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Gesundheit und Gesellschaft
Health Literacy
im Kindes- und
Jugendalter
Ein- und Ausblicke
Gesundheit und Gesellschaft
Health Literacy im
Kindes- und Jugendalter
Ein- und Ausblicke
Hrsg.
Torsten M. Bollweg Janine Bröder
Universität Bielefeld, Fakultät für Universität Bielefeld, Fakultät für
Erziehungswissenschaft Erziehungswissenschaft
Bielefeld, Deutschland Bielefeld, Deutschland
Paulo Pinheiro
Universität Bielefeld, Fakultät für
Erziehungswissenschaft
Bielefeld, Deutschland
© Springer Fachmedien Wiesbaden GmbH, ein Teil von Springer Nature 2020
Das Werk einschließlich aller seiner Teile ist urheberrechtlich geschützt. Jede Verwertung, die
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Der Verlag, die Autoren und die Herausgeber gehen davon aus, dass die Angaben und
Informationen in diesem Werk zum Zeitpunkt der Veröffentlichung vollständig und korrekt
sind. Weder der Verlag, noch die Autoren oder die Herausgeber übernehmen, ausdrücklich oder
implizit, Gewähr für den Inhalt des Werkes, etwaige Fehler oder Äußerungen. Der Verlag bleibt
im Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten
und Institutionsadressen neutral.
V
VI Vorwort
Dieses Werk ist ganz bewusst als Sammelband angelegt, der vielfältige
Perspektiven auf und um Gesundheitskompetenz erfasst. Erklärtes Ziel ist hier-
bei, einen strukturierten und kritischen Überblick über den gegenwärtigen Stand der
Forschung zum Thema Health Literacy im Kindes- und Jugendalter, insbesondere
in Deutschland, zu geben. Aber auch weiterführende Perspektiven sind Teil dieses
Sammelbands, die über die unmittelbare Arbeit des Verbunds hinausgehen und
weiterführende Entwicklungsmöglichkeiten und Potenziale für die internationale
Gesundheitskompetenzforschung aufzeigen. Auch der Kreis der Autor*innen ist
darauf ausgelegt, die Diversität der im Forschungsfeld Gesundheitskompetenz
Tätigen abzubilden. Vertreten sind beispielsweise Fachdisziplinen wie Erziehungs-
wissenschaft, Soziologie, soziale Arbeit, Medizin, Public Health, Epidemiologie,
Geschlechterforschung, Gesundheitsökonomie, Wissenschaftskommunikation oder
Psychologie, wodurch ein multiperspektivischer Blick auf Health Literacy ermöglicht
wird.
Das Buch ist in fünf Abschnitte unterteilt, die einerseits eine strukturierte
Einführung in die Thematik erlauben und andererseits die Struktur des
Forschungsverbunds wiedergeben. Der erste Abschnitt des Sammelbands bietet
eine Hinführung zum Gegenstand Health Literacy und stellt grundlegende
theoretisch-konzeptionelle Zugänge sowie Grundlagen der Messung von Health
Literacy bei Kindern und Jugendlichen vor. Im zweiten Abschnitt erfolgt eine
Fokussierung auf das Thema Mental Health Literacy und somit auf Aspekte
der mentalen Gesundheit. Der Zugang erfolgt exemplarisch durch die Bezug-
nahme auf die Zielgruppe Kinder psychisch erkrankter Eltern, die aufgrund
der familiären Belastungen einem erhöhten Risiko ausgesetzt sind, selbst eine
psychische Erkrankung im weiteren Lebenslauf zu erfahren. Hierbei wird ins-
besondere die Mental Health Literacy derjenigen Erwachsenen und Institutionen
in den Blick genommen, die relevant für das Aufwachsen dieser Kinder sind.
Die Perspektive ist hierbei eine ressourcenorientierte, in der die Förderung der
Mental Health Literacy und die Prävention psychischer Erkrankungen im Vorder-
grund stehen. Der dritte Abschnitt des Sammelbands widmet sich der Rolle von
digitalen Informationsangeboten für die Gesundheitsförderung und Krankheits-
prävention im Kindes- und Jugendalter, sowie dem kompetenten Umgang mit
digitalen Medien. Im Zentrum des Abschnitts steht folglich der Themenbereich
eHealth Literacy bzw. Media Health Literacy. Adressiert werden unter anderem
die Bedeutung des digitalen Angebots und der multimodalen Möglichkeiten des
Zugangs zu gesundheitsbezogenen Informationen für Kinder und Jugendliche,
wobei auch Zielgruppen aus bildungsfernen und/oder ressourcenschwachen
Vorwort VII
Milieus in den Blick genommen werden. Der vierte Abschnitt widmet sich
Aspekten der Forschungsorganisation, die im Kontext des HLCA Verbunds
von Relevanz gewesen sind. Er beinhaltet eine Vorstellung des Verbunds, seiner
Projekte und Strukturen, und thematisiert forschungsrelevante Querschnitts-
themen beispielhaft entlang der Leitthemen Wissenschaftskommunikation,
Genderforschung und Gesundheitsökonomie. Der fünfte und letzte Abschnitt
vereint weiterführende Perspektiven und Ansätze, die Impulse für die künftige
Weiterentwicklung des Gegenstands Health Literacy im Kindes- und Jugend-
alter setzen wollen. Zu nennen sind hier beispielsweise bislang vernachlässigte,
ethische Dimensionen von Health Literacy(-Forschung) sowie die Verknüpfung
von Health Literacy mit Themenfeldern wie Literalität, Salutogenese, Inklusion
und sozialer Arbeit.
Während der Großteil der Beiträge dieses Sammelbands als wissenschaftliche
Artikel verfasst ist, sind fünf der Beiträge als informelle Dialoge angelegt, um
die diskursartige Bearbeitung ausgewählter Fragestellungen ermöglichen. Hierbei
treten verschiedene Mitwirkende des HLCA-Forschungsverbunds ins persönliche
Gespräch, um im jeweils eigenen Forschungsfeld bedeutsame Leitthemen zu dis-
kutieren.
Das vorliegende Werk vereint Elemente eines einführenden Handbuchs, einer
Dokumentation aktueller Ergebnisse für Deutschland, sowie einer kritischen
Diskussion und Weiterentwicklung des Gegenstandes Health Literacy im
Kindes- und Jugendalter. Der Sammelband setzt sich mit aktuellen Heraus-
forderungen an Prävention und Gesundheitsförderung bei Aufwachsenden
auseinander und gibt multiperspektivische Ausblicke auf die künftige Aus-
einandersetzung mit dem Thema. Dieser Sammelband adressiert somit
gleichermaßen Forscher*innen, Praktiker*innen und Entscheidungsträger*innen,
die in verschiedensten Bereichen zur Förderung der Gesundheit und Gesund-
heitskompetenz arbeiten, aber auch Studierende und Auszubildende in den ent-
sprechenden Fachdisziplinen. Hiermit gemeint sind all solche Professionen, in
denen die Kommunikation von und der kompetente Umgang mit gesundheits-
bezogenen Informationen eine zentrale Rolle spielt – wodurch keineswegs eine
Einschränkung auf den medizinischen Sektor oder den Bildungsbereich impliziert
wird.
Unser besonderer Dank gilt all denjenigen, die die Arbeit des Verbunds unter-
stützt und tatkräftig an der Vorbereitung dieses Werks mitgearbeitet haben.
Zunächst danken wir dem Bundesministerium für Bildung und Forschung
(BMBF), das mit seiner Förderung die Arbeit des HLCA-Verbunds erst
VIII Vorwort
IX
X Inhaltsverzeichnis
XIII
XIV Autorenverzeichnis
Prof. Dr. Fabian Kessl Bergische Universität Wuppertal, Fakultät für Human-
und Sozialwissenschaften, Fach Erziehungswissenschaft, Wuppertal, Deutschland
Sandra Kirchhoff Universität Bielefeld, Fakultät für Erziehungswissenschaft,
Bielefeld, Deutschland
Lea Kuntz Pädagogische Hochschule Freiburg, Abteilung Public Health and
Health Education, Freiburg, Deutschland
Prof. Dr. Albert Lenz Katholische Hochschule Nordrhein-Westfalen, Institut für
Gesundheitsforschung und Soziale Psychiatrie, Paderborn, Deutschland
Prof. Dr. Diane Levin-Zamir University of Haifa, School of Public Health,
Haifa, Israel & Clalit Health Services, Department of Health Education and
Promotion, Tel Aviv, Israel
Anne-Kathrin Loer Robert Koch-Institut, Abteilung für Epidemiologie und
Gesundheitsmonitoring, Berlin, Deutschland
Almas Merchant Medizinische Universität Wien, Innere Medizin I, Abteilung
für Onkologie, Wien, Österreich
Prof. Dr. Thomas Mößle Hochschule für Polizei Baden-Württemberg, Fakultät
II - Kriminalwissenschaften, Villingen-Schwenningen, Deutschland
Dr. Maike Müller Universität Duisburg-Essen, Zentrum für Medizinische
Biotechnologie, Essen, Deutschland
Dr. Orkan Okan Universität Bielefeld, Fakultät für Erziehungswissenschaft,
Bielefeld, Deutschland
Dr. Leena Paakkari University of Jyväskylä, Faculty of Sport and Health
Sciences, Research Center for Health Promotion, Jyväskylä, Finnland
Prof. Dr. Jürgen Pelikan Gesundheit Österreich GmbH, Wien, Österreich
Marlene Pieper Universität Bielefeld, Fakultät für Erziehungswissenschaft,
Bielefeld, Deutschland
Dr. Paulo Pinheiro Universität Bielefeld, Fakultät für Erziehungswissenschaft,
Bielefeld, Deutschland
Vanessa Rawlings University of Suffolk, Graduate School, Ipswich, England
Torben Reher Katholische Hochschule Nordrhein-Westfalen, Institut für
Gesundheitsforschung und Soziale Psychiatrie, Paderborn, Deutschland
XVI Autorenverzeichnis
© Springer Fachmedien Wiesbaden GmbH, ein Teil von Springer Nature 2020 1
T. M. Bollweg et al. (Hrsg.), Health Literacy im Kindes- und Jugendalter,
Gesundheit und Gesellschaft, https://doi.org/10.1007/978-3-658-29816-6_1
2 P. Pinheiro et al.
Mit Hinblick auf den Sinn und Zweck von Health Literacy offenbart sich ein
weiteres Feld möglicher Standpunkte, beginnend bei funktionalen Perspektiven,
die auf basale Fertigkeiten des Umgangs mit Schriftsprache abzielen, um lebens-
alltägliche oder gesellschaftliche Anforderungen zu erfüllen (Lese-, Schreib-
und Rechenkompetenzen), bis hin zu emanzipatorischen Aspekten, die auf mehr
Autonomie bei der eigenen Lebensgestaltung sowie auf die aktive Teilhabe an
gesundheitsbezogenen Entscheidungsprozessen ausgerichtet sind. Da Health
Literacy oftmals auch mit positiven gesundheitlichen Outcomes in Verbindung
gebracht wird, stehen nicht nur Kompetenzen im Fokus der Betrachtung, sondern
auch Aspekte wie Wissen, gesundheitsrelevante Einstellungen und motivationale
Aspekte. Ebenso spielen sozio-kulturelle Bedingungen eine wesentliche Rolle
für den Kompetenzerwerb und das Gestalten des Umgangs mit schriftsprach-
lichen Materialien und rücken die Bedeutung der Umwelten, in denen das
handelnde Individuum eingebettet ist, stärker in den Vordergrund. Ein flüchtiger
Seitenblick auf Forschungsperspektiven zum Gegenstandsfeld Literacy, das sich
mit dem Lesen und Schreiben befasst und in deutschsprachigen Raum mit der
Bezeichnung Alphabetisierung und Grundbildung abgebildet wird, eröffnet alter-
native Zugänge mit der Bereitstellung von Perspektiven, die sich vorranging an
die soziale Praxis richten, bei der ein Schriftstück zentraler Gegenstand von Inter-
aktionsprozessen ist.
Vor diesem Hintergrund wird zunehmend klar, dass die im deutsch-
sprachigen Raum für Health Literacy etablierte Übersetzung „Gesundheits-
kompetenz“ die Bandbreite an Zugängen nicht vollständig reflektiert. Mit der
Begriffswahl Gesundheitskompetenz wird ein Verständnis- und Deutungs-
rahmen nahegelegt, der zwar einen wesentlichen Teil der internationalen
Diskussionen abbildet – mit einem starken Fokus auf die Fähigkeiten von
Individuen – genauso jedoch relevante Perspektiven zu vernachlässigen oder
gar auszublenden scheint. An denkbaren Alternativen oder Impulsen mangelt
es hierbei nicht – was deutlich wird, wenn wir das Experiment unternehmen,
Aktivitäten im Forschungsfeld Health Literacy entsprechend ihrer Inhalte zu
paraphrasieren: Gesundheitsinformationsverarbeitungskompetenz, theoretisches
und praktisches gesundheitsrelevantes Wissen, gesundheitliche Grund-
bildung, kritisches Denken und Reflexionsfähigkeit, Selbstbewusstsein in der
Kommunikation in klinischen Kontexten, Nährwertangabeninterpretationsfähig-
keit, patient*innenorientierte Gestaltung von Institutionen und Dienstleistungen,
adressat*innengerechte Gestaltung von gesundheitsbezogenen analogen und
digitalen Informationsmaterialien,… In Anlehnung an die Alphabetisierungs- und
4 P. Pinheiro et al.
egenstandsfeld lässt zudem erahnen, dass das Thema selbst und die thematische
G
Zuspitzung auf das Kindes- und Jugendalter mit einer Reihe von Forschungs-
perspektiven assoziiert sind, die vom wissenschaftlichen Diskurs noch nicht
hinreichend aufgegriffen worden sind. Hier lassen sich auf unterschiedlichen
Analyseebenen Leerstellen identifizieren, die z. B. den Gegenstand selbst und
seine Konstruktionen betreffen, sich an die theoretisch konzeptionelle Rahmung
und die sich daran anschließenden Pfade der Operationalisierung richten,
oder an der Verschränkung des Themas mit übergeordneten Leitmotiven wie
Digitalisierung und gesundheitlichem Wandel ansetzen.
Theoretische und empirische Grundlagen
von Health Literacy im Kindes- und
Jugendalter
Von Chicago 1958 bis Shanghai
2016: Ein Rückblick auf zentrale
Entwicklungstrends in der Geschichte
der Gesundheitskompetenz
1 Einführung
Der vorliegende Beitrag basiert auf einem Aufsatz des Erstautors, der 2019 im von Okan
et al. herausgegebenen und von Policy Press verlegten „International Handbook of Health
Literacy“ veröffentlicht worden ist (Okan 2019). Bei der aktuellen Fassung auf Deutsch
handelt es sich um eine aktualisierte, hinsichtlich der Inhalte deutlich erweiterte und
übersetzte Version des ursprünglichen Beitrags. Bearbeitung und Übersetzung aus dem
Englischen: Orkan Okan, Marlene Pieper und Paulo Pinheiro.
© Springer Fachmedien Wiesbaden GmbH, ein Teil von Springer Nature 2020 11
T. M. Bollweg et al. (Hrsg.), Health Literacy im Kindes- und Jugendalter,
Gesundheit und Gesellschaft, https://doi.org/10.1007/978-3-658-29816-6_2
12 O. Okan und P. Pinheiro
Einleitend greift der Beitrag zunächst den frühesten und anekdotisch ver-
bliebenen Versuch von 1958 auf, die Begriffskombination „Health Literacy“ zu
bedienen und etablieren (Dixon 1959), und zeichnet anschließend vier wesent-
liche Entwicklungslinien (schulische Gesundheitserziehung, Erwachsenen-
bildung, Versorgungsforschung und öffentliche Gesundheit) nach, die seit 1974
mit einer sich nach und nach verstetigenden Kontinuität das Verständnis von
Gesundheitskompetenz geprägt haben. Das Kapitel rekonstruiert den historischen
Weg, der 1973 in Saranac Lake, NY, USA, begann (Simonds 1974) und 2016
einen vorläufigen Höhepunkt auf der neunten Global Conference on Health
Promotion der Weltgesundheitsorganisation WHO in Shanghai, China (WHO
2017) erreicht hat. Für jede der vier Strömungen erfolgt die Profilbildung durch
die Beschreibung von zentralen Merkmalen, die sich aus den leitgebenden
Forschungs-, Praxis- und Politikansätzen für die jeweilige Auseinandersetzung
mit Gesundheitskompetenz ergeben haben. Abgerundet wird der Beitrag mit einer
Gesamtschau auf die vier Hauptströmungen, die – im Sinne der Leitthemen des
vorliegenden Sammelbands – u. a. eine erste Einordnung der das Verständnis der
Gesundheitskompetenz prägenden historischen Entwicklungsmuster für die Ziel-
gruppe Kinder und Jugendliche vornimmt.
Rahmen der 58. Annual National Conference on Social Welfare am 14. Mai 1958
in Chicago gehalten hat. Dixon thematisiert und diskutiert in seinem Beitrag die
Rolle, die zu der Zeit vom öffentlichen Sektor für die medizinische und gesund-
heitliche Versorgung einzunehmen sei. Hierbei greift er in seiner Argumentation
unterschiedliche Facetten auf. So werden z. B. Verantwortlichkeiten, die
öffentlichen Einrichtungen für das gesundheitliche Versorgungsgeschehen einer
Bevölkerung zugewiesen werden, erörtert, ungleichheitsorientierte Überlegungen
zu Bedarfslagen von Bevölkerungsgruppen mit unterschiedlichen kulturellen,
ethnischen und materiellen Ressourcen angestellt, oder Vorschläge zur Gestaltung
von öffentlichen Versorgungsstrukturen samt Finanzierungsaspekten gemacht.
Die Begriffskombination „Health Literacy“ wird dann im Schlussteil des Bei-
trags eingebracht (Dixon 1959, S. 81). In diesem werden u. a. die möglichen
Schwerpunkte, welche die Diskussionen über die öffentlichen Systeme und
Einrichtungen der gesundheitlichen Fürsorge in der Folge bestimmen könnten,
thematisiert. Benannt werden hier eine zunehmende Sensibilisierung für
sozial benachteiligte Gruppen, Bedarfe nach und gerechte Verfügbarkeit von
öffentlichen Gesundheitsdiensten sowie öffentliche Vorsorgemaßnahmen für
den Umgang mit möglichen bevölkerungsweiten Katastrophen und Notfällen.
Diese eher bevölkerungsbezogene Perspektive erfährt dann eine Erweiterung um
Aspekte, die auf einer personalen Ebene verortet werden. Eine Konkretisierung
erfolgt hier mit dem Verweis auf die Bedeutung von Eigenverantwortung und
dem Hinweis auf die Individualisierung von Möglichkeiten der Absicherung
sowie mit der abschließenden Benennung der Bedeutung von „Health Literacy“.
Leider wird der letztgenannte Aspekt in dem Beitrag nicht weiter erörtert. Es lässt
sich daher nicht klären, welches Verständnis dem Begriff „Health Literacy“ hier
zugrunde liegt. Unzweifelhaft ist jedoch, dass die Begriffskombination hier erst-
malig in einer absichtsvollen Form eingesetzt und in einen Kanon von personalen
Attributen, die eine Stärkung der individuellen Eigenverantwortlichkeit bedingen,
eingefügt wird.
In einem weiteren von Dixon veröffentlichten Beitrag aus dem Jahr 1962
beschreibt er Gesundheitskompetenz dann u. a. als ein Ergebnis von schulischer
Gesundheitserziehung:
„Finally, the public health movement in this country has had a profound educational
component. That part of the movement that is reflected in health education in schools
and community, despite the drag of cultural lag, is rapidly creating in our country a
high level of health literacy. This in turn improves the capacity of people to serve as
their own physicians, and the effective custodians of their personal health“ (Dixon
1962, S. 132/133).
Von Chicago 1958 bis Shanghai 2016: Ein Rückblick … 15
Der Kontext, in dem der Ursprung des Themas Gesundheitskompetenz für den
Bereich der schulischen Gesundheitserziehung gesehen wird, wird in der Fach-
literatur mit der Saranac Lake Konferenz von 1973 beschrieben (Simonds 1974).
Im Rahmen dieser bildungs- und sozialpolitischen Fachkonferenz erfolgte der
Vorschlag, „Health Literacy“ als Lehr- und Lernziel in der schulischen Gesund-
heitserziehung zu definieren (Simonds 1974). Wie bereits erwähnt, wird in der
Fachliteratur einhellig auf diese Publikation als Ursprung des Gegenstands
„Health Literacy“ verwiesen. Simonds begreift „Health Literacy“ als Ergebnis
16 O. Okan und P. Pinheiro
schulischer Gesundheitserziehung und spricht sich für eine Stärkung der Gesund-
heitskompetenz von Schüler*innen aus. Er begreift Gesundheitskompetenz
zugleich als wichtigen Faktor in der Lehrkräfteausbildung, da diese es erst
ermöglicht, dass Lehrpersonen relevante Inhalte im Unterricht vermitteln und
somit erst die Gesundheitskompetenz der Schulkinder fördern können.
Trotz dieser relativ frühen Datierung und Verortung im Bildungssektor ist
der weitere Umgang mit dem Thema Gesundheitskompetenz in Schule, Lehr-
plänen und in der Ausbildung von Lehrkräften bis in die 1990er Jahre nicht
dokumentiert. Der Begriff „Health Literacy“ taucht erst im Jahr 1990 in einer
Veröffentlichung wieder auf, in der das US-amerikanische Joint Committee
on Health Education Terminology die Begrifflichkeit Gesundheitskompetenz
definiert und in ein Glossar wichtiger Begriffe der Gesundheitserziehung auf-
nimmt (Joint Committee on Health Education Terminology 1991). Mit dem
Curriculum „Achieving Health Literacy“, das die Stärkung der Gesundheits-
kompetenz im Rahmen der schulischen Gesundheitserziehung beabsichtigt,
wurde nachfolgend eine an entwicklungstheoretische Aspekte orientierte
Programmatik für den schulischen Unterricht vorgelegt (Joint Committee on
National Health Education Standards 1995). Gesundheitskompetenz wurde dabei
als personale und soziale Fähigkeit, um mit gesundheitsbezogenen Informationen
und Dienstleistungen umzugehen, definiert:
Als gesundheitskompetent wird hier eine Person erachtet, die durch die schulische
Gesundheitserziehung in Gesundheitsthemen gebildet bzw. gut ausgebildet ist
(well-educated, health literate person) (Joint Committee on National Health
Education Standards 1995, S. 5). Gesundheitskompetentes Handeln einer Person
zeichnet sich demzufolge durch vier Hauptmerkmale aus: 1) die Fähigkeit zum
kritischen Denken und zur Problemlösung, 2) das bürgerschaftlich verantwortungs-
volle Verhalten und das produktive Handeln, 3) das eigenverantwortliche Lernen
sowie 4) die Fähigkeit zur effektiven Gesundheitskommunikation (siehe Okan
2020). Dieser Definition wohnt zudem die normative Zielvorgabe inne, die
personalen Kompetenzen und das Wissen in einer gesundheitsförderlichen Art
und Weise zu verwenden. Im Jahr 2007 wurde das Curriculum „Achieving Health
Literacy“ zum „Achieving Excellence“-Curriculum erweitert und mit weiteren
Themen der Gesundheitserziehung querverbunden (Joint Committee on National
Health Education Standards 2007).
Von Chicago 1958 bis Shanghai 2016: Ein Rückblick … 17
Diese konzeptionelle Variante ist jedoch nicht willkürlich, sondern geht daraus
hervor, dass das finnische Modell im Rahmen einer qualitativen Interview-
studie entstanden ist, bei der Schüler*innen bezüglich ihrer Erwartungen an
die schulische Gesundheitserziehung befragt worden sind. Dieses hierauf auf-
bauende Modell wurde zudem mit Lerntheorien und Aspekten der Persön-
lichkeitsentwicklung angereichert (vgl. Paakkari und Paakkari 2012; Paakkari
2015). Folglich wird Gesundheitskompetenz als Ergebnis schulischer Gesund-
heitsbildung im finnischen Ansatz durch fünf Dimensionen widergegeben: 1)
theoretisches Faktenwissen, 2) praktisches Wissen (die Fähigkeit, das Fakten-
wissen in Handlungen zu übersetzen), 3) kritisches Denken, 4) Selbstwahr-
nehmung und 5) bürgerschaftliches Verhalten bzw. „Citizenship“ im Sinne einer
sozialen und politischen Dimension im Kontext von Gesundheit (vgl. Paakkari
und Paakkari 2012). Mit einer Ausrichtung an personale Kompetenzen lassen
sich Gemeinsamkeiten mit den anderen skizzierten Schulansätzen vorfinden. Die
Schnittstellen liegen hierbei im Gesundheitswissen, im kritischen Denken und in
der Verknüpfung mit der soziokulturellen und soziopolitischen Dimension von
Gesundheit. Das finnische Modell wird über das Curriculum hinaus auch als
Grundlage für die Skala im Fragebogen zur Erfassung der Gesundheitskompetenz
von Jugendlichen in der „Health Behaviour in School-aged Children“ (HBSC)
Studie der WHO verwendet (Paakkari et al. 2016, 2018). Folglich orientiert sich
dieser Fragebogen an ein Modell von Gesundheitskompetenz, das sich von den
Referenzmodellen, die in anderen Erhebungsinstrumenten stärker auf gesund-
heitsbezogene Informationskompetenzen von Erwachsenen (vgl. Wang et al.
2012; Sørensen et al. 2012, 2015; Bo et al. 2014), Kindern (Okan und Bollweg
2018; Bollweg et al. 2020) oder Jugendlichen (Röthlin et al. 2013; Messer et al.
2016; Domanska et al. 2018) Bezug nehmen, unterscheidet.
Im deutschen Schulsystem ist der Ansatz der Gesundheitskompetenz noch
nicht angekommen. Es liegen allerdings diesbezüglich bereits einige bildungs-
politische Ziele (Schaeffer et al. 2018; Bauer et al. 2018) und weitere Dokumente
auf Ebene der Bundesländer und der Kultusministerkonferenz vor (Okan et al.
2019). Die Hinwendung zur Gesundheitskompetenz als Thema für Schule
und Bildung lässt sich mittlerweile in vielen Ländern feststellen (Perry 2014;
Kilgour et al. 2015; Hagell et al. 2015; Okan et al. 2015; Velardo und Drummond
2017; Fleary et al. 2018). Für diese Entwicklung sind nicht zuletzt zahlreiche
gesundheitspolitische Dokumente von sowohl Regierungs- als auch Nicht-
Regierungsorganisationen ausschlaggebend. So wird die Stärkung der Gesund-
heitskompetenz von Kindern und Jugendlichen in der Schule z. B. bei der WHO
(McDaid 2016; WHO 2017), der Organisation für wirtschaftliche Zusammen-
arbeit und Entwicklung OECD (OECD 2018) und der International Union for
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that but for his many afflictions the coroner would probably have pressed
him much harder.
"'I couldn't 'ear what they said,' Mrs. Trapp explained, with eager
volubility, 'but I could 'ear the ole gentleman screaming. I 'ad 'eard 'im
storm like that at Mr. Philip once before—about a month ago. But Lor' bless
you, Mr. Philip 'e didn't seem to care, and on Wednesday, when I let 'im out
of the flat 'e just looked quite cheerful like. But the ole gentleman 'e was
angry. I 'ad to give 'im a nip o' brandy, 'e was sort o' shaken after Mr. Philip
went.'
"You see then, don't you?" the Old Man in the Corner said with a grim
chuckle, "how gradually a network of sinister evidence was being woven
around Philip Ashley. He himself was conscious of it, and he was conscious
also of the wave of hostility that was rising up against him. He looked now,
not only grave, but decidedly anxious, and he held his arms tightly crossed
over his chest, as if in the act of making a physical effort to keep his nerves
under control.
"He gave me the impression of a man who would hate any kind of
publicity, and the curious, eager looks that were cast upon him, especially
by the women, must have been positive torture to a sensitive man. However,
he looked a handsome and manly figure as he stood up to answer the
questions put to him by the coroner. He said that he had arrived at the flat
on the Saturday at about mid-day, explaining to the jury that he always
came once a fortnight to be with his father, whilst his brother Charles
enjoyed a couple of days in the country. On this occasion, however, he was
told that his father was too ill to see him. Charles, however, went off on his
bicycle as usual, but contrary to precedent, a lady had apparently been left
in charge of the invalid. Witness understood that this was Mrs. Triscott, the
wife of a neighbour, who had kindly volunteered to stay over the week-end.
She was an experienced nurse and would know what to do in case the
patient required anything. For the moment he was asleep and must not be
disturbed.
"'I naturally felt very vexed,' the witness continued, 'at being kept out of
my father's room, and I may have spoken rather sharply at the moment, but
I flatly deny that I was rude to Mrs. Triscott, or that I was in a violent rage.
I did get a glimpse of my father, as he lay in bed, and I must say that I did
not think that he looked any worse than he had been all along. However, I
was not going to argue the point. I preferred to wait until the Monday
morning when my brother would be home, and I could tackle him on the
subject.'
"At this point the coroner desired to know why, in that case, when the
witness was told that his brother would not be at the flat before ten o'clock,
he turned up there as early as half-past eight.
"'Because,' the witness replied, 'I was naturally rather anxious to know
how things were, and because I hoped to get a day on the river with a
friend, and to make an early start if possible. However, when I got to the
flat, Mrs. Triscott wanted to get away, and so I agreed to stay there and wait
until ten o'clock, when, so Mrs. Triscott assured me, my brother would
certainly be home. As a matter of fact he always used to get home at that
hour with clockwork regularity on the Monday mornings after his holiday.
My father was asleep, and Mrs. Triscott left me instructions what to do in
case he required anything. At half-past nine he woke. I heard him stirring
and I went into his room and gave him some barley-water and sat with him
for a little while. He seemed quite cheerful and good-tempered, and,
honestly, I did not think that he was any worse than he had been for weeks.
Just before ten o'clock he dropped off to sleep again. I knew that my brother
would be in within the next half hour and, as this would not be the first time
that my father had been left alone in the flat, I did not think that I should be
doing anything wrong by leaving him. I went back to my chambers and was
busy making arrangements for the day when I had a telephone message
from my brother that our father was dead.'
"'My father,' he said, 'had a very violent temper and a very harsh,
penetrating voice. He certainly did get periodically angry with me whenever
I explained to him that my marriage to Lady Peet-Jackson could not, in all
decency, take place for at least another six months. He would storm and
shriek for a little while,' the witness went on, 'but we invariably parted the
best of friends.'"
The Old Man in the Corner paused for a little while, leaving me both
interested and puzzled. I was trying to piece together what I remembered of
the case with what he had just told me, and I was longing to hear his
explanation of the events which followed that memorable inquest. After a
little while the funny creature resumed:
"I told you," he said, "that a wave of hostility had risen in the public
mind against Philip Ashley. It came from a sense of sympathy for the other
son, who, deformed and afflicted, had been done out of a fortune. True that
it would not have been of much use to him, and that in the original will
ample provision had been made for his modest wants, but it now seemed as
if, at the eleventh hour, the old miser had thought to make reparation toward
the son who had given up his whole life to him, whilst the other had led one
of leisure, independence, and gaiety. What had caused old Thornton Ashley
thus to change his mind was never conclusively proved; there were some
rumours already current that Philip Ashley was in debt and had appealed to
his father for money, a fatal thing to do with a miser. But this also was
never actually proved. The only persons who could have enlightened the
jury on the subject were Philip Ashley himself and his brother, Charles, but
each of them, for reasons of his own, chose to remain silent.
"And now you will no doubt recall the fact which finally determined the
jury to bring in their sensational verdict, in consequence of which Philip
Ashley was arrested on the coroner's warrant on a charge of attempted
murder. It seemed horrible, ununderstandable, unbelievable, but,
nevertheless, a jury of twelve men did arrive at that momentous decision
after deliberation lasting less than half an hour. What I believe weighed
with them in the end was the fact that the assistant who came with the
divisional surgeon to conduct the post-mortem found underneath the bed of
the deceased, a walking-stick with a crook-handle, and the crumpled and
torn copy of the notes for the new will which Mr. Triscott had prepared.
Philip Ashley when confronted with the stick admitted that it was his. He
had missed it on the Saturday when he was leaving the flat, as he was under
the impression that he had brought one with him; however, he did not want
to spend any more time looking for it, as he was obviously so very much in
the way.
"Now, both the charwoman and Mrs. Triscott swore that the patient's
room had been cleaned and tidied on the Sunday, and that there was no sign
of a walking-stick in the room then.
§5
"And so," the Old Man in the Corner went on, with a cynical shrug of his
lean shoulders, "Philip Ashley went through the terrible ordeal of being
hauled up before the magistrate on the charge of having attempted to
murder his father, an old man with one foot in the grave. He pleaded 'Not
Guilty,' and reserved his defence. The whole of the evidence was gone
through all over again, of course, but nothing new had transpired. The case
was universally thought to look very black against the accused, and no one
was surprised when he was eventually committed for trial.
"Anyway, I don't think that, as things were, any one blamed Lady Peet-
Jackson for her decision. A week before Philip Ashley's trial came on she
announced her engagement to Lord Francis Firmour, son of the Marquis of
Ettridge, whom she subsequently married.
"On the other hand, there was Mr. Oldwall and Dr. Fanshawe-Bigg, old
friends of the deceased, both swearing positively that Thornton Ashley had
a peculiarly shrill and loud voice, that he would often get into passions
about nothing at all, when he would scream and storm, and yet mean
nothing by it. The only evidence of any tangible value was the walking-
stick but even that was not enough to blast a man's life with such a
monstrous suspicion.
"Philip Ashley was acquitted, but there are not many people who
followed that case closely who believed him altogether innocent at the time.
What Lady Peet-Jackson thought about it no one knows. It was for her sake
that the unfortunate man threw up the chances of a fortune, and when it
came within his grasp it still seemed destined to evade him to the end. In
losing the woman for whom he had been prepared to make so many
sacrifices, poor Philip lost the fortune a second time, because, as he was not
married within the prescribed time-limit, it was Charles who inherited under
the terms of the original will. But I think you will agree with me that any
sensitive man is well out of a union with a hard and mercenary woman.
"And now there has been another revolution in the wheel of Fate.
Charles Ashley died the other day in a nursing home of heart failure,
following an operation. He died intestate, and his brother is his sole heir.
Funny, isn't it, that Philip Ashley should get his father's fortune in the end?
But Fate does have a way sometimes of dealing out compensations, after
she has knocked a man about beyond his deserts. Philip Ashley is a rich
man now, and there is a rumour, I am told, current in the society papers, that
Lady Francis Firmour has filed a petition for divorce, and that the
proceedings will be undefended. But can you imagine any man marrying
such a woman after all that she made him suffer?"
"Then you, for one," I said, "are quite convinced that Philip Ashley did
not know that his father intended to make a new will, and did not try to
murder him?"
"Well," I rejoined, somewhat lamely, "some one did assault the old
miser, didn't they? If it was not Philip Ashley then it must have been just an
ordinary burglar, who thought that the old man had some money hidden
away under his mattress."
"Can't you theorise more intelligently than that?" the tiresome creature
asked in his very rude and cynical manner. I would gladly have slapped his
face, only—I did want to know.
"Well, and whom did that particular crime benefit the most?"
"Philip Ashley did not benefit by the crime," the old scarecrow broke in,
with a dry cackle. "No, no, but for the fact that a merciful Providence
removed Charles Ashley so very unexpectedly out of this wicked world,
Philip would still be living on a few hundreds a year, most of which he
would owe to the munificence of his brother."
"That," I argued, "was only because that Peet-Jackson woman threw him
over, otherwise——"
"And why did she throw him over? Because old Thornton Ashley died
under mysterious circumstances, and Philip Ashley was under a cloud
because of it. Any one could have foreseen that that particular woman
would throw him over the very moment that suspicion fell upon him."
"Exactly," he broke in, excitedly, "it was Charles who benefited by the
crime. It was he who inherited the fortune."
"But, by the new will he would have inherited anyhow. Then, why in the
world——"
"You surely don't believe in that new will, do you? The way in which I
marshalled the facts before you ought to have paved the way for more
intelligent reasoning."
"Can you see Charles cudgelling his wits as to what crime could most
easily be fastened on a man of Philip's personality and social position?
Probably a chance word dropped by his father put the finishing touch to his
scheme, a chance word on the subject of a will. And there was the whole
plan ready. The unsigned will, the assault on the dying man, and quarrels
there always were plenty between the peppery old miser and his somewhat
impatient son. As for Triscott, the dapper little local lawyer, I suppose it
took some time for Charles Ashley's crooked schemes to appear as feasible
and profitable to him. Of course, without him nothing could have been
done, and the whole of my theory rests upon the fact that the two men were
partners in the crime.
"Where they first met, and how they became friends, I don't profess to
know. If I had had anything to do with the official investigation of that
crime I should first of all have examined the servant in the Triscott
household, and found out whether or no Mr. Charles Ashley had ever been a
visitor there. In any case, I should have found out something about
Triscott's friends and Triscott's haunts. I am sure that it would then have
come to light that Charles Ashley and Mr. Triscott had constant intercourse
together.
"I cannot bring myself to believe in that unsigned will. There was
nothing whatever that led up to it, except the supposed quarrel on the
Wednesday. But, if that old miser did want to alter his will, why should he
have sent for a man whom he hardly knew and whom, mind you, he would
have to pay for his services, rather than for his friend, Oldwall, who would
have done the work for nothing? The man was a miser, remember. His
meanness, we are told, amounted to a mania; a miser never pays for
something he can get for nothing. There was also another little point that
struck me during the inquest as significant. If Triscott was an entire stranger
to Charles Ashley, why should he have taken such a personal interest in him
and in the old man to the extent of sending his wife to spend two whole
days and nights in charge of an invalid who was nothing to him? Why
should Mrs. Triscott have undertaken such a thankless task in the house of a
miser, where she would get no comforts and hardly anything to eat? Why, I
say, should the Triscotts have done all that if they had not some vital self-
interest at stake?
"And I contend that that self-interest demanded that one of them should
be there, in the flat, on the watch, to see that no third person was present
whilst Philip spent his time by his father's bedside—a witness, such as Lady
Peet-Jackson, perhaps, or some friend—whose testimony might demolish
the whole edifice of lies, which had been so carefully built up. And, did you
notice another point? The charwoman, by a new arrangement, was never at
the flat on a Monday morning, and that arrangement had only obtained for
the past two months. Now why? Charwomen stay away, I believe, on
Sundays always, but, I ask you, have you ever heard of a charwoman
having a holiday on a Monday?"
I was bound to admit that it was unusual, whereupon the old scarecrow
went on, with excitement that grew as rapidly as did the feverish energy of
his fingers manipulating his bit of string.
"And now propel your mind back to that same Monday morning, when,
the coast being clear, Charles Ashley, back at the flat and alone with the old
man, was able at last to put the finishing touch to his work of infamy. One
pressure of the fingers, one blow with the walking-stick, and the curtain
was rung down finally on the hideous drama which he had so skilfully
invented. Think of it all carefully and intelligently," the Old Man in the
Corner concluded, as he stuffed his beloved bit of string into the capacious
pocket of his checked ulster, "and you will admit that there is not a single
flaw in my argument——"
The next moment he was gone, and I just caught sight of the corner of
his checked ulster disappearing through the swing doors.
XII
§1
"Are you prepared to admit," the Old Man in the Corner said abruptly as
soon as he had finished his glass of milk, "that sympathy, understanding,
largeness of heart—what?—are invariably the outcome of a big brain? It is
the fool who is censorious and cruel. Your clever man is nearly always
sympathetic. He understands, he appreciates, he studies motives and
understands them. During the war it was the fools who tracked down
innocent men and women under pretence that they were spies; it was the
fools who did not understand that a German might be just as fine a patriot
as a Briton or a Frenchman if he served his own country. The hard, cruel
man is almost always a fool; the backbiting old maid invariably so.
"I am tempted to say this," he went on, "because I have been thinking
over that curious case which newspaper reporters have called the Fulton
Gardens Mystery. You remember it, don't you?"
"Yes," I said, "I do. As a matter of fact I knew poor old Mr. Jessup
slightly, and I was terribly shocked when I heard about that awful tragedy.
And to think that that horrid young Leighton——"
"Ha!" my eccentric friend broke in, with a chuckle, "then you have held
on to that theory, have you?"
"I did not mean sympathy for the guilty," he argued, "but for the women
who were the principal witnesses in the case."
"You put it crudely," he rejoined complacently, "and had you not given
ample proof of your intelligence before now I might have thought it worth
while to refute the second half of your argument. As for the first..."
"Hadn't you better tell me about the Fulton Gardens Mystery?" I broke in
impatiently.
"I dare say," he began, "that to most people the mystery appeared
baffling enough. But to me ... Well, there was the victim of what you very
properly call the cowardly assault, your friend—or acquaintance—Mr.
Seton Jessup, a man on the wrong side of sixty, but very active and
vigorous for his years. He carried on the business of pearl merchant in
Fulton Gardens, but he did not live there, as you know. He was a married
man, had sons and daughters and a nice house in Fitzjohn's Avenue. He also
owned the house in Fulton Gardens, a four-storied building of the pattern
prevalent in that neighbourhood. The ground floor, together with the one
above that, and the basement were used by Mr. Jessup himself for his
business: on the ground floor he had his office and showroom, above that
were a couple of reception rooms, where he usually had his lunch and saw a
few privileged customers, and in the basement there was a kitchen with
scullery and pantry, a small servants' hall, and a strong-room for valuables.
The top story of all was let to a surgical-instrument maker who did not sleep
on the premises, and the second floor—that is the one just below the
surgical-instrument maker and immediately above the reception rooms—
was occupied by Mrs. Tufnell, who was cook-housekeeper to Mr. Jessup,
and her niece, Ann Weber, who acted as the house-parlourmaid. Mrs.
Tufnell's son, Mark, who was a junior clerk in the office, did not sleep in
the house. He was considered to be rather delicate, and lived with a family
somewhere near the Alexandra Palace.
"All these people, as you know, played important parts in the drama that
was enacted on the sixteenth of November at No. 13, Fulton Gardens—an
unlucky number, by the way, but one which Mr. Jessup did not change to
the usual 12a when he bought the house, because he despised all
superstition. He was a hard-headed, prosperous business man; he worked
hard himself, and expected hard work from his employés. Both his sons
worked in the office, one as senior clerk, and the other as showman, and in
addition to young Mark Tufnell there was another junior clerk—a rather
unsatisfactory youth named Arthur Leighton, who was some sort of a
relation of Mrs. Jessup's. But for this connection he never would have been
kept on in the business, as he was unpunctual, idle, and unreliable. The
housekeeper, as well as some of the neighbours, had been scandalised lately
by what was picturesquely termed the 'goings on of that young Leighton
with Ann, the housemaid at No. 13.'
"Ann Weber was a very pretty girl, and like many pretty girls she was
fond of finery and of admiration. As soon as she entered Mr. Jessup's
service she started a flirtation with Mark Tufnell, then she dropped him for
a while in favour of the youngest Mr. Jessup; then she went back to Mark,
and seemed really in love with him that time until, finally, she transferred
her favours to Arthur Leighton, chiefly because he was by far the most
generous of her admirers. He was always giving her presents of jewellery
which Mark Tufnell could not afford, and young Jessup apparently did not
care to give her. But she did not, by any means, confine her flirtations to
one man: indeed, it appears that she had a marvellous facility for keeping
several men hanging about her dainty apron-strings. She was not on the best
of terms with her aunt, chiefly because the latter noted with some asperity
that her son was far from cured of his infatuation for the pretty housemaid.
The more she flirted with Leighton and the others the greater did his love
for her appear, and all that Mrs. Tufnell could hope for was that Mr.
Leighton would marry Ann one day soon, when he would take her right
away and Mark would then probably make up his mind to forget her. Young
Leighton was doing very well in business apparently, for he always had
plenty of money to spend, whilst poor Mark had only a small salary, and,
moreover, had nothing of the smart, dashing ways about him which had
made the other man so attractive to Ann."
§2
"And now," the Old Man in the Corner continued after a while, "we
come to that sixteenth of November when the mysterious drama occurred at
No. 13, Fulton Gardens. As a general rule, it seems, Mr. Jessup was in his
office most evenings until seven o'clock. His clerks and showmen finished
at six, but he would, almost invariably, stay on an hour longer to go through
his accounts or look over his stock. On this particular evening, just before
seven o'clock, he rang for the housekeeper, Mrs. Tufnell, and told her that
he would be staying until quite late, and would she send him in a cup of tea
and a plate of sandwiches in about an hour's time. Mrs. Tufnell owned to
being rather disappointed when she had this order because her son Mark
had arranged to take her and Ann to the cinema that evening, and now, of
course, they could not leave until after Mr. Jessup had gone, in case he
wanted anything, and he might be staying on until all hours. However,
Mark stayed to supper, and after supper Mrs. Tufnell got the tea and
sandwiches ready and took the tray up to Mr. Jessup herself. Mr. Jessup was
then sitting at his desk with two or three big books in front of him, and Mrs.
Tufnell noticed that the safe in which the cash was kept that came in after
banking hours was wide open.
"Mrs. Tufnell put down the tray, and was about to leave the room again
when Mr. Jessup spoke to her.
"'I expect Mr. Leighton back presently. Show him in here when he
comes. But I don't want to see anybody else, not any of you. Understand?'
"It seems that he said this in such a harsh and peremptory manner that
Mrs. Tufnell was not only upset, but quite frightened. Mr. Jessup had
always been very kind and considerate to his servants, and the housekeeper
declared that she had never been spoken to like that before. But we all know
what that sort of people are: they have no understanding, and unless you are
perpetually smiling at them they turn huffy at the slightest word of
impatience. Undoubtedly Mr. Jessup was both tired and worried, and no
great stress was laid by the police subsequently on the fact that he had
spoken harshly on this occasion. Even to you at this moment I dare say that
this seems a trifling circumstance, but I mention it because to my mind it
had a great deal of significance, and I think that the police were very wrong
to dismiss it quite so lightly.
"Well, to resume. Mr. Jessup was in his office with his books and with
the safe, where he kept all the cash that came in after banking hours, open.
Mrs. Tufnell saw and spoke to him at eight o'clock and he was then
expecting Arthur Leighton to come to him at nine.
"'What is it, Auntie?' she kept on asking as she ran. 'What has
happened?'
"And when she reached the office door, she only gave one look into the
room and exclaimed, 'Oh, my God! He's killed him!'
"But Ann couldn't or wouldn't utter another word. She was as white as a
sheet and, staggering backwards, she had fallen up against the bannisters at
the foot of the stairs and was clinging to them, wide-eyed, with twitching
mouth and shaking knees.
"'Pull yourself together, Ann Weber,' Mrs. Tufnell said peremptorily, 'and
run and fetch the police at once.'
"But Ann looked as if she couldn't move. She kept on reiterating in a dry,
meaningless manner, 'The police! The police,' until Mrs. Tufnell, who by
now had gathered her wits together, gave her a vigorous push and then went
upstairs to put on her bonnet. A few minutes later she had gone for the
police.
§3
"I don't know," the Old Man in the Corner went on glibly, "whether you
remember all the circumstances which made that case such a puzzling one.
Indeed, it well deserved the popular name that the evening papers bestowed
on it—'The Fulton Gardens Mystery'—for it was, indeed, a mystery, and to
most people it has so remained to this day."
"Not to you," I put in, with a smile, just to humour him, as I could see he
was waiting to be buttered-up before he would proceed with his narrative.
"No, not to me," he admitted, with his fatuous smile. "If the members of
the police force who had the case in hand had been psychologists, they
would not have been puzzled, either. But they were satisfied with their own
investigations and with all that was revealed at the inquest, and they looked
no further, with the result that when the edifice of their deductions
collapsed, they had nowhere to turn. Time had gone on, evidences had
become blurred, witnesses were less sure of themselves and less reliable,
and a certain blackguard, on whom I for one could lay my fingers at this
moment, is going through the world scot-free.
"But let me begin by telling you the facts as they were revealed at the
inquest. You can then form your own conclusions, and I dare say that these
will be quite as erroneous as those arrived at by the public and the police.
"The drama began to unfold itself when Mr. Ernest Jessup, the younger
son of the deceased gentleman, was called. He began by explaining that he
was junior clerk in his father's office, and that he, along with all the other
employés had remarked on the sixteenth that the guv'nor did not seem at all
like himself. He was irritable with everybody, and just before luncheon he
called Arthur Leighton into his office and apparently some very hot words
passed between the two. Witness happened to be in the hall at the moment,
getting his hat and coat, and the housemaid was standing by. They both
heard very loud voices coming from the office. The guv'nor was storming
away at the top of his voice.
"But the girl only giggled and shrugged her shoulders. Then she said:
'Do you think so?'
"'Yes,' witness replied, 'aren't you sorry to see your devoted admirer in
such hot water?'
"Again the girl giggled and then ran away upstairs. Mr. Leighton was not
at the office the whole of that afternoon, but witness understood, either from
his father or from his brother—he couldn't remember which—that Leighton
was to come in late that night to interview the guv'nor.
"'Stuff and nonsense!' he said. 'I don't believe in that sick sister a bit. I'll
see that young blackguard to-night.'
"She deposed that on the sixteenth, just before the luncheon hour, she
was crossing the hall at 13, Fulton Gardens. The door into the office was
ajar, and she heard Mr. Jessup's voice raised, evidently in great wrath. Mrs.
Tufnell also heard Mr. Leighton's voice, both gentlemen, as she
picturesquely put it, going at one another hammer and tongs. Obviously,
though she wouldn't admit it, Mrs. Tufnell stopped to listen, but she does
not seem to have understood much of what was said. However, a moment or
two later, Mr. Jessup went to the door in order to shut it, and while he did
so, Mrs. Tufnell heard him say quite distinctly:
"'Well, if you must go now, you must, though I don't believe a word
about your sister being ill. But you may go; only, understand that I expect