SIR DOMINIC JOHN C O R R I G A N *

B y RISTE_~RD MULCAHY T is my pleasure and privilege to address you tonight about Sir Dominic J o h n Corrigan, P a t r o n of this clinical group and one of the most illustrious names in the annals of Irish medicine. Time allows me only a very limited discussion of Corrigan's career and achievements, and I have therefore decided to confine m y remarks to two important aspects of his life. Firstly, I should like to attempt a careful analysis of his best known and greatest contribution to medicine on the subject of aortic incompetence (Corrigan, 1832), and, secondly, I should like to say a few words about the man himself and about his impact on medicine and on the social and political developments in Ireland d u r i n g the 19th century. I shall first r e f e r to his classical publication on aortic incompetence. I am doing so because I believe Corrigan's initial and chief claim to fame rests on his article on permanent patency of the mouth of the aorta and I believe that the originality of the contribution has been questioned often enough to leave misgivings in all our minds about its true worth. I am sure that, without the reputation he acquired after the publication of this article, Corrigan's name would be little known in medical literature, and this Club would undoubtedly find itself dedicated to a different patron. It is most important therefore that we in the Corrigan Club should have a clear idea of the worth and originality of his famous monograph, and it is with this object that I hope to put to you the results of my recent enquiries. " On permanent p a t e n c y of the mouth of the aorta, or inadequacy of the aortic valves " is a monograph extending over t w e n t y pages and of about ten thousand words which was published in the Edinburgh Medical and Surgical Journal, Volume 37, on 1st April, 1832, when Corrigan was 30 years of age. He begins the monograph by stating that, to his knowledge, the disease under consideration had not been described before in any works on heart disease. This statement suggests to us that he was unaware of the publications on this subject by William Cowper (1705), Raymond Vieussens (1715) and James Hope (1831) amongst others, and that he was not familiar with the two addresses given by Hodgkin to the Hunterian Society in London in 1827 and 1829 and subsequently published in the London Medical Gazette (1829). Corrigan describes the pathology of the disease fully and with care, including in his description the four important types of valvular anomaly, viz., cribriform or patchy defects in the cusps, r u p t u r e of a cusp, shortening and thickening of the valve leaflets and, finally, gross dilatation of the aortic ring. These observations on the pathology of the disease were by f a r the most complete and accurate at the time. A brief and relatively unimportant reference to symptoms is followed by a careful appraisal of physical signs :

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*An Address delivered to the Corrigan Club at the Royal Victoria Hospital, Belfast, on March 3, 1961. The Corrigan Club, which first met in 1960, was founded by a group of physicians from various parts of Ireland, principally from Belfast and Dublin.

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He dwells at length on the visible pulsation of the large vessels of the head and neck, and he properly attributes this increased pulsation to the large stroke output of the left ventricle followed by the retrograde flow during diastole. He notes the well-known effect of posture on the pulse and explains the genesis of this phenomenon. It is interesting and perhaps a little confusing to the modern reader when Corrigan states that the pulsation is synchronous with the diastole of the vessel, a legitimate use of the word diastole, but one which has now become obsolete. Corrigan only refers en passant to the palpable jerky pulse of aortic incompetence, but a much more dramatic and enduring refer-

Statue in Great Hall, by Foley.

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ence to this sign was published by Vieussens of the University of Monpellier a s early as 1715. One should be careful therefore to use the t e r m " C o r r i g a n ' s pulse " only when one is r e f e r r i n g to the visible p u l s e in the neck. The palpable pulse is the w a t e r - h a m m e r pulse, an analogy first used b y Thomas Watson (1843) of London, or, alternatively, if one prefers an eponymous term, the pulse of Vieussens. Corrigan then goes on to dwell at length on the bruit de soufflet, or bellows m u r m u r , which he considers a pathognomonic sign of aortic incompetence and which is always best heard at the base of the heart a n d going into the great vessels, sometimes as f a r as the elbow. This m u r m u r , often accompanied by fr~missement, or a palpable thrill in the vessels, is synchronous with the pulsation in the vessels and therefore systolic in timing. When the deficiency of the valves is considerable, he states, a double bruit is heard, but he refel~s only casually to this diastolic element and returns to the more serious discussion of the systolic bruit de soufflet. This surprising preoccupation with a systolic m u r m u r , with or without a thrill, is most interesting, and I feel one is justified in speculating that m a n y of C o r r i g a n ' s cases were cases of combined aortic stenosis and incompetence. Also I am sure t h a t the stethoscope of that day was not at all efficient in detecting the high frequency, blowing diastolic m u r m u r of aortic incompetence. H e n c e the reference to the double m u r m u r only when the deficiency of the valve is considerable. The double bruit of aortic incompetence had been previously described lry tIodgkin in 1829, but H o d g k i n ' s e x t r a o r d i n a r i l y clear clinical description was almost entirely obscured b y C o r r i g a n ' s later and more complete review. Subsequent efforts by Sir Samuel Wilks (1871) and S i r William Hale-White (1924), amongst others, have gone some little w a y to placing H o d g k i n ' s name on the list of those who have contributed to the knowledge of aortic disease. Corrigan goes into excellent detail about the causation of the bruit de soul~et and his experiments with a closed system of tubing are in the classical vein and clearly illustrate the connection between turbulence a n d the production of m u r m u r s . This experimental work was first alluded to in a note to the Lancet in 1829. H e is impressed by the huge size of the left ventricle noted at a u t o p s y a n d states that it resembles r a t h e r the heart of a bullock t h a n that of a man. This is not the first reference to the cor bovinum, for one find~ t h a t William Cowper in 1705 describes the h e a r t as " larger t h a n t h a t of an ox ". I t is of some clinical interest that Corrigan dwells on the f r e q u e n c y of a poor apical impulse, despite the huge left ventricle. H e was obviously unaware of the m o d i f y i n g effect of heart failure on the apical impulse, largely because the concept of heart failure did not clearly exist for him. Also, Corrigan makes no reference to the effect of chronic lung disease on the apex beat. H c refers in some detail to the mechanism of s y m p t o m s and the mode of death. Here we are presented with some confused ideas, and I believe this confusion is the result of his ignorance of the concept o f v e n t r i c u l a r failure and of heart muscle dynamics. Death in aortic incompetence is a t t r i b u t e d to " a generalised exhaustion, consequent on exhaustion of the left ventricle." This r e m a r k seems accurate out o f

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context, but he qualifies it by saying that the lungs are permeable to air, remarkably healthy and rarely prone to sudden congestion. This is, of course, completely at variance with his earlier statement that sudden asthmatic attacks are common, and is not compatible with our present day concept of left ventricular failure causing raised pulmonary capillary pressure and pulmonary oedema. Despite these criticisms, one must admire Corrigan's interest in every aspect of the disease. At that period in medical evolution, he was virtually a pioneer exploring the as yet uncharted terrain of pathophysiology. Of greatest interest to us are his descriptions of the physical signs of aortic disease and his notions on their causation. I f I may be permitted a moment, however, before commenting on the originality of his observations, I should like to dwell on other interesting points he makes. On the subject of diagnosis he mentions the important difference between aortic incompetence and such conditions as mitral disease, ancurysm and hyperkinetic states. Referring to aortic stenosis, he states that the systolic murmur and powerful left ventricle are common to both, but the small contracted pulse of stenosis contrasts with the full and swelling pulse of regurgitation. As regards aetiology, he recognises that aortic disease has a variety of causes including rheumatism, aneurysm and trauma. He relates prognosis to the size of the leak and he rightly considers that sudden death is not a feature in aortic incompetence and that the patient may therefore be reassured on this point. On the subject of treatment he states that " under proper restriction thc patient is not only able to lead an active life for years, but is actually benefited by doing so ". He attacks the whole principle of treatment by debilitating measures and differs with the conventional views of his contemporaries in this regard. He recognises ventrieular hypertrophy as nature's attempt to endow the heart with added strength and he deplores any treatment calculated to interfere with this arrangement. He goes on to refer to " the constant struggle between nature and medicine. The repeated bleedings, the starvings, the enforcement of debilitating measures are totally unsuited to the disease we are considering ". Instead he recommends a good diet, abstinence from alcohol, normal activities and reassurance about sudden death. Corrigan contributed m u c h in his long life to medical literature. He was interested in medical educatima a n d social and medical reform, and was passionately devoted to the standards and welfare of the medical profession in Ireland. He had an immense private practice and was a popular and enthusiastic clinical teacher. These qualifications alone ensure him an important place in medical history in this country, but his fame abroad rests primarily on his contribution to the knowledge of aortic incompetence. The credit he has received for this contribution has been a source of controversy since the early years when Hope claimed precedence in the description of the physical signs of the disease. I believe myself from an examination of Flaxman's History of Aortic Incompetence (Flaxman, N., 1939) that Hope was aware of the clinical syndrome at the same time, but, although he did describe a jerky pulse in the first edition of his Treatise (Hope, 1831), he did not identify it with a leaking aortic valve as Corrigan was to do a year later (Bedford, D. Evan).

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I have already referred to Hodgkin's contribution before the Hunterian Society in London and to the fact that his excellent account of certain aspects of the disease went unnoticed. Also in 1715 Vieussens of Monpellier gave a vivid description of the water-hammer pulse in a patient who at necropsy was shown to have aortic disease, and before him in 1705, William Cowper described the pathology of the disease. Morgagni refers again to aortic disease in 1761. We must therefore concede that Corrigan's reference to aortic incompetence is by no means the first in medical literature. We must concede that the physical signs he describes had been referred to on isolated occasions by other writers. We are also aware from Hodgkin's writings that some at least of his contemporaries were familiar with the important signs of the disease: this is not at all a surprising fact when one considers the rapid increase in the popularity of the stethoscope at the time. Yet, despite these reservations, it is clear that Corrigan's paper was by far the most thoughtful and comprehensive account then available. His description of the pathology and physical signs, although not entirely original, was up to then the most complete, and his experimental approach and physiological insight in these early years deserve our most generous praise. Also this classical description was enhanced by his views on prognosis and his rational outlook on treatment. Indeed he must have been one of the first, if not the first, to deplore blood letting, starvation and purging, and, although his strictures specifically refer to the treatment of aortic incompetence, this advice in itself commends his article to us. I think, perhaps, that there is a wrong emphasis generally on the credit due to Corrigan. We think of his description of the physical signs of aortic incompetence instead of his broader contribution on the physiology and pathology, the diagnosis, prognosis and treatment of this condition. His fame is assured because he provided for the first time a synthesis of ideas and facts which formed a clear picture of the disease in question and which was immediately and widely acknowledged. Like others, I have had my misgivings about the credit due to Corrigan, but despite the criticisms which can be sustained against some of his concepts and his claims to originality, I am sure he richly deserves his place amongst the major contributors to the knowledge of heart disease. Dominic John Corrigan, the second son of John and Celia Corrigan, was born in Thomas Street, Dublin, on December 1st, 1802. Thomas Street, leading south-west from the city, was described then as a squalid thoroughfare, and his father's house stood on the present site of the Augustinian Church. He came of a gifted and hard-working family, and, like many successful men, he had a mother who was described as intelligent and beautiful, and devoted to her children. Corrigan's father was a hard-working and successful tradesman who acquired some wealth and property. He sold spades and rakes and other tools to farmers and gardeners visiting the city and he himself had a small farm in Kilmainham. Dominic was educated at the Lay College in Maynooth, a branch of Maynooth's activities which lasted only from its foundation in 1800 until 1817. He was a keen student and received an excellent education

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in the classics, and he had the good fortune to meet two people who were to guide and influence him in choosing his career in medicine. Dr. O'Kelly, the local practitioner and medical attendant to the College, reeognised Corrigan's talents, and, having given him an early interest and training in medicine in Maynootb, he encouraged him to attend Sir Patrick Dun's Hospital for his formal medical classes. Corrigan also met Dr. Cornelius Denvir, who later became Bishop of Down and Connor, and who taught mathematics and natural philosophy: An earlier biographer attributes Corrigan's interest in blood flow through vessels and deranged valves to the training in experimental physics he received from Dr. Denvir. They remained close friends all their lives and possibly the reverend doctor may have helped Corrigan with his later experimental studies. After a brief period as a student attending Sir Patrick Dun's, Corrigan went to Edinburgh University where he took his degree in 1825. Amongst the classmates to qualify with him were William Stokes and James Hope. He returned immediately to Dublin where he set up in practice at 11 Ormond Quay. A few years later he moved to 13 Bachelor's Walk and, by 1834, he had made his final move to No. 4 Merrion Square, now No. 92. Private patients were apparently few and far between at the beginning, and we read that well-meaning friends advised him to appear overwhelmed with work, to have himself called away frequently from public gatherings and to drive at great speed through the streets in a showy carriage. Instead, he apparently never showed haste, and even in his busiest years (and at this time the size of his practice was legendary) he remained entirely imperturbable and never reacted to the pressure of time. Also he was careful never to allow a patient to see him looking at his watch. It is interesting to dwcll awhile on his academic career. His first appointment in Dublin was to the Dispensary in Meath Street, which I presume was within the Earl of Meath's liberties. Soon we find him working in Cork Street Fever Hospital. He published a few important papers during these earl:/years. F o u r appeared in the Lancet, the first (1828-1829, 1) dealing with the diagnosis of aneurysm of the aorta, and the second (1828-1829, 2) dealing with the cause of the systolic murmur and thrill which had already begun to attract his attention. The third monograph (1829-1830, 1) dealt at length with the epidemic fever in Ireland and was highly commended to the Public Health Authorities by the Editor. The fourth (18294830, 2) contained a description of Corrigan's animal experiments and the conclusions he reaches on certain physiological aspects of heart action. It was in the latter paper that he described his experiments on the causation of murmurs. In 1830 in the Dublin Medical Transactiozts. he published an important monograph of fifty-two pages entitled " On the Motions and Sounds of the Heart ". describing his complete views on the physiology of heart action. This monograph was based on his own experimental work which had been largely carried out on reptiles and fish. Surprisingly enough, in view of his important and authoritative paper on aortic incompetence which appeared only two years later, some of his main conclusions about: the actions of the heart are quite erroneous.

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H e considers that the apex beat is due to atrial systole and that the first sound is due to the blood rushing into the ventricles. Also he attributes the second sound to striking together of the walls of the ventricles. H e reached these conclusions despite much animal experimentation, and in describing his views he states that he stands at issue with all the physiologists of the day and that he is at variance with the views of Laennec. His views were indeed unorthodox and were strongly and justifiably criticised by J a m e s Hope in the London Medical Gazette later in 1830. Corrigan was to a d m i t some of his errors in his later and classical p a p e r on aortic incompetence. He was elected physician to the Charitable I n f i r m a r y in J e r v i s Street at a f a i r l y early date and it is stated t h a t most of his clinical and pathological observations which led to the publication of his classic on aortic incompetence were made there on eleven patients. I n 1840 he became physician to the House of Industries ltospital, later known as the Richmond, W h i t w o r t h and Hardwieke, and now St. L a u r e n c e ' s Hospital, and he did most of his teaching and clinical work there until his retirement in 1866. H e was a teacher of great enthusiasm and ability, and his classes at William H a r g r a v e ' s School of Medicine in Digges Street in the 1830s, and subsequently at the Richmond, were attended by an unusually big n u m b e r of students. I have been unable to draw up a complete bibliography of all C o r r i g a n ' s writings, but there are enough references to prove t h a t he was a prolific writer all his life. On looking through the bibliography presently available, one notices a clear trend of interest f r o m the strictly experimental and clinical papers of his early years, the extensive p a m p h l e t s and letters of his middle years on social and preventive medicine, and finally his numerous contributions to medical politics and to social and medical reform. The early phase of interest in clinical and experimental writing was a relatively short one, but nevertheless he continued all his active life to present cases to the Dublin Pathological Society, even if they did a p p e a r with decreasing frequency in later years. Much could be written about his contributions on social and preventive medicine. His publications included " On F a m i n e and F e v e r " and " A Cholera Map of I r e l a n d ". Both these publications were valuable additions to the knowledge of the epidemiology of the fevers, and Corrigan is credited with being the first to distinguish between typhoid a n d typhus. His attacks on the authorities at the time of the F a m i n e of 1845 and 1846 were most outspoken and he attributed much of the pestilence and widespread ill health to poor nutrition " at a time ", he states, " when our own corn was forbidden f r u i t " His answer to the p r e v a i l i n g epidemics of ill health was in active industries, full e m p l o y m e n t and food, not in hospitals, medicine and the knife. P e r h a p s there was something in his remark, " the offspring will inherit for generations to come the weakness a n d a p a t h y of mind which famine and fever had engendered " ; the recent Commission on Population states " its effects are with us to the present d a y " Corrigan was a keen traveller and paid m a n y visits to the Continent. He was a lover of F r a n c e and a p p e a r e d to have close contacts with his

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French colleagues. Aortic incompetence is called " maladie de Corrigan " in France to this day. On one of his many visits to the Continent, in 1866, he spent a month in Greece and his journal describing this memorable visit has been published in book form. In later years Corrigan became more and more interested in general and medical politics. After the publication of his pamphlet " On Famine and Fever ", he was elected to the newly appointed Central Board of Public Health. The function of this Board was to organise relief and medical help during the many epidemics at the time. Although there were four appointed to the Board, Corrigan was virtually the only influential and active member, and, for a variety of reasons, particularly in connection with the question of remuneration of doctors attending fever cases, he came into conflict with many members of his own profession and with the Royal College of Physicians. Later he was closely connected with the reform of medical education and improving the standards of the profession. He pressed for greater authority for the General Medical Council and was an original member of this body on its foundation. He led a persistent and dedicated campaign f o r an improvement in the terms of employment of the dispensary doctors. Also he led the pharmacists in the country in a successful campaign to improve legislation on pharmacy. He pressed strongly for a better water supply for Dublin and was one of a Commission set up to study reform in the Lunatic Asylums. These are only a few of his many interests in the betterment of his profession and his country, and his connection with politics was to introduce a degree of stress to his declining years which contrasts with the rest and tranquillity which he so richly deserved. His sense of responsibility and public spirit eventually led him to the hustings in 1868, when he first stood for Parliament as a Liberal candidate. His chief purpose in standing for Parliament was to provide a voice for the Irish medical profession in the House of Commons. F o r years the medical profession, through the Medical Association of Ireland and through other channels, had pleaded for better conditions of employment for the dispensary doctor, who was disgracefully paid and who was denied the security of a pension. At a large meeting of doctors in Dublin, before the election, Sir Dominic vowed to devote his Parliamentary life to the service of the Irish medical profession in general and to the dispensary doctors in particular. It is interesting to recall that the doctors at that time had the same irritating and frustrating difficulties with the authorities which we have passed through in recent years. It is interesting also to read that the Medical Association of Ireland, whose avowed aim at the time was to seek direct Irish medical representation in the Commons, refused its support to Corrigan by the majority of its Council, and he was bitterly opposed by many of his colleagues in the two elections of 1868 and 1870, This opposition came from reactionary forces in the Association and was attributed widely at the time to political and religious bias. Corrigan was unsuccessful in the election of 1868, but was elected to the Commons in 1870. Apart from his interest in the welfare of the medical profession, he was opposed to Home Rule and amongst ~tlmr things to Sunday opening of licensed premises, His convict~or~ on

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S u n d a y opening were responsible for his withdrawal from politics at the election in 1874, when he refused to yield to an important pressure group of publicans within the Liberal P a r t y who insisted that he should forgo his views on the S u n d a y Opening Bill then being presented to Parliament. Before closing this Address I might remind you about Corrigan's connection with the College of PhysiCians. He had been blackballed for Fellowship of the College in 1847 on account of his connection with the Board of Health and the controversy at the time with Robert Graves and other members of the College. He was elected a Fellow eight years later and soon had the distinction of being the President for the unprecedented period of five years h'om 1858 to 1863. D u r i n g this time he was responsible for the purchase of the present building in Kildare Street, so that the Fellows had for the first time a home of their own. Previous to this, they used meet in Sir Patrick D u n ' s Hospital. H e collected the necessary funds quite easily by issuing 5 per cent. debentures to the Fellows and he himself contributed the sum of £2,000. These debentures were repaid fairly quickly afterwards. His portrait by Catterson Smith hangs in the hall of the College and his statue by Foley is one of the finest pieces of sculpture there. The stained glass window with the arms of the College was presented by Corrigan in 1864. Many other honours came Corrigan's way. He was for m a n y years Physician-in-0rdinary in Ireland to Queen Victoria. He was M.D. h o n o r i s c a u s a of Dublin University and a Vice Chancellor of the Queen's University. He was several years President of the Royal Zoological Society. He was created a Baronet in 1866 and was one of only eight doctors in the history of Ireland to receive this honour. The baronetcy became extinct not tong after his own death with the death of his grandson at a n early age. Of Corrigan's three sons, one died in infancy, the second, whose own son. inherited the title, predeceased Corrigan, and his third son died of yellow fever in America whilst a young man. There is therefore no male descendant of Sir Dominic Corrigan to c a r r y on the title. Corrigan died on F e b r u a r y 1st, 1880, at his home, Inniseorrig, at Dalkey, Co. Dublin. D u r i n g his last years he was greatly troubled by gout, but he a p p a r e n t l y died from right carotid a r t e r y insufficiency and occlusion. A f t e r a few minor episodes he developed a left-sided hemiplegia on December 30th, 1879, and lived then for little more than a month. He is buried in the family vault in the crypts of St. A n d r e w ' s Church in Westland Row. C o r r i g a n was an exceptionally early riser and a hard worker and he was a powerful advocate of his own views and principles. W e can see from the portrait and statue in t h e Royal College of Physicians that he was a big dominating man with a fine posture and a proud bearing. He was a powerful and trenchant speaker and a p p a r e n t l y outspoken and utterly, fearless i n debate. I n later years he may have become too garrulous and he was criticised even by his friends for his obstinate adherence to his own views and principles. A number of writers pay tribute to his inflexible integrity and h e was also remembered for his constant loyalty to the medical profession and to every-member of the profession whatsoever his station. His successful career, and his out-

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standing position in the profession i n I r e l a n d occurred at a time and in a milieu not too favourable to a professional m a n of his persuasion, and his o b i t u a r y notice in the F r e e m a n ' s Journal stated t h a t "The people of Ireland regarded his career with peculiar interest and his success with gratified pride. This feeling was nowise sectarian. I t was rather racial and national. They felt t h a t intellectual triumph was their best and noblest vindication against the contumely which had fallen on them in consequence of the ignorance enforced upon the nation by the Penal Laws".

Corrigan was a highly successful physician and contributed much to medical knowledge. He deserves our eternal g r a t i t u d e for his contribution to medical thought and literature, but I feel our greatest debt to him as doctors and I r i s h m e n lies in his e x t r a o r d i n a r y sense of responsibility and public spirit. Despite the inevitable preoccupation with and temptations of a large p r i v a t e practice, he became increasingly concerned over the years with the problems of the profession, of the medical services and of the people, and he devoted an increasing amount of his time to this work. I t is i m p o r t a n t that posterity should be informed about this aspect of his life, and we of the Corrigan Club shall do well to p e r p e t u a t e the m e m o r y of this remarkable m a n who did so much f o r his colleagues, his patients and his country. References. Bedford, D. Evan, Personal communication. Corrigan, D. J. (1828-1829, 1), Aneurysm of Aorta, Lancet, 1 : 586-590. Corrigan, D. J. (1828-1829, 2), Lancet, 2 ; 1-5 ; 33-35. Corrigan, D. J. (1829-1830, 1), Lancet, 2 ; 569-575 ; 600-605. Corrigan, D. J. (1829-1830, 2), Lancet, 2 ; 964-971. Corrigan, D. J. (1830), "On the Motions and Sounds of the H e a r t , " Dublin Med. Trans., N.S.I. ; Pt. 1 ; 151-203. 7. Corrigan, :D. J. (1832), Edin. Med. Surg. J., 37, 275. 8. Corrigan, D. J. (1846), On Famine and Fever, Fannin & Co., Dublin. 9. Corrigan, D. J. (1866), Cholera Map of Ireland, Browne & Nolan, Dublin. 10. Cowper, William (Abridged 1809), Trans. No. 299, p . 1970. Phil. Trans. Royal Society London, 5 ; 215-219, 1703-1712. Quoted by Willius and Keys, Cardiac Classics. l 1. Flaxman, N. (1939), History of Aortic Incompetence, Bull. Hist. Med., 7, 192-209. 12. Hale-White, W. (1924), Guy's Hoop. Rep., 74, 117. 13. Hodgkin, T. (1928-1929), "Retroversion of the Valves of the A o r t a " , London Med. Gaz., 3, 433-443. 14. Hope, J. (1830), London Med. Gaz., 6, 680-687 ; 782-789. 15. Hope, J. (1831), Treatise on the Diseases of the Heart and Great Vessels. Quoted b y Willius and Keys, Cardiac Classics. 16. Morgagni, J. B. (1761), De Sedibus et Causis Morborum per Anatomen Indagatis, Libri Quinque, 23. (Trans. by Benjamin Alexander, London, 1869), 684. 17. Vieussens, R., Traitd Nouveau de la Structure et des Causes du mouvement naturel du Coeur; Toulouse. J. Guillemete, 1715, 107. 18. Watson, T. (1843). Principles and Practice of Physick. London, 3rd edition, Vol. 2, 264. 19. Wilks, S. (1871), Guy's Hoop. Rep., 16, 211. Those who are interested in the history'of aortic incompetence will find the following additional monographs of value : Dock, G. (1934), (1) Dominic John Corrigan ; His place in the Development of our Knowledge of Cardiac Disease. (2) The Waterhammer Pulse. Ann..2YIed. Hist., 6, 381-395. Irvine, R. E. (1957); James Hope and the History of Aortic Regurgitation ;: Guy's Hosp. Rep., 106, 1-10. M a j o r , . R . H . (1932), Raymond, Vieussens and his Treatise on the Heart. Ann. Med. Hist., 4, 147-154. 1. 2. 3. 4. 5. 6.

Acknowledgments. I am particularly indebted to Dr. Charles Dickson, Registrar, and to Miss Gardiner, Librarian of the Royal College of Physicians, for valuable assistance in preparing this Address.. I am equally grateful to Professor Widdess of the Royal College of Surgeons in Ireland.; Amongst the~vari0us sources of reference consulted, I found Dr. Eileen :Dixon's monograph Sir Dominic Corrigan particularly useful. I t is published in the Dublin Historical Record, 1946, in two parts at pages 28 and 67. There is a useful biographical note about Corrigan in The History of the Royal College of Surgeons in Ireland, b y Sir C. A. Cameron, 2nd edition, 1916, page 706. No full biography of Corrigan has been written.