Clinical Anatomy 14:387388 (2001)

A GLIMPSE OF OUR PAST

Abraham Colles 17731843

One of the most common skeletal injuries is a fracture of the distal radius, routinely referred to as Colles fracture. For centuries this injury was mistaken for a dislocation of the wrist. It was probably rst described as a fracture by Claude Pouteau (1725 75), but his description remained obscure (Peltier, 1984). It was the succinct and accurate description by Abraham Colles (1814) that is widely regarded as the denitive description. Named for his maternal grandfather, Abraham Colles (Fig. 1) was born near Kilkenny, Ireland on 23 July 1773. His family was relatively wealthy, as they were involved in the marble quarry business for which Kilkenny is famous. His father died when Abraham was 6, however, leaving a widow with three sons and a daughter. During the time Abraham was in grammar school, the house of a local doctor was partially destroyed by a ood. The doctors anatomy book was swept away, and Abraham found it in a eld and returned it to the doctor, who sensed an interest in the young man, and let him keep the book (Brian, 1976). Inspired to study medicine at a young age, Abraham entered the University in Dublin in 1790 and received the diploma of The Irish College of Surgeons 5 years later. For further training, Colles went to Edinburgh, which was considered a leading center of medical education at the time. He learned more anatomy, probably from Alexander Monro and John and Charles Bell. After completing a thesis and receiving his M.D. degree in 1797, Colles walked the 400 miles to London, a reection of the frugality of the times. He lived in London for a short time, assisting the famous surgeon Astley Cooper with dissections of the inguinal region. Colles and Cooper remained life-long friends (Fallon, 1976). Colles returned to Dublin to establish himself as a surgeon. After a few nancially difcult years, he dedicated himself to surgery and was elected President of the Irish College of Surgeons before he turned 29 (Benjamin, 1965). He held positions as Resident Surgeon and later Professor of Anatomy, Physiology, and Surgery in Dublin. He was known as a cheerful, personable man and was regarded as the most popular surgeon in Ireland for decades (Fallon, 1976). He retired in 1841 and died 2 years later, long a martyr to gout (Benjamin, 1965). From clinical observations, Colles recognized that extravasated urine was contained within specic ana

tomic boundaries. He described the membranous layer of the subcutaneous tissue of the perineum, which is commonly called Colles fascia, and the supercial perineal pouch, sometimes called Colles space. From his dissections with Cooper, he described the reected (inguinal) ligament, which has been called Colles ligament. He is also credited with Colles Law that dealt with the transmission of syphilis, but this law was proven incorrect by Wassermann after the disease was better understood (Benjamin, 1965). Abraham Colles is best known, however, for his description of the distal radial fracture several decades before X-rays were discovered (Colles, 1814). His description is considered a model for conciseness and clarity, resulting in Colles fracture being used in everyday medical practice. Here is an excerpt from Colles classic article:
The posterior surface of the limb presents a considerable deformity; for a depression is seen in the forearm, about an inch and a half above the end of this

Fig. 1. Abraham Colles at about age 50.

2001 Wiley-Liss, Inc.

388

Carmichael Colles A. 1814. On the fracture of the carpal extremity of the radius. Edinburgh Med Surg J 10:182 (reprinted in J Bone Joint Surg 1973. Colless classic description of fractures of the lower end of the radius. 55:454 456). Fallon M. 1976. Abraham Colles of Dublin and Edinburgh. J R Coll Surg Edinb 21:378 382. Peltier LF. 1984. Fractures of the distal end of the radius. An historical account. Clin Orthop 187:18 22.

bone, while a considerable swelling occupies the wrist and metacarpus. Indeed, the carpus and base of metacarpus appear to be thrown backward so much, as on rst view to excite a suspicion that the carpus has been dislocated forward.

REFERENCES
Benjamin JA. 1965. Abraham Colles (17731843) Distinguished surgeon from Ireland. Invest Urol 3:321323. Brian VA. 1976. The man behind the name. Abraham Colles. Nurs Times 72:1064.

Stephen W. Carmichael Mayo Clinic Rochester, Minnesota