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HEALING HANDS
from RCSI Alumni Magazine 2023
by RCSI
One of the greatest Irish surgeons, anatomist Abraham Colles (1773-1843) is remembered by a fracture, a fascia, a law and a ligament. RCSI Historian Ronan Kelly marks the 250th anniversary of his birth
Abraham Colles grew up in Kilkenny, where his father, who died when Colles was a boy, ran a successful marble works. All his life, Colles remained close to his mother: his letters to her survive in RCSI’s Heritage Collections (‘As to your question, What am I to do for the itch?’ he once wrote to her, ‘the practice here which seems to be most pleasant to the generality of patients is ... to scratch’). Family lore has it that Colles’ interest in surgery began early: he is supposed to have found an anatomy textbook oating in the River Nore after a local doctor’s house flooded. Seeing the boy entranced, the doctor told him to keep the book.
Five days after Colles enrolled at RCSI, he also registered in Trinity College – but in Arts, not Medicine. With his brother, William, he was a regular debater at Trinity’s Historical Society – aka ‘the Hist’ – membership of which was, for many, the whole point of a Trinity education. Frustratingly, as only surnames were recorded, it is not known which Colles brother was the more active in the Society.
Colles’ time at RCSI is better recorded, not least as his admission cards to lectures and dissections also survive. At this time, RCSI’s modest home was a house on Mercer Street; amongst Colles’ professors was William Hartigan, famous for carrying a pair of kittens around with him in the deep pockets of his greatcoat (pet therapy avant la lettre?). With another professor, William Lawless – soon to flee the country for his lawless membership of the United Irishmen, for which he was expelled from RCSI, only to be posthumously reinstated 198 years later – Hartigan co-authored a Syllabus of Lectures in Anatomy and Physiology (1796). This was the exact terrain Colles would go on to revolutionise.
Also surviving is Colles’ Indenture Certificate, dated 15 September 1790. Much of the small print is predictable (‘the said Apprentice his said Master faithfully shall serve, his Secrets keep, & his lawful Commandments everywhere gladly do’); but other, more niche prohibitions suggest the life an average apprentice might prefer (‘He shall not commit Fornication, or contract Matrimony...He shall not play at Cards, or Dice-Tables or any other unlawful games...He shall not haunt or use Taverns, Ale-Houses, Play-Houses, nor absent himself from his said Master’s Service, Day nor Night unlawfully’). It is hardly surprising that apprentices might like to blow off some steam: theirs was a generally arduous (and expensive) existence – but Colles fared better than most. His Master was Philip Woodroffe (PRCSI 1788), under whose guidance Colles had little difficulty obtaining his Licence on 24 September 1795. He had already collected his BA from Trinity in April.
Next, Colles headed for Edinburgh – then the capital of medicine in the English-speaking world. This was a well-worn route for Irish students: of the 800 graduates there in the last quarter of the 18th century, 237 were Irish, 217 English, 179 Scottish and 167 ‘colonists and foreigners’. is Hibernian brain-drain – or at least, fee-drain – was not lost on Colles; he noted that Irish students were collectively shelling out £20,000 per annum in Scotland. In time, he would do much to stanch this flow. Meanwhile, as his landlady feared he’d read himself into a coffin, he earned his doctorate. Both his thesis, entitled ‘De Venaesectione’ (‘On Bloodletting’), and his viva voce defence of it were in Latin. Little is known of the six months Colles then spent in London, except that he made the acquaintance of Astley Cooper (1768–1841), then on the cusp of becoming Britain’s most celebrated anatomist. Colles and Cooper corresponded frequently for the rest of their lives, and in 1820 Cooper was made an Honorary Member (the precursor to Fellow) of RCSI.
ONE OF THE REASONS HE WAS SO POPULAR WAS BECAUSE HE MADE HIS ANATOMY TEACHING MEMORABLE AND UNDERSTANDABLE.
Returning to Dublin, Woodroffe did Colles another good turn: he died, and Colles took over at Dr Steevens’ Hospital. Thereafter, he rocketed through the ranks at RCSI, from Membership (1799) to President (1802), when he was just twenty-nine years old. From 1804 he held both the Chairs of Anatomy and Physiology (until 1827) and Surgery (until 1836). Students flocked to him, and the College – in its salubrious new home on St Stephen’s Green from 1810 – flourished.
One of the reasons he was so popular was because he made his anatomy teaching memorable and understandable in a way that was entirely new. Before this, anatomical teaching had not changed much since the time of Vesalius (1514–1564). The method was systemic – that is, week by week students learned about the entire muscular, vascular or nervous systems, all neatly separated. Colles found this fundamentally misconceived: one might as well, he said, take apart a watch and describe each cog and spring in detail, but never say a word about how they work together. In a short volume entitled A Treatise on Surgical Anatomy (1811), Colles advocated instead a regional approach – that is, the study of how the various systems function relative to one another in any given part of the body. In time, regional, as opposed to systemic, anatomy became the new orthodoxy. Along the way, however, Colles’ pioneering role was often forgotten. In some respects, he was a victim of his own success: so completely had he transformed his subject, the world came to believe it was always ever thus.
Colles’ other great claim to fame is his eponymous fracture, caused by a fall on an outstretched hand and resulting in a characteristic ‘dinner-fork’ deformity. In 1814, Colles published an article on the subject in the Edinburgh Medical and Surgical Journal, entitled ‘On the fracture of the carpal extremity of the radius’. is classic description might have been lost to posterity had it not been for Trinity College’s first Professor of Surgery, Robert William Smith (1807–73), who drew attention to it in 1847: ‘It is certainly very extraordinary that...not a single British or foreign author who has written since has made the slightest reference to Mr Colles’ name in connection with the subject, even when almost quoting his words.’ Ever since, the names of Colles and Smith have been, as it were, handed down together: a ‘reversed’ Colles fracture – the result of force applied to the back of the wrist – is known as Smith’s fracture.
In 1839, Colles declined a baronetcy, saying such distinctions held ‘no attraction’ for him. For some time he had been suffering from gout and bronchitis, and in 1841 he made a tour of Switzerland for his health. He improved temporarily, but in October 1842 he felt the end was approaching; accordingly, he wrote the following letter to his friend (and successor as Chair of Anatomy and Physiology), Professor Robert Harrison:
My Dear Robert,
I think it may be of some benefit, not only to my own family, but to society at large, to ascertain by examination the exact seat and nature of my last disease. I am sure you will grant my request, that you will see this be carefully and early done. The parts to which I would direct particular attention are the heart and lungs, a small hernia immediately above the umbilicus, and the swelling in the right hypochondrium. From the similarity of the Rev. P. Roe’s case with mine, I suppose there is some connection between the swelling of the hypochondrium and the diseased state of the heart.
Yours truly, dear Robert,
A. Colles
Colles died a year later, on 1 December 1843, at home in Kingstown (Dún Laoghaire). When the news reached the city, all medical schools closed immediately as a mark of respect. On the day of the funeral, the north and west sides of St Stephen’s Green were impassable due to the great number of mourners and carriages. The Fellows of RCPI walked from their President’s house in Merrion Square, joined by members of the Apothecaries Company; members of the judiciary walked too, headed by the Master of the Rolls. As the hearse passed number 123 St Stephen’s Green, the doors opened and President James O’Beirne (1787–1862) processed out ahead of the Members and the Licentiates; remaining on foot, they followed the cortège to Mount Jerome Cemetery. Some days earlier, Robert Harrison, Henry Marsh and William Stokes were in attendance as Robert Smith fulfilled Colles’ last request. There was evidence of chronic bronchitis, a fibrotic left lung, and a dilated and fatty heart with no indication of valvular disease. William Stokes called this ‘the last great act of Mr. Colles’s medical career’. ■
