Dominic Corrigan.
The third of the great trio of the founders of the Irish School of Medicine is Sir Dominic John Corrigan, whose name will be forever associated with the form of pulse which occurs in aortic heart disease. It was his supreme merit to have been the first to describe in all its details this type of heart disease, and the distinguished French clinician, Trousseau, declared that aortic regurgitation should be called Corrigan's Disease. At this time Trousseau was deservedly [{201}] looked up to as the leading spirit among the clinicians of Europe. He was never tired of commending to his students Corrigan's acute clinical observations, and insisted that it was work of this kind which assured real progress in medicine. Trousseau's suggestion as to nomenclature was not adopted in its entirety, but Corrigan's pulse is well-known all over the medical world, and there is no doubt now that it will continue for many generations to confer deserved honor on the man who first appreciated its full significance though he was not the first to recognize it--and indeed it could scarcely escape notice--but who showed just what diagnostic conclusions might be reached from it.
Corrigan's career should prove a stimulating example to the young physician just taking up that real post-graduate work in medicine which comes after he has received his degree, finished, perhaps, his hospital work, and is beginning his practice. Corrigan was only twenty-seven when he began the series of observations on which was founded his paper on aortic heart disease, which was published when he was about thirty. In this matter of youthful accomplishment, Corrigan is not alone among his distinguished Irish contemporaries. Stokes, it will be remembered, wrote his little book on the stethoscope when he was only twenty-one and had made some very important observations on disease of the chest before he had reached the age of thirty. Graves had showed very clearly the sound metal of his intelligence before he was twenty-five, and had described the cases of the nervous disease which have since come to be called after his name, Graves' disease, before his fourth decade had run more than a year or two. In fact these young men accomplished so much by their careful observation and dependence on their own resources that the medical writer of the modern times is tempted to wonder if perhaps that most precious [{202}] quality of the human mind in the young adult, its originality, is not obscured by the amount of information that it is expected to absorb before it is tempted to do any thinking for itself.
There is another remarkable feature of Corrigan's achievement, in the recognition and description of this form of heart disease. At the time he was the physician to a hospital which had only room for six medical patients. This appointment to the little Jervis Street Hospital in Dublin had been secured only after competition, and Corrigan had to pay for the privilege of being the attending physician. This he could ill afford to do at the time, and so he resolved, as he told a friend, to make all his opportunities for the study of patients count to the greatest possible extent. He did not visit his hospital merely to see patients, but to study the cases carefully. His success is only another example of the necessity for seeing much, and not many things, if there is to be any real progress. In our day, physicians scarcely consider that they have any hospital experience unless they are the attending physicians to several hospitals, seeing at least one hundred patients a week. The result is that patients do not receive the skilled care they should, and that advance in medicine suffers because of the wasted opportunities for clinical observations while a busy attending physician rushes through a ward and the resident physician has only time for the routine work that enables him to keep just sufficiently in touch with the progress of his cases to satisfy the hurrying chief.
Before publishing his classic paper on the Permanent Patency of the Aortic Valves, on which his reputation as a wonderful clinical observer in medicine rests, Corrigan had called attention to some mistakes in the classification of heart murmurs as made by Laennec in Paris. At this time Laennec was considered to be the best authority in Europe [{203}] on diseases within the thorax. As regards diseases of the lungs, he well deserved the reputation. To him the medical world owes all that it knows about diseases of the chest, as far as these can be detected by means of the ear. His young contemporary in Ireland, however, was able to show that in diseases of the heart some of the ideas acquired in long years of study of the lungs were leading Laennec into false conclusions as regards the significance of murmurs of the heart. Even genius does not succeed in doing more than one thing well, and especially in the matter of taking a second step into the unknown. While the distinguished Frenchman might have been thought just the one to complete the work he began so well on the heart, and while his experience with the lungs might have been expected to help him in the recognition of the significance of heart murmur, this did not prove to be the case. The privilege of solving the mystery of heart diseases was to be left for his Irish contemporaries, one of the most successful of whom in this matter was Corrigan.
Anyone who wishes to see how little subsequent study has added to our knowledge of aortic disease should read Corrigan's original paper on this subject. He describes all the varying forms of affections of the aortic valve, with their various clinical manifestations. His paper is illustrated by a set of plates that would still be valuable for demonstrative purposes, and which serve to show how painstaking were his pathological studies. He illustrated experimentally his ideas of how the murmurs and thrills occur by means of an apparatus consisting of rubber tubes through which water might be allowed to flow under pressure, and varying calibre. Some of his conclusions, derived from experimental observations, will not stand the test of our modern knowledge, but they are very suggestive. Perhaps the best idea of the clinical [{204}] value of Corrigan's observations can be given by a quotation from his original paper, in which he discusses the interesting and difficult question of the relationship between aneurism of the aorta and inadequacy of the aortic valve. He said:
"The two diseases, aneurism of the aorta and inadequacy of the valves, may, however, be combined. Aneurism of the ascending aorta may, by extending to the mouth of this vessel, dilate it so that the valves are unable to meet, and there is then a combination of the two diseases; there is aneurism and there is permanent patency of the aortic opening. The first cases that came under my observations presenting the signs of inadequacy of the aortic valves were cases in which the valves were rendered useless in this way, namely, by the mouth of the aorta sharing in the aneurismal dilatation. These cases led me into an error; for, meeting the signs of permanent patency of the aortic orifice in conjunction with aneurism, I erroneously attributed to the aneurism the signs which arose from the permanent patency. Aneurism of the aorta of itself does not produce the signs arising from permanent patency of the mouth of the aorta. It can only produce them in the way already described, by involving in the dilatation the mouth of the aorta; and hence, when in conjunction with an aneurismal tumor of the arteria innominata or aorta, there are found visible pulsation, bruit de soufflet, and frémissement in the ascending aorta, and the trunks arising from it, we may be certain that, in addition to the aneurism, there is a defect in the aortic valves, or that the aneurism has extended downward, involving the mouth of the aorta. On the other hand, if these signs be absent, the valves are sound and the mouth of the aorta is not included in the disease. The propriety of performing Mr. Wardrop's or indeed the common operation for aneurism about the neck might depend on the information [{205}] thus obtained of the state of the aortic valves. To perform either in a case where the aneurismal dilatation was so extensive as to involve the mouth of the aorta, or where the aortic valves were diseased, would only bring the surgical treatment of the disease into unmerited discredit."
Another very distinct contribution of Corrigan to the medicine of his time was his insistence on the distinction that exists between typhoid and typhus fever. This is one of the most interesting features of his little book on the Nature and Treatment of Fever. With our present knowledge, it seems hard to understand that these two fevers should have been so long confounded, but as a matter of fact it was not until the middle of the nineteenth century that the distinction between them was recognized even by the most acute observers. In this matter the French and Americans anticipated most of the rest of the world, though Corrigan's teaching in the matter had been correct for many years before others in the British Isles came to the true position.
It was his work among the poor particularly that enabled Corrigan to recognize the differences between these two diseases. He came to have one of the largest practices that any practitioner in Dublin, or for that matter in any city of the world, has ever enjoyed, if enjoyment it can be called. His office used to be crowded with patients who would occupy all his time if he allowed them to do so. In order to secure opportunities for his other work, for his lectures, for his hospital visitation, and for his pathological investigation, he had a back entrance to his house through which he could steal out--even though there were many patients waiting for him--when he felt that it was time for him to fill another engagement.
Late in life, after his return from Parliament when he took up his practice again, it was only a very short time [{206}] before the same state of affairs developed once more. It almost seemed as though every sick Irishman and Irish woman wanted to have the opinion of Dr. Corrigan. He had also a large consultant practice, though he was known for being a very different man from the ordinary type of the medical consultant. As one of his younger colleagues said, "he never wore the supreme air of a consultant." He was always simple and easy in his manner, was always congenial and ready to listen to what had developed and had been found in the case before consultation with him, and had none of that superciliousness that was supposed to characterize the true high-grade consultant physician in the British Isles a half a century ago.
Within a few years after his essay on aortic heart disease, Corrigan published a paper on chronic pneumonia or, as he called it, cirrhosis of the lungs. Corrigan's successful achievements in medicine depended mainly on the fact that he studied the pathological anatomy of fatal cases with the greatest care. He had detected that in certain cases of chronic pneumonia the process seemed to be quite different from tuberculosis. Observations made postmortem showed that his clinical observations were justified by the differences observed in the organ. As a result he formulated his opinions on the subject. He called particular attention to the fact that what he found corresponded very closely with the pathological process which had been observed by Laennec in the liver, and to which the French medical pathologist had given the name of cirrhosis. It would seem as though the pathology of the time was so crude that Corrigan must surely fall into serious errors in his account of what he saw. Twenty years later, Virchow was to revolutionize pathology by the publication of his "Cellular Pathology." Notwithstanding the progress made since his time, [{207}] however, Corrigan's description of the condition of the lungs that he noted and of the pathological process observed is so true that even to the present day this paper remains of distinct value in medicine and represents the beginning of correct ideas on the subject.
After Corrigan's death in 1881 the London Lancet said: "In the light of recent pathology Corrigan's speculations on cirrhosis of the lungs are more meritorious than ever and continue to be regarded as in the main sound. They anticipated by forty years much of the present pathology." Needless to say it is only a genius of a very high order that is thus capable of rising above the limitations of environment, and in spite of the defective knowledge of his times observing correctly and drawing proper conclusions, though all the usual accepted principles would seem to be sure to lead him from the truth. The principal lesions of chronic pneumonia, after having been the subject of much disputation, with conclusions now one way and now another in the intervening years, are at the present time recognized as being essentially due to the pathological processes Corrigan originally pointed out.
The man who thus made a permanent place for himself in the history of medicine was the son of a poor shopkeeper in one of the outlying districts of Dublin. His early education was obtained at Maynooth College, which had at that time a department for the training of youth for secular vocations, though it has since become an exclusively clerical institution. It is needless to say he acquired an excellent knowledge of the classics, of which he made abundant use later in life, and of which he was always very proud. The physician in attendance at Maynooth in his time took quite a liking to him, and it was the result of his suggestion that Corrigan took up medicine as his profession. For a time [{208}] he was under the tutelage of this Doctor O'Kelley, who seems to have been a very intelligent man, and a rather painstaking clinical observer. Most of his medical studies were made in Dublin and he attended the practice at Sir Patrick Dun's Hospital. It was the fashion at this time, however, for Irish students of medicine to finish their medical education at Edinburgh, whenever possible, and Corrigan spent several years there, receiving his degree of Doctor in Medicine in 1825.
He had attracted considerable attention in Edinburgh for his acute powers of observation, and received an appointment to the Meath Street Dispensary shortly after his return. From the service here he was appointed to the Jervis Street Hospital. He had to pay, however, for the privilege of being attending physician here, and this, as he said, made him more careful in endeavoring to secure all the advantages possible from his service.
After his publication of the article on "The Permanent Patency of the Mouth of the Aorta," or "Inadequacy of the Aortic Valves," he at once became recognized as one of the best clinicians in the city. This article appeared, in April, 1832, in the Edinburgh Medical and Surgical Journal, at a time when, as has been said, its author was not yet thirty years of age. As soon as he began his work at the Jervis Street Hospital, he gave a course of lectures, and as he was an excellent talker and a good demonstrator, he at once attracted a large class. In 1834 he joined Hargrave's School, in Digges Street, Dublin, as lecturer on the practice of medicine, and continued to hold the position for more than ten years. His success as a lecturer attracted many students from the other medical schools. Corrigan's class was often three times as large as that of other medical lecturers in the city. It not infrequently happened that as a result of his [{209}] popularity the medical class was two or even three times as large as the surgical and anatomical classes at the same institution. This was very unusual, for Dublin was famous for its anatomical instruction, and there were often five times as many pupils enrolled in the anatomy classes as in the medical classes.
It was not long before honors began to be showered upon Corrigan. When he was about forty the diploma of the London College of Surgeons was conferred upon him, and, as according to the by-laws of the institution the diploma can only be conferred after examination, Corrigan's examination was made to consist of the reading of the thesis, "Inadequacy of the Aortic Valves," before the faculty and the other members of the college. In 1849 the University of Dublin conferred upon him the degree of M.D., honoris causa.
There was only one setback in Corrigan's medical career in Dublin. When first proposed for honorary fellowship in the Irish College of Physicians, he was rejected. The reason was entirely apart from medical matters. Corrigan was the most active member of the Irish Board of Health, which had charge of the famine cases in Ireland, during the awful years between 1845 and 1850. This Board proposed to allow about five shillings per day to physicians who would be sent to the country to attend famine fever cases. It is easy to understand that this remuneration was considered inadequate and the Board's decision in the matter raised a storm of protest. Graves wrote very bitterly with regard to it, and blamed Corrigan for any part he might have had in it. The result was that for some time Dr. Corrigan was the most popularly hated physician in the medical profession of Dublin.
Corrigan made, up for any lack of tact he might have had [{210}] in this matter, however, before long, and in 1855 he obtained the license of the college. Two years later he was elected a Fellow. Before another two years had passed he was elected President of the College, and had the unprecedented honor of being re-elected four years in succession. The college further made up for its offense by having a statue of Dr. Corrigan, by the famous Irish sculptor Foley, made for its hall while he was still alive.
His own self-sacrificing work during the famine fever years was well known. After he had achieved nearly every distinction that his brother physicians could confer upon him, he was created a baronet. It was understood that this distinction was mainly meant as a reward for his services during the famine, though also for the time which he had so unstintedly given to the improvement of national education in Ireland, in the capacity of a Commissioner of Education.
Not long after his creation as a baronet, Sir Dominic stood, in Dublin, for a seat in Parliament in the Liberal interests. At first he was unsuccessful. In 1869, however, he was returned as one of the members of the government and sat in Parliament for five years. As he was a very eloquent speaker, it was thought that he would produce a very distinct impression in Parliament. His type of eloquence, however, did not prove to have any special influence in the cold British House of Commons, though Sir Dominic was always looked upon as one of the men to be counted on whenever there was under consideration legislation that affected Irish interests.
He was defeated for re-election in 1874, but it is rather to his credit than otherwise, since he had been approached by the vintners of Dublin, who were at that time all-powerful in municipal politics, and offered the membership, provided he would agree not to actively support the Sunday Closing [{211}] Bill, which was to come up at the next session of Parliament. Such an agreement Sir Dominic absolutely refused to consider as consistent with his legislative honor, and the result was the close of his Parliamentary career.
His years in Parliament, however, did not separate him from his interests either in medicine or in general science. He continued to be especially interested in zoology and made liberal contributions to the Dublin Zoological Garden. His residence at Dalkey, the grounds of which ran down to a rocky coast line, enabled him to obtain many specimens for his aquarium, and these were often transferred to the Dublin Zoological Gardens, for which he was one of the most active collectors. It was his custom during his Parliamentary career, though he was more than seventy, to leave London on Friday night and reach Dublin about eight o'clock on Saturday morning. From the station he went directly to the Zoological Gardens and took part in the pleasant breakfast which the Council of Officers of the Zoological Society, with some invited guests, had there every Saturday morning. He was noted for his humor, and his presence at these breakfasts was always appreciated, because in spite of his advancing years he was sure to add to the pleasure of the occasion.
His friends feared that his Parliamentary career might prove a serious drawback to his health at his time of life, and their fears were not without foundation. He suffered severely from gout, which left its marks upon his feet and made it very difficult for him to walk for a time, and maimed him for all his after-life. Though a man who had worked very hard all his life and who, at the age of seventy, practically took up another career, that of politics, Sir Dominic lived to be nearly eighty years of age; thus illustrating the old aphorism that "it is not work but worry that kills," and [{212}] furnishing another example of the fact that great men are great also in their superabundant vitality, and are able to spend their lives in the hardest kind of work, yet, barring accident, live on to an age beyond even that which is considered the average term of human existence.
Few men have had happier lives than Corrigan, if the high esteem of contemporaries can ever confer happiness. There was no honor in the gift of his Dublin professional brethren or of scientific bodies in which he was interested which was not conferred upon him. He was the president of the Royal Zoological Society, the president of the Dublin Pathological Society, of which he was one of the founders, and the first president of the Dublin Pharmaceutical Society. When not yet fifty years of age he was made physician in ordinary to the Queen in Ireland, and had the unapproached record of five elections to the presidency of the King and Queen's College of Physicians in Dublin--more than enough to make up for the one serious setback in his medical career, his black-balling by the college only a few years before. Foreign medical societies invited him to honorary membership and foreign universities conferred many degrees on him.
It is easy to understand then that his death was followed by tributes of the loftiest character to his professional work, to his standing as an influential member of the community and as a man of the highest intelligence and thoroughly conservative patriotism. The London Lancet said in its obituary: "By the death of Sir Dominic Corrigan, the medical profession loses one of its most conspicuous members, the University at Edinburgh one of its most illustrious graduates, and the Irish race one of its finest specimens. Though a perfect Irishman, Sir Dominic was as much at home in London, and though a sincere Catholic in religion, he had [{213}] too much humor and too much humanity in his constitution to be a bigot. It were well for Ireland if all her public men displayed so much moderation, sense, and good humor as Sir Dominic habitually displayed in dealing with difficult and delicate questions."
About the same time the British Medical Journal said, after calling attention to the distinguished contemporaries with whom Corrigan had been associated, that he was "haud minimus inter magnos--not the least among the great ones." "Indeed," his biographer added, "in originality of conception which, confirmed by later and independent observation, is the true test of genius, in a correct appreciation of the operation of natural laws, in producing and modifying the phenomena of disease, in a rare aptitude for testing his hypotheses by actual experience, and in a forcible exposition of them, he probably had no equal among his contemporaries."
In the midst of all his honors and political influence, including association with the highest English officials in Ireland, Sir Dominic Corrigan had remained a consistent and faithful Catholic. Educated at Maynooth as a boy, he was proud to remain the physician to the college during many of the busiest years of his life when he must have often found it very difficult to spare the time to fulfil the duties attached to the position. He was the consultant physician till the end of his life. He is not even yet, after a quarter of a century, forgotten by the poor of Dublin, who recall his kindly help in affliction and his generous aid often given in ways that would be arranged with studied care so as not to hurt delicate Irish susceptibilities.
The Irish School of Medicine has in Graves and Stokes and Corrigan a greater group of contemporaries than has been given to any other nation at one time. If we were to eliminate from nineteenth century medicine all the [{214}] inspiration derived from their work there would be much of value lacking from the history of medical progress. These men were deeply imbued with the professional side of their work as physicians, and were not, in any sense of the word, money-makers. Another very interesting phase in all their careers is that no one of them occupied himself exclusively with medical studies. All of them had hobbies followed faithfully and successfully together with medicine, and all of them were deeply interested in the uplifting of the medical profession, especially in securing the rights of its members and saving poor sick people from exploitation by quacks and charlatans. All of them gave of their time, their most precious possession, for the political and social interests of their fellow-men, and felt in so doing that they were only accomplishing their duty in helping their generation to solve the problem that lay immediately before it.