RCSI is proud to commemorate the 250th anniversary of the birth of former student, professor and President – and Ireland’s most illustrious anatomist – Abraham Colles (1773 – 1843).
Colles’ story begins in the murky era of barber-surgeons, when surgery was a ramshackle, ill-regulated trade; thanks in large part to Colles’ revolution of his subject, by the end of his career, surgery had been elevated to the status of a highly-respected profession, with Dublin established as a world-leading medical city.
To this day, Colles’ eponymous fracture is known to every practitioner, while the influence of his innovative teaching is apparent in medical curricula the world over.
Read on to explore the life and legacy of this extraordinary man, or watch the Colles at 250 exhibition video below.
On 23 July 1773, Colles was born at the family home, Millmount House, in Kilkenny. His father – who died when Abraham was a boy – ran a successful marble-works in the city. Family lore has it that Colles’ interest in surgery began early: as a pupil at Kilkenny College, he is supposed to have found an anatomy textbook floating in the Nore after a local doctor’s house had flooded. Seeing the boy entranced, the doctor told him to keep the book.
But surgery was also in the family: his great-grandfather, William Colles (1648 – 1719), had started life as a ship’s surgeon. After some amorous scrapes in the north of England, this Colles settled in Ireland. In the family he was known as ‘Brown Billy’ on account of the deep sepia portraits he commissioned of himself every seven years. The story is told that young Abraham would stare at one such portrait and plot his own career – much encouraged in this by his doting mother. Throughout his life, Colles kept up a constant, affectionate, often comic correspondence with his mother – even when the subject was medical: ‘As to your question: ‘What am I to do for the itch?’’ he once replied to her, ‘I must tell you that the practice here which seems to be most pleasant to the generality of patients is to scratch!’
View of Colles’ childhood home, Millmount House, from the banks of the River Nore in Co. Kilkenny / RCSI Heritage Collections
Colles the student
Aged 17, Colles enrolled at RCSI, itself a fledgling six-year-old institution at the time. It had its origins in a meeting that took place a decade earlier, when a group calling themselves the Dublin Society of Surgeons banded together to throw off the constraining yoke of the Barber-Surgeons Guild. The minute book of these meetings records that in the King’s Arms, Fownes Street, they agreed to the following resolution:
That it is the opinion of this Committee that a Royal Charter, dissolving the proposterous [sic] and disgraceful union of the Surgeons of Dublin with the Barbers, and incorporating them seperately [sic] and distinctly upon liberal, and scientific principles would highly contribute not only to their own Emolument and the advancement of the profession in Ireland but to the good of Society in general by cultivating and diffusing, surgical knowledge.
In a revolutionary era, the Dublin surgeons were, in effect, making their own declaration of independence. The call came to fruition four years later, on 11 February 1784, when the surgeons received a Charter from King George III establishing the Royal College of Surgeons in Ireland. RCSI had no permanent home for several years, but in 1789 it leased a house in Mercer Street, behind Mercer’s Hospital, and this is where Abraham Colles attended his first lectures.
Colles was one of perhaps 100 students at the time, many of them destined for military careers. Amongst their teachers were members of the Dublin Society of Surgeons, such as William Dease (c1752 – 1798) and William Hartigan (c1756 – 1812). The latter was famed for carrying kittens about with him in the deep pockets of his greatcoat; he also co-authored – with William Lawless (c1764 – 1824) – A Syllabus of Lectures in Anatomy and Physiology, Delivered in the Schools of Anatomy and Surgery, Under the Direction of the Royal College of Surgeons in Ireland (1796). This was more or less the curriculum that Colles followed as a student. Later, it would be the exact terrain he reinvented.
Minute book of the Dublin Society of Surgeons (1780) / RCSI Heritage Collections
Colles the apprentice
As a trade, surgery was taught by apprenticeship, and Colles’ ‘Indenture Certificate’ – which survives in RCSI Heritage Collections – gives a vivid glimpse of the period of his clinical training. He signed up for a term of five years’ duration – in accordance with the College bye-laws – thereby binding himself to a sweeping range of commitments, some of which are ordinary enough:
… the said Apprentice his said Master faithfully shall serve, his Secrets keep, & his lawful Commandments everywhere gladly do… He shall do no Damage to his said Master nor see it to be done of others… He shall not waste the Goods of his said Master, nor give or lend them unlawfully to any …
Other, more niche prohibitions suggest the life an average apprentice might prefer to live:
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…
Certificate of Indenture for the apprenticeship of Abraham Colles to Philip Woodroffe (1790) / RCSI Heritage Collections
It is hardly surprising that apprentices might like to blow off some steam: theirs was a generally arduous and expensive existence. Day and night they were at their master’s beck and call, oftentimes poorly fed, spartanly housed and expected to jump to any and all duties, whether menial or medical. Apprentices as young as 14 or 15 were in the thick of things, helping to tie or hold down the patient, or wipe a blade on their sleeve before they passed it to their master. The wards they worked in were often overcrowded nests of infection; in those pre-Listerian days, all wounds went septic and indeed the flow of so-called ‘laudable’ pus was welcomed as a necessary step towards recovery.
For his apprenticeship, Colles fared better than many. His master was the forward-thinking Philip Woodroffe (d. 1799) at Dr Steevens’ Hospital, under whose guidance, he had little difficulty obtaining his Licence on 24 September 1795.
Watercolour by Robert F. Power showing a surgical operation to remove a malignant tumour from a man's left breast and armpit in a Dublin drawing room (1817) / Image courtesy of Wellcome Collection
Colles the teacher
Colles the ‘postgrad’: Edinburgh and London
Colles left Dublin within days of his qualification, boarding a packet boat for Scotland to continue his studies in Edinburgh, then the capital of medicine of the English-speaking world. Students flocked there from all over Europe, the Irish being the largest contingent. This Hibernian brain-drain – or at least, fee-drain – was not lost on the newcomer; 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.
The young ‘postgrad’ worked diligently – his landlady worried he was ‘reading himself into a coffin’ – and he steered clear of his compatriots’ excesses (‘all people make it a rule to fight and quarrel with their own countrymen rather than with any other’). His teachers were eminent, including Benjamin Bell (1749 – 1806), author of the landmark six-volume System of Surgery (1783 – 88), and an Honorary Member of RCSI since its earliest days.
In June 1797, Colles was awarded his doctorate. Both his thesis, entitled De Venaesectione (‘On Bloodletting’), and his viva voce defence of it were in Latin (in later life Colles would recommend to his students that they ‘refresh and extend your knowledge of the classics at your leisure hours’). Phlebotomy might be prescribed today for conditions such as haemochromatosis, but even in Colles’ time bloodletting was part of an old-guard orthodoxy – essentially, it was ancient humeral doctrine in action. Its efficacy – or, more to the point, its lack thereof – was hard to prove: if a patient recovered, it was interpreted as thanks to the treatment; if they unfortunately died – well, that was simply because they were beyond salvation already. (Two years after Colles submitted his thesis, US President George Washington developed a sore throat after horse-riding in the rain. He might have gone to bed with a hot whiskey and lived to tell the tale; instead, his doctors bled him over two days and he died.)
Colles next headed south, to London. Little is known of the six months he spent in the city, except that he ‘walked the hospitals’ and that he made the acquaintance of Astley Cooper (1768 – 1841), then on the cusp of becoming one of Britain’s most celebrated anatomists. Colles and Cooper corresponded frequently for the rest of their lives, and in 1820 Cooper was made an Honorary Member (later Fellow) of RCSI.
Map of the British Isles, engraved by J. & C. Walker (London, 1842) / Image courtesy of Library of Congress
Practitioner and professor
The Ireland that Colles returned to was simmering towards insurrection, stirred by an outlawed group called the United Irishmen who hoped to liberate Ireland from colonial rule. In this, they had natural affinities with the surgeons who had liberated themselves from their barber guild-mates. But the affinities went further: both the United Irishmen and RCSI were avowedly non-sectarian, which in a country divided along confessional lines was not just anomalous but something of a wonder. Indeed, certain individuals were members of both groups, including Colles’ teachers Lawless and Dease. When rebellion broke out, Lawless fled to France, where he was appointed captain of Napoleon’s Irish Legion. Dease, meanwhile, died a mysterious death – according to some, by his own hand, in order to avoid arrest.
Westminster’s reaction to the insurrection was the Act of Union (1800), which at a stroke converted Dublin into the ghost of a capital. Most narrative histories of Ireland posit the half century that followed as a time of terminal decline, reaching a nadir with the horror of the Great Famine. But there is another story, too. The same period was a golden age in Irish medicine, later characterised as ‘the Dublin School’. The leading lights of the movement were the physicians Robert Graves (1796 – 1853), William Stokes (1804 – 78) and, as their surgical counterpart, Abraham Colles.
The eldest of three, Colles’ career had taken off following the death of his former master, Woodroffe. Within a month, Colles was appointed resident surgeon at Dr Steevens’ Hospital, for which he earned £55 a year, plus ‘£5 per annum in lieu of furniture’. In November he was elected a Member of RCSI, meaning he could now take on apprentices. These represented sea-changes in his fortunes; previously he had eked out a precarious living (‘feeless’, ran one plaintive entry in his monthly records). Thereafter, he rocketed through the ranks at RCSI: he was elected an Assistant in 1800, a Censor in 1801, and then, in January 1802, in recognition of his evidently outstanding abilities, President of the College. He was just 29 years old. In 1804 he was appointed to two chairs at once: Anatomy and Physiology, which he held for the next quarter of a century; and Surgery, which he occupied even longer, until his retirement in 1836.
Illustration of Dr Steevens’ Hospital from Views of the most remarkable public buildings, monuments and other edifices in the city of Dublin, delineated by Robert Pool and John Cash (Dublin, 1780) / Image courtesy of Dun’s Library, Royal College of Physicians of Ireland
A Treatise on Surgical Anatomy (1811)
With Colles at the helm, RCSI saw its student numbers nearly quadruple inside a decade, from 55 at the turn of the century to 204 in 1811. This is a cardinal date in anatomical pedagogy, owing to a slim volume Colles published, A Treatise on Surgical Anatomy, in which he suggested that anatomical teaching had been misconceived since the time of Vesalius (1514 – 1564).
Vesalius pioneered what became known as systemic anatomy: in one limb the entire musculature would be dissected and displayed, in another it would be the nerves or blood vessels, and so on. For several hundred years, anatomy professors – and their students – followed suit, dissecting one system at a time: the arteries this week, the veins the next.
Drawings from 'De Humani Corporis Fabrica' by Andreus Vesalius (Italy, 1543) / RCSI Heritage Collections
As a working surgeon – and teacher – Colles found this method manifestly deficient. One might as well, he says, take apart a watch and describe each cog and spring in detail, but never say a word about how they work together. Little wonder, then, that the poor student should find the study of anatomy ‘so difficult to acquire, and almost as difficult to retain’. What Colles advocated instead was a regional or topographical approach – that is, the study of how the various systems function relative to one another in any given part of the body. The Treatise is laid out according to this new principle: there are sections on the abdomen, the thorax, the pelvis, the neck and throat, and so on.
Slim as the Treatise is – it was meant to be the first instalment of a larger work, though no sequel followed – it had an immense influence, initially as part of ‘the Dublin School’, subsequently in the wider medical world. 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.
Illustrations from 'Medical Anatomy: Or, illustrations of the relative positions and movements of the internal organs' by Francis Sibson (Dublin, 1869) / RCSI Heritage Collections
Colles the innovator
The Colles fracture
In 1814, Colles published an article in the Edinburgh Medical and Surgical Journal entitled ‘On the fracture of the carpal extremity of the radius’. Accident and Emergency Departments the world over know the description therein as a Colles fracture. The cause is a fall on an outstretched hand, and its fame is owed to its prevalence, affecting both young adult and older populations (thanks, respectively, to high- and low-energy falls, or ski-slopes and slips). Nowadays, diagnosis is by X-ray; in Colles’ time it depended on external observation of the characteristic ‘dinner-fork’ deformity.
Colles’ classic description might have been lost to posterity had it not been for Robert William Smith (1807 – 73), who drew attention to his predecessor’s work 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 handed down together: a ‘reversed’ Colles fracture – the result of force applied to the back of the wrist – is known as Smith’s fracture.
The quicksilver cure
In 1837, Colles finished his labour of many years, a 350-page study entitled Practical Observations on the Venereal Disease and on the Use of Mercury. From a modern point of view, Colles and his contemporaries were working in the dark. Syphilis was highly infectious and contagious, but little else could be said with confidence except that it was ‘a poison’. Everyone knew how it was transmitted, but conjecture and rumour still abounded.
Colles’ interest in the condition dated back to 1820, when the male patients of Westmoreland Lock Hospital were transferred to Dr Steevens’ Hospital (the name ‘lock hospital’ refers to earlier leprosy hospitals where patients wore rags or ‘locks’ to cover their lesions). His Observations was hailed by many as Colles’ ‘greatest work’, establishing him as ‘one of the great authorities’ in the field – but posterity (very quickly) failed to agree. A good deal of the book charts Colles’ favoured mercury treatment – essentially, an early chemotherapy. In subsequent decades, studies established that mercury treatment was iatrogenic – that is, it actively caused harm – but even in Colles’ time there was a growing ‘non-mercurial’ school of thought.
Plate illustration representing the last stage of Lues Venerea where the mouth, nose and part of the face are destroyed from the disease and the baneful effects of mercury. From The Secret Companion, a medical work on onanism or self-pollution, with the best mode of treatment in all cases of nervous and sexual debility, impotency, etc. by RJ Brodie (London, 1845) / Image courtesy of Wellcome Collection
A last lesson
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), Prof. 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
Excerpt from Observations on the Case of the late Abraham Colles … by William Stokes, Dublin Quarterly Journal of Medical Science (No. 11; May 1846) / RCSI Heritage Collections
Colles died a year later, on 1 December 1843, at home in Kingstown (Dún Laoghaire). When the news reached the city, its 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. As the hearse passed number 123 St Stephen’s Green, the doors opened and the President 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 and William Stokes were in attendance as Robert Smith fulfilled Colles’ last request. The findings of their post-mortem examination were communicated to the Pathological Society of Dublin. There was evidence of chronic bronchitis, a fibrotic left lung, and a dilated and fatty heart with no indication of valvular disease. Once a teacher, always a teacher. William Stokes called this ‘the last great act of Mr Colles’s medical career’.
As Colles bowed out, medicine and surgery were on the cusp of several Copernican revolutions. The riddle of the ages – how to control pain – was solved by the introduction of anaesthesia (1846). Not much later, the discovery of the preservative properties of formaldehyde meant that anatomical teaching was no longer in a race against (putrefying) time. A new focus on the microscopic realm, led by figures such as Louis Pasteur and Joseph Lister – both conferred with Honorary Fellowship of RCSI in 1886 – introduced the world to ‘germ theory’.
And yet, throughout this radical change – and through the leaps and bounds of the century to follow – Colles’ own revolution in anatomical pedagogy stood the test of time. Why? Because human anatomy may be as varied as humanity itself, but in our attempts to make sense of it – and, moreover, to fix it when it fails – we are all still students of Abraham Colles.