Abraham Colles: Colles' fracture.
Every reader of this journal will be all too familiar with
Colles' fracture; either seeing patients with it in a & e,
helping with its reduction and splinting or being part of the
Anaesthetics team involved in its management. on an icy winter's
day there might be half a dozen patients with this injury in your
accident unit, mostly elderly ladies. yet it was not until 1814 that
Abraham Colles accurately described this injury and its treatment in his
paper 'on the fracture of the carpal extremity of the radius',
published in the Edinburgh medical and surgical journal of that year.
KEYWORDS Abraham Colles / Colles' fracture / Fracture
|Publication:||Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2012 Association for Perioperative Practice ISSN: 1750-4589|
|Issue:||Date: August, 2012 Source Volume: 22 Source Issue: 8|
"His article begins; 'The injury to which I wish to
direct the attention of surgeons has not, as far as I know, been
described by any other author'. Before Colles, the injury was
mistaken for a sprain or a dislocation of the wrist joint, which is, in
fact, a rare injury. The diagnosis of a fracture was missed because
impaction of the distal fragment of the radius meant that crepitus, (an
important diagnostic sign of a fracture in those pre-X-ray days), was
absent. He describes his method of diagnosis as follows; 'Let the
surgeon apply the fingers of one hand to the seat of the suspected
fracture and, locking the other hand into that of the patient, make a
moderate extension until he sees the limb restored to its natural form.
As soon as this is affected, let him move the patient's hand
backward and forward and he will, at every attempt, be sensible of
yielding of the fracture ends of the bone, and this to such a degree as
must remove all doubts from his mind'.
He then goes on to give meticulous instructions for reduction and splintage of the fracture, using anterior and posterior splints of tin and states; 'The cases treated on this plan have all recovered without the smallest defect or deformity of the limb in the ordinary time for the care of fractures'.
Abraham Colles was born in 1773 in a village near Kilkenny, in what is now Eire. His father owned a marble quarry, but his paternal grandfather had been a surgeon in that town. The story goes that while young Abraham was at school, a flood spread through the local doctor's house, carrying away his possessions, including his books. Abraham found an anatomy book, read it and then returned it to the doctor, who, in turn, presented it to the boy. This is said to have turned his mind to medicine.
Colles entered Trinity College Dublin in 1790, studied at Dr. Steeven's Hospital and the Foundling Hospital in that city and also in Edinburgh, qualifying with his Edinburgh MD in 1796. Colles then travelled to London and spent time with Astley Cooper, surgeon at Guy's Hospital.
Returning to Dublin, Colles became a Member of the Royal College of Surgeons in Ireland and, in 1799, was appointed to the staff of the Dispensary for the Sick Poor in Meath Street and opened premises for the teaching of Anatomy and Surgery - Dublin at that time was an important centre for postgraduate students - and was later appointed surgeon to Dr. Steeven's Hospital.
Much of Colles' academic career was at the College of Surgeons in Dublin. He held the Chair of Surgery there from 1804 to 1836, and also the Chair of Anatomy and Physiology from 1804 to 1827. He was appointed President of the College 1802, (at the young age of only 29), and again in 1830. He took his teaching duties most seriously. He was an effective lecturer, without resorting to flowery rhetoric. He was particularly skilled at painting a vivid word-picture of the disease he was discussing.
Colles was a hard worker. He had a particular interest in anatomy, and would often get in some dissection at six in the morning before commencing his hospital round at 7am. He published a treatise on anatomy in 1811 and described Colles' fascia in the perineum. This is the sheet of connective tissue that descends from the lower abdominal wall into the scrotum and then attaches to the posterior margin of the perineum. In rupture of the bulb of the urethra - classically in a fall with legs apart across a fence - blood and urine extravasate into the scrotum, track up into the lower abdominal wall, but the fluid remains trapped in front of the anal verge.
Much of the work of the surgeon in those days was concerned with venereal diseases and Colles published an important treatise on the subject, 'Practical Observations on the Venereal Disease and the Use of Mercury' in 1837. In this he describes a clinical phenomenon which is still called 'Colles Law'; 'It is a curious fact that I never witnessed nor ever heard of an instance in which a child deriving the infection of syphilis from its parents has caused an ulceration of the breast of its mother', though infection of the breast of a hired wet-nurse was invariable.
A colleague wrote of him in his obituary in the Lancet; 'As an operator he had many equals, and some superiors; but in advice, from long experience and a peculiar tact in discovering the hidden causes of disease, he has scarcely a rival'.
Colles retired from his chair of surgery in 1836 because of ill health - gout and cardiac failure, which was treated with infusion of digitalis. He died in 1843 and was given a public funeral.
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by Professor Harold Ellis
Correspondence address: Department of Anatomy, University of London, Guy's Campus, London, SE1 1UL.
About the author
Professor Harold Ellis
Emeritus Professor of Surgery, University of London; Department of Anatomy, Guy's Hospital, London
No competing interests declared
Provenance and Peer review: Commissioned; Peer reviewed; Accepted for publication January 2012.
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