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Introduction to Clinical
Pharmacology

EDITION 9

Constance G. Visovsky, PhD, RN,

ACNP, FAAN
Associate Professor and Director of Diversity
College of Nursing
University of South Florida
Tampa, Florida

Cheryl H. Zambroski, PhD, RN

Associate Professor
College of Nursing
University of South Florida
Tampa, Florida

Shirley Meier Hosler, RN, BSN,

MSN
Adjunct Faculty
Santa Fe Community College
Santa Fe, New Mexico
Special Editor

M. Linda Workman, PhD, RN,

FAAN
Formerly, Gertrude Perkins Oliva Professor of Oncology
Frances Payne Bolton School of Nursing
Case Western Reserve University
Cleveland, Ohio
Table of Contents

Cover image

Title Page

Copyright

Reviewers

LPN/LVN Advisory Board

Preface
Organization and Features

Teaching and Learning Package for the Instructor

For the Student

Acknowledgments

About the Authors

To the Student
Reading and Review Tools

Chapter Features
Unit I General Principles

1 Pharmacology and the Nursing Process in LPN Practice

The LPN/VN's Role and the Nursing Process

Get Ready for the NCLEX® Examination!

2 Legal, Regulatory, and Ethical Aspects of Drug Administration

Introduction

Regulation of Drug Administration

The Drug Order

Drug Administration Systems

Drug Errors

Protection of Healthcare Workers

Get Ready for the NCLEX® Examination!

3 Principles of Pharmacology
Drug Names

Drug Attachment

Basic Drug Processes

Drug Actions

Drug Therapy and Special Populations

Drug Cards

Get Ready for the NCLEX® Examination!

Unit II Principles of Drug Administration

4 Drug Calculation
Calculating Drug Dosages

Calculations for IV Infusions

General Principles of Drug Administration

Enteral Drugs

Parenteral Drugs

Percutaneous Drugs

Get Ready for the NCLEX® Examination!

Unit III Drug Categories

5 Anti-Infective Drugs
Infection

Antibiotics

Antitubercular Drugs

Antifungal Drugs

Antiparasitic Drugs

Get Ready for the NCLEX® Examination!

6 Antivirals and Antiretrovirals

Virus

Antivirals

Retrovirus
 Antiretrovirals

Get Ready for the NCLEX® Examination!

7 Drugs for Allergy and Respiratory Problems

Allergy

Drug Therapy for Allergy

Asthma and Chronic Obstructive Pulmonary Disease

Drug Therapy for Asthma and Chronic Obstructive Pulmonary Disease

Mucolytics and Antitussives

Get Ready for the NCLEX® Examination!

8 Drugs Affecting the Renal/Urinary and Cardiovascular Systems

Drugs That Affect the Renal/Urinary System

Drugs That Affect the Cardiovascular System

Get Ready for the NCLEX® Examination!

9 Drug Therapy for Central Nervous System Problems

Drugs for Epilepsy

Get Ready for the NCLEX® Examination!

10 Drug Therapy for Mental Health

Drug Therapy and Mental Illness

Drugs for Sleep and Anxiety

Antipsychotics
 Antidepressants and Mood Stabilizers

Get Ready for the NCLEX® Examination!

11 Drugs for Pain Management

Pain

Analgesic Drugs for Pain Management

Miscellaneous Drugs for Pain Management

Get Ready for the NCLEX® Examination!

12 Anti-Inflammatory, Antiarthritis, and Antigout Drugs

Inflammation Causes and Action

Inflammation Management

Gout

Get Ready for the NCLEX® Examination!

13 Drugs for Gastrointestinal Problems

The Digestive System

Antiemetic Drugs

Drugs for Peptic Ulcer Disease and Gastroesophageal Reflux Disease

Drugs for Constipation and Diarrhea

Get Ready for the NCLEX® Examination!

14 Drugs Affecting the Hematologic System

Blood Clotting
 Anticoagulants

Fibrinolytic Drugs

Erythropoiesis-Stimulating Agents

Get Ready for the NCLEX® Examination!

15 Drugs for Immunization and Immunomodulation

Overview of Immunity

Vaccination

Immunomodulating Therapy

Get Ready for the NCLEX® Examination!

16 Hormones and Drugs for Osteoporosis

Overview of the Endocrine System

Drugs for Thyroid Problems

Drugs for Adrenal Gland Problems

Female Sex Hormones

Male Sex Hormones

Drugs for Osteoporosis

Get Ready for the NCLEX® Examination!

17 Drug Therapy for Diabetes

Drug Therapy for Diabetes Mellitus

Get Ready for the NCLEX® Examination!

18 Drugs for Ear and Eye Problems
Ear Problems

Eye Problems

Get Ready for the NCLEX® Examination!

19 Over-the-Counter Drugs, Herbal and Alternative Drugs, and

Vitamins and Minerals
Overview

Over-the-Counter Drugs

Herbal Products and Complementary and Alternative Medicine

Vitamins

Minerals

Get Ready for the NCLEX® Examination!

Bibliography

Glossary
A

G
 H

Index
Copyright

3251 Riverport Lane

St. Louis, Missouri 63043

INTRODUCTION TO CLINICAL PHARMACOLOGY, NINTH

EDITION
ISBN: 978-0-323-52911-2

Copyright © 2019 Elsevier Inc. All rights reserved.

Previous editions copyrighted 2016, 2013, 2010, 2006, 2000, 1995,
1991.

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).

Notices
Practitioners and researchers must always rely on their own
experience and knowledge in evaluating and using any information,
methods, compounds or experiments described herein. Because of
rapid advances in the medical sciences, in particular, independent
verification of diagnoses and drug dosages should be made. To the
fullest extent of the law, no responsibility is assumed by Elsevier,
authors, editors or contributors 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

Names: Visovsky, Constance G., editor. | Preceded by (work):

Edmunds, Marilyn W. Introduction to clinical pharmacology.
Title: Introduction to clinical pharmacology / special editor, M. Linda
Workman.
Description: 9th edition. | St. Louis, Missouri : Elsevier Inc., [2019] |
Preceded by Introduction to clinical pharmacology / Marilyn
Winterton Edmunds. 2016. | Includes bibliographical references and
index.
Identifiers: LCCN 2017054727 | ISBN 9780323529112 (pbk. : alk.
paper)
Subjects: | MESH: Pharmaceutical Preparations–administration &
dosage | Drug Therapy | Nurses' Instruction
Classification: LCC RM300 | NLM QV 748 | DDC 615.5/8–dc23 LC
record available at https://lccn.loc.gov/2017054727

Senior Content Strategist: Nancy O'Brien

Senior Content Development Specialist: Laura Goodrich
Publishing Services Manager: Jeff Patterson
Senior Project Manager: Tracey Schriefer
Design Direction: Renee Duenow

Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Reviewers
Linda Gambill RN, MSN/Ed
LPN Instructor/Clinical Coordinator
Southwest Virginia Community College
Cedar Bluff, Virginia

James Graves PharmD

Clinical Pharmacist
University of Missouri Hospital Inpatient Pharmacy
Columbia, Missouri

Teresa Peirce RN, BSN

Nursing Instructor
Locklin Technical Center
Milton, Florida

Jackie Taylor-Wynkoop RN, MSN, EMS-I, PHRN, FAEN

Coordinator
PITC Practical Nursing Program
Wyncote, Pennsylvania

Tiffany Vollmer RN, BSN

Nursing Department Director
Locklin Technical Center
Milton, Florida
LPN/LVN Advisory Board
Nancy Bohnarczyk MA
Adjunct Instructor
College of Mount St. Vincent
New York, New York

Sharyn P. Boyle MSN, RN-BC

Instructor, Associate Degree Nursing
Passaic County Technical Institute
Wayne, New Jersey

Nicola Contreras BN, RN

Faculty
Galen College
San Antonio, Texas

Dolores Cotton MSN, RN

Practical Nursing Coordinator
Meridian Technology Center
Stillwater, Oklahoma

Patricia Donovan MSN, RN

Director of Practical Nursing and Curriculum Chair
Porter and Chester Institute
Rocky Hill, Connecticut

Nancy Haughton MSN, RN

Practical Nursing Program Faculty
Chester County Intermediate Unit
Downingtown, Pennsylvania

Dawn Johnson DNP, RN, Ed

Practical Nurse Program Director
Great Lakes Institute of Technology
Erie, Pennsylvania

Mary E. Johnson RN, MSN

Director of Nursing
Dorsey Schools
Roseville, Michigan

Bonnie Kehm PhD, RN

Faculty Program Director
Excelsior College
Albany, New York

Tawnya S. Lawson MS, RN

Dean, Practical Nursing Program
Hondros College
Westerville, Ohio

Kristin Madigan MS, RN

Nursing Faculty
Pine Technical and Community College
Pine City, Minnesota

Hana Malik DNP, FNP-BC

Academic Director
Illinois College of Nursing
Lombard, Illinois

Mary Lee Pollard PhD, RN, CNE

Dean, School of Nursing
Excelsior College
Albany, New York

Barbara Ratliff MSN, RN

Program Director, Practical Nursing
Cincinnati State
Cincinnati, Ohio

Mary Ruiz-Nuve RN, MSN

Director of Practical Nursing Program
St. Louis College of Health Careers
St. Louis, Missouri

Renee Sheehan RN, MSN/Ed

Director of Nursing, Vocational Nursing
Nursing Assistant Programs
Summit College
Colton, California

Fleur de Liza S. Tobias-Cuyco BSc, CPhT

Dean, Director of Student Affairs, and Instructor
Preferred College of Nursing
Los Angeles, California
Preface
This ninth edition of Introduction to Clinical Pharmacology offers the
fresh and exciting perspectives of authors who have years of
experience teaching pharmacology. Most students believe that
pharmacology is a very important part of their nursing education
and one that is difficult to learn. The author team has strived to make
the pharmacology learning experience one that combines updated
information in an easy-to-remember format that promotes high
levels of content retention.
This textbook is written using the second person throughout to
engage students and help them understand the nursing
responsibilities required for use in the clinical setting. The textbook's
new organization and style are intended to engage students and help
them develop an in-depth understanding of the “need to know”
content that is critical for safely administering medications in all
environments in which licensed practical nurses/vocational nurses
(LPN/VNs) are employed. The components of the nursing process
most important to this function are emphasized. The number of
illustrations has been greatly expanded to explain drug actions and
techniques for administration. The textbook uses current
terminology for education and healthcare practice. For example,
more settings include nurse practitioners and physician assistants as
legal prescribers in addition to the physician. To reflect this change,
the term healthcare provider is used throughout. Learning outcomes
replace chapter objectives. These outcomes concisely and clearly let
the student know which content represents the highest priority for
safe medication administration. Drugs and drug categories no longer
in common usage, or that do not apply to the LPN/VN role, have
been eliminated. The textbook also helps students learn to make use
of prevailing technology. Internet resources and references have
been identified and highlighted with Bookmark This features.
 Newly created drug tables are divided by drug category and
organized to provide students with concise access to mechanisms,
common adult drug dosages, and essential nursing implications for
administration and patient teaching. Key terms critical for
pharmacology are first listed at the beginning of the chapters and
include phonetic pronunciations, definitions, and page numbers
where each term is first used. This textbook takes advantage of the
use of medical and nonpharmacologic terminology, with short
definitions placed alongside the terms, as well in the Glossary, to aid
student reading and retention.
Throughout this textbook, ensuring patient safety remains a major
theme. The new safety features are the Top Tip for Safety boxes that
highlight very specific precautions, unusual drug dosages, or critical
nursing interventions. This author team deeply believes that it is
critical to provide patient safety information to reduce drug errors.
In addition, patients and families who understand the why of
directions are more likely to adhere to them. Toward this purpose,
nursing actions are accompanied by the appropriate rationale. In the
discussion of each drug category, the sections on patient and family
teaching provide direct examples of exactly what to teach patients
and families, as well as the rationales for why these actions or
precautions are necessary. Specific content on Lifespan
Considerations for drug administration related to older adults and
pediatric patients and for pregnancy and lactation are appropriately
placed for maximum retention. A completely revised chapter
covering herbals, vitamins, and supplements is included.
Other user-friendly learning techniques provided in this
streamlined and updated edition include features such as Memory
Jogger and mnemonics. All of the end-of-chapter review questions
have been changed to reflect the latest NCLEX® format for critical
thinking and application of content, including the “select all that
apply” and multiple-choice questions. These formats help the
student to think through responses rather than focus on rote
memorization. All clinical chapters have newly developed case
studies designed to help students learn to apply specific content.
 The ancillary package has also been heavily revised. The Student
Study Guide, written by a very experienced educator, is completely
new. The instructor's TEACH resource is completely updated based
on the revised Learning Outcomes for each chapter. The test bank is
also heavily revised with new questions that require the student to
apply knowledge, and they are in the latest question formats.
Organization and Features
This textbook has been completely revised to include updated drugs,
to remove drugs and terms that are no longer used in practice, and
to add tables for each drug classification that list common drugs for
each class and normal adult dosage ranges. Throughout this text,
medications will be referred to as drugs, and the drug prescriber is
called the healthcare provider because this can be a physician,
advanced practice nurse, certified registered nurse anesthetist, or
physician's assistant. The text has been reorganized into 3 units
totaling 19 chapters to streamline access to specific content areas.
Chapter-ending Get Ready for NCLEX® Examination questions have
been updated and revised throughout the text, and use mostly
application format questions to provide students with practice in
answering these types of examination questions.

Unit I
The first unit provides an overview of general content covering the
nursing process as it relates to drug administration, the importance
of safely giving drugs, and the principles of pharmacology that set
the knowledge base for specified drug categories. For example, this
completely revised textbook includes information on unique aspects
of the contemporary LPN/VN practice environment, including
working in teams with the registered nurse, healthcare provider, and
other healthcare professionals. An overview of the nursing process
as it applies to pharmacology is provided.
Safe practice is accentuated throughout Chapter 1, with a guide to
planning and giving drugs to patients. The updated 9 Rights of Drug
Administration is presented in detail and includes the right of the
patient to refuse a drug. Although giving drugs properly is
important, equally important are evaluating the expected drug
response, understanding common side effects, and knowing how to
handle adverse events from drugs.
 The legal regulatory and ethical content related to giving drugs in
the LPN/VN role has been updated to include a thorough discussion
of schedule drugs, drug diversion, and a distinction between
addiction and physical dependence in a patient. In Chapter 2,
technology-associated patient identification, drug orders, and the
giving and recording of drugs in either a standard Kardex or
electronic health record are covered.

Unit II
Unit II is concerned with drug calculation, preparation, and
administration. LPN/VNs often practice in assisted nursing centers,
nursing homes, and care centers where high-tech drug
administration systems may not be used. Thus they need to be able
to give medications safely and accurately, relying on their own
ability to calculate the drug dosages accurately. Chapter 4 incudes
the “need to know” content related to drug calculation and includes
dimensional analysis, a mathematical technique that is being
adopted by many nursing programs for drug calculation.
Intravenous drugs, oral drugs, parenteral drugs, and intravenous
infusion calculation are presented in an organized, step-by-step
manner. The application of topical, transdermal, mucous membrane,
and eye and ear drugs is also presented with accompanying
illustrations to help the student visualize the process while reading
the material.

Unit III
Drug classification groups provide essential information on 15
specific drug classifications. Unit III focuses on content that has
application to treatment purpose (i.e., anti-infective drugs) and are
associated with body systems, such as renal, urinary, and
cardiovascular systems. Drugs for the treatment of cancer have been
removed because the LPN/VN does not administer or monitor these
drugs, which are given by specially certified oncology nurses. By
grouping drugs using the drug classification system, students
Discovering Diverse Content Through
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 Lucrezia. Madonna Adriana brought me here;
She stays without: I go back to the convent.
Cesare—;tell me all that I should pray.

Cesare [turning his head back towards her from

the couch]. Amanda, that your scruples be removed.
That I be Cesar.

Lucrezia. Take a little rest.

Cesare. Shall you, from prayer?

To-night you look a sibyl.
Who did this deed?

Lucrezia. Let Juan play the lute;

You must have music through these restless nights.
How lost you look!

Cesare. You startled me. How lost!

[He closes his eyes.
Lucrezia. He is dreaming; he has quite forgotten me.
Come, Adriana, soft! As an astronomer
He must not be disturbed: he is quite lost.

One leaves Borgia reluctantly, having done so much less than justice to
it: nevertheless, it is refreshing to turn to Deirdre after an atmosphere so
charged and tropical. Not that Deirdre is set on any lower plane of emotion,
for it also deals with vast passions. But in this play we pass visibly to a
more northerly latitude, to an austerer race and a more primitive age; and it
is in an air swept clean by storm that the business of sowing the wind and
reaping the whirlwind goes forward.
Michael Field has made a noble rendering of this old Irish story which,
its subject dating from the first century, suggests a cause no less remote
than that for the ancient feud between Ulster and the rest of Ireland. The
story is well known: the birth of Deirdre and the prophecies of doom to
Ulster through her; the defiance of the doom by Conchobar the king, and
the fostering of Deirdre to be his wife; the carrying off of Deirdre on the
eve of her wedding by Naisi and their flight to Alba; the invitation to Naisi
and his brothers to return under Conchobar’s promise of forgiveness; and
the treacherous assassination of them upon their arrival. There are many
variants of the legend; and our poet has chosen the oldest of them all, that
preserved in the Book of Leinster, for the chief events of her drama. She
was compelled to alter the story at one point, for it would hardly have been
convenient to represent the Sons of Usnach slain, all three at one stroke, by
the magic sword. But in varying the manner of their death she was enabled
to adopt another form of the legend, in which Naisi and his two brothers
were overcome by a Druid’s enchantment, and, believing themselves to be
drowning, dropped their weapons and were immediately overpowered by
Conchobar’s men. There was, however, a difficulty here too; for whereas
three heads lopped off at one blow was a little too dynamic even for the
purposes of drama, an unseen spell of wizardry was altogether too static;
and the poet therefore contrived a scene in which Naisi’s comrades are
actually drowned, and he, left alone to protect Deirdre, is slain by Eogan.
Another modification, with less warrant from the documents, perhaps,
but of even greater interest, is that which introduces into this primitive
world the first gleam of Christianity. The fact might suggest that the Deirdre
play was written after the poets’ conversion, did one not know that they
were at work on the theme some time before. But it is extremely probable
that the passage in which the wise woman Lebarcham tries to turn
Conchobar from brooding on vengeance by the tale of a new god who
refused to avenge himself on his enemies was inserted after the first draft of
the play was made. It is written in prose, and, placed at the beginning of Act
III, hardly affects the subsequent action. From that point of view it might be
considered superfluous; but Michael, though not Henry, was capable of so
much over-zeal. She was, however, also capable of justifying her act
artistically. The interpolation is at least not an anachronism. It is possible,
there in Ireland, that even so early had penetrated “the story of how a god
met his death ... young, radiant ... bearing summer in his hands.” But it
might have been a menace to the unity of the drama: it might have
destroyed the satisfying wholeness which, in whatever form one finds it, the
pagan story possesses. Michael Field avoided that calamity. She threw her
glimmer of Christian light across the scene in such a way that it reveals
more strongly by contrast the dark elements of which the story is composed.
By it one instinctively measures the barbarity of the age out of which the
story came, and realizes its antiquity. The poet does not allow it to influence
action, for that would weaken the tragedy; but she uses the occasion to
humanize and make credible that which, in the Conchobar of the records,
seems almost monstrous. In those ancient tales Conchobar plans his
vengeance on Naisi and his brothers with a coldness that is diabolic and a
precision almost mechanical. He provides for his own safety, too, with
comical caution, carefully sounding one after another of his knights until he
finds one who does not immediately threaten to kill him for suggesting such
a dastardly deed as the murder of the Sons of Usnach. Yet, as our poet has
re-created Conchobar, he is a human soul driven this way and that in a
running fight with passion; pitiable in his hopeless love for Deirdre,
comprehensible in his wrath against Naisi, sinister and terrifying in his
revenge. And underneath the overt drama lies a profounder irony; for while
he is plotting in his heart the enormous treachery, Lebarcham tells of the
young god who was betrayed by his friends, and he says:
Hush, woman, for my heart is broken. Would I had been there, I who can
deal division between hosts. I would have set the Bound One free. If I could
avenge him!
The play is written in five acts and a prologue; but is not divided into
scenes. Its form is for the most part blank verse—;the iambic pentameter of
Michael Field which is so often neither iambic nor a pentameter. Her verse
is, indeed, a very variable line, changing its unit as frequently as will
consist with a regular form; and as flexible, sinewy, and nervous as will
consist with dignity, grace, and splendid colour. Prose passages occur in
Acts III and V; and a form of lyrical rhapsody is used to express the Druid
prophecies and Deirdre’s lament. The use of lyrics in her drama was not
new to Michael Field, who from the beginning could always relieve the
strain of intense emotion by a graceful song. But in this case she is
following, with her accustomed fidelity, lines laid down in older renderings
of the legend.
The most notable feature of this play is its ending. No author of the more
important modern versions of this theme has dared to take his conclusion
from the oldest one of all. Usually he has preferred the variant which tells
of Deirdre, broken-hearted at Naisi’s murder, falling dead into his grave.
This is, of course, in some respects a more ‘poetic’ passing: it lends itself to
romantic treatment, and its tragedy is more immediate and final. Moreover,
from the dramaturgic point of view the action is easier to handle and more
certain of its effect. Michael Field was not, however, attracted by mere
facility. Truth drew her with a stronger lure, and to her the more ancient
story would make a claim deeper than loyalty. For she would see Deirdre’s
survival not only as a more probable thing, but as something more
profoundly tragic; and the manner of her death, when it came, as more
clearly of a piece with the old saga and essentially of Deirdre’s wilful and
resolute character.
Deirdre is no Helen, though her legend has features so similar. The mere
outline of her which the old story gives indicates a creature who will
compel destiny rather than suffer it; and our poet has but completed,
imaginatively, what the original suggests—;a girl whose instinct of chastity
drives her away from marriage without love; whose ardour and courage
claim her proper mate; whose fidelity keeps her unalterably true; and whose
head is at least as sound as her heart is tender. For although she is a rather
tearful creature, she is also very astute; and Naisi need not have died quite
so young if he had only listened to her warning and condescended to take
her advice. Deirdre is, in short, of her race and of her time as surely as
Lucrezia Borgia is a daughter of Pope Alexander VI and a child of the
Italian Renaissance. Michael Field’s range in the creation of women
characters is very wide, and the verisimilitude with which she presents
natures so alien from herself as the courtesan and the voluptuary might be
astonishing if one thought of her simply as a Victorian lady, and not as a
great creative artist. Nevertheless, in the re-creation of Deirdre one feels
that she must have taken an especial joy, as witness the opening passage of
Act I, where Lebarcham and Medv the nurse are discussing their fosterling.
It is the morning of her sixteenth birthday, and King Conchobar is coming
to the little secluded house where Deirdre has been brought up to claim her
as his bride:

Medv. But look at her!

Lebarcham. Ay, Medv, it is not for our eyes to look.

The beauty!

Medv. She is dreaming.

Lebarcham. She sees true;

 Lebarcham. She sees true;
Therefore she is no poet. Gentle Medv,
My sister with the mother-eyes that rest
But when they rest on her, she is not ours,
Nor fate’s, nor any man’s; for she will choose,
Close prisoner as she is, her destiny,
Choose for herself the havoc she will make,
The tears that she will draw from other eyes,
The tears that will burn through her, the delights
That she will ravish from the world. She knows
So definitely all she wants: such souls
Attain. She is not dreaming; look at her!

Medv. She does not sigh as other maids kept close;

She is soft as a wood-pigeon, but no crooning—;
And when I speak of love—;King Conchobar
To be her lord—;she laughs.

Lebarcham. A wanton laugh!

Medv. No, no! Dear heart, she has no wantonness;

And yet I am afraid to hear her laughter,
It is so low and sure. My maid, my maid!
What shall I do that bitter day the King
Tears her away from me?

Lebarcham. Be comforted.
She loves you, she will bless you all her years:
But if she hate—;I would not be the creature
To cross her path, not if I were the chieftain
Of Ulla, or of Alba, or the world.

Medv. She has no malice. Would you slander her?

Lebarcham. I praise her! She can hate as only those

Of highest race, without remorse, for ever.

Again, in the same first act, when Deirdre has prevailed on Lebarcham
to bring Naisi to the hut, and the two have spoken of their love, it is she
who at once perceives where that confession must lead. Naisi would rather
kiss and part than rob the mighty Conchobar of his bride. But for Deirdre,
having kissed, there shall be no parting:

Deirdre. But we shall never part again, O Naisi,

Bear me away with you. I cannot speak,
Not much, not anything to listen to,
Yet I shall lie awake at night to ease
The pain it is to think of you by thinking
More constantly each moment. Bear me with you
To Alba, to the loveable, soft land.
[Naisi pauses stupefied: then turns away.
Naisi. But he has waited
For sixteen years; I am his chosen knight:
At dance, at feasting never has he turned
His eyes on woman, or if idly turned
An instant, he was back with Lebarcham
Asking of thee, thy years.
Where are you stepping?
Your feet are towards the waves.

Deirdre. For I shall travel

Either across this narrow sea with you,
Or else alone with the currents and the creatures
That travel fleet and silent underneath.

Naisi. O vehement, mad girl, it is for freedom

That you would draw this ruin on us all,
On the great King my Overlord, on Erin.
It is not well.
Women are ever captive
In their spirits and their bodies: so the gods
Have fashioned it and there is no escape.

Deirdre. You will not give me love?

Naisi. Your liberty

I shall not give you, if I give you love.
 Love is the hardest bondage in the world.
I would not put such chains on any woman
To love me....

Deirdre. Let me be with you, the name

Of being with you call it what you will—;
Bondage or freedom, I should still be happy,
Yea, for a year, yea, for a brood of years.

It is, however, in the last act that Michael Field again triumphantly
proves her mettle as poet and dramatist. She had stubborn material here,
harsh and crude stuff which kept the poets long at bay. For Deirdre’s end as
related by the old bard is a bit of primitive savagery matched in terms of the
plainest realism. Conchobar, after Naisi is enticed back to Ulster and
murdered, takes possession of Deirdre; and she remains in his house for a
year. But her constant reproaches and lamentation weary him; and at last, in
order to subdue her, he threatens to lend her for a year to the man she hates
most, Eogan, the slayer of Naisi. She is thereupon driven off in Eogan’s
chariot, apparently subdued, seated in shame between him and Conchobar.
At a gross taunt from Conchobar, however, she springs up, and flings
herself out upon the ground. “There was a large rock near: she hurled her
head at the stone so that she broke her skull, and killed herself.”
Our poet does not try to make this pretty or pleasing: and at one point at
least she uses the exact terminology of the translation from which she
worked. Its brutal elements are not disguised: Deirdre’s humiliation and the
animal rage of Conchobar and Eogan remain hideous even after the poet,
accepting all the material, has wrought it into a tragedy of consummate
beauty. Its beauty has, indeed, more terror than pity in it—;it is brimmed
with life’s actual bitterness—;but the depth and power of this Deirdre are
not equalled by any other.
In quoting the closing passage of the play one does not afflict the reader
by a comment on it; but there is a technical point which should be noticed.
It is the device of the Messenger by which the poet avoids the
representation of Deirdre’s death. The manner of that death was not only
too awkward to present, but its horror as a spectacle was too great for
artistic control. In causing it to be related by the charioteer Fergna, the poet
has, in classic fashion, removed it from actual vision, but has enabled the
mind to contemplate what the eyes could not have borne to look upon.
The chariot has driven off with Deirdre, Eogan, and Conchobar; and
Lebarcham watches it till it passes out of sight beyond the mound that
marks Naisi’s grave. Then she turns away, lamenting; and suddenly Fergna,
the charioteer, re-enters, scared and breathless:

Lebarcham. Speak, Fergna! Are they dead?

Fergna. I scarce may say.

The woman’s shoulders panted on the rocks,
And over her a struggle fiercely raged
Of Conchobar with Eogan.

Lebarcham. Fosterling,
My Deirdre! Had they cast her from the car,
That thus she lay on the sharp rocks of stone?

Fergna. None touched her. She had gazed on yonder mound,

Setting her eyes on it, while car and horses
Moved on, until the little crests at last
Rose over it; then she awoke and swept
One fierce glance over Eogan, set before,
And slid one glance as fierce toward Conchobar,
Behind her and more close! It was one hatred,
The hatred of each glance. A shudder ran
All through my body: and through all the air
Ran laughter.

Lebarcham. Hers?—;her laughter?

Fergna. No, the king’s.

And then his words, the words of jest that followed!
“Deirdre, the glance a ewe
Would cast between two rams you cast on us,
Eogan and me.”
She started, and the horses
Started beneath my hand. I tightened rein,
And the whole chariot shivered as she leapt
Upon the rocks before her. Then those two
Sprung to the place where she was dashed, their breath
Whistled like winds: their crossing swords, with gnash
Of hungry teeth, affrighted me. I fled,
Leaving behind the chariot stopped by trees,
Rock-rooted....
He returns—;
The king! He leads the horses of his car
Slowly along. They come, but yet as night
Comes by long twilight.

Lebarcham. Lonely Conchobar!

[Re-enter Conchobar solemnly leading
the chariot.
O king....

Conchobar. Your horses, Fergna! Take the reins;

Lead them....

Fergna. My lord, forgive me. I will lead them

Back to their stable.

Lebarcham. Deirdre? Where is Eogan?

And Deirdre—;where?

Conchobar [with a hoarse laugh]. Ho, they have passed the borders,
Passed from my realm.
Nay, Fergna,
Lead the great car, checking the horses’ heads
Beside yon barrow of a hero: there
Unyoke them. Dig a neighbour sepulchre.
And let the bases of each monument
Touch where they spring.

Fergna. My lord ... and shall I seek

Among the rocks?

Conchobar You shall but lift its burthen

 Conchobar. You shall but lift its burthen
Forth of the chariot to the hollowed grave.

Lebarcham. O Deirdre! She is hidden by that cloak.

O shattered loveliness of Erin, hidden
From the ages, evermore! Thy Lebarcham,
Who saw thee come from hiding to our light,
Will go with thee along
To thy last screening cover, to thy tomb.
[Exit, following the chariot led by Fergna.
Conchobar. The land!... I wended hither: car and horses
Are wending from me. Did I move like that,
So solitary, dark above the grass?—;But
to no goal. In one of those near graves
She will be with him, one of them will open;
There can but be one tomb. The chariot lingers
Its way in happy sloth: so wheat is carried
Till night-fall to the barn....
[He remains watching in the silence.
The car
Has turned the cromlech....
So wheat is carried.

* * *
In concluding this very brief survey of Michael Field’s life and poetry,
one turns back with a sense of illumination to her sonnet called The Poet,
which has been already quoted. For therein Michael Field has indicated the
nature of her own genius and the conditions of its activity. She was not
thinking of herself, of course, but of the poetic nature in the abstract, when
she declared in the first two lines of the sestet that the poet is

a work of some strange passion

Life has conceived apart from Time’s harsh drill.

Those verses apply in some degree to the whole race of poets, which is,
indeed, the test of their truth. Yet it is significant that in choosing precisely
that form of expression for the truth, Michael Field has inadvertently stated
the essential meaning of her own life, of her long service to literature, and
of the peculiar greatness and possible limitation of her poetry.
“A work of some strange passion.” Strange, indeed, and in many ways.
For, first, it is no common thing to find, in a world preoccupied with traffic
and ambition, two souls completely innocent of both. Not small souls, nor
stupid nor ignorant ones—;as clever people might aver in order to account
for the phenomenon—;but of full stature, intelligent, level-headed, and with
their sober measure of English common sense. They knew themselves, too
—;were aware that they possessed genius, that they had first-rate minds and
were artists of great accomplishment. Moreover, for the larger part of their
life they were on terms with ‘the world’; they welcomed experience as few
Victorian women dared, gathered knowledge eagerly wherever it was to be
found, and had business ability sufficient to direct prudently their own
affairs.
They would have denied that there was anything of the fanatic or the
visionary in the dedication of themselves to their art, believing fanaticism to
be incongruous with the undiluted English strain of which they boasted.
And, indeed, there is something typical of the race in this deliberate setting
of a course and dogged persistence in it. Yet there is hardly an English
precedent for their career; and it is to France one must look—;to the
Goncourts or to Erckmann-Chatrian—;to match the long collaboration, or
to find similar examples of their artistic method. And not even there, so far
as I know, will be found another such case of disinterested service.
But the lines we have noted have an application to the work as well as to
the life of Michael Field. They may be used almost literally, to summarize
in a convenient definition the nature of her poetry. For in this body of work
one sees passion as an almost over-powering element, and it is of surprising
strangeness. However fully one may recognize the truth that there is no sex
in genius, I suppose that we shall always be startled at the appearance of an
Emily Brontë or a Michael Field. They seem such slight instruments for the
primeval music that the earth-mother plays upon them. And their
vehemence mingles so oddly with tenderer and more delicate strains that it
will always be possible for a reviewer to sneer at what is “to the Greeks
foolishness”—;he having no perception of the fact that in gentleness added
to strength a larger humanity is expressed. Such an eye as Meredith’s could
perceive that, and, catching sight of some reviewing stupidity about it,
would flash lightnings of wrath in that direction, and send indignant
sympathy to the poets.
There is strangeness, too, of another kind in the passion which was the
impulse of this poetry. Under the restraint that art has put upon it, it is, as
we have seen, an elemental thing. It is a creative force akin to that of Emily
Brontë or of Byron, and is tamer than their wild genius only in appearance.
Its more ordered manner grew from two causes: that one of the
collaborators blessedly possessed a sense of form, and that both of them
lived withdrawn from the brawl of life. They were placed, perhaps, a little
too far from “Time’s harsh drill.” Their lives were, on the whole, easier and
happier ones than are given to most people. That is why the loss of their
Chow dog caused them a grief which seems exaggerated to minds not so
sensitively tuned as theirs. Until the agony of the last three years overtook
them, their share of the common lot of sorrow had been the barest
minimum: adversity did not so much as look their way: poverty laid no
finger on them, and was but vaguely apprehended, in the distance, as
something pitiful for its ugliness. Therefore, secure and leisured, they
envisaged life, in the main, through art, through philosophy, through
literature, and hardly ever through the raw stuff of life itself. And thence
comes the peculiar character which the passion of their poetry acquired, as
of some fierce creature caught and bound in golden chains.
It may be that this seclusion from life will be felt in Michael Field’s
poetry as a limitation; that the final conviction imposed upon the mind by
the authority of experience is wanting; and that the work lacks a certain dry
wisdom of which difficult living is a necessary condition. It may be so; but
I do not think the stricture a valid charge against their work, first because of
our poets’ great gift of imagination, and second because they chose so
rightly their artistic medium. Comedy may require the discipline of
experience, the observing eye constantly fixed upon the object, and a rich
knowledge of the world; but surely tragedy requires before everything else
creative imagination, sympathy, and a certain greatness of heart and mind.
Those gifts Michael Field possessed in very large degree; so large that one
often stands in amazement before the protagonists of her drama,
demanding, in the name of all things wonderful, how two Victorian women
“ever came to think of that.” A Renaissance pope, a Saxon peasant, or a
priest of Dionysos—;decadent emperors, austere Roman patriots, or a
Frankish king turned monk—;those are only a few of the surprising
creatures of her imagination, conceived not as historical figures merely, but
as living souls. And by the range of her women characters—;from the
dignity of a Julia Domna to the wild-rose sweetness of a Rosamund; from
the Scottish Mary, with her rich capacity for loving, to the fierce chastity of
an Irish Deirdre, or the soul of goodness in a courtesan; from the subtlety of
a Lucrezia Borgia to the proud singleness of a Mariamne; from the virago-
venom of an Elinor to the sensitive simplicity of a country-girl, or the
wrong-headedness of a little princess whose instincts have been perverted
by frustration—;Michael Field has greatly enriched the world’s knowledge
of womanhood.
She did not set out to do that, of course. Her sanity is evident once more
in the moderation with which she held her feminist sympathies, despite the
clamour of the time and the provocation she received from masculine
mishandling of her work. Herein too she had removed herself from “Time’s
harsh drill,” having too great a reverence for her art to use it for the
purposes of propaganda. That fact leads us again to her sonnet and the light
it throws upon herself. For in studying her work one sees that she fulfilled
completely her own conception of the poet—;as an artist withdrawn from
the common struggle to wrestle with a fiercer power, and subdue it to a
shape of recognizable beauty.
 BIBLIOGRAPHY

Of the works of Michael Field, published to 1919

The New Minnesinger. (Arran Leigh.) Longmans, Green and Co.

1875.
Bellerophôn. (Arran and Isla Leigh.) C. Kegan Paul. 1881.
Callirrhoë, and Fair Rosamund. J. Baker and Son. First edition
in spring of 1884; second edition in autumn of 1884.
The Father’s Tragedy, William Rufus, and Loyalty or Love. J.
Baker and Son. 1885.
Brutus Ultor. J. Baker and Son. 1886.
Canute the Great and The Cup of Water. J. Baker and Son. 1887.
Long Ago. G. Bell and Sons, Ltd. 1889.
The Tragic Mary. G. Bell and Sons, Ltd. 1890.
Stephania. Elkin Mathews and John Lane. 1892.
Sight and Song. Elkin Mathews and John Lane. 1892.
A Question of Memory. Elkin Mathews and John Lane. 1893.
Underneath the Bough. G. Bell and Sons, Ltd. First edition in
spring of 1893; second edition in autumn of 1893; third edition,
published by T. B. Mosher, Portland, Maine, 1898.
Attila, my Attila! Elkin Mathews. 1896.
Fair Rosamund. Reissued from the Vale Press. Decorated by
Charles Ricketts. 1897.
The World at Auction. The Vale Press. Decorated by Charles
Ricketts. 1898.
Anna Ruina. David Nutt. 1899.
Noontide Branches. The Daniel Press. 1899.
The Race of Leaves. The Vale Press. Decorated by Charles
Ricketts. 1901.
Julia Domna. The Vale Press. Decorated by Charles Ricketts.
1903
Borgia. (Anonymous.) A. H. Bullen. 1905.
Queen Mariamne. (Anonymous.) Sidgwick and Jackson, Ltd.
1908.
Wild Honey. T. Fisher Unwin, Ltd. 1908.
The Tragedy of Pardon, and Diane. (Anonymous.) Sidgwick and
Jackson, Ltd. 1911.
The Accuser, Tristan de Leonois, and A Messiah. (Anonymous.)
Sidgwick and Jackson, Ltd. 1911.
Poems of Adoration. Sands and Co. 1912.
Mystic Trees. Eveleigh Nash. 1913.
Whym Chow. Privately printed at the Eragny Press. 1914.
Dedicated. G. Bell and Sons, Ltd. 1914.
Deirdre, A Question of Memory, and Ras Byzance. The Poetry
Bookshop. 1918.
In the Name of Time. The Poetry Bookshop. 1919.
Note.—;The volumes containing Borgia, Queen Mariamne, The
Tragedy of Pardon, and The Accuser are now controlled by the
Poetry Bookshop.
*** END OF THE PROJECT GUTENBERG EBOOK MICHAEL
FIELD ***

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