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Public Policy
in ALS/MND Care
An International Perspective

Edited by
Robert H. Blank · Jerome E. Kurent · David Oliver
Public Policy in ALS/MND Care
 Robert H. Blank
Jerome E. Kurent • David Oliver
Editors

Public Policy in
ALS/MND Care
An International Perspective
Editors
Robert H. Blank Jerome E. Kurent
University of Canterbury, Medical University of South Carolina
Christchurch, New Zealand Charleston, SC, USA

David Oliver
University of Kent
Canterbury, UK

ISBN 978-981-15-5839-9    ISBN 978-981-15-5840-5 (eBook)

https://doi.org/10.1007/978-981-15-5840-5

© The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer
Nature Singapore Pte Ltd. 2021
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 Foreword

When I was a neuromuscular fellow back in 1980, I would observe how

my mentors, Drs. Walter G. Bradley and Theodore L. Munsat, managed
their ALS Clinic and early clinical trials. Because I was concentrating on
basic research, I did not know the factors involved in running clinical pro-
grams. I have to admit I did not pay much attention to administration, as
these issues were neither clinical nor scientific. A few years later when I
wanted to start a multidisciplinary ALS Clinic, I struggled to learn how to
do it successfully. This knowledge was clearly over my head.
When I wanted to conduct my first clinical trial with thyrotropin-­
releasing hormone (TRH), I would not have been able to accomplish this
task without the support and assistance of my chairman Dr. John
P. Conomy and his capable administrative assistant. I learned and started
this process from scratch. In those days, public policies and the overall
infrastructure for ALS was still in the early stages of development. I have
to say that since then we have come a long way! We have many multidisci-
plinary ALS Clinics throughout many parts of the world. However, there
are still some areas that lack these clinics. I often use the word, “ALS
Community,” which I believe includes people with ALS (PALS) and their
family caregivers; doctors, clinicians, any scientists who are involved in the
field; hospice and home care agencies; voluntary disease organizations and
advocacy groups; investigator-initiated study groups; clinical trial consor-
tia; the National ALS Registry; ALS-specific annual symposium organiz-
ers; funding agencies for research and patient care; federal health agencies;
policy makers; regulatory agencies; pharmaceutical companies; and new

v
vi FOREWORD

biotech companies. All these stakeholders are working to improve ALS

care and research to help combat this “intractable” disease.
In 2003, I was asked to assemble a new committee to promote excel-
lence in end-of-life care among PALS by the Robert Wood Johnson
Foundation and ALS Association. We published the committee’s recom-
mendations in 2005 and pointed to the need for improvement in public
policies, more overall research in ALS, and the dissemination of key infor-
mation (1). In 2011, I organized an international conference to promote
clinical and patient-oriented research to identify the pathogenesis of ALS
with the support of many funding agencies and pharmaceutical companies
(ALS Community). Prof. Martin Turner and I published a conference
supplement in 2013 in the journal Amyotrophic Lateral Sclerosis and
Frontotemporal Degeneration. There were two articles that were devoted
to discussing infrastructure and resources. Dr. Alexander V. Sherman and
his colleagues reviewed public policies for funding agencies and discussed
overall infrastructure resources for clinical research in ALS (2). Key infra-
structure included ALS Clinics, brain banks, the National ALS Registry,
and study consortia in the United States and Europe. Dr. David A. Chad
also reviewed “Funding agencies and disease organizations: resources and
recommendations to facilitate ALS clinical research” (3). Our efforts are
still largely fragmented, and at times, I wonder if we may need to repeat
our messages over and over again. It has now been ten years since the
international conference. I must admit that management and care for
PALS is much more complicated due to a multitude of health insurance
companies, health care agencies, and palliative care and hospice providers.
Movements such as “right to try” and “right to die” also require a great
deal of knowledge. The number of ALS clinics has really grown in the
United States, Canada, Europe, and Pan-Asian countries. These clinics
have become more comprehensive, as they provide the best care for
patients and conduct extensive clinical research including clinical trials.
Our ultimate goal is to find the cause and pathogenesis of ALS to develop
a cure. In the meantime, we must develop medications to markedly slow
down the disease. We also need to develop interventions to improve diffi-
cult symptoms in ALS, so PALS can maintain their quality of life for as long
as possible. Again, the ALS Community as a whole is working toward these
objectives. As I experienced many years ago, young energetic doctors and
researchers are immediately confronted with a lack of knowledge on public
policies and overall complex infrastructure even within the small world of
ALS. I must admit knowledge of public policies in ALS health care has
 FOREWORD vii

grown into a far more complicated web with an overwhelming amount of

information. Some countries are more efficient and have great infrastruc-
ture, whereas other countries may not be as developed. Furthermore, effec-
tive implementation of this information is not easy. Some health agency
workers or officials, government or non-­ government, may attempt to
improve their policies and infrastructure for the benefits of PALS. Yet, if
there are no data available, any improvement will be challenging. There are
many ALS books on science and clinical care which have been published in
the past, but there is a paucity of information on public policies and beyond,
as well as the infrastructure for ALS care and research.
When I heard the plan for this book and its focus on public policies and
infrastructure for the ALS Community (versus science or patient care), I
was so excited, because I feel it is truly needed. The editors of this book
include Dr. Robert Blank, a world expert on public policies and health
care delivery systems; Dr. Jerome Kurent, a doctor who is most respected
for compassion and humanistic care for PALS and their caregivers; and Dr.
David Oliver, a doctor who introduced the concept of palliative care for
PALS and successfully implemented it. The authors are among the world
experts of ALS across 21 countries and provide commentary on their own
countries’ health policies and infrastructure for ALS. The title of the book
is Public Policies in ALS/MND Care. Yet, I believe this book also covers
broader issues that we need to know that go beyond research when treat-
ing PALS from diagnosis to end-of-life care.
One of the most important goals of this book is to provide the most
comprehensive view possible of ALS/MND care and policy through com-
mentary on different systems across 21 countries and beyond. When we face
the impossible feat of finding the solution for ALS, we need to take a
moment and critically evaluate the field. This book will give us the opportu-
nity to really understand where the field stands and how we can move for-
ward. The impact of this book will be wide-ranging, as it provides the most
thorough and broad view of ALS/MND care and policy—not just locally
but around the world. This is indeed the first book of its kind. I would like
to provide my heartfelt congratulations to the editors and authors, who pro-
vided this crucial information and have addressed gaps in knowledge within
the field. This is an essential book to read for any stakeholder in ALS.

Wesley J Howe Professor of Neurology (at CUIMC) Hiroshi Mitsumoto

Columbia University Irving Medical Center
New York, NY
March, 2020
viii FOREWORD

References
Mitsumoto, H., M. Bromberg, W. Johnston, R. Tandan et al. (2005). Promoting
excellence in end-of-life care in ALS. Amyotrophic Lateral Sclerosis and
Frontotemporal Degeneration 6 (3): 145–54.
Sherman, A.V., A.K. Gubitz, A. Al-Chalabi, R. Bedlack et al. (2013). Infrastructure
resources for clinical research in amyotrophic lateral sclerosis. Amyotrophic
Lateral Sclerosis and Frontotemporal Degeneration 14 (Suppl 1): 53–61.
Chad, D.A., S. Bidichandani, L. Bruijn, J.D. Capra et al. (2013). Funding agencies
and disease organizations: Resources and recommendations to facilitate ALS
clinical research. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration
14 (Suppl 1): 62–66.
 Preface

This book was first proposed by the three editors to be a co-authored

volume on ALS/MND public policy in the United Kingdom and the
United States. Thanks to an astute reviewer who suggested involving addi-
tional countries, we decided to develop an edited multi-authored volume
which includes a broad range of contributors from across the globe. We
were soon encouraged by the enthusiasm of the many ALS/MND experts
willing to participate in this project, including representation from coun-
tries often overlooked in comparative studies. Authors from twenty-one
countries were requested to describe the current state of ALS/MND pub-
lic policy as well as implications for patient care.
This book focuses on the public policy and ethical dimensions of ALS/
MND care. Policy issues include adequacy of funding for patient care and
research, payment policy and regulatory functions of public and private
insurers, long-term services and caregiver support, access to genetic test-
ing and assistive technologies, and ensuring a competent and adequate
workforce, especially for hands-on caregivers. There also are numerous
challenges related to providing palliative and hospice care for patients with
ALS/MND, as well as use of advance directives and the highly controver-
sial area of assisted suicide. These are matters that confront policy makers
in almost all geographic regions and were addressed whenever possible by
each author.
To provide a starting point for coverage and to facilitate evaluation of
comparative data, chapter contributors were asked to address a series of
questions and issues (these are enumerated in Chapter 1) that embody a
wide range of policy issues. To avoid repetition while maintaining the

ix
x PREFACE

primary focus on policy, authors were requested not to include general

background coverage of ALS/MND since this is provided in the introduc-
tory chapter along with policy themes of the book. A concluding chapter
written by the editors examines the collective findings from the disparate
countries represented in this book. Hopefully, this discussion will serve to
facilitate workable and humane ALS/MND public policy for patient care
and caregiver support in the coming decades. Overall, we argue
for approaches that are both multidisciplinary and international.
We are indebted to the more than fifty authors who provided their
expertise and insights of ALS/MND in producing the chapters that made
this book a reality. We especially thank Professor Hiroshi Mitsumoto of
Columbia Presbyterian Hospital for his invaluable assistance on this proj-
ect and for writing the Foreword. We also thank Mr. Anushangi Weerakoon
at Palgrave Macmillan Publishing for his enthusiastic support of the book’s
concept and for his encouragement over the duration of this project.
We dedicate this book to patients with ALS/MND and their families
across the globe, and to provide hope for the future of eventually conquer-
ing this group of tragic disorders.

Sarasota, FL Robert H. Blank

Charleston, SC  Jerome E. Kurent
Canterbury, UK  David Oliver
 Contents

1 Introduction to Public Policy of ALS/MND  1

Jerome E. Kurent, David Oliver, and Robert H. Blank

2 Public Policy in MND Care: The Australian Perspective 29

Samar Aoun, Carol Birks, Anne Hogden,
and Susan Mathers

3 Public Policy in ALD/MND Care:

The Belgian Perspective 51
Evy Reviers, Ludo Vanopdenbosch, Ludo Van Den Bosch,
and Philip Van Damme

4 Amyotrophic Lateral Sclerosis in Brazil 65

Tauana Bernardes Leoni and Marcondes C. França Jr.

5 Public Policy of ALS in Canada 77

Wendy S. Johnston and Westerly Luth

6 Public Policy for Amyotrophic Lateral Sclerosis

in China 97
Lu Chen and Dongsheng Fan

xi
xii CONTENTS

7 German Perspective on ALS/MND Policy107

Maike F. Dohrn and Roman Rolke

8 Living and Dying with ALS/MND in India:

Public Policy and Private Realities121
Roop Gursahani and Satish Khadilkar

9 The Experience of Amyotrophic Lateral Sclerosis

in Ireland131
Orla Hardiman, Stela Lefter, and Miriam Galvin

10 Public Policy of ALS Care in Israel149

Marc Gotkine and Efrat Carmi

11 Public Policy in ALS Care: The Italian Situation163

Simone Veronese and Andrea Calvo

12 ALS Policy: A Japanese Perspective177

Mieko Ogino and Tamerlan Babayev

13 ALS Policy in Mexico191

Ildefonso Rodriguez-Leyva

14 Public Policy in MND Care: Nigerian Perspective201

Yomi Ogun and Babawale Arabambi

15 Public Policy of ALS: A Pakistani Perspective209

Asfandyar Khan Niazi, Aqdas Kazi, and Arsalan Ahmad

16 Public Policy in ALS Care: The Polish Perspective219

Anna Adamczyk and Wojciech Leppert
 CONTENTS xiii

17 ALS Policy: A Russian Perspective227

L. V. Brylev, D. V. Nevzorova, M. N. Zakharova,
and A. B. Guekht

18 Public Policy in ALS/MND Care: South African

Perspective233
Jeannine M. Heckmann and Alexandra S. Amaler

19 Public Policy in ALS Care: South Korea247

Seung Hyun Kim, Kiwook Oh, and Bugyeong Son

20 Amyotrophic Lateral Sclerosis Care in Tunisia263

Imen Kacem, Ikram Sghaier, Amina Nasri,
and Riadh Gouider

21 Public Policy in MND Care: The United Kingdom279

David Oliver and Christopher McDermott

22 ALS Public Policy in the United States301

Benjamin Rix Brooks and Jerome E. Kurent

23 Conclusions: What We Can Learn from the Country

Perspectives327
Robert H. Blank, Jerome E. Kurent, and David Oliver
 Notes on Contributors

Anna Adamczyk is a specialist in neurology and in palliative medicine.

She is Head of the Department of Palliative Medicine at the University
Hospital No. 1 in Clinical Hospital in Bydgoszcz and a lecturer at the
Department of Palliative Care at the Ludwik Rydygier Collegium
Medicum in Bydgoszcz of the Nicolaus Copernicus University in Toruń.
She works within palliative medicine, and practices as a neurologist, with
an interest in caring for patients with diseases of the nervous system, par-
ticularly amyotrophic lateral sclerosis, and in the treatment of neuro-
pathic pain.
Arsalan Ahmad MBBS, MD (Neurology), is Professor of Neurology at
Shifa International Hospital, Shifa Tameer-e-Millat University, Islamabad,
Pakistan. He completed his MBBS from Dow Medical College in 1990
and Doctor of Medicine in Neurology in 2000. He joined Shifa
International Hospital in 2003 and was Head of Neurology from 2005 to
2009 and 2012. He was President of Pakistan Society of Neurology from
2016–2018 and President of Movement Disorders Society Pakistan from
2018–2020. He has an interest in movement disorders, neuromuscular
disorders and neurogenetics. He has over 100 publications and abstracts
including two articles on familial ALS in The Neurogenetics Journal.
Alexandra S. Amaler is a final year postgraduate law student at the
University of Cape Town, who completed her moot on the question of
assisted dying with respect to ALS.

xv
xvi NOTES ON CONTRIBUTORS

Samar Aoun is Professor of Palliative Care Research. She adopts a public

health approach and a focus on under-served population groups such as
people with MND and advocates for person-centred health and social
care. Her research programs on supporting family caregivers at end
of life and the Public Health Model of Bereavement Support have
informed policy and practice at the national and international levels.
She chairs the MND Association in Western Australia, is a director on
the board of MND Australia and a member of the scientific committee of
MND Research Institute Australia.
Babawale Arabambi is a neurologist and physician at the Lagos State
University Teaching Hospital, Nigeria, with a keen interest in stroke neu-
rology, movement disorders, and clinical neurophysiology. He also co-­
manages the hospital’s neurophysiology laboratory, where he performs
and interprets the relevant procedures. He is a recipient of the International
Scholarship Award of the American Academy of Neurology for his
work on non-motor symptoms of Parkinson’s disease in Nigerian
outpatients in 2019. He has also authored/co-authored several publica-
tions touching on various fields in neurology.
Tamerlan Babayev graduated from Imperial College London in 2011
before undertaking postgraduate clinical training in the UK. He moved to
Japan in April 2017 to take up an assistant professorship in International
University of Health and Welfare and pursue a passion for medical
education and research. His contribution to this book stems from an
interest in medical ethics and the interplay between culture and health-
care policy.
Carol Birks has worked with people living with MND for over 20 years.
She worked initially as manager of support services at MND NSW before
becoming CEO of MND Australia in 2006. Her work with MND
Australia encompasses influencing government policy to address the
complex care needs of people with MND. Birks was a board member
of the International Alliance of ALS/MND Associations from 2010
to 2017, serving as Treasurer and President. Birks has supported new
and emerging ALS/MND associations globally, particularly in the
Asia Pacific region. Birks is a registered nurse with a graduate diploma in
palliative care.
Robert H. Blank PhD, has been Professor of Public Policy at universities
in New Zealand (Canterbury), Britain (Brunel) and the U.S. (Idaho and
 NOTES ON CONTRIBUTORS xvii

Northern Illinois) and a frequent guest professor at Aarhus University

in Denmark and National Taiwan University in Taiwan. Among the
over forty books he published on comparative health policy, genetic
and reproductive policy, and neuroscience policy are Rationing
Medicine (Columbia University Press), Brain Policy (Georgetown
University Press), Intervention in the Brain (MIT Press), Comparative
Health Policy, 1st–5th eds. (Palgrave) and End of Life Decision Making: A
Comparative Study (MIT Press).
Benjamin Rix Brooks MD, is Medical Director of the Carolinas
Neuromuscular/ALS–MDA-Care-Center and the Atrium Health ALS
Association Certified-Treatment-Center-of-Excellence (CTCE) at the
Atrium Health Neurosciences Institute that received the first ever Joint
Commission awarded Disease-Specific Care Certification in ALS, and
Professor, Department of Neurology, University of North Carolina School
of Medicine, Charlotte Campus. Brooks is a founding member of the
World Federation of Neurology Research Group on Motor Neuron
Diseases leading efforts to design the El Escorial criteria for diagno-
sis of ALS and the ALS-Functional-Rating-Scale-Revised
(ALSFRS-R). In 2012, he received the Forbes Norris Award from The
International Alliance of ALS/MND Associations.
L. V. Brylev graduated from the Medical Faculty of Lomonosov Moscow
State University in 2004 and completed residency in the Research Center
of Neurology RAMS in 2006. He is head of the Department of
Neurology at the Buyanov City Hospital, and the Medical Director
of “Live now”, a charity foundation for people with ALS. He is team
leader of ALS Center Moscow, part of the European Network to Cure
ALS Network, and co-author of Russian Clinical Guidelines on ALS.
Andrea Calvo is Associate Professor of Neurology at the Department of
Neurosciences ‘Rita Levi Montalcini’ of the University of Turin. He
has been vice-director at Turin ALS Expert Centre since 1997. He is
the Co-Chair of the EAN Scientific Panel for ALS and FTD from
2019 and Chair of the Italian Motoneuron Diseases Study Group of
the Italian Society of Neurology (SIN). His research interests are in
the neurological field, particularly related to ALS and other neuro-
muscular diseases—epidemiology, clinical genetics, neuroimaging,
palliative care, and clinical trials—with 170 papers in international journals.
xviii NOTES ON CONTRIBUTORS

Efrat Carmi is the CEO of IsrALS—The Israeli ALS Research

Association--and has been with IsrALS since 2007. IsrALS is the primary
organization supporting ALS research and patient care in the country.
Efrat got her Psychology degree from Tel Aviv University and her MBA
from the University of Central Florida. Efrat is an active member in the
ALS/MND International Alliance and has served as a board member of
the Alliance for six years.
Lu Chen MD, is a physician in the Department of Neurology, Peking
University Third Hospital. Chen got her medical degree from Peking
University Health Science Center in 2014. She is focusing on the study
of ALS and has published thirty-six peer-reviewed articles. Her repre-
sentative articles include studies about the natural history and clinical
features of patients with ALS in China (JNNP 2015), the prevalence
and incidence of ALS in China (JNNP 2020), and the difference in
clinical features between German and Chinese ALS patients (J
Neurol 2019).
Maike F. Dohrn is a specialist for neuromuscular disorders with a scien-
tific focus on neurogenetics. She collaborated in the neuromuscular out-
patient clinic of the RWTH Aachen University hospital as a student before
she undertook her resident clinical training in 2015. She has con-
ducted several studies on Charcot-Marie-Tooth disease, hereditary
transthyretin amyloidosis, and small fiber neuropathies. Dohrn
worked as an intern at the Center for Genomics and Transcriptomics
(CeGaT) in Tübingen, Germany, and at the University of Porto,
Portugal. Currently, she has a research fellowship at the John
P. Hussman Institute for Human Genomics at the University of Miami,
Florida.
Dongsheng Fan MD, Professor and Director of the Neurological
Department at PUTH, has focused on the study with the aim of curing
ALS. Fan and his colleagues have made great efforts for Chinese ALS
patients, including the establishment of the biggest follow-up database in
China. Their current works include clinical trial studies, palliative
and hospice care, and genetic investigations to find new genes that
cause ALS in families. The Neurological Department of PUTH has
therefore become a nationally recognized center for research and clinical
care in ALS in China.
 NOTES ON CONTRIBUTORS xix

Marcondes C. França Jr. MD, PhD, is Associate Professor in the

Department of Neurology at the School of Medical Sciences at the
University of Campinas (UNICAMP), Campinas, Brazil. He is the direc-
tor of the ALS outpatient clinic at UNICAMP hospital. His research
group has been working in the search for neuroimaging biomarkers and in
the characterization of the genetic epidemiology of ALS in Brazil. França
is the former chair of the Neuromuscular section at the Brazilian Academy
of Neurology. He serves on the board of the Brazilian Association of
Amyotrophic Lateral Sclerosis (ABrELA).
Miriam Galvin is Associate Professor in Intersectional Research
Methodology at the Academic Unit of Neurology, School of Medicine,
TCD and Atlantic Senior Fellow for Equity in Brain Health, Global Brain
Health Institute. She works across a range of health research projects,
mixed methods and qualitative research tracking patient and caregiver
journeys, interaction with the health services and the conceptualisation
and assessment of quality of life and caregiving experiences. She has
a multi-disciplinary academic background in human geography, pop-
ulation health and psychosocial studies, with interests in research method-
ologies, medical anthropology, and discourse.
Marc Gotkine received his medical degree from King’s College, London.
After moving to Israel, he completed his residency in Hadassah University
Hospital, Jerusalem. He set up the Hadassah ALS clinic and he also
heads the neuromuscular service and EMG lab. The Hadassah ALS
clinic serves as an ALS research hub for the whole country both in
basic science and clinical trials. He has a special interest in studying
the genetics of ALS in Israel, with a focus on ALS in consanguineous
families. His other research interests are the genetics and epidemiology of
ALS, ALS biomarkers and the microbiome in ALS.
Riadh Gouider is the head of Department of Neurology at Razi
University Hospital, the Clinical Investigation Centre (CIC), the
Alzheimer’s center and the Multiple Sclerosis Center. He is Trustee of the
World Federation of Neurology and Member in the ALS research project
and related syndromes in tropical zone (TROPALS). He is a fellow of the
European Academy of Neurology as well as the American Academy of
Neurology since 2019. He authored and co-authored many original
papers or book chapters such as Epidemiology of ALS and Clinical Features
of ALS in Africa.
xx NOTES ON CONTRIBUTORS

A. B. Guekht is the director of the Moscow Research and Clinical Center

for Neuropsychiatry and Professor of Neurology at the Russian National
Research Medical University. She is the author of more than 200 publica-
tions, including more than 90 papers in international peer-­reviewed jour-
nals and chapters in international textbooks. She is the Elected Trustee of
the World Federation of Neurology, Secretary-General of the National
Society of Neurologists and involved in collaborative projects with the
World Health Organisation.
Roop Gursahani is a practicing clinical neurologist at P.D. Hinduja
National Hospital in Mumbai. He finished formal training and certifica-
tion in Internal Medicine and then in Neurology by 1988. His special
interests include epilepsy and palliative neurology. His advocacy efforts
concern end-of-life care in India and include working for appropriate leg-
islation, professional training, and public awareness. He is a member of
the steering committee of ELICIT, the interdisciplinary task force of
intensivists, palliative care physicians and neurologists for End of Life Care
in India.
Orla Hardiman is Professor of Neurology at Trinity College Dublin and
Consultant Neurologist at Beaumont Hospital, where she is Director of
the National Amyotrophic Lateral Sclerosis service. She is also the National
Clinical Lead in Neurology. She is one of only five active clinicians elected
to the Royal Irish Academy. She is Editor-in-Chief of the journal
Amyotrophic Lateral Sclerosis and the Frontotemporal Degenerations. Her
research interests are in clinical phenotyping, epidemiology, genomics,
biomarker development and new therapeutics in ALS and related disorders.
Jeannine M. Heckmann MBChB, PhD, is a neurologist in the Division
of Neurology at Groote Schuur Hospital and the University of Cape
Town, South Africa. Her clinical expertise is in neuromuscular diseases.
She established and heads the multi-disciplinary ALS clinic at Groote
Schuur Hospital, as well as an ALS research group, which collaborates
with international partners.
Anne Hogden is a Senior Lecturer and researcher with the Australian
Institute of Health Service Management. Her research interests are in
healthcare communication, patient-centred care and decision-making and
interprofessional team processes, with an emphasis on people with life-­
limiting conditions. Anne’s research includes developing web-based deci-
sion tools to support people living with ALS/MND to make difficult
 NOTES ON CONTRIBUTORS xxi

decisions for care and quality of life. Her teaching work is in convening
and delivering healthcare safety and quality and research units for the
Master of Health Service Management, and supervision of PhD students.
Wendy S. Johnston is Professor Medicine in the Division of Neurology
at the Faculty of Medicine and Dentistry at the University of Alberta,
Edmonton, Canada. As Medical Director of the University of Alberta
Amyotrophic Lateral Sclerosis Programme she leads a multidisciplinary
team dedicated to the care of patients with ALS and other motor neuron
diseases. Her research encompasses both qualitative research in ALS as
well as an active investigational drug trial programme. She serves on the
Board of ALS Canada and is past-Chair of the Canadian ALS Clinical
Research network.
Imen Kacem is the director of the ALS center in Department of
Neurology at Razi University Hospital. She is member in the ALS research
project and related syndromes in tropical zone (TROPALS). She won the
International Scholarship Award of the American Academy of
Neurology in 2017. She authored and co-authored many papers and
book chapters about ALS and CMT, such as Epidemiology of ALS and
Clinical Features of ALS in Africa.
Aqdas Kazi MBBS, MRCP, CCST (Palliative Medicine), is a consultant
in Palliative Medicine at Shifa International Hospital, Islamabad. After
MRCP and completion of four years of Specialized Registrar train-
ing, she received the Certificate of Completion of Specialized Training
in Palliative Medicine from the Royal College of the Physicians of the
UK. After working at Singapore General Hospital with the hospital
based palliative care team, she established the Palliative Care Unit at
Shifa and is the lead for Home Based Palliative care. She teaches
medical staff and has been an active advocate for Palliative Care at the
national level.
Satish Khadilkar is one of the first few Indian neurologists to pursue the
subspecialty of neuromuscular disorders, nationally and internationally.
He has been involved with a new clinical sign, sarcoglycanopathies and
dysferlinopathies and the gene in calpainopahties. He has over 130 publi-
cations to his credit and has written six and edited one book on neurology.
He has been trustee and secretary of the Muscular Dystrophy Society and
National Vice President of Multiple Sclerosis Society of India. He was the
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 "The thought of it made Mother so happy!" said Robin,
with animation. "Perhaps our going makes her all the
happier now, for Mother may be watching us still. I do not
like to think how much trouble I gave her, little
unmanageable cub that I was!"

"You never gave her a tithe of the trouble that I did,"

remarked Harold regretfully; "but Mother had the patience
of a saint. If I ever do anything for my Master in the
mission field, I owe it—under grace—to her."

The rain after a while ceased, and passengers emerged

from below to have a sight of Greenwich, as Elizabeth's
stately old palace was passed. Suddenly the brothers were
surprised by a shrill, familiar voice behind them exclaiming,
"Dear me! Can it be! Yes, Harold and Robin Hartley! Though
almost grown out of knowledge!"

"Miss Petty!" cried both the brothers at once, turning

round to greet an old acquaintance whom they had not seen
for seven long years, yet whom they would have recognised
by her peculiarities had the seven been numbered thrice.

There stood the small, thin form, a little more shrivelled

and bent, there was the familiar face, a good deal more
wrinkled, but otherwise little altered. It was surmounted by
a bonnet almost as gay as that which, in Robin's childhood,
had diverted his attention in church by its gaudy wreath of
artificial flowers. There was exactly the same inquisitive
expression in the narrow slits of eyes, but the lashes had
become white, for eye-lashes are not so easily dyed as hair
on head or brows.

"Miss Petty, are you really going to India?" asked

Harold, with unaffected surprise; he had almost added "at
your age," but happily checked himself ere the words
passed his lips. Poor Miss Petty indulged herself in a dream
of perpetual youth, from which it would have been
discourteous to have awakened her.

"You wonder at my having the courage to cross the sea,

but you see I had a reason, a very particular reason," said
Miss Petty in a confidential tone, which she was fond of
assuming. "My dear friend, Lady O'More—you have of
course heard of Sir Patrick O'More—very distinguished man
—in high command—had to leave her only child in England
last year, on account of measles or mumps, or something of
the catching kind of illness. Now Lady O'More wants to have
her Shelah with her—such a fond mother, you know; and
she could not trust the darling to anyone but me, so I
consented, as guardian, you understand, to my dear
friend's child, to take her under my care as far as Bombay."

The Hartleys did not inquire whether the friendship, now

first heard of by them, was a mere formal correspondence
concerning what was really a simple matter of business,
Miss Petty, for a consideration, undertaking to play the
nurse to a baronet's child. If they guessed this, their guess
was not far from the truth, for Miss Petty was so much
accustomed to exaggeration, to giving out fiction as fact,
merely because she wished it to be so, that her mind had
gradually lost all power to discriminate between false and
the true. As some persons have no sense of smell, so had
she none of the delicate spiritual perception of—and disgust
at falsehood, possessed those of sensitive conscience. Miss
Petty had not the warning of danger which such perception
bestows.

"But what are you going to India for?" inquired Miss

Petty, looking up curiously at the tall, graceful, intellectual
man whom she had known in his boyhood and early youth.
 "I am going out as a missionary," was Harold's reply.

"Oh, dear! What a pity! You might have done much

better in England!"

"I do not think so," said Harold.

"I am certain of it," cried Miss Petty. "I saw in the

'Times' that you had taken honours, and come out a double
First. You might in time have been a Lord Chancellor, or a
Lord Mayor, and have ridden in your carriage and four.
Missionaries are as poor as rats, no one thinks anything of
them, they ain't in society, you know! You would have done
ever so much better for yourself, had you remained at
home."

Harold answered with a smile, "I am quite contented

with my lot."

"Well, well, you'll repent of your choice one of these

days. But what on earth is taking you across the sea,
Master Robin? You ought to be learning Greek and Latin at
home. You're not fledged; you can't fly about the world as a
missionary yet."

"No," laughed Robin, "I'm a callow downy nestling; but I

can hop about a little, and I hope to fly when my feathers
are grown."

"What can you do?" persisted Miss Petty, who had

seated herself on a bench by the bulwarks, prepared for
what she called a good long chat with old friends.

"Not much, but I can do something," said Robin, good-

humouredly. "I can make a box, pack it, and carry it; groom
a horse, shoe it, and ride it; act as clerk or medicine
compounder; cut down a tree and light a fire; cook a dinner
and eat it, and make myself useful to my father and brother
in a general sort of way—at least I'll try to do so."

"But all that won't bring in a penny," observed sage

Miss Petty.

"You know that when a piece of machinery is packed up

in a box to go some distance, one sticks in little odd items
to fill up the crannies and corners, to keep the instrument
from being shaken by the jolts on the journey. My brother is
the machine, and I—well, I'm one of the odd items to keep
him safe and steady," said Robin, gaily.

"You won't like India," observed Miss Petty, shaking her

head; "no more shall I, but I don't mean to stay in it long. I
hear that snakes, scorpions, cockroaches, and mosquitoes
are as plentiful as the blackberries on our hedges, and you
feel like a leg of mutton being turned round on a spit before
a big kitchen fire!"

Robin laughed so merrily at this description of the

miseries before him that his mirth was infectious. "I can't
enter into the feelings of a leg of mutton in such a
predicament," he cried.

"Ah! Master Robin, you were always fond of joke," said

Theresa Petty; "but you'll find life in India no joke, I warrant
you. Besides, I can never make out what missionaries want
to do with those dirty blackies. Not that I know much about
them; I never saw one but that wretched creature whom
my cousin brought home as a bearer."

Every trace of mirth vanished from Robin's face in a

moment. "You must not—you shall not speak so of dear
Prem Dás!" he exclaimed. "Do you not know that he was
converted, that my father baptised him, and that he lived
Christ's true servant?"
 "And died Christ's faithful martyr," was added in
Harold's deep rich voice, but in a tone almost too low to
catch Miss Petty's attention.

"Oh! You need not fire up, Master Robin; you were not
always so very fond. I've heard that one day when you
found the idiot praying to a plaster-of-Paris figure, you
kicked him as you would have kicked a dog."

"I was a dog when I did so!" exclaimed Robin

passionately. "And you do ill to bring up against me an act
of childish brutality, of which I shall repent to my dying
day!" The youth fiercely strode away to a distant part of the
deck, his heart boiling over with anger.

"I see that Robin has lost none of his pepper and
mustard," observed Miss Petty in a testy manner; "he never
knew how to treat a lady."

"A more courteous, generous-hearted fellow never

existed!" exclaimed Harold, almost as indignant as his
brother, though he had much more command over his
feelings.

"Ah, well! Ah, well! I can't sit gossiping here now, I

must go and look after my Lammikin!" cried Miss Petty,
rising, and then shuffling towards the companion ladder
which led down to the saloon and cabins below. Harold
heard her muttering to herself, "None lose their tempers as
soon as your saints!"

The old lady had some difficulty in descending the steep

steps, for the "Alligator" was beginning to heave up and
down, as the ship was nearing the Nore.

Miss Petty made her way to No. 6, the number of her

cabin, after blunderingly looking into 4 and 5. She was
never clever at finding her way. On pushing back the sliding
door of her cabin, she saw her young charge seated on the
floor, happily engaged in eating toffy.

Shelah O'More was a child of about five years of age,

with fiery red hair and a freckled face. Her nose had an
inclination to turn upwards, to counterbalance which the
corners of her mouth had a tendency to turn downwards
when anything aroused the little girl's ire. Shelah's mouth,
however, looked good-tempered enough at the moment, for
it was full of the sweets which bedaubed her lips with
brown, while her treacle-covered fingers had left an
unbecoming smudge of the same on her saucy little nose.

"You dirty young pup! I'm ashamed of you! You're not

fit to be seen!" exclaimed the guardian of the baronet's
child. "Have you gobbled up all your toffy already?"

"No," replied Shelah, speaking indistinctly and with

difficulty, on account of the sticky lump which she was
serenely sucking. "I've put what's left in that thing," and the
brown-smeared, thick-tipped finger pointed to Miss Petty's
new yellow satin workbag.

"Oh! You mischievous monkey; you—you—" And poor

Miss Petty made a dash at the bag, which Shelah did not
surrender without a struggle. Miss Petty then opened it, and
found reels of cotton, bodkin, needle-case, scissors, and
thimble, all sticking together in most unlovely union, her
exploration only ending in her soiling her own fingers, and
utterly losing her temper. The guardian caught hold of
Lammikin by the shoulders and gave her a hearty shake,
which vigorous action produced a loud roar which
resounded over the ship.
 This was the first, but was not to be the last struggle
between the guardian and her Lammikin charge.

CHAPTER II.
CONTRASTS.

ROBIN, after a brief rapid striding up and down deck,

returned to the side of his brother. The youth was flushed
and excited.

"Harold, if that woman tack herself on to us during all

the voyage, what shall we do?" he exclaimed.

"Bear and forbear," was the quiet reply.

"That's easy enough for a calm, self-possessed, sensible

fellow like you, but not so for me!" cried Robin. "Of all
things on earth, what I most dislike is an elderly butterfly,
with dyed hair, and a mischief-making tongue."

"A species unknown to entomology," observed Harold.

The remark brought a smile to Robin's downy lip, and so

almost restored his good-humour.

"I am afraid that we shall have a very disagreeable

voyage," said Robin, "and the worst of it to me is—that I am
to blame for all that we may have to bear."

"How so?" inquired his brother.

 "If I had not been in such a desperate hurry to join our
father and begin our work, we would never have embarked
in this 'Alligator.' Instead of waiting till the proper month,
October, I was eager to start in August."

"I was your partner in that piece of folly," said Harold.

"Then it was your kindness to me that made you choose

a vessel for cheapness rather than for anything else, so that
what would have taken you to India comfortably had you
travelled alone, might cover the expenses of two."

"If I thought that my boy's company would more than

compensate for petty discomforts, this second piece of folly
must be entered entirely on my side of the account," said
Harold, looking with a loving smile on his brother.

"I am afraid that we shall have more than petty

discomforts," observed Robin; "one can laugh at trials if
they are confined to rough fare, bad accommodation,
slower sailing, or such-like trifles; but one cannot be quite
indifferent as to the company which one keeps. Miss Petty
always puts one out of patience, and from what I have
heard and seen of the captain, I am sure that he is neither
a gentleman nor a Christian!"

"Dear old boy, I thought that you and I had resolved to

speak evil of no one," said the young clergyman.

"Ah! Broken resolutions! They vex me more than

anything!" cried poor Robin, throwing himself on the bench
which Miss Petty had vacated. Harold, more leisurely, took
his seat beside his brother. "You know, Harold, that we have
lately been studying together the life and character of St.
John, and I have been setting that loved and loving disciple
before me as a model, determined that I would, by God's
help, try to be in every thing like the holy apostle. New, I
have not been a day on board before I have flared up like a
fury, said bitter things, and thought more bitter, just as if I
were still just a foolish, passionate child."

"My brother," said Harold, and he intuitively drew nearer

to Robin as he spoke, "do you think that the Apostle John
was born a saint, or that he developed into a saint?"

"I think that he became one by living very very near to

His Lord, resting on His sacred bosom, and learning love
from close intercourse with Him who is Love itself."

"John seems to have been naturally of a fiery

disposition," observed Harold Hartley. "Christ gave to him
and his brother the title of 'Sons of thunder,' and it is
remarkable that it was the disciple whom we commonly
associate with ideas of gentleness and tenderness who
proposed to call down fire from heaven on an inhospitable
village."

"It is some comfort to know that even the beloved

disciple had human imperfections," said Robin, "as it
prevents our being utterly discouraged at our own. But,
Harold, some people, and good people too, think that they
can attain to perfection even in this life."

"It seems to me," observed the young missionary, "that

they do so by unconsciously lowering the standard of
perfection which God has placed before us. It is not even
St. John, but his Divine Master, whom we are to seek to
resemble. It is indeed only a growing likeness, such as was
doubtless seen in St. John; but would not the apostle, even
when almost ripe for heaven, have shrunk from indulging
such a thought as this: 'I am as good, as holy, as perfect as
was Christ, my Divine Master, when on earth'?"
 "John would have rejected such a thought as
blasphemous," exclaimed Robin. "St. John's words are, 'We
know that when He shall appear we shall be like Him, for we
shall see Him as He is.'"

"And this assurance of future perfection in the Divine

Presence made the apostle add, 'Every man that hath this
hope in him, purifieth himself even as He is pure,'"
remarked Harold.

Robin was silent for several minutes, and then observed

in a different tone, "It would have been much easier for me
to have kept my good resolutions, if I had not had Miss
Petty for a travelling companion."

"Do you think that her being in the same ship is a

matter of chance? Is it not possible that she may have been
made our fellow-traveller without any choice on our part, on
purpose to show us how imperfect is our patience, and to
give us an opportunity of improving it by practice?" Harold
smiled as he spoke, but his words were not uttered in jest.

"Then you think that intercourse with those whom we

naturally dislike or despise may be an actual means of
grace?" inquired Robin.

"Undoubtedly so, if we are enabled to conquer the

inclination to dislike and despise them," said Harold.

The conversation then took another turn. "If I can in the

least, judge of character by face, I think that there is one of
our fellow-passengers whom we shall like," observed
Harold, glancing in the direction of a lady, past middle age,
who—clad in deep mourning—was sitting on the other side
of the deck, engaged in reading.
 "What a beautiful chastened expression is hers!"
exclaimed Robin. "That is a face that can never grow old; it
has the stamp of heaven's loveliness on it. Do you know
who the lady is?"

"One of our people," replied Harold Hartley. "I was so

much struck by her gentle meek dignity when Captain
Gump spoke to her in his rough way about her luggage; her
mildness made me inquire about her. 'Mrs. Evendale' is
marked on her boxes, and I understand that the lady is the
widow of a missionary, and that she is going out to take
charge of some orphanage in South India."

"I shall try to sit next to her at table," said Robin; "one
could fancy Mary of Nazareth like our fellow-passenger,
allowing for the difference of costume, and the veil over the
dark braided hair, and the simple drapery of her dress,
makes even that difference less striking. The lady looks like
one chastened by deep sorrow—sorrow borne in calm faith;
one who has trod a thorny path, but with heaven's
brightness upon it."

"My informant told me that Mrs. Evendale is not only

widowed but bereaved of her children," said Harold. "She
received the tidings of the death of one son by a fearful
accident, when she was closing the eyes of the other."

"I wish that I could be as a son to her," said kind-

hearted Robin. "Mrs. Evendale reminds me a little of our
mother in expression, though not in feature and colouring.
Our mother was so fair, and Mrs. Evendale looks like a
daughter of Italy. Perhaps this fellow-traveller, such a
contrast to the other, may not have been sent to us by
chance."
 A sudden puff of wind blew away from Mrs. Evendale a
packet of papers which she had placed on the seat beside
her, and sent them careering over the deck. Robin sprang
up and gave chase to the fluttering leaves, glad of the
opportunity of doing some slight service to the widow who
interested him so much.

When the youth had picked up the last paper, he

courteously carried all back to their owner. The lady
thanked him in a voice which was melodious as music. Thus
began an intercourse between the elder and younger
traveller, which was to be fraught with consequences to
both, which,—could they have been foreseen,—would have
sent a strange thrill through their hearts. They now met for
the first time, but they were only to be parted by—but we
must not anticipate the rest of the story.

CHAPTER III.
BALKING THE BEAR.

THE "Alligator" had quitted the dock on a dull morning,

when the August sun had been dimly visible through
yellowish mist, and rain fell in a drizzling shower; but the
evening sunset was glorious, and as the vessel steamed
over the heaving waters of the Channel, rosy radiance fell
on Albion's chalky cliffs, crimsoned the clouds, and made a
pathway of light over the waves. The evening was one of
calm beauty; there was now scarcely a breeze to waft
slowly along the aërial islands which floated above.
 The brothers again stood on the deck watching the
changing aspect of the shore which they were quitting. After
a brief silence, Robin began the conversation.

"I don't want to give all my hours to idleness during the

voyage, though I have not, like you, Harold, made the eight
feet square of our cabin into a floating library of
commentaries, dictionaries, and grammars in languages
living and dead."

"A soldier must have his weapons and the workman his
tools," observed Harold.

"You are pretty well up in Urdu already, as you have

kept up that language since childhood. Of course you need
works in Persian and Hindi type. But I cannot understand
why you burden yourself with big Arabic books—Koran,
dictionary, and grammar—seeing that Arabia is not our field.
It seems to me like a soldier of the Victorian era loading
himself, in addition to modern weapons, with the cumbrous
ones used at the time of the Conquest."

"Hardly so," said Harold, smiling. "You must remember

that in India I shall be brought into contact with many
Mahomedans, and that Arabic is the sacred language in
which the Koran is written, which is used by all learned
men, of whatever nation, who follow the False Prophet.
What you look upon as a superannuated pike or battle-axe,
is the weapon now, as it has ever been, of educated
Mahomedans, whether met with in Palestine, India, Africa,
Arabia, or Persia. Arabic holds the same place with Orientals
that Hebrew and Greek do with us."

"My stupid head never took in much Greek," observed

Robin, "and of Hebrew I knew not a letter. I left all that
learning to you. I don't believe that I should ever manage
Arabic."

"You are very quick—much quicker than myself—in

acquiring language colloquially," said Harold. "In our
Continental tour, you put me to shame with your French; I
might have something packed in my brain, but yours was
always at the end of your fingers."

"Oh! That's a different thing," cried Robin, amongst

whose failings vanity was not to be reckoned. "One can't
help drawing in air when it's all around, one learns to drink
it as children drink, and to jabber a language even as they
do. But learning from big books is to me like pulling up
water from a very deep well; mine is too small a bucket,"
added Robin, tapping his own forehead, "it holds little, and
goes swinging about, dropping its contents before ever it
reaches the top. Do what you will, you can't make me into
an Arabic grammar, or a walking encyclopedia."

"Well, my boy, you said just now that you did not mean
to give the voyage to idleness; what are you going to learn?
You have already caught up a good deal of nautical
knowledge during visits to the coast, but may not be quite
qualified to manage a steamer."

"I did not mean that sort of thing," replied Robin. "I am
not going to apprentice myself to Captain Gump. I intend to
do something in the way of learning by heart. I might
commit to memory the First Epistle of St. John."

"You would possess yourself of a treasure."

"One ready to be used on every occasion, when a book

is not at hand," observed Robin. "I want to drink in the
spirit of St. John, and if his works are in my memory and
heart, they will intuitively come to mind when I am going to
give way to some fit of temper; they may,—don't you think
so?—act as a kind of restraint?"

"'Thy Word have I hid in any heart, that I sin not

against Thee,'" said Harold. "Your design is good; I will try
to learn the same portion of Scripture in Arabic."

"It would never seem the same as in the dear mother

tongue," observed Robin; "but perhaps it is foolish to think
so; the Epistle was, of course, not first written in English.
Harold, there's another thing which I want to ask you. Don't
you think that you, as a clergyman, could do something for
the sailors and our fellow-passengers here?"

"That thought has been in my mind all day," replied

Harold; "I have been waiting for an opportunity of speaking
to Captain Gump on the subject."

"There he is," said Robin. "Does he not look like a bear

standing on his hind legs, or a chess-castle wrapped in a
shaggy brown coat? I'm afraid, from what people say, that
you'll not find him an easy customer to deal with. He is not
like one of the pleasant, gentlemanly men usually chosen to
command passenger ships. He must be an adept in ill
manners to have shown rudeness to Mrs. Evendale, as he
did this morning."

The appearance of Captain Gump was certainly not

prepossessing. In stature he was almost dwarfish; but he
made up in breadth for want of height, being a remarkably
powerful man. The captain's face was blackened by
superabundant hair, which seemed to be always of three
days' growth; no one could remember having seen him
clean-shaven, even on a Sunday, and the captain's black
bristles, like the porcupine's quills, had a "touch-me-who-
dares" appearance about them.
 When Harold walked up to the captain with a courteous
"Good evening, sir," the commander of the "Alligator" only
returned the greeting with a grunt. Captain Gump had
taken a dislike to Harold from the minute that he saw the
young clergyman step on deck, partly because Hartley was
a missionary, partly because of his height, for Gump bore a
grudge against any man who happened to be a foot taller
than himself.

"I wish to say to you, sir," said Harold, politely, "that if

you propose to have services on board your ship, as there
seems to be no minister on board but myself, I shall be
most willing to conduct them."

"I propose no such thing," was the blunt reply; "this is a

vessel, and not a Methodist chapel."

"But I think—"

"I don't care what you think," interrupted the bear.

"Who are you, that you want to bring your preaching and
prosing here?"

"I am a missionary," was Harold's reply.

"One of those amiable idiots who expect to wash

blackamoors white," growled the captain; "not even a
reg'lar parson."

"I am in orders," said the young clergyman, who was

slightly nettled by the remark.

"Orders! What are your orders to me? There are no

orders here to be obeyed but mine;" the captain
emphasised his words by giving a slight stamp with his
broad, heavy foot. "And we don't want no Jonahs here; I've
read enough of the Bible in schooldays to know that the first
'un with his preaching nearly sent a ship—crew, cargo, and
all—to the bottom o' the sea. I won't have that sort of thing
in my vessel," added the captain, with a profane oath.

"'Thou shalt not take the name of the Lord thy God in
vain,'" said Harold, sternly.

"Did you ever hear the story of the 'cute captain who
made his Jack-tars obey him without so much us a touch of the
cat?"
cried Robin.
 Gump looked as if he were going to spring at the man
who had dared to rebuke him on his own deck, and in the
presence of others, for the swearer's loud voice had drawn
some listeners to the spot. Robin saw the storm brewing,
and with his quick wit managed to act as a lightning-
conductor ere the fierce captain's fury had time to burst.

"Did you ever hear the story of the 'cute captain who
over-reached his Jack-tars, and made them obey his will
without so much as a touch of the cat?" cried Robin.

"Hold your tongue, boy," rudely growled the captain.

But Robin was not to be silenced when he had a good

story to tell, especially when he had an object in telling it.
He put himself between his brother and Gump, and went on
with what the captain thought effrontery quite astounding.

"The captain was new to the ship, and the crew were a
rough lot, a very rough lot, you see. So the captain got
them together, and made a kind of short speech; perhaps
you did so to your salts, though not such a very odd speech
as was made by that very eccentric captain."

Even Gump's curiosity was slightly aroused; he was

much more given to cursing and swearing than to making
speeches, but he had spoken a few words to his men when
assuming command.

"The captain said," continued Robin, "'My hearties, I've

a favour to ask of you all.'"

"Ask a favour of his own tars! What a muff he must

have been!" muttered Gump.
 Robin went on with animation, as if unconscious of any
interruption, or any probability of giving offence. "'Then,'
said the captain, 'I ask you to let me swear the first oath on
this ship.'"

"Not much to ask," said Gump, with a grim smile.

"Oh! But it was something," cried Robin, "for of course

the tars agreed to do what the captain wished, and as he
never swore the first oath, they had no chance of swearing
at all!"

Captain Gump's anger, as Robin intended, was now

turned upon him instead of his brother. The swearer was all
the more provoked because some of the hearers laughed at
the story, and glanced at him to see if the arrow had hit the
mark. Gump began in a loud, fierce tone, "You're a young
Jack-a—"

But Robin gave him no time to finish the sentence,

adroitly ending the title in a way not intended by Gump—

"Jack of all trades, yes, that's what folk call me; and
here is one of my tricks!" And with the agility of a cat, the
youth sprang at one of the ropes of the ship, clambered up,
and was looking laughingly down from the shrouds before
Gump had sufficiently recovered from his surprise at the
sudden feat to be able to utter a word.

Shelah O'More clapped her hands, and Miss Petty

exclaimed:

"Robin was always climbing; he'll break his neck one of

these days."

"The sooner the better!" grumbled Gump, as he walked

to another part of the deck; but he spoke with a grin on his
face. He could not refrain from a chuckle, Robin had so
utterly taken him by surprise, and when an angry man has
once been drawn into a laugh, or anything like it, it is
difficult to him to resume his ill-humour.

Robin, having accomplished his object, swung himself

down by a rope and rejoined his brother.

"Suppose that we enjoy the quiet of the saloon below,

and leave the captain's red-heat time to cool down," said
Robin playfully to Harold.

The brothers accordingly went below, and sat down to a

game of chess. Harold gave grave attention to the game
and won it: he was of a calm, self-possessed nature now,
though fiery in earlier youth; but the excitement of the
scene on deck filled Robin with mingled indignation and
mirth, distracting his thoughts from the board. Robin moved
his castle as if it were a knight, jumping over the heads of a
couple of pawns, and captured his own queen by mistake in
a very triumphant manner.

"Chess is too dull and sober a game for me!" exclaimed

Robin, starting from his seat when Harold gave the
inevitable checkmate; "I always feel inclined to go head-
over-heels when I'm done, to recover from the strain of so
much thinking!"

CHAPTER IV.
A BATTLE, AND ITS RESULT.