107RETIREMENT OF SIR ALFRED KEOGH & APPOINTMENT OFHIS SUCOESSOR.

THE LANCET.

LONDON: SATURDAY, JANUARY 19, 1918.

The Retirement of Sir Alfred

Keogh and the Appointmentof his Successor.

THE retirement of Sir ALFRED KEOGH from theduties of Director-General of Army MedicalServices was announced at the beginning of the

week, its imminence having been an open secretfor some little time. Sir ALFRED KEOGH has-beenpermitted to resume his duties as General Execu-tive Officer of the Imperial College of Scienceand Technology and will be replaced at the WarOffice from March 1st next by Colonel T. H. J. C.GOODWIN, R.A.M.C. To Sir ALFRED KEOGH, on hisreturn to civil duties which are bound up in aninextricable and important manner with the con-duct of the war, one feeling will go forth, not onlyfrom his medical colleagues, military and civilian,and not only from all those officially concernedin the conduct of the war, but from every citizenof the Empire; and that feeling is made up ofprofound gratification for what he has done and ofadmiration for the way in which he has done it.

It is needless to recall the well-known story howthe universal conflagraticn found this country,with its colossal interests concerned indirectly,bound to support the equally colossal and directinterests of allied nations, but with land forcesimmeasurably too small to enforce the right uponthose who had wilfully scouted treaties and rushedinto a struggle for world empire. Recalled fromhis important civil post to the position which heoccupied during and after the Boer War, Sir ALFREDKEOGH took charge of the Army Medical Services athome, working in touch with Sir ARTHUR SLOGGETT,who went out to France as Director-General withthe British Expeditionary Forces. The immediate

responsibilities that fell upon Sir ALFRED KEOGHwere a mere prelude to those that followed. Thenumbers of the British Army, at first by splendidvoluntary effort and later by conscription of gradually increasing severity, were increased in twoyears by eightfold, while our military plans tookshape in Expeditionary Forces despatched foroffensive or defensive purposes to Mesopotamia,Egypt and Palestine, Gallipoli, Salonika, and lastly,Italy. In these gigantic developments it wasSir ALFRED KEOGH’s business to find the medicalofficers to take charge of the health of the

troops at home and on various fronts, and tocollaborate with the military authorities on ques-tions of supply, transport, hospital establishment,and hospital maintenance; and in no case waspast experience of medical activities in connexionwith real war able to afford a direct precedentfor the new work. For the changes and chancesof this war have been kaleidoscopic, and multi-farious have been the directions in which newfactors have come into being, or in which the

unimportant points of the past have been turned into _

the urgent considerations of the present. And beit remembered that these transformations did nottake place at separate intervals or in homologousregions ; they often overlapped in their dates andpresented problems asking for varying and some-times mutually contradictory measures. For threeyears and a half Sir ALFRED KEOGH has held

supreme position as adviser of the militaryauthorities in such circumstances of terrible weightfor the nation and of the deepest poignancy forhim whose counsel was demanded. The generalverdict throughout has been that he has borne theburden with unexampled courage and resourceful-ness ; that he has held the balance betweenthe rights of long service and the claims of

progressive learning with fairness ; and that everyquestion submitted to him, whether brought to hismind by the facts as they happened or officiallyintroduced to him by others in possession of thedetails, has been answered with a single eye to thewinning of the war. Humanity, business efficiency,consistency, and convenience have had their say inhis conduct of the post of Director-General of theArmy Medical Services, but none of them has everbeen allowed to interfere with the grand resolveheld by this nation that with the help of the Alliesthe war is to be won.

The appointment was announced in THE LANCETlast week of Colonel T. H. J. C. GOODWIN as DeputyDirector-General of Army Medical Services on theretirement of Sir M. W. RUSSELL. Colonel GOODWINreceived his commission in 1893, and is thereforejunior in rank and years to many officers overwhom he has been promoted. His appointment isdefinitely one ’of selection, and for our part wewelcome cordially the fact that this principle hasbeen acted upon. We feel, also, that those whoin this case may suffer a disappointment of per-fectly legitimate hopes will acquiesce in the feelingthat for responsibilities so onerous as those whichthe new Director-General must assume it was

necessary to appoint a head who had proved him-self by actual accomplishment during the conductof the war to be possessed of the necessary

qualities. We may be certain that Sir ALFREDKEOGH has expressed thorough confidence in theability of his successor, who brings to the newpost not only a fine general- record of previousservice, but special recommendations at this

juncture for placing him where his individualityshould tell. As long ago as 1897 Colonel GOODWINacted as staff-surgeon in military operations on

the North-West Frontier of India, where his serviceswere. specially mentioned and honourably recog-nised. During the present war his name has appearedin despatches, and decoration and promotion haveborne witness to the value of his energies; but inparticular, just as the United States are reachingthe position of active and effective cooperation withthe Allies, is it necessary to remember that to themedical and military authorities of the greatwestern republic Colonel GOODWIN is favour-

ably known. As Assistant Director of MedicalServices to the British Recruiting Mission in

America, he proved himself an effective instigator

108 A MEDICAL MAN AND A LADY SUPERVISOR.

of rapid and workmanlike preparation in the States sfor the huge medical task that lies immediately ]ahead. He showed himself both informing andtactful in the manner in which he approached our colleagues in the United States, being able to take the point of view of one who had worked on thefield of battle from the beginning, and who there-fore knew alike the value of what had been doneand the directions in which it was necessary thatin the future we should all do better. It is not theleast of Colonel GooDWIN’s recommendations to his

important post that he should have won the confi-dence, even the admiration, of the medical profes-sion in the United States, whence already is pro-ceeding to these shores and to France, the advanceguard of an army of healing and prevention.

In the time that is coming the share whichmedical science will have in winning the war and inminimising the losses to civilisation brought aboutthrough its grievous influence- will become moreobvious to the general public. Under Sir ALFREDKEOGH almost every aspect of medicine in con-

nexion with the war had to be realised by theimagination before ib appeared in fact, and had tobe considered while in a state of experiment beforeeffective administration could give shape to anyconsequent measures. But now, in the fourth yearof the war, scientific and clinical research are

going hand in hand with the daily labours of thefighting fronts, while the methods not only forarresting evil and alleviating misery at themoment but for obtaining the best after-results

among the injured material have become codi-fied and placed in a position to work them-selves out to better things. It will be ColonelGooDWIN’s magnificent task to carry on all thiscollated work with the zeal and absorption of thosewho have gradually brought it into being. He, likeSir ALFRED KEOGH, will have to hold the balancEbetween conflicting policies and discordant interestsand we may be certain that his endeavours will beunder the perpetual guidance of a resolute intenito win the war.

A Medical Man and a LadySupervisor.

A SOMEWHAT unusual case, and a very serious

one, of interference by a lady supervisor of an

Approved Society in a matter concerning a medicalpractitioner on the panel and his insured patientwas recently brought before the DenbighshireInsurance Committee by Dr. E. Moss, of Wrexham. The facts narrated by Dr. Moss on behalf of Mr.R. EVANS, a medical colleague practising, like

himself, at Wrexham, were as follows. A female

patient of Mr. EVANS was certified by him as

suffering from rheumatism and was in receiptof sickness benefit from her society accordingly.A lady visitor of the society reported the womanfor being out of doors late and her benefit was

suspended, but was afterwards restored upon herexpressing regret and promising amendment. Afterthis had occurred a lady supervisor had an

interview with her, and made a report to the

society which included the statement that " thepatient is supposed to be suffering from rheumatism,as appears on the medical certificate, but I findthat she is suffering from syphilis." Dr. Mosscontinued that the supervisor obtained an admissionof an act of immorality from the woman, andlearnt something from her which caused her toreport further that " symptoms of syphilis appearedat a certain time." She also made an exa-

mination of her breast and the upper partof her arms. As a consequence, presumably, ofremonstrance by Mr. EvANS, a medical refereewas requested later on by the society to exa-

mine the insured person with the supervisor’sreport before him, and he reported to theeffect that, in his opinion, she was not sufferingfrom syphilis, but that her condition was as statedby Mr. EvArrs. In the course of correspondencewith Mr. EvANS, in which the society gave neitheran apology nor any undertaking that such an

incident should not occur again, the society referredto certificates by Mr. EVANS subsequent to the firstone, in which he stated that the insured person was

suffering from psoriasis as well as rheumatism.To have mentioned this at the outset, the societyalleged, would have avoided the whole trouble,but Dr. Moss explained to the committee that

psoriasis was simply a skin disease, which, exceptunder certain conditions, would not involve in-

capacity for work. LTpon the facts summarised abovea motion to refer the matter to the Welsh InsuranceCommissioners was introduced by the chairmanand carried. It is to be observed that the seconder ofthe motion referred to the case as the first complaintagainst an approved society with which the Denbigh-

; shire committee had had to deal. In comment,; however, it may be pointed out that it is as grave a3 case of its kind as could well be brought forward. That the society should have instructed their super-,

visor to examine a medical practitioner’s patient inthe manner described is hardly conceivable, but if

t that lady exceeded her instructions, her conductdoes not appear to have been repudiated by heremployers. No doubt the Welsh Insurance Commis-sioners will give the matter their serious considera-tion ; but both the lady supervisor and the ApprovedSociety may be reminded that the statements made

by the former were gravely defamatory both of themedical man and his patient, that they were withoutfoundation, and that in the circumstances in whichthey were made it is, to say the least, doubtfulwhether in an action for defamation the com-munications would be held to be privileged.

I

THE LANCET, VOL. II., 1917: THE INDEX.

THE Index and Title-page to the volume ofTHE LANCET completed with the issue of Dec. 29this now ready. Owing to the increasing shortagein the paper-supply, the Index will not be issuedwith all copies of THE LANCET, as was the customprior to the War. Subscribers who bind up theirnumbers are requested to send a post-card tothe Manager, THE LANCET Office, 423, Strand,London, W.C. 2, when a copy of the Index andTitle-page will be supplied free of charge.

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