Makers of Modern Medicine

by James J. Walsh

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.