CHAPTER XIX

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_SIR THOMAS WATSON, SIR DOMINIC CORRIGAN, SIR WILLIAM GULL, AND CLINICAL MEDICINE._

The Nestor of the medical profession, Sir Thomas Watson, died in 1882, at the great age of ninety, universally beloved and honoured. Yet he had written but one extended work, the “Lectures on the Principles and Practice of Physic,” and had made no striking discovery. But to have written a book which every cultivated practitioner reads, and reads with delight and satisfaction, is an achievement given to few, many though there be who aim at it. And Sir Thomas Watson’s personal character was as unique as his advice was valuable.

THOMAS WATSON was born on March 7th, 1792, at Montrath (now Dulford) House, near Cullompton, Devonshire, where his father, Joseph Watson, a Northumbrian by family, was then living. He was educated at Bury St. Edmund’s Grammar School, where he was a schoolfellow with Blomfield, afterwards Bishop of London, and a great friend of Watson’s. In 1811 he entered at St. John’s College, Cambridge, and became tenth wrangler and fellow of his college. At that time only two fellows of St. John’s could retain their fellowships without taking orders, and one of these must study medicine. This circumstance availed to turn Watson’s attention to medicine in 1819 at the age of 27, when he entered St. Bartholomew’s Hospital, and came under the powerful influence of Abernethy. During the session 1820-1 he attended medical lectures at Edinburgh University, and in 1822 received his licence to practise from Cambridge. But academical pursuits were continued, and Watson took private pupils, among whom was Lord Auckland, afterwards Bishop of Bath and Wells, and served the office of proctor in 1823-4. In 1825 he took his M.D. degree, and married Miss Jones, niece of Turner, Dean of Norwich and Master of Pembroke College. Soon afterwards he established himself as a physician in Henrietta Street, Cavendish Square, London, in which street he continued to live for fifty-seven years. His wife died, to his lasting regret, five years later, leaving him with one son and daughter, to whom he was devotedly attached.

Watson was recognised from the commencement of his London career as a man of mark, and in 1827 he was elected Physician to the Middlesex Hospital. In 1828, on the opening of the University College, he was appointed Professor of Clinical Medicine, retaining his post at the Middlesex Hospital; but he transferred his services as lecturer to King’s College in 1831, becoming Professor of Forensic Medicine. Practice had come but slowly in these years. In 1831 he made his first contribution to medical literature, in the shape of “Remarks on the Dissection of Bishop, and the Phenomena attending Death by Strangulation” (_Medical Gazette_). Bishop had murdered an Italian organ-boy, and brought the body to King’s College for sale: Bishop was hanged, and his body, like that of his victim, came to King’s College for dissection. From this time Dr. Watson made numerous contributions to the _Medical Gazette_, largely embodied in his subsequent great work. In July 1832 he was chosen to accompany Sir Walter Scott from London to Edinburgh when he was returning from Italy to Abbotsford for the last time.

In 1836 Dr. Watson was appointed to the chair of the Principles and Practice of Medicine at King’s College, and in the ensuing winter delivered the first draught of those lectures on which his fame rests. They soon became well known, and they were printed weekly in the _Medical Gazette_ in 1840-2. Finally they were published in two volumes by Parker in 1844, and became acknowledged as medical classics. Mr. Parker showed a righteous liberality when their great sale had brought in a large sum, in granting the author two-thirds of the profits instead of one-half, as had been agreed, and handing him twelve hundred pounds as a first payment. Watson had already, in 1840, resigned his chair at King’s College rather than leave his old post at Middlesex Hospital, but in 1843 he was compelled by the increase of private practice to resign even this. Henceforward, especially after the retirement of Dr. Chambers in 1848, he was at the head of London practice for many years. He was not, however, appointed one of the Queen’s Physicians-Extraordinary till 1859; in 1861 he was called in to attend the Prince-Consort in his fatal illness, and in 1866 he was created a baronet, receiving in 1870 the further appointment of Physician-in-Ordinary to the Queen. The College of Physicians elected him President in 1862, an office he held for five years. From 1858 to 1860 he represented the College on the General Medical Council. In 1857-8 he was President of the Pathological Society, and he was in 1868 the first President of the Clinical Society. In 1859 he was elected a Fellow of the Royal Society.

Two quotations from Watson’s Introductory Lecture to his course will serve to indicate some of the qualities which have given his book such popularity. Referring to the study of anatomy and physiology, he says; “Do not think that I am wandering from my proper subject when I bid you to remember how profoundly interesting, how almost awful, is the study in itself and for its own sake, revealing, as it surely does, the inimitable workmanship of a Hand that is Divine. Do not lose or disregard that grand and astonishing lesson. Do not listen to those who may tell you not to look for the evidence of purpose in this field of study, that the visible mechanism of that intricate but marvellously perfect and harmonious work, the animal body—the numberless examples of means suited to ends, of fitness for a use, of even prospective arrangements to meet future needs, of direct provisions for happiness and enjoyment—that all these have no force at all, in true philosophy, as evidences of design. For my own part, I declare that I can no more avoid perceiving, with my mental vision, the evidential marks of purpose in the structure of the body, than I can help seeing with my open eyes, in broad daylight, the objects that stand before my face.”

Again, he characterises the profession of medicine in noble terms. “The profession of medicine having for its end the common good of mankind, knows nothing of national enmities, of political strife, of sectarian divisions. Disease and pain the sole conditions of its ministry, it is disquieted by no misgivings about the justice or the honesty of its client’s cause; but dispenses its peculiar benefits, without stint or scruple, to men of every country or party, and rank and religion, and to men of no religion at all. And like the quality of mercy, of which it is the favourite handmaid, it “blesses him that gives and him that takes,” reading continually to our own hearts and understandings the most impressive lessons, the most solemn warnings. It is ours to know in how many instances, forming indeed a vast majority of the whole, bodily suffering and sickness are the natural fruits of evil courses—of the sins of our fathers, of our own unbridled passions, of the malevolent spirit of others. We see, too, the uses of these judgments, which are mercifully designed to recall men from the strong allurements of sense, and the slumber of temporal prosperity, teaching that it is good for us to be sometimes afflicted. Familiar with death in its manifold shapes, witnessing from day to day its sudden stroke, its slow but open siege, its secret and insidious approaches, we are not permitted to be unmindful that our own stay also is brief and uncertain, our opportunities fleeting, and our time, even when longest, very short, if measured by our moral wants and intellectual cravings.”

These lectures had the largest sale of any similar work in the author’s lifetime. Five large editions were published under his own revision. He most unsparingly altered his previous views with the advance of science, and showed rare modesty in his expressions thereupon. Dr. Charles West has admirably sketched his friend’s character (_Medical Times and Gazette_, Dec. 16, 1882): “He laid no claim to genius; he made no great discovery. Though a scholar he was not more learned, though a good speaker he was not more eloquent, than many of his contemporaries whose names are now well-nigh forgotten; and yet he was by universal consent regarded as the completest illustration of the highest type of the physician. His moral as well as his intellectual qualities had much to do with the estimate which all formed of his character. His faculties were remarkably well balanced, his mind was eminently fair. He had that gift—the attribute and the reward of truth—the power intuitively to detect all specious error. Hence, while the added experience of each year gave increased value to his teachings and his writings, it brought but little for him to unlearn or to unsay. He took a wide view of every question.... He availed himself of knowledge from all sources, and for all purposes except vain display; he used theories to illustrate his facts and to point their meaning, but no further, conscious that, with imperfect knowledge, it would be idle to attempt to build up correct theory.... Take him in his teaching, all in all, he seems to me, more than any one I ever knew, to be the undoubted heir of England’s greatest practical physician, Thomas Sydenham.”

Another writer in the _British Medical Journal_, Dec. 23, 1882, speaks of his serene and gentle temper, his modest dignity, his benevolent kindness, his unfailing clearness of judgment. “Nothing that happened in the professional world, of human or scientific importance, was alien to him; and there are few men among his contemporaries who have not at one time or another come to him for advice and guidance. Conciliatory to the utmost bounds of kindness, he was never open to the charge of favouring compromise.... It is rare indeed to find any man of whom it may be said as of him, that there is not one man in the profession who would at any time have declined to accept Sir Thomas Watson’s judgment on any personal or professional question as final. His sense of justice, his habitual reference of all questions of detail to unassailable principle, his flexibility of mind, and his quick perception of character, gave him a rare but well-justified ascendancy over even the ablest of his contemporaries.” After a long old age spent in retirement from practice, but in continued vigorous professional study, of which he gave evidence in a little book on the Abolition of Zymotic Diseases, published as late as 1879, the venerable man died of old age at his son’s residence at Reigate, in Surrey, on December 11, 1882.

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Born about ten years after the last-mentioned eminent physician, DOMINIC JOHN CORRIGAN for many years held a position in Dublin somewhat parallel to that of Watson in London. He was a native of Dublin, born on December 1st, 1802, his father having been a merchant in Thomas Street. Educated first at the lay college of St. Patrick’s at Maynooth, he entered upon medical study as the pupil of Dr. O’Kelly of Maynooth, who had foresight to discern that his pupil was capable of rising to the highest position in the profession, and advised his being sent to the Edinburgh Medical School. Part of his medical study was, however, pursued in Dublin, where he attended clinical lectures at Sir Patrick Dun’s Hospital. His Edinburgh degree dates from 1825.

The rising science of pathology had deeply impressed young Corrigan’s mind, and he devoted himself, after settling in Dublin as physician to the Meath Street Dispensary, to original study. One of the principal fruits of his inquiries was his classic paper on “Permanent Patency of the Mouth of the Aorta, or Inadequacy of the Aortic Valves,” published in the _Edinburgh Medical and Surgical Journal_, April 1832. This paper commenced with the following statement, “The disease to which the above name is given has not, so far as I am aware, been described in any of the works on diseases of the heart. The object of the present paper is to supply that deficiency. The disease is not uncommon. It supplies a considerable proportion of cases of deranged action of the heart, and it deserves attention from its peculiar signs, its progress, and its treatment. The pathological essence of the disease consists in inefficiency of the valvular apparatus at the mouth of the aorta, in consequence of which the blood sent into the mouth regurgitates into the ventricle. This regurgitation, and the signs by which it is denoted, are not necessarily connected with one particular change of structure in the valvular apparatus.” One particular feature attending these cases, which Corrigan was the first fully to describe, was the extraordinary character of the pulse, since known very generally as “Corrigan’s pulse.” The strong visible pulsation in the arteries of the head, neck, and arms, bounding into a new position with each beat of the heart, and becoming prominent under the skin, has since proved the means whereby aortic valvular disease of the heart has been recognised in multitudes of cases. The full pulse, followed by almost complete collapse, has since been termed “jerking, splashing, or collapsing,” or the “water-hammer pulse.” The peculiar rushing thrill felt by the finger in the large superior arteries was also dwelt upon, as well as the “bruit de souffle” heard as an accompaniment of the heart-sounds. Corrigan had corrected Laennec’s erroneous view of the cause of this bruit, in a previous paper in the _Lancet_ of vol. ii., 1829, p. 1.

Dr. Corrigan continued for some years zealously to investigate the functions of the heart, and he experimented largely upon the hearts of fishes and reptiles. He published an important paper “On the Motions and Sounds of the Heart,” in the _Dublin Medical Transactions_, 1830, part i. At this period of his career, when practice as yet was but scanty, he was much encouraged by reading “The Lives of British Physicians, from Linacre to Gooch,” published in 1830, and he referred to it afterwards as showing that “there is but one road to excellence and success in our profession, and that is by steady study and hard labour; and you will at least always have this consolation in your dreariest hour of labour, that no proud man’s contumely, no insolence of office, nor ‘spurns that patient merit of the unworthy takes,’ can bar your way.”

Resigning his post at the Meath Street Dispensary, Corrigan became successively attached to the Cork Street Fever Hospital, and to the Jervis Street Hospital. Yet the Irish College of Physicians failed to discern his great merits, and blackballed him when he was first proposed for the fellowship, a mistake which they subsequently atoned for in some measure by electing him their president for five successive years, and by commissioning a statue of him, by Foley, at the conclusion of his term of office. In 1833 he began to lecture on the practice of medicine in the Carmichael School of Medicine, and practice grew rapidly. In 1840 he was appointed physician to the House of Industry Hospitals, which post he held till 1866. Here he delivered a noteworthy course of lectures on the Nature and Treatment of Fever, which were published in 1853. He accepted and enforced the modern views as to the distinctness of typhoid from typhus fever.

In 1841 Dr. Corrigan became a member of the Senate of the new Queen’s University, of which after thirty years he was appointed Vice-Chancellor. In 1849 Dublin University gave him the honorary M.D. He was assiduously devoted to the onerous duties of a Commissionership of National Education. As to practice, he became the most popular and highly remunerated physician Dublin had ever seen, having for many years more calls upon him than he could possibly attend to, and receiving in several years as much as £9000 per annum in fees. In 1866 he was made a baronet in consideration both of his medical position and of his important services to national education. He was also Physician-in-Ordinary to the Queen in Ireland.

As member of the General Medical Council from 1858 till his death, Sir Dominic Corrigan exercised a strong influence in favour of elevating the standard of professional education. He was an eloquent and lively debater and not at all averse to a display of verbal pugnacity, but he was much and generally beloved. In 1868 Sir Dominic was induced to come forward as an advanced Liberal candidate for the representation of the city of Dublin in Parliament; but on that occasion, however, he was defeated. In 1870 he was elected by a majority of over a thousand votes, and sat in Parliament till 1874. Originally of a fine constitution, he suffered severely from gout in his later years, and died after an attack of paralysis on Feb. 1, 1880.

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The succession of clinical physicians is well sustained at the present day in the person of Sir WILLIAM WITHEY GULL, Baronet. Born on the last day of December 1816, at Thorpe-le-soken, Essex, William Gull was educated privately, and early became a student of Guy’s Hospital, London. To this establishment he was so attached that for fifteen years he resided within its walls or immediately adjacent. In 1841 he became M.B. of London University, and in 1846 M.D. He was elected Fellow of the College of Physicians in 1846, and Fullerian Professor of Physiology at the Royal Institution in 1847, which office he held till 1849.

Very early after his graduation as M.B., Dr. Gull was appointed to assist the pupils at Guy’s in their studies, or in other words, he became medical tutor. In 1843 he began to lecture on natural philosophy. In 1846 he undertook the important lectureships of physiology and comparative anatomy in Guy’s Medical School. Meanwhile about 1843 Dr. Gull had been appointed resident superintendent of the asylum for twenty female lunatics which Guy had ordered to be maintained. He formed a close acquaintance with Dr. Conolly, whose name will ever be connected with the rational treatment of the insane in this country, and by adopting improved methods Dr. Gull was finally so successful that the patients were all discharged cured, and the wards occupied by them devoted to the treatment of acute cases more properly coming under care in a general hospital. Meanwhile Dr. Gull was appointed assistant-physician to Guy’s, and in due course succeeded to the full physiciancy. In this capacity his clinical teaching was long one of the important features at Guy’s. In 1856 he became joint-lecturer on medicine, which office he held till 1867 with great distinction. At this date he was compelled by the increasing claims of practice to resign his appointment; but he is still attached to Guy’s as consulting physician.

Practice, indeed, came upon Dr. Gull all too soon for medical science to reap the highest advantage from his original research. But whatever he has written has been of high value and worthy of deep consideration. Among his writings may be mentioned the Gulstonian Lectures on Paralysis (_Medical Gazette_, 1849), essays on Hypochondriasis and Abscess of the Brain, in Reynolds’ “System of Medicine,” and Guy’s Hospital Reports, 1857; on Paraplegia, in Guy’s Hospital Reports for 1856, 1858, and 1861; on Anorexia Nervosa, and on a Cretinoid State, in the _Transactions of the Clinical Society_, vol. vii. His Report on Cholera, with Dr. Baly, for the College of Physicians (1854), and his paper, with Dr. Sutton, on Arterio-Capillary Fibrosis (_Med. Chir. Transactions_, vol. lv.), rank high as original contributions, which must always be consulted by writers on those subjects.

In an oration delivered before the Hunterian Society in 1861 Dr. Gull took occasion to utter a protest against the popular prejudice for specialists. “Who can treat as a speciality,” he asks, “the derangements and diseases of the stomach, whilst its relations and sympathies are so universal? How can there be a special ‘brain doctor,’ whilst the functions of the brain are so dependent upon parts the most distant, and influences the most various? A tumour in the brain may tell of its presence only through disturbance in the stomach, and a disorder of the stomach and its appendages may have for its most prominent symptoms only various disturbances of the brain.”

In his address on “Clinical Observation in Relation to Medicine,” before the British Medical Association in 1868, Dr. Gull thus expressed his impartial attitude in medicine: “We have no system to satisfy; no dogmatic opinions to enforce. We have no ignorance to cloak, for we confess it.” “Medicine is a specialism; but of no narrow kind. We have to dissect nature; which, for practice, is better than to abstract it.” “To clinical medicine the body becomes a pathological museum. In every part we recognise certain proclivities to morbid action; and the purpose of our study is to trace these tendencies to their source on the one hand, and to their effects on the other.” “The effects of disease may be for a third or fourth generation, but the laws of health are for a thousand.” “Happily, at this day, hygiene has gained strength enough to maintain an independent position in science. To know and counteract the causes of disease before they become effective is evidently the triumph of our art; but it will be long before mankind will be wise enough to accept the aid we could give them in this direction. Ignorance of the laws of health, and intemperance of all kinds, are too powerful for us. Still we shall continue to wage an undying crusade; and truly we may congratulate ourselves that no crusade ever called forth more able and devoted warriors than are thus engaged.”

In 1870 Dr. Gull delivered the Harveian Oration before the Royal College of Physicians, and expressed himself forcibly as to the duty of preventing disease. Indeed, it is a strong article of faith with him that at some future time the office of the physician will be gone. “I cannot doubt it is on all sides imperative on us to limit, and if possible to blot out, all diseases of whatever kind. Who would assume the responsibility of letting a preventable evil fester in society, on a pretence of a knowledge of the divine purposes, or under the pretext that public morality would be thereby promoted? The duty which lies nearest to us must ever have the first claim; and it cannot but be admitted that the nearest duty each man has to his fellow is to save him as far as possible from all injury, even though that injury may arise as the consequence of his own fault. Nor will it be questioned that the cause of morality is more advanced by beneficent interference than by permitting ourselves to stand passively by whilst intemperance and vice work ruin and infect the very fountains of life.”

Meanwhile Dr. Gull had attained many of the highest honours of the profession. He was one of the first graduates of London University to attain a seat on its Senate, which he continues to occupy. He was Censor of the College of Physicians in 1859-61 and in 1872-3, and Councillor in 1863-4. Oxford conferred on him the degree of D.C.L. in 1868, the Royal Society elected him to its Fellowship in 1869, Cambridge followed suit with the LL.D, in 1880, and Edinburgh in 1884. He was appointed a Crown Member of the General Medical Council in 1871, holding office till 1883, when he resigned. His successful attendance on the Prince of Wales in 1871, in conjunction with Sir W. Jenner, became the occasion of his receiving a baronetcy in 1872, and being made Physician-Extraordinary to the Queen.

The evidence given by Sir William Gull before the Lords’ committee on intemperance, in 1877, has often been referred to as one of the most valuable aids to temperance that a medical man has rendered. He distinctly assigned a subordinate value to alcohol as a medicine, and expressed his belief that its value lay chiefly in its action on the nervous system as a sedative, not as a stimulant. He further stated that a very large number of people in society are dying, day by day, poisoned by alcohol, but not supposed to be poisoned by it. In the case of inebriates, with most patients he would not be afraid to stop the use of alcohol altogether. He sees no good in leaving off drink by degrees. “If you are taking poison into the blood, I do not see the advantage of diminishing the degrees of it from day to day.... I should say, from my experience, that alcohol is the most destructive agent that we are aware of in this country.”

His own example is powerfully instructive. “If I am fatigued with overwork, personally, my food is very simple. I eat the raisins instead of drinking the wine.... I should join issue at once with those people who believe that intellectual work cannot be so well done without wine or alcohol. I should deny that proposition and hold the very opposite.” In the life of James Hinton, by Ellice Hopkins, to which Sir William Gull has contributed a preface, we learn another secret of a popular physician’s endurance in the record of early constitutionals in the parks and remote suburbs, from six to eight in the morning.

In 1882, in the controversy on Vivisection, Sir William Gull, writing in the _Nineteenth Century_, showed that his sympathy with the struggles of physiologists for their science was combined with a fully answering appreciation of the value of physiological research to medicine. “Yearly in this country,” he says, “more than twenty thousand persons, children and others—mostly children—die of scarlet fever; and nearly twenty thousand more of typhoid fever; and one of the chief causes of this mortality is the high temperature of the blood, which results from the disturbance due to the fever process. No wonder therefore that physiologists and physicians have anxiously and laboriously occupied themselves in investigating that mechanism of the living body which in health maintains so constant a temperature under varying circumstances, both internal and external, and which becomes so easily and fatally deranged in disease.... The febrile state must have arrested attention from the infancy of man. The mothers of a palæolithic age must have watched their children consumed to death in it, as do the mothers of to-day. The name of this fiery state is as old as literature.... This fiery furnace, with its uncounted millions of victims, science hopes to close.”

“There is no doubt that physiological experiments are useful, useful for animals as well as for man. They are therefore justifiable.... Nothing is so cruel as ignorance. For how many centuries had human sufferers to bear pain which is now preventable by better knowledge? How many thousands festered to death in small-pox before the discovery of vaccination? How many are now dying of tubercle and scrofula whom a better knowledge of their conditions might rescue? Yet the pursuit of this knowledge is hindered in England by the outcry of cruelty—the cruelty being no more than the inoculation of some of the lower animals with tubercular and scrofulous matter, in order to study the course of the disease and the modes of prevention. The cruelty obviously lies, not in performing these experiments, but in the hindering of progressive knowledge.”

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