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 Feline
Behavioral Health
and Welfare
 Feline
Behavioral
Health
and Welfare
Edited by

Ilona Rodan, DVM, DABVP (Feline Practice)

Founder, Cat Care Clinic
Feline-Friendly Consultations
Cat Behavior Consultations
Madison, Wisconsin

Sarah Heath, BVSc, DipECAWBM(BM), CCAB, MRCVS

European Veterinary Specialist in Behavioural Medicine
(Companion Animals)
Behavioural Referrals Veterinary Practice
Upton, Chester, United Kingdom
3251 Riverport Lane
St Louis, MO 63043
FELINE BEHAVIORAL HEALTH AND WELFARE 978-1-4557-7401-2

Copyright © 2016 by Elsevier Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher's permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notice
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product
to be administered, to verify the recommended dose or formula, the method and duration of
administration, and contraindications. It is the responsibility of practitioners, relying on their own
experience and knowledge of their patients, to make diagnoses, to determine dosages and the best
treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.

Library of Congress Cataloging-in-Publication Data

Feline behavioral health and welfare / edited by Ilona Rodan, Sarah E. Heath.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-4557-7401-2 (pbk. : alk. paper) 1. Cats–Behavior. 2. Cats–Behavior therapy. I. Rodan, Ilona,
editor. II. Heath, Sarah, 1964-, editor.
[DNLM: 1. Behavior, Animal–physiology. 2. Cats. 3. Animal Welfare. 4. Behavior Control–methods.
5. Behavioral Symptoms–therapy. SF 446.5]
SF446.5.F447 2015
636.8'083–dc23
2015021780
Vice President and Publisher: Loren Wilson
Content Strategy Director: Penny Rudolph
Content Development Manager: Jolynn Gower
Content Development Specialist: Brandi Graham
Publishing Services Manager: Jeffrey Patterson
Project Manager: Tracey Schriefer
Designer: Margaret Reid

Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
I dedicate this book to my late parents, Susan and Kenneth Rodan, who taught me to love all
animals and to care for those in need while allowing them to maintain species-specific
behaviors; to my husband, Barry Ganetzky, for his incredible support and patience
during the past 2 years; and to my daughter Rebecca, son-in-law David, and grand-
daughter Leora, for being the wonderful family that they are.
Ilona Rodan

I dedicate this book to my family and friends and also to all my pets and patients past
and present who have taught me so much about the art of veterinary medicine.
Sarah Heath
 PREFACE

Cats are not small dogs. of great concern to feline practitioners and owners and
Barbara Stein this book explores the link between obesity and behavior
in terms of both etiology and potential management.
Cats are not small people. We need to allow cats to
Pain is commonly found to be involved in cases that pre-
be cats!
sent as behavioral concerns, and experts from the field of
Ilona Rodan
veterinary pain management have provided in-depth
The veterinary disciplines of feline internal medicine
consideration of the issues associated with the recogni-
and behavioral medicine are inextricably linked, and
tion and management of acute and chronic pain in feline
in this first edition of Feline Behavioral Health and Wel-
patients. The specific condition of feline orofacial pain
fare, authors from both of these fields have come
syndrome is also discussed.
together with colleagues from other specialties, such
When dealing with behavior cases, it is important to
as pain management and neurology, to address the
have a good understanding of the emotional motiva-
importance of feline behavior in veterinary practice
tions that are involved, and in Part 6 of the book, the
and the interplay between behavior and disease.
first chapter is dedicated to this important topic. An
overview of some of the tools that can be used when
ORGANIZATION managing and treating behavior cases is given in the
chapters on pheromones, drugs, and nutraceuticals.
The aim of this book is to improve the quality of care
In the last two sections of the book, the focus is on
that feline patients receive during their visit to the vet-
dealing with behavior that is considered to be problem-
erinary practice and maximize the benefits of the rela-
atic first within the veterinary context and secondly
tionship between cats and their owners.
within the home. The veterinary section concentrates
In Part 1, the book starts by looking at the impor-
on providing a cat-friendly approach to the consultation
tance of behavior in a veterinary practice setting and
and gives practical advice on handling fearful, painful,
considers the implications for feline welfare, for exam-
and behaviorally challenging feline patients.
ple in terms of lack of adequate veterinary care; lack of
The final section begins with a review of those normal
understanding of feline physical, social, and emotional
feline behaviors that can be undesirable within the home
needs; and risk of relinquishment and euthanasia.
and offers practical advice for owners on how to deal with
The section that follows explores the issue of normal
these. The remaining chapters concentrate on the two
feline behavior and encourages better understanding of
most commonly presented feline behavior problems of
social interactions and communication styles. Informa-
house soiling and aggression and the distressing issue
tion about feline learning processes also provides
of behavioral change in the senior cat.
important background knowledge that lays the founda-
To accompany the book, client handouts are pro-
tion for a better understanding of feline patients.
vided to support the veterinary profession in educating
Parts 3 and 4 focus on the need to prevent behavior
cat owners.
problems, both in the home setting and in the veterinary
practice. Practical advice for clients regarding pet selec-
tion is combined with information about the provision Key Information
of adequate healthcare for cats in both a physical and an • The relevance of behavior to feline health and welfare
emotional sense. Prevention of behavior-related prob- • Normal feline behavior and how it affects provision
lems in the veterinary practice is addressed over three of resources within a domestic environment
chapters covering the overall veterinary experience • Important client concerns and barriers to feline vet-
and the specific contexts of the consulting room and erinary visits
the hospitalization area. • Feline emotions and how to recognize and manage
In the following section, the interplay between behav- negative emotional states within the veterinary
ior and disease is explored. Changes in behavior are often practice
the key to owners recognizing illness, pain, or stress and • The interplay between behavior and disease
can also be important tools in the diagnostic process. • The tools that are available to assist in the manage-
Stress as a risk factor for disease has now been well rec- ment and treatment of behavioral cases
ognized in feline patients, and the first chapter in this • Commonly encountered behavioral challenges,
section looks at this issue. Obesity is a medical problem including house soiling and aggression

vii
viii PREFACE

important resource for veterinary students, behavior

INTENDED AUDIENCE residents, and veterinary technician students and those
This book is principally written for primary veterinary preparing for the behavior specialty. It is hoped that
practitioners who work with cats regardless of the type behavior and other veterinary specialists will also find
of practice, and other members of the veterinary team the focus on feline behavior and welfare interesting
including veterinary technicians/nurses. It is also an and enlightening.
 ACKNOWLEDGMENTS

This book would not have been possible without our to veterinary behaviorists, especially Sarah Heath, as
outstanding authors. Recruitment of international well as Karen Overall, Gary Landsberg, and Debbie
authors was important to provide a global perspective Horwitz, who taught and mentored me during the past
on feline behavioral health and welfare. Additionally, 18+ years, accepting me as a nonbehaviorist with a pas-
authors specializing in behavior, feline medicine, pain sion to help veterinarians understand cats and to pre-
management, and other fields were chosen to ensure vent behavior problems. Last, but certainly not least,
the emotional, social, and physical aspects of feline wel- my gratitude goes to coeditor Sarah Heath for her
fare were all included. Tremendous thanks goes to all of incredible knowledge of feline behavior, her patience
them. We would like to specifically acknowledge the and ability to write, her perseverance and dedication
contribution from our colleague, Sophia Yin, who trag- despite her health problems and treatments, and for
ically died while the book was in production. Her con- her friendship.
tribution to animal welfare was significant and she will
Ilona Rodan
be sadly missed. While it is customary to edit a multiple-
author book into a common style, you will note that one
The writing and editing for this book has been a struggle
of Sophia’s chapters (Chapter 5) has been left in her
as it has coincided with a period of ill health. My treat-
original writing style as a mark of respect.
ment for breast cancer has been a hard journey and this
We are also grateful to several colleagues for their
book has been a companion along the way. That com-
help in editing certain chapters, and they include Irene
panionship has not always been easy but I am glad we
Rochlitz, Margie Scherk, Andrew Sparkes, and Clare
have made it to the end of the publication process. I
Wilson. Thanks also goes to Gaille Perry for pictures
would like to thank Ilona for her patience when I have
she provided.
been unable to contribute and when health and hospital
We would also like to thank Penny Rudolph, Brandi
visits have prevented me from responding as promptly
Graham, and Tracey Schriefer from Elsevier for all their
as she would have liked. Ilona has been a true friend and
support and commitment throughout the writing and
I thank her for her personal support as well. I would like
editing stages.
to acknowledge all of those who have been beside me on
We hope that this book will make a positive contri-
my cancer journey and have shown me so much love
bution to the understanding of our feline patients and
and support. There are too many to mention all by name
will help to improve the welfare of cats within the vet-
but in particular I would like to thank my sons Matthew
erinary practice and at home.
and David, my daughter-in-law Emma, grandchildren
Ilona Rodan
Ethan and Beth, and all my wonderful friends including
Sarah Heath
Rachel Dean, Christine Neilson, Ann Parry, Tiny
DeKeuster, John Robinson, Dorothy Cummins, Allison
In addition to thanking my family to whom I dedicate
German, Jill McPherson, Laura Borromeo, Clare
this book, I also wish to thank the veterinary team at
Hemmings, Karin Fairhurst, and Jane Trundle. Thanks
the Cat Care Clinic, our clients, and especially all the
also to all the staff at my practice for their help in sup-
cats who have helped teach me about feline behavior
porting me over this difficult time and to Chris Fozzard,
and welfare over the past three decades. Thanks also
who will always be someone special to me. Above all I
to the American Association of Feline Practitioners
would like to thank the wonderful staff of the NHS
for helping me become the best feline practitioner pos-
(Clatterbridge Cancer Centre and the Countess of
sible and a leader in veterinary medicine. Enormous
Chester Hospital) and Macmillan Cancer Support
thanks also goes to my best friend, Eliza Sundahl,
who have quite literally saved my life.
who emotionally supported me throughout the long
process of writing and editing. I am also forever grateful Sarah Heath

ix
 CONTRIBUTORS

Martha Cannon, BA, VetMB, DSAM(Fel) Understanding Emotions

Oxford Cat Clinic Providing Feline-Friendly Consultations
Oxford, Oxfordshire, UK Handling the Cat that is in Pain
The Cat in the Veterinary Practice Intercat Conflict
The Cat in the Consulting Room
Housing Cats in the Veterinary Practice Debra F. Horwitz, DVM, Diplomate ACVB
Veterinary Behaviorist
Rachel Casey, BVMS, PhD, DipECAWBM, CCAB, Veterinary Behavior Consultations
MRCVS St. Louis, Missouri
Senior Lecturer in Companion Animal Behaviour and Pet Selection
Welfare Tools of the Trade: Psychopharmacology
School of Clinical Veterinary Science and Nutrition
University of Bristol
Bristol, UK Isabelle Iff, Dr.med.vet., DipECVAA, CertVetAc
Human-Directed Aggression in Cats (IVAS), LicAc(BAWMA), MRCVS
Anaesthetist and Instructor
Sagi Denenberg, DVM, MACVSc(Behaviour) Veterinary Anaesthesia School For Technicians
Behaviour Consultant (VASTA)
North Toronto Veterinary Behaviour Specialty Clinic Veterinary Anaesthesia Services
Thornhill, Ontario, Canada Zurcherstrasse, Winterthur, Switzerland
Behavior Problems of the Senior Cat Chronic Pain and Behavior

Theresa L. DePorter, DVM, MRCVS, DipECAWBM Christos Karagiannis, DVM, MSc, MRCVS
Oakland Veterinary Referral Services Resident ECAWBM
Bloomfield Hills, Michigan Animal Behaviour, Cognition and Welfare Group
Use of Pheromones in Feline Practice School of Life Sciences
Tools of the Trade: Psychopharmacology and Nutrition University of Lincoln
Lincoln, Lincolnshire, UK
Alexander German, BVSc(Hons), PhD Stress as a Risk Factor for Disease
Reader in Small Animal Medicine Understanding Emotions
Department of Obesity and Endocrinology
School of Veterinary Science Gary M. Landsberg, BSc, DVM, DACVB,
University of Liverpool DECVBM-CA
Neston, Merseyside, UK Veterinary Behaviourist
Feline Obesity North Toronto Animal Clinic;
Director of Veterinary Affairs
Richard Gowan, BVSC(Hons), MACVSc(Feline CanCog Technologies
Medicine) Toronto, Ontario, Canada
The Cat Clinic Tools of the Trade: Psychopharmacology
Melbourne, Victoria, Australia and Nutrition
Chronic Pain and Behavior Behavior Problems of the Senior Cat

Sarah Heath, BVSc, DipECAWBM(BM), CCAB, Jacqueline M. Ley, BVSc(Hons), PhD

MRCVS (Psychology), FANCVS(Veterinary
European Veterinary Specialist in Behavioural Medicine Behaviour), DECAWBM
(Companion Animals) Registered Specialist in Veterinary Behaviour
Behavioural Referrals Veterinary Practice Animal Behaviour Consultations
Upton, Chester, UK Narre Warren, Victoria, Australia
Feline Behavior and Welfare Feline Communication
Feline Obesity Normal Social Behavior
Feline Orofacial Pain Syndrome Normal but Unwanted Behavior in Cats

xi
xii CONTRIBUTORS

Susan Little, DVM, DABVP(Feline) Kersti Seksel, BVSc(Hons), MRCVS. MA(Hons),

President FACVSc, DACVBM, DECAWBM
American Association of Feline Practitioners Adjunct Senior Lecturer
Hillsborough, New Jersey; School of Animal and Veterinary Sciences
Owner, Bytown Cat Hospital, Charles Sturt University
Ottawa, Ontario, Canada Wagga Wagga, NSW, Australia
Providing Appropriate Healthcare Providing Appropriate Behavioral Care
House Soiling Problems
Amy L. Pike, BS(Zoology), DVM
Resident Eliza Sundahl, DVM, DABVP(Feline)
Veterinary Behavior Consultations KC Cat Clinic
St. Louis, Missouri Kansas City, Missouri
Pet Selection Overland Park, Kansas
Providing Feline-Friendly Consultations
Sheilah A. Robertson, BVMS(Hons), PhD
Assistant Director Sophia Yin†, DVM, MS, DACVB
Animal Welfare Division Department of Animal Science
American Veterinary Medical Association University of California
Schaumburg, Illinois Davis, California;
Acute Pain and Behavior Premier Pet Behavior Consultant;
Behavior Consultant
Ilona Rodan, DVM, DABVP(Feline Practice) San Francisco Veterinary Specialists
Founder, Cat Care Clinic San Francisco, California;
Feline-Friendly Consultations President
Cat Behavior Consultations CattleDog Publishing
Madison, Wisconsin Davis, California
Importance of Feline Behavior in Veterinary Practice Feline Learning
Feline Behavior and Welfare Handling the Challenging Cat
The Cat in the Veterinary Practice
The Cat in the Consulting Room
Housing Cats in the Veterinary Practice
Providing Feline-Friendly Consultations
Handling the Cat that is in Pain

Clare Rusbridge, BVMS, PhD, DECVN, MRCVS

Chief of Neurology
Fitzpatrick Referrals
Eashing, Surrey, UK;
Reader In Veterinary Neurology
School of Veterinary Medicine
University of Surrey
Guildford, Surrey, UK
Feline Orofacial Pain Syndrome

†
Deceased.
 CLIENT HANDOUTS

Advantages and Risks of Feline Spay or Castration My Cat is Healthy—Or is it? 429
Surgery 397 Pheromonatherapy 431
Advantages of Boarding Your Cat at a Veterinary Playing With Your Cat 433
Practice 399 Senior Health and Behavior: Early Reporting is
Cat-Friendly Medication Administration the Best Medicine 435
Techniques 403 Setting up a Home for Cats 437
Did You Know? Fun Facts and Figures to Help Should I Adopt Another Cat? 439
Select a New Feline Family Member 405 Social Behavior 441
Does My Cat Hurt? 407 Training Your Cat to Love Medications 443
Does My Cat Suffer From Chronic Pain? 409 Transporting Your Cat Made Easier 445
Does My Cat Suffer From Painful Arthritis? 411 Understanding Our Commitment to Minimize
Excessive Vocalization 413 Your Cat’s Stress 447
Feline Orofacial Pain Syndrome (FOPS) 415 What are Feline Odontoclastic Resorption
Help! My Cat Keeps Waking Me Up! 417 Lesions? 449
How to Pill Your Cat With Kindness: A Cat What Care Does Your Cat Need? 451
Friendly Approach to Medicating 419 What Is My Cat Trying to Say? Information
Informed Consent for Psychotropic Drug Use for Owners About Cat Body Language 453
for a Cat 421 What We Learn When We Examine
Introducing a New Cat into a Household 423 Your Cat 455
Managing Normal but Unwanted Behavior 425 When Your Cat Needs Hospitalization 459
Managing Your Cat’s Painful Degenerative
Joint Disease (Arthritis) 427

xvii
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CHAPTER

1
Importance of Feline Behavior
in Veterinary Practice
Ilona Rodan

essential in all aspects of feline healthcare. Incorporating

INTRODUCTION behavior into each and every appointment is the key to
The growing popularity of the cat as a pet has led to optimizing feline veterinary care and to keeping cats
many benefits, including increased feline safety and healthy, content, and remaining in their homes.
length of life. Cats are beloved companions, with the
majority of cat owners considering them to be family
members.1,2 Many cat owners adopt a cat that needs a
CHALLENGES IN FELINE PRACTICE
home and provide them with love, food, and comfort. There are four major challenges for the veterinary pro-
The majority of today’s cats live longer lives due to safer fession in the context of striving to provide an optimal
environments and advances in feline medical care.3 This level of feline healthcare. The first challenge is the lack of
all sounds great, but do most cats truly have a great life? regular veterinary care and the resulting late presenta-
Are cat owners and veterinary professionals really doing tion of cats with physical disease or behavioral health
the best for the cat? issues. A large number of cats do not receive routine
The sad reality is that millions of pet cats receive little preventative healthcare and never see a veterinarian
or no veterinary care and suffer significant levels of unless they are sick. As a result of the cat’s ability to
unrecognized pain and illness.4,5 Other cats endure mask signs of illness and pain, these animals are often
boredom and stress due to inadequate feline environ- presented with advanced disease that is often unable
ments and stressful social situations.6,7 Feline stressors to be treated. Some cats do come to the practice for pre-
negatively impact physical health, resulting in a range ventive treatment through vaccination, worming, and
of recurrent physical conditions.8,9 Add to that the flea treatment as kittens, but their owners never bring
relinquishment and euthanasia each and every year of them back for booster vaccinations or repeated preven-
millions of cats that were once beloved companions tive treatments. For many, this lack of ongoing veteri-
because of undesirable or abnormal behaviors10,11 and nary care is a result of poor client education and
it would appear that the cat is not getting the best pos- awareness, but for others there may be specific reasons
sible care despite its popularity. for client reluctance to return, such as the stress of
The good news is that most of the problematic issues bringing a cat to the veterinary practice. Infrequent
facing the domestic cat can be prevented or addressed feline visits can be frustrating for veterinary personnel,
if we understand cats as pets as well as patients. The who are seeking to provide a high standard of care, and
vast majority of problems that owners and veterinarians can lead to decreasing levels of job satisfaction. In addi-
encounter with cats do not occur out of feline malice, but tion, there are financial implications for the veterinary
rather due to a lack of understanding of the cat, its normal practice as a result of poor levels of feline attendance.
behaviors, and its needs. The cat is a paradox—although This can indirectly affect the quality of feline care that
fairly adaptable and social animals, cats have retained can be provided due to lack of ability to invest in prac-
many of the behaviors of their wild ancestors.12,13 tice development and staff selection.
Veterinarians have a unique opportunity to vastly The second challenge in feline practice is the preva-
improve the cat’s physical and emotional health and to lence of stress-associated illness. In many cases the phys-
enhance the relationship between them and their people. ical signs are identified and treated without any
In turn this will improve feline welfare and benefit the understanding of the influence of stress and behavioral
veterinary profession as they gain more satisfaction from factors on the condition. As a result, resolution is tem-
their feline work. Behavior and physical health are closely porary and recurrence is a familiar outcome. True reso-
intertwined, making the need to address behavior lution is not possible without addressing the

2
 CHAPTER 1 Importance of Feline Behavior in Veterinary Practice 3

environmental and social needs of the cat in a consistent problems in terms of appropriate handling in the veter-
and predictable fashion, and therefore, behavioral inary context. Failing to see things from a feline perspec-
knowledge is essential for the feline practitioner. tive can result in restraint methods that induce fear and
The third challenge is the incidence of behavioral lead to escalating levels of feline aggression which is not
issues in the feline population and the risk of cats being only detrimental to the cat but also to practice person-
relinquished or euthanized because of behavior problems, nel. Improving veterinary education in the field of
normal but undesirable feline behaviors, or incompatibil- behavioral medicine is perhaps one of the major chal-
ity with other cats in the household. It is also important to lenges facing the profession.
remember those cats that remain in the same household The aim of this book is to address the behavioral
but suffer from unrecognized stress, pain, and even illness issues that are so fundamentally important in relation
and fail to receive appropriate veterinary intervention. to feline veterinary practice and explain how a better
The fourth challenge is that, although veterinary pro- understanding of feline behavior can help to improve
fessionals strive to provide the best healthcare for their the physical and emotional health of feline patients
feline patients, many are poorly equipped to deal with (Box 1-1) as well as increase owner and veterinary team
the behavioral factors that are such an important com- satisfaction when living and working with cats.
ponent of the preceding three challenges. Behavioral
medicine is a relatively young veterinary discipline
and many veterinary schools still fail to provide specific
LACK OF VETERINARY CARE
education in this field. The fact that there are consider- Although the majority of owners consider their cats
able differences between feline and human social behav- to be family members, many fail to understand the
ior and communication makes intuitive interaction importance of regular veterinary care. A lack of under-
more of a challenge. As a result, there can be significant standing of normal feline behavior leads to many

BOX 1-1 Problems Associated with Poor Understanding of Feline Behavior

Medical Problems • Increased temperature
• Lack of preventive care due to: • Tension or aggression making it difficult to
• Poor recognition of value perform a comprehensive examination
• Stress surrounding the veterinary experience • Pupillary dilation
• Increase in preventable diseases, such as: • Difficulty differentiating illness or pain from fear on
• Diabetes mellitus laboratory findings
• Intestinal parasites • White coat hypertension
• External parasites • Stress hyperglycemia +/ glucosuria
• Dental disease • Mature neutrophilia and lymphopenia
• Lack of recognition and prevention of painful • Lymphocytosis
conditions, such as: • Alkaline urine +/ struvite crystals
• Appendicular degenerative joint disease • Advanced disease or pain due to the client’s inability to
• Axial degenerative joint disease recognize the subtle signs of illness and pain
• Oral disease—resorptive lesions, periodontal • Decreased feline welfare associated with sickness
disease • Early death
• Stress-associated sickness behavior—feline idiopathic
cystitis Behavioral Problems
• Obesity epidemic • Lack of understanding of normal feline behavior
• Lack of recognition of behavioral signs of pain and • Lack of understanding of feline social and emotional
illness, such as: needs
• Subtle changes in behavior • Lack of appropriate resources for cats
• Loss of normal behaviors • Inadequate distribution of resources in relation to
• Abnormal behaviors number of cats within home
• Stress surrounding the veterinary visit • Inadequate prevention of behavior problems
• Difficulty differentiating illness or pain from fear • Decreased feline welfare
on exam findings • Behavior problems
• Tachycardia • Surrender and relinquishment to shelters
• Increased respiratory rate • Early death
4 CHAPTER 1 Importance of Feline Behavior in Veterinary Practice

the American Veterinary Medical Association [AVMA])

to increase awareness of the need for regular feline
healthcare. Tremendous support has been provided by
industry to complete surveys and to increase veterinary
awareness and cat owner education. Despite all of this,
there continues to be a decline in feline veterinary visits.
Comparing 2011 with 2006, the number of cat-owning
households in the United States that did not take their
cat to the veterinarian increased by a staggering 24%.1
Despite similar awareness campaigns driven by Interna-
tional Cat Care in the UK and Europe, there is no reason
to believe that cats receive better healthcare in other
countries.
FIGURE 1-1 Since cats show only subtle signs of illness In order to address this problem, the veterinary
and pain, many cat owners assume they are healthy profession needs to be aware of the issues that are
and bring them to the veterinarian only when disease contributing to this decline in feline healthcare and
is advanced or when behavior problems occur. (Copyright become educated in the role of behavior-related
© iStock.com) misunderstandings. This will enable them to educate
not only clients, but also veterinary practice staff in ways
misconceptions. The fact that cats are often acquired at that will decrease feline stress and increase client com-
little or no cost can lead to a perception that they are low pliance with the goal of regular veterinary visits.
cost, low maintenance pets.5 When cats are apparently
healthy and are kept in an indoor environment that is Owners Think Cats are Self-Sufficient and
considered to be free of disease risk, owners do not Convenient to Own
see any reason to visit the veterinary practice. The fact In a study of almost 2000 cat owners, 81% believe that
that many owners consider veterinary visits stressful for cats are self-sufficient and healthy and therefore require
both the cat and themselves compounds this.4,5,14 little care.5 Another report indicated that 57% of cat
A further complication in the battle to convince owners said that cats were convenient and easy to main-
owners to provide their cats with regular veterinary tain, whereas dog, fish, and bird owners indicated that
attention is the fact that feline signs of pain and illness these pets needed more care to maintain.15 Unfortu-
are often very subtle and many owners simply do not nately, some of the popularity of the cat has occurred
recognize that the pet is in need of assistance because cats are considered “low maintenance” pets.
(Figure 1-1). When cats display undesirable behaviors, With changing human lifestyles, such as both adult fam-
owners will often attribute this behavior to being ily members working, and more apartment and condo-
“old” or spiteful rather than considering the possibility minium dwellers, the “low maintenance” or
of pain or illness as an underlying cause. “independent” cat is considered easier to care for than
As a result of all of these factors, the veterinary pro- the dog.4
fession faces a huge challenge in trying to ensure that
cats are given the veterinary care that they deserve. Cats are Often Acquired Through Impulse
Between 2001 and 2011, there has been an almost Adoptions or as “Free Cats”
15% decline in the number of feline veterinary visits The majority of cats enter people’s homes as impulse
in the United States despite the growing number of acquisitions and with no education about their needs
pet cats and cats considered to be family members.1,5 (Figure 1-2). Of those who acquired new cats, 59% of
In 2011, only 55.1% of cat owners took their cat to people did not expect to get a cat, and 69% adopted a
the veterinarian at least once, as compared with cat at no cost. This differs dramatically from dogs
81.3% of dogs.1 If both dogs and cats live in the same who were adopted after thoughtful consideration and
home, the dogs go to the veterinarian almost twice as at a cost.5 There are two significant problems here—
often as the cats.4 Of the cats receiving veterinary care the misconception of cats adopted at little or no cost
on an annual or more frequent basis, only 48% received being “low cost” pets and the lack of education about
wellness or preventive care.5 The decline in feline the necessary level of veterinary and home care. When
healthcare negatively impacts pet cats, cat owners, a cat shows up on someone’s doorstep, or is given to
and the veterinary care that practices provide. someone as a present or through rehoming, cat owners
Major efforts have been taken since 2006 by most receive little to no education about the associated care
American veterinary organizations that work with cats and expenses of owning a cat.
(American Association of Feline Practitioners [AAFP], Many people have unrealistic expectations when they
American Animal Hospital Association [AAHA], and acquire a cat, resulting in 54% of newly adopted cats
 CHAPTER 1 Importance of Feline Behavior in Veterinary Practice 5

in dental disease, 13% increase in internal parasites, 16%

increase in flea and tick infestation, and a 16% increase
in diabetes mellitus.19 With almost 60% of cats in the
United States being overweight or obese, the increase
in diabetes mellitus comes as no surprise.20
Cat owners are often very devoted to their pets and
often expect that they will be able to tell if their cats
are sick because of the bond they share with them. How-
ever, cats are particularly skilled at masking the signs of
illness, and many health conditions go unrecognized
until they are advanced and difficult to treat or manage.
Painful and common conditions, such as dental disease
and degenerative joint disease, are often not recognized
FIGURE 1-2 Many adoptions are unplanned, with a cat by owners; without regular veterinary visits there is no
showing up on a doorstep or when free kittens are available opportunity for the veterinary profession to detect them
for adoption. Often these cats are adopted without advice in the early stages. Even when disease has been identi-
about home and veterinary care, which may result in their fied, many owners find the administration of medica-
surrender. (Copyright © iStock.com) tion is a real challenge and they may opt to euthanize
cats with advanced disease, or keep cats at home without
being returned within the first 2 weeks post-adoption.16 analgesia or other treatments, unable to accept the wel-
Initially excited to bring home a new pet, owners felt fare effects of their decision.
they had no option but to return the pet. They also felt
a sadness and a sense of failure, with 41.4% indicating Owners and Cats Experience Stress
that they would not adopt another pet in the near in Association With the Veterinary Visit
future.16 Most realized that they needed to devote more The stress of the veterinary experience is a major factor
time, thought, and planning to both the consideration in the lack of preventive healthcare for cats and in the
and the process of adoption. Others indicated that they delays for many sick cats in gaining access to veterinary
needed to learn more about cat behavior.16 care. In one survey 58% of owners said their cat hates
going to the veterinarian, and 37.6% said that just think-
Owners Underestimate the Need for Regular ing about taking their cat to the veterinarian is stress-
Veterinary Care ful.14 It is not only the fear-related behavior of the cat
In some countries, such as the United States and Austra- within the practice setting which is disturbing for
lia, there has been a push to keep cats indoors with the owners, but also the related behavioral challenges at
goals of increased safety for the cat and prevention of home before and after the consultation, such as chasing
destruction of wildlife. The problem with this is two- the cat to get it into the carrier, listening to the howling
fold—first, clients do not think indoor cats need health- in the car, cleaning up the urine and feces in the carrier
care, and second, unless the home environment meets the on arrival at the veterinary practice, and then dealing
needs of the cat, stress can lead to behavior problems and with the hostility from other household cats when the
recurrent health problems which may lead owners to cat returns from the visit. A consultation that lasts for
relinquish or euthanize a once beloved cat. Interestingly, five to thirty minutes in the veterinary practice can result
veterinary visits in the United States started to decline in stress for the owner over a matter of days to weeks.
after 2001 which was the same year that the American Clients need specific advice from the veterinary practice
Veterinary Medical Association (AVMA) developed a as to how to minimize this stress (see Chapters 9 and 20).
position statement to keep cats indoors.17 The goals of
that position statement were to increase life expectancy
and reduce injury, disease, and zoonoses,17 but other fac-
STRESS-RELATED DISEASES
tors such as behavioral needs and quality of life also need The negative impact of chronic stress on the physical
to be considered. Cat owners often assume that due to the health of humans is well recognized. More recently,
indoor lifestyle of their cat, it will be protected from dis- awareness of feline stressors leading to physical
ease, injury, and parasites, and therefore there will be no health problems in cats has been well documented.8,9,21
need for veterinary care. This misunderstanding leaves Although cats do not always express overt signs of
indoor cats vulnerable, and since the majority of pet cats stress, it is important for owners and veterinary prac-
have non-infectious health conditions that impair their tices to be aware of how feline stress can be associated
quality of life,18 the decline in veterinary visits has been with suboptimal environmental and social conditions.
associated with a significant increase in cats with prevent- There is a strong link between feline stress and the
able diseases. U.S. studies have identified a 10% increase chronic pain syndrome, feline idiopathic cystitis
6 CHAPTER 1 Importance of Feline Behavior in Veterinary Practice

(FIC).8,9,22 Also called feline interstitial cystitis, it is the

most common cause of feline lower urinary tract dis-
ease, with 54%-64% of cats presenting with lower uri-
nary tract signs having idiopathic disease.23 FIC was
initially considered a disease of the bladder alone, but
it is now recognized that the response is activated in
the brain by the hypothalamic stress response system.9
Co-morbid disorders commonly occur in combina-
tion with FIC and affect organs such as the skin, gastro-
intestinal tract, or immune system.24 The combination
of multiple affected body systems, signs that wax and
wane in severity, and that the cats show a favorable
response to environmental enrichment has led to the
identification of these cases as “Pandora Syndrome.”24
In addition to the well-documented contribution of
stress to cases of feline lower urinary tract disease, stress
has also been shown to have other negative health
effects. For instance, stress decreases food intake and
increases incidence of upper respiratory infections in
cats in humane shelters.21
Stress-related diseases can occur in the home, the vet-
erinary practice, and the humane society. Stressors
include unfamiliar environments and individuals, and
a lack of predictability and sense of control. For example,
a hospitalized cat may have a perception of poor predict-
ability and a lack of sense of control if there are incon-
FIGURE 1-3 Vertical space enriches the environment by
sistencies in caretakers, feeding and cleaning routines, or providing a safe perch from which the cat can monitor
periods of light and dark.9 the environment. (Copyright © iStock.com)
Studies indicate a significant decrease in the fre-
quency of signs of stress-related diseases with environ-
mental enrichment, familiarity, and a sense of control
(Figure 1-3).8,22 Interestingly, there was also a decrease
in fear and upper respiratory infections.8 Based on this
information, it is necessary for veterinarians to address
environmental stressors and consider how to improve
the environment and offer predictability for the cat.
For more information about what causes stress in
cats in the home environment, see Chapter 2. For more
detailed information about stress as a risk factor for
physical disease, see Chapter 12.

RELINQUISHMENT AND EUTHANASIA

OF PET CATS FIGURE 1-4 Once beloved cats are often released to
enter the stray cat population because people worry that
A significant proportion of adopted cats do not remain they will be euthanized if surrendered to a shelter. How-
in their original home for life. Many apparently healthy ever, these cats may not be able to properly fend for them-
cats are rehomed, released to enter the stray cat popu- selves among feral cats, and their welfare is often poor.
lation, surrendered to shelters, and/or euthanized (Copyright © iStock.com)
(Figures 1-4 and 1-5). While many of the reasons that
owners give for these decisions relate to the behavior in the United States,25 with millions of cats being eutha-
or characteristics of the cat, changes in the owners’ cir- nized each year because of behavior problems. House
cumstances, for example a housing or relationship soiling is the most commonly reported behavior prob-
change, are also offered as reasons why a cat needs to lem to result in surrender,10,11 and the second is a newly
leave its present home. Euthanasia due to behavior adopted cat not getting along with existing cats in the
problems is the number one cause of death of adult cats household.11,26,27 The third most common cause is
Discovering Diverse Content Through
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 “Exactly.”
“Only people do like to tell me things.”
“I can quite understand that—when they’ve anything to tell.”
“Which is what I thought you might have.”
“How could I have anything to tell when I’ve just spent two years
in trenches and hospitals?”
“You haven’t been in trenches and hospitals during the last ten
days. Oh, don’t say anything if you don’t want to. I’m not in the
least curious.”
“Of course you’re not. No one would ever think so.”
“I’ve only been—well, just a little afraid.”
“What were you afraid of?”
“Of the situation. I suppose it wasn’t an accident that you took the
boat that she was on?”
“No, it wasn’t an accident. But what has that to do with it?”
“Just that much—that you did it on purpose.”
“So that you were afraid on my account?”
“No; on hers. You see, she’s been so terribly talked about that
now that it’s beginning again—”
“Oh, it’s beginning again, is it?”
She said, mysteriously, “Stephen Cantyre is rather a goose, you
know.”
“In what way?”
“In the way of dropping hints when he’d much better keep still.
He’s so crazy about her—”
“It’s a pity for him to be dropping hints if he isn’t sure.”
“Oh, he must be sure enough! After the way she treated him
before, he’d never expose himself to the same thing the second
time. It isn’t that he’s not sure. It’s just the way he does it—
confiding in every one, but only saying that he hopes.”
“If he only hopes, it doesn’t bind any one but himself.”
“It isn’t a question of binding; it’s one of the situation. If she’s let
him hope—the second time—she’s bound. If it was only the first
time—or if she hadn’t made such an insane reputation for herself—
don’t you see?—the whole thing is in that.”
“I should think the whole thing was in whether or not she was in
love with him.”
“Well, it isn’t. If she was as much in love with somebody else as
Juliet she couldn’t throw over Stephen Cantyre now. She’d have to
be put under restraint if she did—shut up in some sort of ward. The
community wouldn’t stand for it.”
“It might be a nine days’ wonder, of course.”
“It would be one of those nine days’ wonders that last all your life.
She’d be done for.” She went on in another key. “But, of course, her
father and mother wouldn’t let her. They’re delighted. He’s very well
off—and a good fellow, who’ll give her everything she wants.”
“But what good will that do if she doesn’t care for him?”
Her animation went into the eclipse that always came over her
when she touched the heart of things.
“What makes you think she doesn’t—if it’s not a rude question?”
“The fact that she turned him down before.”
She broke in with that directness which she never hesitated to
make use of when the time came.
“You don’t think she cares anything about you?”
I considered two or three ways of meeting this, the one I adopted
being to put on a rather inane smile.
“What if she did?”
 “She’d just have to get over it, that’s all. You, too!”
“Why?”
“I needn’t tell you why. You must see for yourself. Or, rather, I’ve
told you already. There are ways in which an engagement is more
important than a marriage—any engagement; and when it’s a
second engagement to the same man—If she’d been married to him,
and couldn’t get along, why, no one would think the worse of her if
she got a divorce and married some one else. She would have given
him a try; she would have done her best. But just to take him up
and put him down, and take him up and put him down again,
without trying him at all—my dear Frank, it isn’t done!”
“But suppose we did it?”
“In that case it might be the world well lost for love—but the
world would be lost; and you needn’t be under any misconception
about it. Personally I’d stand by any one through almost anything; I
have stood by Regina in the past when lots of other women have
given her the cold shoulder because of her—”
“Call it anything you like. Most of us have other names for it. All I
want to say now is that I wouldn’t stand by her in this; nor by you,
either. If you had come to me when you were in your other troubles
—three or four years ago—you’d have found me just the same as if
you’d been keeping straight. Any one can go to the bad. There isn’t
a family that hasn’t some one who’s done it. But this would be the
kind of thing— Frank, old boy, I’m telling you right now, so that
you’ll know where you stand with me. I’d have to be the first to cut
you both.”
To this there were several retorts I could have made, any of them
quite crushing to Annette; but I was thinking of the practical
difficulties before us. The rôle of unscrupulous coquette was the last
in which Regina would care to appear; that of cad was equally
distasteful to me. Had it been possible to make one plunge and be
over with it, it would have been different; as it was, the preliminaries
—the facing of all the people who would have to be faced—the
explaining all the things that would have to be explained—couldn’t
but be devilish.
I was just beginning, “Why should you assume that we are
thinking of any such thing—?”
But before I could finish the sentence the door opened gently and
a maid’s voice announced, “Mrs. Barry.”
Of all the people in the world, this lady was the last I wanted to
meet at that moment. Knowing how I must have figured in her eyes
in the past, I was planning for the future to figure in a worse light
still. I had thrown her kindness back in her face and never given her
an explanation. She must have known that my seeming flight from
Long Island after that last Sunday in June, 1914, had left her
daughter unhappy; and the reason had remained a mystery.
She gave me the first glance as she entered, and only the second
to our hostess. The awful severity of those who are temperamentally
gentle and unjudging was in the very coldness of her eye.
She was a charming, delicate, semi-invalid woman who seemed to
have been spun, like the clothes she wore, out of the least durable
materials in life. Regina had the same traits, but harder, stronger,
and more lasting. It was difficult to think of the latter as an invalid;
while you couldn’t see the mother as anything else.
Prettily old-fashioned, she seemed not to have changed her style
of dressing since the eighteen-seventies. The small bonnet might
have dated from the epoch of professional beauties when Mrs.
Langtry was a girl. The long fur pelisse with loose hanging sleeves
was of no period at all. I think she wore a train. In her own house
she habitually did, and she seemed to have just flung on the pelisse
and driven down the Avenue in her motor.
She greeted me politely, without enthusiasm, but with due regard
to the fact that I was a wounded hero home from the wars. Talking
of the invasion of Rumania, she showed herself much more alive to
America’s international duty than any of the few men I had met
since my landing.
 “I wish we could get my husband and Stephen to see things that
way,” she continued, sweetly, over her tea-cup. “They’re so pacifist,
both of them. My husband feels that we’ve nothing to do with it, and
Stephen is opposed to war on any ground. You must talk to him, Mr.
—or captain, isn’t it? Oh, major? You must talk to him, Major
Melbury. He’ll listen to you.” She turned to Annette. “You know,
Annette, I just ran in to share our good news with you. Regina and
Stephen—they’ve made it up again—and they’re so happy!” An
oblique glance included me. She was getting the satisfaction that
women receive from a certain kind of revenge. “Poor darling! You
don’t know how hard she’s tried, Annette. People haven’t understood
her. All she’s wanted was to be sure of herself—and now she is.
She’s really been in love with Stephen all these years, only she didn’t
know it. That is, she knew it; and yet—But I’m sure you see it.
You’re one of the few who’ve never been unkind to her. She wanted
me to tell you. She’ll be so glad to have you know it, too, Major
Melbury. Perhaps she told you on the boat. I think she said she did. I
don’t quite remember. There’s been so much to say in the last few
hours. There always is at such a time, don’t you think?... No; they’re
not going to announce an engagement. It would only make more
talk, after all the talk there’s been. One of these days they’ll be
married—without saying anything about it. And, oh!—I know you’ll
be interested, Annette, though it may bore Major Melbury—Stephen
has bought that very nice house—the Endsleigh Jarrotts lived in it for
a little while—on Park Avenue near Sixty-sixth Street. Ralph
Coningsby is going to remodel it for them, and I’m sure it will be
awfully attractive. That’s where they’ll live.”
It was my opportunity. I could have shouted out there and then
and made a scene.
Do you think me a coward for not doing it? Do you think me a
fool?
All kinds of speeches were hot within me—and I kept them back.
More correctly, I didn’t keep them back; I simply couldn’t utter them.
I couldn’t give pain to this sweet lady sipping her tea so contentedly;
I couldn’t give pain to Annette. Annette was enjoying the situation in
which we found ourselves; the sweet lady had got compensation for
months, for years, of wondering and unhappiness in those seemingly
artless words, “She’s really been in love with Stephen all these years,
only she didn’t know it.” I knew they were spoken for my benefit.
Between the lines, between the syllables, they said, “And if you think
she was ever in love with you you’re wrong.” Whether the sweet lady
believed her own statements or not made little difference. It would
gratify her all her life to remember that she had had the chance of
making them.
So I came away, following the line of least resistance, because I
didn’t see what else I could do.
I didn’t see what else I could do when Cantyre came into my
bedroom late that night.
I knew he would be dining at the Barrys’, and that he would come
looking me up after his return. To avoid him I had the choice
between staying out and going to bed. My physical condition kept
me from staying out very late, and so I took the other alternative. It
made no difference, however, since he waked Lovey by pounding on
the door, and insisted on coming in.
Dropping into the arm-chair beside my bed, with no light but that
which streamed in behind him from the sitting-room, he took me on
my weak side by beginning to talk about the war.
I have said that my mission had become unreal and fantastic, but
that was only in relation to my personal fitness for the task. That the
war was a holy war, to be fought to a holy end, remained the alpha
and omega of my convictions. And to Cantyre war of any kind was
plainly unholy war, productive of unholy reactions. What I felt as he
talked may best be expressed by Lovey’s words next morning when
he betrayed the fact that he had been listening.
“Didn’t it get yer goat, Slim, the way the doctor went on last
night?”
 It did get my goat, and I restrained myself only because I had
been warned in London to be patient with Americans. “You must
treat them as wise parents treat their sons,” I had been told. “Help
them to see for themselves—and when they do that you can trust
them.” So the best I could do was to help Cantyre to see for himself;
and to make any headway in that I had to pretend to be tolerant.
“No one contends that war is the ideal method for settling human
difficulties,” I admitted; “but as long as human society stands on
certain planks in its platform there’ll be no other way.”
“Then isn’t this the time to take another way?”
“No; because you’ve got to change your bases of existence first.
You can’t change your effects without first changing your causes,
any more than you can graft an apple on an oak.”
“But even without removing the cause you can still sometimes nip
the effect.”
“Which is what in the present instance we tried to do, and didn’t
succeed in. All the trend of education during thirty years has been in
the direction of eliminating war, while still keeping the principle that
makes for war as part of the foundation of our life. We created a
system of international law; we set up a Hague Tribunal; many of us
had come to the conclusion that no great war could ever again take
place; but the law by which human beings prefer as yet to live
outwitted us and brought war upon us whether we would or not. So
long as you keep the causes you must have the effects.”
“Then let us do away with the causes.”
“Yes! Let us. Only, to do that in time for the present situation we
should have begun five hundred years ago. You can’t put out the fire
the ages have kindled as you’d blow out a candle. When you’ve
spent centuries in preparing your mine, and fixed a time fuse to
make it explode, you’ve nothing to do but to let it go off. This war
wasn’t made overnight. The world has been getting ready for it as
long as there have been human beings to look askance at one
another. Now we’ve got it—with all its horrors, but also with all its
compensations.”
“Compensations for the lives it has ruined?”
“In the lives it has saved—yes. You’ll never get its meaning unless
you see it as a great regenerative process.”
“Do you mean to tell me that we can only be regenerated by fire
and sword and rapine?”
“Not at all! We’re regenerated by courage and honor and sacrifice
and the sense that every man gets—every Tommy, every poilu,
every bluejacket—that he personally is essential to man’s big fight in
his struggle upward. It’s one of the queer things of the whole
business that out of the greatest wrong human beings can inflict on
one another—to go to war with them—there can come the highest
benefits to every individual who gets himself ready to receive them.
It makes one believe in an intelligence compelling the race toward
good, however much we may be determined to go the other way.”
He tuned his voice to a new key.
“Oh, I’ve never doubted that; and now, old chap, now I—I see it.”
I knew what was coming. It was the great subject that could
eclipse even that of the war. I had just force to pull the bedclothes
up about my mouth and mutter a suffocated, “How?”
“What I hinted this morning. It’s all—it’s all come right. I used to
think it never would, sometimes. And then—don’t laugh, old boy!—
but then I’d say to myself that God would never have made me feel
as I did unless He meant something to come of it. Religion keeps
telling you to trust; and I did trust—on and off.”
Again I had an opportunity; but again such words as rose in me
choked themselves back in my throat. I could have told him that she
was ready to come to me if I lifted a finger. I knew I should have to
tell him sometime, and it occurred to me that it might as well be
now. It was the words that failed me, not the intention; or if it was
the intention, it was the intention in any degree that made it
compulsory.
I don’t think he noticed that I said nothing, for he went falteringly
on:
“It’s a wonderful thing to be happy, Frank. I’ve never been happy
before in my life. I’m a pusillanimous sort of bloke, and there’s the
truth. I wasn’t happy at home, or at school, or at college, or in any
of the hospitals where I worked; and I never made any friends. You
must know I’ve been queer when I say that women have always
looked at me as if I was outside of their range. They’ve never made
up to me in the way they do to most fellows with a bit of money and
not deformed. Regina—there! I’ve said her name—she was the very
first who ever took the trouble to be more than just decently civil.”
I managed to stammer the words, “What did she do?”
“Oh, nothing very much—not at first. She seemed to think—she
used to say it—that I was different from most men. That’s what she
appeared to be on the lookout for. All the other chaps she knew
were so much alike, and I—Well, that’s how it began. She wanted
the unusual—and I turned up. After a while she thought I wasn’t
unusual enough—said it in so many words—But you know that story.
I’ve told you too many times already.”
“And now?”
“She thinks she’ll marry me.”
He brought out the statement in a voice all awe and amazement.
“She only thinks?”
“Oh, she will. She wouldn’t say anything about it if she didn’t
mean—”
“And—and you’re going to—to let her?”
“Let her? Why, man, you might as well ask me if I’d let God
forgive my sins if He said He’d do it.”
 “God could forgive your sins and not be any the worse off
Himself.”
He sprang forward in his chair, grabbing at the bedclothes.
“Frank, I swear to you it will be the same with her. She’ll never be
sorry. I’ll never let her. She’ll be like God to me. I’ll make my whole
life worship and service.”
“If that’s what she wants.”
“It’s what every woman wants, so they say. They just ask to be
loved; and when you love them enough—” He uttered a little shrill
laugh, in which there was a touch of the hysterical that was always
somewhere about him. “God! Frank, it’s wonderful! Even you who
know her can’t imagine what it means to a lonely bloke like me.”
I pumped myself up to a great effort.
“Suppose”—I had to moisten my lips before going on—“suppose
she was to play you the same trick she played you before?”
“She wouldn’t.”
In spite of his evident conviction, I pressed the question.
“But if she did?”
He threw off in a tone that seemed careless: “In that case there’d
be just one thing for me to do. I’d leave her everything I possess—
I’m doing that as it is—and, well, you can guess the rest. I—I
couldn’t go through all that again. The first time—well, I just pulled
it off; but the second—”
It was the old story. They all seemed to have the second time on
the brain. I, too, was getting it on the brain. It was like a trip-
hammer pounding in my head.
I forced myself, however, to make some foolish, semi-jovial speech
in which there was no congratulation, begging him, then, for the
love of Heaven, to clear out, as I wanted to go to sleep.
 CHAPTER XXV
No record of the next few weeks exists for me. I suppose I must
have done things—little things. I must have gone in and out, and
eaten my meals, and fulfilled Lovey’s orders—for, lacking volition of
my own, I was entirely at his command. But the recollection of it all
has passed from me. I remember reading in some one’s
reminiscences of prison life that the weeks of solitary confinement
went by; but the released prisoner could not say how. Nothing
remained with him, apparently, but a big, black blur; and of these
first weeks in New York it was all that stayed with me.
I know that Christmas came and went, and that I spent the
festival at Atlantic City. I did this in a wild hope, which I knew was
idiotic when I formed it. I told Lovey what I was about to do; I knew
he, in the course of his valeting, which he still kept up, would tell
Cantyre; I guessed that Cantyre would tell Regina; and I hoped—it
never really amounted to hoping, I only dreamed—that Regina might
find the moment a favorable one for slipping away and joining me.
Then we should actually do the thing so impossible to plan.
But, of course, nothing came of it; and I returned to New York
more unsatisfied than I had gone away. The sense of being
unsatisfied sent me at last to Sterling Barry’s door.
You will observe that I had not talked with Regina since our last
night on board ship. On the morning of landing her quick
movements, as compared with my slow, lumbering ones, enabled
her to elude me. Since our landing my will had been positively
paralyzed. Those words of hers, “Oh, Frank, I hope you won’t make
me!” were always in my memory; but the very sense that I could use
the power held me back from doing it. I meant to use it; but as each
minute came round when I might have taken a step toward that end
I seemed to fall backward, like the men who went out with swords
and staves to take the Christ.
But two days after my return from Atlantic City I came to the
conclusion that I could wait no longer. I could go and call on her at
least. For the family it would mean no more than that I had come to
offer my congratulations. For her—but I could tell that only by being
face to face with her.
The old manservant recognized me on coming to the door. He was
sorry that Miss Barry had gone to tea with Miss van Elstine, and was
sure his mistress would be sorry, too. Moreover, they had all heard of
my prowess in battle, and were proud of me.
So I drove round in my taxi to Annette’s.
The maid would have ushered me straight up to the library, but I
preferred to send in my card. As I was being conducted up-stairs a
minute later I had the privilege of hearing a few words which I am
sure Annette intended for my ear.
“Well, I don’t mind this once, Regina; but I can’t have it going
on.... Yes, I know it’s an accident; but it’s an accident that mustn’t
continue to happen. The very fact that he’s my cousin obliges me to
be the more careful. It wouldn’t be fair to your father and mother if I
were to let you come here—”
“But, Annette, this once is all I’m asking for.”
“And all I mean to grant.”
I could tell by Annette’s voice that she was retreating to another
room, so that by the time I entered Regina stood there alone. Before
I knew what I was doing I held both her hands in mine and was
kissing them.
It is an odd fact that on raising my eyes I saw her features for the
first time since that summer afternoon at Rosyth. On board ship she
had always worn the yashmak; and on the dock she had been too
far away to allow of my seeing more than that she was there.
 The face I saw now was not like Annette’s, untouched by the
passage of time and suffering and world agony. You might have said
that in its shadows and lines and intensities the whole history of the
epoch was expressed. It was one of those twentieth-century faces—
they are women’s faces, as a rule—on which the heroic in our time
has stamped itself in lineaments which neither paint nor marble
could reproduce. It flashed on me that the transmigrated soul had
traveled farther than I had suspected.
I don’t know what we said to each other at first. They were no
more than broken things, not to be set down by the pen. When I
came to the consciousness of my actual words I was saying, “I’m
going to make you, Regina; I’m going to make you.”
She responded like a child who recognizes power, but has no
questionings as to right and wrong.
“Are you, Frank? How?”
“In any way that suggests itself.” I added, helplessly, “I don’t know
how.”
“I’ll do whatever you tell me,” she said, simply and submissively.
“Then will you just walk away with me some afternoon—and be
married—without saying anything to any one?”
“If you say so.”
“When shall we do it?”
“Whenever you like.”
“Next week?”
“If that suits you.”
“Would it suit you?”
She bent her head and was silent. I repeated the question with
more insistence.
“Would it suit you, Regina?”
 “There’s no question of suiting me. I’ve got myself where I can’t
be”—she smiled, a twitching, nervous smile—“where I can’t be
suited.”
“Do you mean that you’d come with me—when you wouldn’t want
to?”
“Something like that.”
“Why should you?”
“I’ve told you that. I’ve—I’ve let you see it—in what I’ve been
doing for the past two years.”
“So that I’m absolutely master?”
“That’s it.”
I turned away from her, walking to the other end of the long
room. When I came back she was standing as I had left her, humbly,
with eyes downcast, like a slave-girl put up for sale.
I paused in front of her.
“Do you know that your abandonment of will puts us both in an
extraordinary position?”
“Yes.” She went on presently, “But I know, too, that where you’re
concerned my will-power has left me.”
“But that isn’t like you.”
She shook her head.
“No, it isn’t. Generally my will is rather strong. But in this case—
You see—I’d—I’d waited so long—and I’d never believed that you—
that you cared anything—and now that I know you do—well, it’s
simply made me helpless. I’ve—I’ve no will at all.”
“So that I must have enough for two?”
“I suppose so.”
“And if I—if I carry you off—and make every one unhappy—and
put you in a position where you’d be—where you’d be done for—
that’s what Annette calls it—the responsibility would be all mine?”
“I should never reproach you.”
“In words.”
“Nor in thought—if I could help it.”
“But you mightn’t be able to help it.”
To this there was no reply. I took another turn to the end of the
room. My freedom of action was terrifying. Since I could do with her
what I liked, I was afraid to do anything. I came back and said so.
The old Regina woke as she murmured, “If you’re afraid to do
anything—do nothing.”
“And what would you do?”
“I should let things take their course.”
“Let things take their course—and marry him?”
“If things took their course that way.”
“Do you mean that they mightn’t take their course that way?”
“I’m not married to him yet. There are—there are difficulties.”
I caught her by the arm. “Of what kind?”
“Of opinion chiefly—but of very vital opinion.”
“Do you mean about the war?”
She said with a force like that of a suppressed cry: “He wants me
not to have anything more to do with it! And I—I can’t stop—not
while it’s going on. I—I must be doing something. It’s one of the
reasons why I could marry him—that he’s a doctor—and I could take
him over there—where they need him so much.”
“And he won’t go?”
“He doesn’t say that exactly; but he doesn’t want to. He thinks it’s
all wrong—that when it comes to brutality, one side is as bad as the
other.”
 “Oh, he’ll get over that—if you insist; and then you’ll marry him.”
“Perhaps so—if I haven’t already married you.”
“What makes you think you may have married me?”
“You said you’d make me.”
And in the end, when Annette came back, we left it at that, with
everything up in the air.
 CHAPTER XXVI
More weeks followed, of which my record is chiefly in the drama
of public events.
Vast as these were at the time, they seem even vaster in the
retrospect. As my memory goes back to them they are like
prodigious portents in the sky, awful to look at and still more awful
to think about. A time will come when we shall find it amazing
merely to have lived through such happenings.
Before the invaders the Rumanian towns were going down like
houses built of blocks. In her attitude to Rumania, Russia was a
mystery—a husband who sees his wife fighting for her life and doing
hardly anything to help her. The rumors, true or false, that reached
us might have been torn from some stupendous, improbable
romance—a feeble Czar, a beautiful and traitorous Czarina, a corrupt
nobility, an army betrayed, a people seething in dreams and furies
and ignorance. Washington, having gone so far as to ask the Allied
nations their peace conditions, had received them—restitution,
reparation, and future security. Then late in that month of January,
1917, there came to people like me an unexpected shock. Before the
Senate President Wilson delivered the speech of which the tag that
ran electrically round the world was peace without victory.
I mention these things because they are the only waymarks of a
time during which my private life seemed to be drearily and
hopelessly at a standstill. The deadlock of the nations reacted on
myself. Mentally I was at grips with destiny, but nothing made any
progress. I was exactly where I had started, as regards Regina, as
regards Cantyre, as regards Annette, as regards the father and
mother Barry. Outwardly I was on friendly terms with them all, and
on no more than friendly terms with any one.
 The Barrys invited me to dinner, and I went. Cantyre made up a
theater party—he was fond of this form of recreation—and I went to
that. Annette asked me to a Sunday lunch at which Cantyre and
Regina were guests. The force of organized life held us together as a
cohesive group; the operation of conventional good manners kept us
to courtesies. That any one was happy I do not believe; but life
threw its mask even on unhappiness.
I got in, of course, an occasional word with Regina, which,
nevertheless, didn’t help me. As far as I could observe, she lived and
moved in a kind of hypnotic state, from which nothing I knew how
to say could wake her. She was always waiting for me to give the
word, and I was afraid to give it. If there was hypnotism, it affected
us both, since I was as deeply in the trance as she.
Now and then, however, she came out of it with some brief
remark which gave me a lead and perhaps made me hope. One such
occasion was at the theater. Cantyre had not put me next to her, but
there was an entr’acte when I found his place empty and slipped
into it.
“And how are events taking their course?” I asked, with a
semblance of speaking cheerily.
“I’m waiting to see.”
“Still?”
“Still.”
“And how long is that to go on?”
“Till events have shaped their course in a way that will tell me
what to do.”
“How shall you know that?”
“How does the twig know when the current takes it from the spot
where it has been caught and carries it down-stream?”
“Oh, but you’ve got intelligence.”
“Any intelligence I’ve got implores me to keep on waiting.”
 “So that you’re not going to be married right away?”
“I shall not be married till I see it’s the obvious thing to do.”
“Not even to me?”
“That’s different. I’ve already told you—”
“That if I give the word— But don’t you see I can’t give it?”
“Exactly. You’re waiting for the sign as much as I am.”
“What sign?”
“We shall recognize it when the time comes.”
“Where will it come from?”
“Right up out of life; I don’t know where, nor how.”
“Who’ll give it to us?”
She had only time, as Cantyre returned to his seat, to send me a
long, slantwise look, with the underscored words, “You know!”
Another time was in the regrouping of guests, after Annette’s
luncheon. Finding myself beside her at a window, I asked the plain
question, “Are you engaged to Cantyre?”
“I’m just where I was when I told you about it on board ship. He
hasn’t asked me to be more definite.”
“Is he just where he was?”
“I think he is, in that—in that he expects me to marry him.”
“And you leave him under that impression?”
“I don’t know what else to do—till I get the sign.”
“You’re still looking for that?”
“Yes. Aren’t you?”
“Not that I’m aware of.”
“Oh, but you are, whether you’re aware of it or not.”
 “And suppose he urges you before the sign comes?”
“I shall still wait.”
“And suppose I urged you?”
“I’d take that as the sign.”
And after the guests went I stayed behind and told the whole
story to Annette. So long as there were no clandestine meetings
under her roof, she was as detached and sympathetic and non-
committal as a chorus in a Greek play.
“Why don’t you give her the sign, if it’s not a rude question?” she
asked, while a marvelous succession of ripples circled over her
duskiness.
“Because I’m afraid to. Think what it would mean to Cantyre,
who’s been so white with me all these years.”
“As well as to every one concerned, including herself and you. I’m
glad you’ve enough common sense to feel that. See here, Frank,”
she went on, kindly, “you’ve got to pull yourself out of this state of
mind. It’s doing you no good. When you ought to be at work for
your country, which needs you desperately, you’re sulking over a
love-affair. Buck up! Be a sport! Be a man! There are lots of nice
girls in New York. I’ll find you some one.”
But at that I ran away.
 CHAPTER XXVII
Within a few days I saw the correctness of Annette’s summing up.
A medieval legend tells of an angel being sent to Satan with the
message that God meant to take from the devil all the temptations
with which he had seduced mankind. To this Satan resigned himself
because he couldn’t help it, begging of the angel that he should be
left with just one—and that the least important. “Which?” asked the
angel. “Depression,” said Satan. The angel considered the request,
found that depression cut but slight figure as a sin, and went back to
heaven, leaving it behind him. “Good!” laughed Satan, as the
celestial vision faded out. “In this one gift I’ve secured the whole
bag of tricks.”
And that is what I was to find.
I was depressed on leaving Europe. I grew more depressed
because of the experience on board ship. In New York I was still
more depressed. There was a month in which all things worked
together for evil; and then I came to the place at which Satan had
desired to have me.
I have not said that during all this time I made no attempt to look
up my old friends at the Down and Out or, beyond an occasional
argument with Cantyre, to fulfil the mission with which I had been
intrusted. Ralph Coningsby had come and offered me work, and I
had refused it. Even the march of public events, with the
introduction of lawless submarine warfare and the breaking off of
diplomatic relations between Germany and the United States, hadn’t
roused me. I marked the slow rise of the impulse toward war in the
breasts of the American people, as passionless and as irresistible as
an incoming tide, but it seemed to have nothing to do with me. I
was out of it, flung aside by a fate that had made sport of me.
 I was so far from the current of whatever could be called life that
I grew apathetic. Though I hadn’t seen Regina for weeks, I sat down
under the impalpable obstacles between us, making no effort to
overcome them. I ate and drank and slept and brooded on the
futility of living, and let the doing so fill my time. Lovey was worried,
and dogged me round till there were minutes when I could have
sprung on him and choked him.
Then came the afternoon when I decided that Satan must have
his way.
There is a hotel in New York of which I had many recollections
because I had frequented its barroom in the days before I went
altogether down. It is a somewhat expensive-looking barroom, with
heavy mahogany, gilded cornices, and frescoes of hunting-scenes on
the wall. Hanging over the bar at any time during the day or night
can be seen all the types that are commonly known as sporting,
from the dashing to the cheap.
They might have been the same as on that day when I turned my
back upon the place five years previously. They hung in the same
attitudes; they called for the same drinks; they used the same
profanities, though with some novelty in the slang. With my limp, my
black patch, and my general haggardness, I felt like a ghost
returning among them.
Timidly I approached a barman at leisure and asked for a cocktail
of a brand for which I used to have a liking. I carried it off to a table
placed inconspicuously behind the door leading to and from the
hotel. Putting it on the table, I stared at its amber reflections.
I had come back to the same old place at last. It was curious; but
there I was. All my struggling, all my wandering, all my up-hill work,
all my days and nights in the trenches, all my suffering, all my love—
everything had combined together to land me just here, where, so
to speak, I had begun. It was the old story of dragging up the cliff,
only to fall over the precipice. It seemed to be my fate. There was
no escaping it.
 I might not take more than that one drink during that afternoon;
but I knew it would be a beginning. I should come back again; and I
should come back again after that. Another type of man would do
nothing of the kind; but I was my own type.
Very deliberately I said good-by to the world I had known for the
past three years and more. I said good-by to work, to ambition, to
salvation, to country, to love. Back, far back in my mind I was saying
the same deliberate good-by to God. I shouldn’t rest now till
everything was gone.
The glass was still untasted on the table. I was taking my time.
The farewells on which I was engaged couldn’t be hurried. The fate
in store for me would wait.
Then the door behind which I sat began to open. It opened
slowly, timidly, stealthily, as if the person entering was afraid to
come in. The action stirred the curiosity, and I watched.
Before I saw a face I saw a hand. Rather, I saw four fingers from
the knuckles to the nails, as if some one was steadying himself by
the sheer force of holding on. They were old, thin, twisted fingers,
and I knew at a glance I had seen them before.
The door continued to open, stealthily, timidly, slowly; and then,
looking like a spirit rather than a man—a neat, respectable spirit
wearing a silver star in his buttonhole, with trembling hands and a
woeful quiver to the corner of his lower lip—Lovey stood in the
barroom.
He stood as if he had never been in any such place before. He
was like a visitant from some other sphere—dazed, diaphanous,
unearthly.
He didn’t look at the table behind the door. His gaze was far off. I
could see it scanning the backs of the hangers across the bar. Then
it went over the tables one by one, traveling nearer and nearer.
Just before the dim eyes reached me I said: “Hello, Lovey! Come
and sit down. What’ll you have to drink?”
 There seemed to be an interval between hearing my voice and
actually seeing me—an interval during which a frosty, unnatural
color, as if snow were suddenly to take fire, flared in his waxlike
cheek. But he came to the table and dropped into a round-backed
chair.
“Oh, Slim!”
Leaning on the table, he covered his face with his hand.
I tried putting up a bluff. “What’s the matter, Lovey? Haven’t got a
headache, have you?”
He raised those pitiful, dead blue eyes. “No, but I’ve got a
’eartache, Slim—a ’eartache I won’t never get over.”
“Why, why—” I began to rally him.
“It’s just what I was afeared of—for days and days I’ve been
afeared of it. Been a-watchin’ of you, I ’ave.”
Here was another transmigrated soul that had traveled farther
than I knew. It was in pure curiosity as to the changes wrought in
him that I said: “I should think you would have been glad, Lovey.
When I was here before you used to want to have us both go back.”
The extinct eyes were raised on me.
“These times ain’t them times. Everything different. I ’aven’t
stayed where I was in them days, not any more nor you. Oh, to
think, to think!”
“To think what?”
“That you should ’ave come back to this—and me believin’ the war
’ad done ye good—lifted you up, like. Not but what you was the best
man ever lived before the war—”
“Oh no, Lovey. No one knows what I was better than yourself.”
“You was good even then, sonny—even in them awful old days.
Goodness ain’t just in doin’ certain things; it’s in being certain things.
I don’t ’ardly know what it is; but I can tell it when I see it. And I
seen it in you, Slim—right from the first. Me and God A’mighty seen
it together. That’s why He pulled you up out o’ what you was—and
made you rich—and dressed you in swell clo’es—and sent you to the
war—and made you a ’ero—and stuck you all over with medals—and
brought you ’ome again to me. And if you’d only waited—”
“Well, if I’d only waited—what?”
“You’d ’a’ got somethink better still. You’d ’a’ got it pretty soon.”
“What should I have got?”
 “That you should ’ave come back to this—and me believin’ the war
’ad done ye good—lifted you up, like. Not but what you was the
best man ever lived before the war—”

“I ain’t a-goin’ to tell ye. If you’d come ’ome with me you’d see.”
Before I could follow up this dark hint he continued: “God A’mighty
don’t play no tricks on His children. Look at me! All He’s give me.
Kep’ me well while you was away—and ’elped me to knock off the
booze when it was mortal ’ard to do it—and pervided me with a
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