbations are frequent and are associated with increased risk for cardiovascular disease and reduced overall health status. The involvement of cardiac autonomic modulation (CAM) has been evidenced in this population in stable periods; however, knowledge about CAM in exacerbated hospitalized COPD, as well as on the influence of functional aspects in this function is still scarce. In this context, of exacerbation of COPD and the possibility of advancing the knowledge about the cardiac autonomic nervous system and the functional capacity in this clinical condition motivated the development of this dissertation, which will consist of the presentation of a study titled " Increased parasympathetic cardiac modulation in patients with acute exacerbation of chronic obstructive pulmonary disease: how should we interpret it?". The aim of this study was to evaluate MAC responses in patients with COPD during exacerbation of the disease compared to patients in stable condition and to verify the possible association of these responses with functional capacity. Patients with COPD were included in the study and divided into two groups according to the clinical condition: stable and exacerbated. The exacerbated patients were evaluated in the first 24-48 hours after initiation of pharmacological therapy for exacerbation. The HR signal and the RR intervals were recorded for 10 minutes in seated position for later analysis of MAC using heart rate variability (HRV) indices. Clinical and functional data were obtained by evaluating handgrip strength, dyspnea and general health status. Our results showed higher values of the representative indices of the parasympathetic modulation for the exacerbated patients compared to the stable patients: RMSSD (17.8 ± 5.6 vs 11.7 ± 9.5 ms); HF (111.3 ± 74.9 vs. 45.6 ± 80.7 ms2); SD1 (12.7 ± 3.9 vs. 8.3 ± 6.7 ms). Significant and negative associations between HF and handgrip strength (r = -0.58) and LF with dyspnea were found (r = -0.53) (P <0.05). These findings can be attributed, among other factors, to the influence of vagal activity on the respiratory system, which results in narrowing of the airways and consequent worse clinical status. Reinforcing these findings it was possible to verify that the parasympathetic modulation is inversely associated to the functional capacity in the exacerbation of the disease. These results add knowledge that may be useful to the clinical practice of the professional involved in the care of this patient.


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"The book is absorbingly interesting: dramatic, subtle, fascinating with allurement." ― The New York Times.
Captain Tom Lingard is on his way to help his friends, a Malay prince and princess, reclaim their stolen land when he gets distracted by a marooned yacht. Lingard feels obliged to help his fellow Europeans out of their plight — and he's increasingly attracted to Edith Travers, the married woman on board — but his rescue of the pleasure boat and its passengers plunges the captain deep into a dangerous vortex of local politics.
One of Conrad's less familiar tales, this powerfully intense novel provides atmospheric seafaring glimpses of the Malay Archipelago along with a suspenseful plot that builds to an explosive climax. The Rescue is chronologically the first in the author's Lingard trilogy, which includes Almayer's Folly and An Outcast of the Islands, although it appeared years later. Begun in 1896 and published in 1920, just four years before Conrad's death, the novel adds resonance to Conrad's other works on colonialism and imperialism.
THE shallow sea that foams and murmurs on the shores of the thousand islands, big and little, which make up the Malay Archipelago has been for centuries the scene of adventurous undertakings. The vices and the virtues of four nations have been displayed in the conquest of that region that even to this day has not been robbed of all the mystery and romance of its past–and the race of men who had fought against the Portuguese, the Spaniards, the Dutch and the English, has not been changed by the unavoidable defeat. They have kept to this day their love of liberty, their fanatical devotion to their chiefs, their blind fidelity in friendship and hate–all their lawful and unlawful instincts. Their country of land and water–for the sea was as much their country as the earth of their islands–has fallen a prey to the western race–the reward of superior strength if not of superior virtue. To-morrow the advancing civilization will obliterate the marks of a long struggle in the accomplishment of its inevitable victory.
The adventurers who began that struggle have left no descendants. The ideas of the world changed too quickly for that. But even far into the present century they have had successors. Almost in our own day we have seen one of them–a true adventurer in his devotion to his impulse–a man of high mind and of pure heart, lay the foundation of a flourishing state on the ideas of pity and justice. He recognized chivalrously the claims of the conquered; he was a disinterested adventurer, and the reward of his noble instincts is in the veneration with which a strange and faithful race cherish his memory.
Misunderstood and traduced in life, the glory of his achievement has vindicated the purity of his motives. He belongs to history. But there were others–obscure adventurers who had not his advantages of birth, position, and intelligence; who had only his sympathy with the people of forests and sea he understood and loved so well. They cannot be said to be forgotten since they have not been known at all. They were lost in the common crowd of seamen-traders of the Archipelago, and if they emerged from their obscurity it was only to be condemned as lawbreakers. Their lives were thrown away for a cause that had no right to exist in the face of an irresistible and orderly progress–their thoughtless lives guided by a simple feeling.
But the wasted lives, for the few who know, have tinged with romance the region of shallow waters and forest-clad islands, that lies far east, and still mysterious between the deep waters of two oceans.
OUT of the level blue of a shallow sea Carimata raises a lofty barrenness of grey and yellow tints, the drab eminence of its arid heights. Separated by a narrow strip of water, Suroeton, to the west, shows a curved and ridged outline resembling the backbone of a stooping giant. And to the eastward a troop of insignificant islets stand effaced, indistinct, with vague features that seem to melt into the gathering shadows. The night following from the eastward the retreat of the setting sun advanced slowly, swallowing the land and the sea; the land broken, tormented and abrupt; the sea smooth and inviting with its easy polish of continuous surface to wanderings facile and endless.
There was no wind, and a small brig that had lain all the afternoon a few miles to the northward and westward of Carimata had hardly altered its position half a mile during all these hours. The calm was absolute, a dead, flat calm, the stillness of a dead sea and of a dead atmosphere. As far as the eye could reach there was nothing but an impressive immobility. Nothing moved on earth, on the waters, and above them in the unbroken lustre of the sky. On the unruffled surface of the straits the brig floated tranquil and upright as if bolted solidly, keel to keel, with its own image reflected in the unframed and immense mirror of the sea. To the south and east the double islands watched silently the double ship that seemed fixed amongst them forever, a hopeless captive of the calm, a helpless prisoner of the shallow sea.
Since midday, when the light and capricious airs of these seas had abandoned the little brig to its lingering fate, her head had swung slowly to the westward and the end of her slender and polished jib-boom, projecting boldly beyond the graceful curve of the bow, pointed at the setting sun, like a spear poised high in the hand of an enemy. Right aft by the wheel the Malay quartermaster stood with his bare, brown feet firmly planted on the wheel-grating, and holding the spokes at right angles, in a solid grasp, as though the ship had been running before a gale. He stood there perfectly motionless, as if petrified but ready to tend the helm as soon as fate would permit the brig to gather way through the oily sea.
The only other human being then visible on the brig's deck was the person in charge: a white man of low stature, thick-set, with shaven cheeks, a grizzled moustache, and a face tinted a scarlet hue by the burning suns and by the sharp salt breezes of the seas. He had thrown off his light jacket, and clad only in white trousers and a thin cotton singlet, with his stout arms crossed on his breast–upon which they showed like two thick lumps of raw flesh–he prowled about from side to side of the half-poop. On his bare feet he wore a pair of straw sandals, and his head was protected by an enormous pith hat–once white but now very dirty–which gave to the whole man the aspect of a phenomenal and animated mushroom. At times he would interrupt his uneasy shuffle athwart the break of the poop, and stand motionless with a vague gaze fixed on the image of the brig in the calm water. He could also see down there his own head and shoulders leaning out over the rail and he would stand long, as if interested by his own features, and mutter vague curses on the calm which lay upon the ship like an immovable burden, immense and burning.
At last, he sighed profoundly, nerved himself for a great effort, and making a start away from the rail managed to drag his slippers as far as the binnacle. There he stopped again, exhausted and bored. From under the lifted glass panes of the cabin skylight near by came the feeble chirp of a canary, which appeared to give him some satisfaction. He listened, smiled faintly, muttered,
Dicky, poor Dick— and fell back into the immense silence of the world. His eyes closed, his head hung low over the hot brass of the binnacle top. Suddenly he stood up with a jerk and said sharply in a hoarse voice:
You've been sleeping–you. Shift the helm. She has got stern way on her.
The Malay, without the least flinch of feature or pose, as if he had been an inanimate object called suddenly into life by some hidden magic of the words, spun the wheel rapidly, letting the spokes pass through his hands; and when the motion had stopped with a grinding noise, caught hold again and held on grimly. After a while, however, he turned his head slowly over his shoulder, glanced at the sea, and said in an obstinate tone:
No catch wind–no get way.
No catch–no catch–that's all you know about it, growled the red-faced seaman.
By and by catch Ali— he went on with sudden condescension.
By and by catch, and then the helm will be the right way. See?
The stolid seacannie appeared to see, and for that matter to hear, nothing. The white man looked at the impassive Malay with disgust, then glanced around the horizon–then again at the helmsman and ordered curtly:
Shift the helm back again. Don't you feel the air from aft? You are like a dummy standing there.
The Malay revolved the spokes again with disdainful obedience, and the red-faced man was moving forward grunting to himself, when through the open skylight the hail
On deck there! arrested him short, attentive, and with a sudden change to amiability in the expression of his face.
Yes, sir, he said, bending his ear toward the opening.
What's the matter up there? asked a deep voice from below.
The red-faced man in a tone of surprise said:
I hear that rudder grinding hard up and hard down. What are you up to, Shaw? Any wind?
Ye-es, drawled Shaw, putting his head down the skylight and speaking into the gloom of the cabin.
I thought there was a light air, and–but it's gone now. Not a breath anywhere under the heavens.
He withdrew his head and waited a while by the skylight, but heard only the chirping of the indefatigable canary, a feeble twittering that seemed to ooze through the drooping red blossoms of geraniums growing in flower-pots under the glass panes. He strolled away a step or two before the voice from down below called hurriedly:
Hey, Shaw? Are you there?
Yes, Captain Lingard, he answered, stepping back.
Have we drifted anything this afternoon?
Not an inch, sir, not an inch. We might as well have been at anchor.
It's always so, said the invisible Lingard. His voice changed its tone as he moved in the cabin, and directly afterward burst out with a clear intonation while his head appeared above the slide of the cabin entrance:
Always so! The currents don't begin till it's dark, when a man can't see against what confounded thing he is being drifted, and then the breeze will come. Dead on end, too, I don't doubt.
Shaw moved his shoulders slightly. The Malay at the wheel, after making a dive to see the time by the cabin clock through the skylight, rang a double stroke on the small bell aft. Directly forward, on the main deck, a shrill whistle arose long drawn, modulated, dying away softly. The master of the brig stepped out of the companion upon the deck of his vessel, glanced aloft at the yards laid dead square; then, from the door-step, took a long, lingering look round the horizon.
He was about thirty-five, erect and supple. He moved freely, more like a man accustomed to stride over plains and hills, than like one who from his earliest youth had been used to counteract by sudden swayings of his body the rise and roll of cramped decks of small craft, tossed by the caprice of angry or playful seas.
He wore a grey flannel shirt, and his white trousers were held by a blue silk scarf wound tightly round his narrow waist. He had come up only for a moment, but finding the poop shaded by the main-topsail he remained on deck bareheaded. The light chestnut hair curled close about his well-shaped head, and the clipped beard glinted vividly when he passed across a narrow strip of sunlight, as if every hair in it had been a wavy and attenuated gold wire. His mouth was lost in the heavy moustache; his nose was straight, short, slightly blunted at the end; a broad band of deeper red stretched under the eyes, clung to the cheek bones. The eyes gave the face its remarkable expression. The eyebrows, darker than the hair, pencilled a straight line below the wide and unwrinkled brow much whiter than the sunburnt face. The eyes, as if glowing with the light of a hidden fire, had a red glint in their greyness that gave a scrutinizing ardour to the steadiness of their gaze.
That man, once so well known, and now so completely forgotten amongst the charming and heartless shores of the shallow sea, had amongst his fellows the nickname of
Red-Eyed Tom. He was proud of his luck but not of his good sense. He was proud of his brig, of the speed of his craft, which was reckoned the swiftest country vessel in those seas, and proud of what she represented.
She represented a run of luck on the Victorian gold-fields; his sagacious moderation; long days of planning, of loving care in building; the great joy of his youth, the incomparable freedom of the seas; a perfect because a wandering home; his independence, his love–and his anxiety. He had often heard men say that Tom Lingard cared for nothing on earth but for his brig–and in his thoughts he would smilingly correct the statement by adding that he cared for nothing living but the brig.
To him she was as full of life as the great world. He felt her live in every motion, in every roll, in every sway of her tapering masts, of those masts whose painted trucks move forever, to a seaman's eye, against the clouds or against the stars. To him she was always precious–like old love; always desirable–like a strange woman; always tender–like a mother; always faithful–like the favourite daughter of a man's heart.
For hours he would stand elbow on rail, his head in his hand and listen–and listen in dreamy stillness to the cajoling and promising whisper of the sea, that slipped past in vanishing bubbles along the smooth black-painted sides of his craft. What passed in such moments of thoughtful solitude through the mind of that child of generations of fishermen from the coast of Devon, who like most of his class was dead to the subtle voices, and blind to the mysterious aspects of the world–the man ready for the obvious, no matter how startling, how terrible or menacing, yet defenceless as a child before the shadowy impulses of his own heart; what could have been the thoughts of such a man, when once surrendered to a dreamy mood, it is difficult to say.
No doubt he, like most of us, would be uplifted at times by the awakened lyrism of his heart into regions charming, empty, and dangerous. But also, like most of us, he was unaware of his barren journeys above the interesting cares of this earth. Yet from these, no doubt absurd and wasted moments, there remained on the man's daily life a tinge as that of a glowing and serene half-light. It softened the outlines of his rugged nature; and these moments kept close the bond between him and his brig.
He was aware that his little vessel could give him something not to be had from anybody or anything in the world; something specially his own. The dependence of that solid man of bone and muscle on that obedient thing of wood and iron, acquired from that feeling the mysterious dignity of love. She–the craft–had all the qualities of a living thing: speed, obedience, trustworthiness, endurance, beauty, capacity to do and to suffer–all but life. He–the man–was the inspirer of that thing that to him seemed the most perfect of its kind. His will was its will, his thought was its impulse, his breath was the breath of its existence. He felt all this confusedly, without ever shaping this feeling into the soundless formulas of thought. To him she was unique and dear, this brig of three hundred and fourteen tons register–a kingdom!
And now, bareheaded and burly, he walked the deck of his kingdom with a regular stride. He stepped out from the hip, swinging his arms with the free motion of a man starting out for a fifteen-mile walk into open country; yet at every twelfth stride he had to turn about sharply and pace back the distance to the taffrail.
Shaw, with his hands stuck in his waistband, had hooked himself with both elbows to the rail, and gazed apparently at the deck between his feet. In reality he was contemplating a little house with a tiny front garden, lost in a maze of riverside streets in the east end of London. The circumstance that he had not, as yet, been able to make the acquaintance of his son–now aged eighteen months–worried him slightly, and was the cause of that flight of his fancy into the murky atmosphere of his home. But it was a placid flight followed by a quick return. In less than two minutes he was back in the brig.
All there, as his saying was. He was proud of being always
all there.
He was abrupt in manner and grumpy in speech with the seamen. To his successive captains, he was outwardly as deferential as he knew how, and as a rule inwardly hostile–so very few seemed to him of the
all there kind. Of Lingard, with whom he had only been a short time–having been picked up in Madras Roads out of a home ship, which he had to leave after a thumping row with the master–he generally approved, although he recognized with regret that this man, like most others, had some absurd fads; he defined them as
bottom-upwards notions.
He was a man–as there were many–of no particular value to anybody but himself, and of no account but as the chief mate of the brig, and the only white man on board of her besides the captain. He felt himself immeasurably superior to the Malay seamen whom he had to handle, and treated them with lofty toleration, notwithstanding his opinion that at a pinch those chaps would be found emphatically
not there.
As soon as his mind came back from his home leave, he detached himself from the rail and, walking forward, stood by the break of the poop, looking along the port side of the main deck. Lingard on his own side stopped in his walk and also gazed absent-mindedly before him. In the waist of the brig, in the narrow spars that were lashed on each side of the hatchway, he could see a group of men squatting in a circle around a wooden tray piled up with rice, which stood on the just swept deck. The dark-faced, soft-eyed silent men, squatting on their hams, fed decorously with an earnestness that did not exclude reserve.
Of the lot, only one or two wore sarongs, the others having submitted–at least at sea–to the indignity of European trousers. Only two sat on the spars. One, a man with a childlike, light yellow face, smiling with fatuous imbecility under the wisps of straight coarse hair dyed a mahogany tint, was the tindal of the crew–a kind of boatswain's or serang's mate. The other, sitting beside him on the booms, was a man nearly black, not much bigger than a large ape, and wearing on his wrinkled face that look of comical truculence which is often characteristic of men from the southwestern coast of Sumatra.
This was the kassab or store-keeper, the holder of a position of dignity and ease. The kassab was the only one of the crew taking their evening meal who noticed the presence on deck of their commander. He muttered something to the tindal who directly cocked his old hat on one side, which senseless action invested him with an altogether foolish appearance. The others heard, but went on somnolently feeding with spidery movements of their lean arms.
The sun was no more than a degree or so above the horizon, and from the heated surface of the waters a slight low mist began to rise; a mist thin, invisible to the human eye; yet strong enough to change the sun into a mere glowing red disc, a disc vertical and hot, rolling down to the edge of the horizontal and cold-looking disc of the shining sea. Then the edges touched and the circular expanse of water took on suddenly a tint, sombre, like a frown; deep, like the brooding meditation of evil.
The falling sun seemed to be arrested for a moment in his descent by the sleeping waters, while from it, to the motionless brig, shot out on the polished and dark surface of the sea a track of light, straight and shining, resplendent and direct; a path of gold and crimson and purple, a path that seemed to lead dazzling and terrible from the earth straight into heaven through the portals of a glorious death. It faded slowly. The sea vanquished the light. At last only a vestige of the sun remained, far off, like a red spark floating on the water. It lingered, and all at once–without warning–went out as if extinguished by a treacherous hand.
Gone, cried Lingard, who had watched intently yet missed the last moment.
Gone! Look at the cabin clock, Shaw!
Nearly right, I think, sir. Three minutes past six.
The helmsman struck four bells sharply. Another barefooted seacannie glided on the far side of the poop to relieve the wheel, and the serang of the brig came up the ladder to take charge of the deck from Shaw. He came up to the compass, and stood waiting silently.
"The course is south by east when you get the wind, Serang," said Shaw, distinctly.
Sou' by eas', repeated the elderly Malay with grave earnestness.
Let me know when she begins to steer, added Lingard.
Ya, Tuan, answered the man, glancing rapidly at the sky.
Wind coming, he muttered.
I think so, too, whispered Lingard as if to himself.
The shadows were gathering rapidly round the brig. A mulatto put his head out of the companion and called out:
Ready, sir.
Let's get a mouthful of something to eat, Shaw, said Lingard.
I say, just take a look around before coming below. It will be dark when we come up again.
Certainly, sir, said Shaw, taking up a long glass and putting it to his eyes.
Blessed thing, he went on in snatches while he worked the tubes in and out,
I can't–never somehow–Ah! I've got it right at last!
He revolved slowly on his heels, keeping the end of the tube on the sky-line. Then he shut the instrument with a click, and said decisively:
Nothing in sight, sir.
He followed his captain down below rubbing his hands cheerfully.
For a good while there was no sound on the poop of the brig. Then the seacannie at the wheel spoke dreamily:
"Did the malim say there was no one on the sea?"
Yes, grunted the serang without looking at the man behind him.
Between the islands there was a boat, pronounced the man very softly.
The serang, his hands behind his back, his feet slightly apart, stood very straight and stiff by the side of the compass stand. His face, now hardly visible, was as inexpressive as the door of a safe.
Now, listen to me, insisted the helmsman in a gentle tone.
The man in authority did not budge a hair's breadth. The seacannie bent down a little from the height of the wheel-grating.
I saw a boat, he murmured with something of the tender obstinacy of a lover begging for a favour.
I saw a boat, O Haji Wasub! Ya! Haji Wasub!
The serang had been twice a pilgrim, and was not insensible to the sound of his rightful title. There was a grim smile on his face.
You saw a floating tree, O Sali, he said, ironically.
I am Sali, and my eyes are better than the bewitched brass thing that pulls out to a great length, said the pertinacious helmsman.
There was a boat, just clear of the easternmost island. There was a boat, and they in her could see the ship on the light of the west–unless they are blind men lost on the sea. I have seen her. Have you seen her, too, O Haji Wasub?
Am I a fat white man? snapped the serang.
I was a man of the sea before you were born, O Sali! The order is to keep silence and mind the rudder, lest evil befall the ship.
After these words he resumed his rigid aloofness. He stood, his legs slightly apart, very stiff and straight, a little on one side of the compass stand. His eyes travelled incessantly from the illuminated card to the shadowy sails of the brig and back again, while his body was motionless as if made of wood and built into the ship's frame. Thus, with a forced and tense watchfulness, Haji Wasub, serang of the brig Lightning, kept the captain's watch unwearied and wakeful, a slave to duty.
In half an hour after sunset the darkness had taken complete possession of earth and heavens. The islands had melted into the night. And on the smooth water of the Straits, the little brig lying so still, seemed to sleep profoundly, wrapped up in a scented mantle of starlight and silence.
IT WAS half-past eight o'clock before Lingard came on deck again. Shaw–now with a coat on–trotted up and down the poop leaving behind him a smell of tobacco smoke. An irregularly glowing spark seemed to run by itself in the darkness before the rounded form of his head. Above the masts of the brig the dome of the clear heaven was full of lights that flickered, as if some mighty breathings high up there had been swaying about the flame of the stars. There was no sound along the brig's decks, and the heavy shadows that lay on it had the aspect, in that silence, of secret places concealing crouching forms that waited in perfect stillness for some decisive event. Lingard struck a match to light his cheroot, and his powerful face with narrowed eyes stood out for a moment in the night and vanished suddenly. Then two shadowy forms and two red sparks moved backward and forward on the poop. A larger, but a paler and oval patch of light from the compass lamps lay on the brasses of the wheel and on the breast of the Malay standing by the helm. Lingard's voice, as if unable altogether to master the enormous silence of the sea, sounded muffled, very calm–without the usual deep ring in it.
Not much change, Shaw, he said.
No, sir, not much. I can just see the island–the big one–still in the same place. It strikes me, sir, that, for calms, this here sea is a devil of loc-ality.
He cut
locality in two with an emphatic pause. It was a good word. He was pleased with himself for thinking of it. He went on again:
Now–since noon, this big island—
Carimata, Shaw, interrupted Lingard.
Aye, sir; Carimata–I mean. I must say–being a stranger hereabouts–I haven't got the run of those—
He was going to say
names but checked himself and said,
appellations, instead, sounding every syllable lovingly.
Having for these last fifteen years, he continued,
sailed regularly from London in East-Indiamen, I am more at home over there–in the Bay.
He pointed into the night toward the northwest and stared as if he could see from where he stood that Bay of Bengal where–as he affirmed–he would be so much more at home.
You'll soon get used— muttered Lingard, swinging in his rapid walk past his mate. Then he turned round, came back, and asked sharply:
You said there was nothing afloat in sight before dark? Hey?
"Not that I could see, sir. When I took the deck again at eight, I asked that serang whether there was anything about; and I understood him to say there was no more as when I went below at six. This is a lonely sea at times–ain't it, sir? Now, one would think at this time of the year the homeward-bounders from China would be pretty thick here."
Yes, said Lingard,
we have met very few ships since we left Pedra Branca over the stern. Yes; it has been a lonely sea. But for all that, Shaw, this sea, if lonely, is not blind. Every island in it is an eye. And now, since our squadron has left for the China waters—
He did not finish his sentence. Shaw put his hands in his pockets, and propped his back against the skylight, comfortably.
They say there is going to be a war with China, he said in a gossiping tone,
and the French are going along with us as they did in the Crimea five years ago. It seems to me we're getting mighty good friends with the French. I've not much of an opinion about that. What do you think, Captain Lingard?
I have met their men-of-war in the Pacific, said Lingard, slowly.
The ships were fine and the fellows in them were civil enough to me–and very curious about my business, he added with a laugh.
However, I wasn't there to make war on them. I had a rotten old cutter then, for trade, Shaw, he went on with animation.
Had you, sir? said Shaw without any enthusiasm.
Now give me a big ship–a ship, I say, that one may—
And later on, some years ago, interrupted Lingard,
I chummed with a French skipper in Ampanam–being the only two white men in the whole place. He was a good fellow, and free with his red wine. His English was difficult to understand, but he could sing songs in his own language about ah-moor–Ah-moor means love, in French–Shaw.
So it does, sir–so it does. When I was second mate of a Sunderland barque, in forty-one, in the Mediterranean, I could pay out their lingo as easy as you would a five-inch warp over a ship's side—
Yes, he was a proper man, pursued Lingard, meditatively, as if for himself only.
You could not find a better fellow for company ashore. He had an affair with a Bali girl, who one evening threw a red blossom at him from within a doorway, as we were going together to pay our respects to the Rajah's nephew. He was a good-looking Frenchman, he was–but the girl belonged to the Rajah's nephew, and it was a serious matter. The old Rajah got angry and said the girl must die. I don't think the nephew cared particularly to have her krissed; but the old fellow made a great fuss and sent one of his own chief men to see the thing done–and the girl had enemies–her own relations approved! We could do nothing. Mind, Shaw, there was absolutely nothing else between them but that unlucky flower which the Frenchman pinned to his coat–and afterward, when the girl was dead, wore under his shirt, hung round his neck in a small box. I suppose he had nothing else to put it into.
Would those savages kill a woman for that? asked Shaw, incredulously.
Aye! They are pretty moral there. That was the first time in my life I nearly went to war on my own account, Shaw. We couldn't talk those fellows over. We couldn't bribe them, though the Frenchman offered the best he had, and I was ready to back him to the last dollar, to the last rag of cotton, Shaw! No use–they were that blamed respectable. So, says the Frenchman to me: 'My friend, if they won't take our gunpowder for a gift let us burn it to give them lead.' I was armed as you see now; six eight-pounders on the main deck and a long eighteen on the forecastle–and I wanted to try 'em. You may believe me! However, the Frenchman had nothing but a few old muskets; and the beggars got to windward of us by fair words, till one morning a boat's crew from the Frenchman's ship found the girl lying dead on the beach. That put an end to our plans. She was out of her trouble anyhow, and no reasonable man will fight for a dead woman. I was never vengeful, Shaw, and–after all–she didn't throw that flower at me. But it broke the Frenchman up altogether. He began to mope, did no business, and shortly afterward sailed away. I cleared a good many pence out of that trip, I remember.
With these words he seemed to come to the end of his memories of that trip. Shaw stifled a yawn.
Women are the cause of a lot of trouble, he said, dispassionately. "In the Morayshire, I remember, we had once a passenger–an old gentleman–who was telling us a yarn about them old-time Greeks fighting for ten years about some woman. The Turks kidnapped her, or something. Anyway, they fought in Turkey; which I may well believe. Them Greeks and Turks were always fighting. My father was master's mate on board one of the three-deckers at the battle of Navarino–and that was when we went to help those Greeks. But this affair about a woman was long before that time."
I should think so, muttered Lingard, hanging over the rail, and watching the fleeting gleams that passed deep down in the water, along the ship's bottom.
Yes. Times are changed. They were unenlightened in those old days. My grandfather was a preacher and, though my father served in the navy, I don't hold with war. Sinful the old gentleman called it–and I think so, too. Unless with Chinamen, or niggers, or such people as must be kept in order and won't listen to reason; having not sense enough to know what's good for them, when it's explained to them by their betters–missionaries, and such like au-tho-ri-ties. But to fight ten years. And for a woman!
I have read the tale in a book, said Lingard, speaking down over the side as if setting his words gently afloat upon the sea.
I have read the tale. She was very beautiful.
That only makes it worse, sir–if anything. You may depend on it she was no good. Those pagan times will never come back, thank God. Ten years of murder and unrighteousness! And for a woman! Would anybody do it now? Would you do it, sir? Would you—
The sound of a bell struck sharply interrupted Shaw's discourse. High aloft, some dry block sent out a screech, short and lamentable, like a cry of pain. It pierced the quietness of the night to the very core, and seemed to destroy the reserve which it had imposed upon the tones of the two men, who spoke now loudly.
Throw the cover over the binnacle, said Lingard in his duty voice.
The thing shines like a full moon. We mustn't show more lights than we can help, when becalmed at night so near the land. No use in being seen if you can't see yourself–is there? Bear that in mind, Mr. Shaw. There may be some vagabonds prying about—
I thought all this was over and done for, said Shaw, busying himself with the cover, "since Sir Thomas Cochrane swept along the Borneo coast with his squadron some years ago. He did a rare lot of fighting–didn't he? We heard about it from the chaps of the sloop Diana that was refitting in Calcutta when I was there in the Warwick Castle. They took some king's town up a river hereabouts. The chaps were full of it."
Sir Thomas did good work, answered Lingard,
but it will be a long time before these seas are as safe as the English Channel is in peace time. I spoke about that light more to get you in the way of things to be attended to in these seas than for anything else. Did you notice how few native craft we've sighted for all these days we have been drifting about–one may say–in this sea?
I can't say I have attached any significance to the fact, sir.
It's a sign that something is up. Once set a rumour afloat in these waters, and it will make its way from island to island, without any breeze to drive it along.
Being myself a deep-water man sailing steadily out of home ports nearly all my life, said Shaw with great deliberation,
I cannot pretend to see through the peculiarities of them out-of-the-way parts. But I can keep a lookout in an ordinary way, and I have noticed that craft of any kind seemed scarce, for the last few days: considering that we had land aboard of us–one side or another–nearly every day.
You will get to know the peculiarities, as you call them, if you remain any time with me, remarked Lingard, negligently.
I hope I shall give satisfaction, whether the time be long or short! said Shaw, accentuating the meaning of his words by the distinctness of his utterance.
A man who has spent thirty-two years of his life on salt-water can say no more. If being an officer of home ships for the last fifteen years I don't understand the heathen ways of them there savages, in matters of seamanship and duty, you will find me all there, Captain Lingard.
Except, judging from what you said a little while ago–except in the matter of fighting, said Lingard, with a short laugh.
Fighting! I am not aware that anybody wants to fight me. I am a peaceable man, Captain Lingard, but when put to it, I could fight as well as any of them flat-nosed chaps we have to make shift with, instead of a proper crew of decent Christians. Fighting! he went on with unexpected pugnacity of tone,
Fighting! If anybody comes to fight me, he will find me all there, I swear!
That's all right. That's all right, said Lingard, stretching his arms above his head and wriggling his shoulders.
My word! I do wish a breeze would come to let us get away from here. I am rather in a hurry, Shaw.
Indeed, sir! Well, I never yet met a thorough seafaring man who was not in a hurry when a con-demned spell of calm had him by the heels. When a breeze comes . . . just listen to this, sir!
I hear it, said Lingard.
Tide-rip, Shaw.
So I presume, sir. But what a fuss it makes. Seldom heard such a—
On the sea, upon the furthest limits of vision, appeared an advancing streak of seething foam, resembling a narrow white ribbon, drawn rapidly along the level surface of the water by its two ends, which were lost in the darkness. It reached the brig, passed under, stretching out on each side; and on each side the water became noisy, breaking into numerous and tiny wavelets, a mimicry of an immense agitation. Yet the vessel in the midst of this sudden and loud disturbance remained as motionless and steady as if she had been securely moored between the stone walls of a safe dock. In a few moments the line of foam and ripple running swiftly north passed at once beyond sight and earshot, leaving no trace on the unconquerable calm.
Now this is very curious— began Shaw.
Lingard made a gesture to command silence. He seemed to listen yet, as if the wash of the ripple could have had an echo which he expected to hear. And a man's voice that was heard forward had something of the impersonal ring of voices thrown back from hard and lofty cliffs upon the empty distances of the sea. It spoke in Malay–faintly.
What? hailed Shaw.
What is it?
Lingard put a restraining hand for a moment on his chief officer's shoulder, and moved forward smartly. Shaw followed, puzzled. The rapid exchange of incomprehensible words thrown backward and forward through the shadows of the brig's main deck from his captain to the lookout man and back again, made him feel sadly out of it, somehow.
Lingard had called out sharply–
What do you see?
The answer direct and quick was–
I hear, Tuan. I hear oars.
The night is all around us. I hear them near.
Port or starboard?
There was a short delay in answer this time. On the quarter-deck, under the poop, bare feet shuffled. Somebody coughed. At last the voice forward said doubtfully:
"Call the serang, Mr. Shaw,
said Lingard, calmly, and have the hands turned up. They are all lying about the decks. Look sharp now. There's something near us.