Colles and Grimshaw
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Abraham Colles and Thomas Wrigley Grimshaw
Abraham Colles (1773-1843) was, like Richard Helsham, a native of Kilkenny, and like his predecessor, studied at Kilkenny College before entering Trinity College Dublin. He was apprenticed to Philip Woodroffe, resident surgeon at Dr Steevens’ in 1790 and nine years later succeeded Woodroffe as resident surgeon. He held this position until 1813, thereafter becoming a visiting surgeon at the hospital, and continued teaching and working at Dr Steevens’ Hospital until 1841, two years before his death in 1843.
When appointed in 1804 as both Professor of Surgery and Professor of Anatomy and Physiology in the Royal College of Surgeons in Ireland, Colles used the insights his practice at Dr Steevens’ had given him to instruct his young medical students. As Rocyn Jones (1950) notes, Colles in effect ‘reorganised the teaching of anatomy at the College and succeeded in arousing and maintaining the interest of students by regional dissections’. The fruits of his anatomical labours may be seen in his 1811 work A Treatise of Surgical Anatomy. It was in this work that he described what is known today as ‘Colles’ fascia’:
‘Now proceed to dissect the perineum. Raise the skin of the perineum, extending the dissection beyond the tubera ischii to the thighs. This exposes to view a strong fascia, which, on dissection, will be found to cover the entire of the perineum, and to blend itself with the structures of the scrotum. This fascia, although on a superficial view it appears continuous with the fascia of the muscles of the thigh, will yet be found, on closer examination, to attach itself very firmly to the rami of the ischium and pubis. The texture and connexions of this fascia will serve to explain many of those phenomena attendant on the effusion of urine into the perineum, by rupture or ulceration of the posterior part of the canal of the urethra.’
‘Colles’ ligament’ is likewise described in this 1811 text.
Today, however, Colles is best known for his description of a common fracture of the radius which is called the ‘Colles’ wrist fracture after him. In a seminal paper entitled ‘On the fracture of the Carpal Extremity of the Radius’, which appeared in the Edinburgh Medical and Surgical Journal of 1814, Colles outlined the nature of this common fracture:
‘This fracture takes place at about an inch and a half above the carpal extremity of the radius, and exhibits the following appearances.
‘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 bone, while a considerable swelling occupies the wrist and the metacarpus. Indeed the carpus and base of the metacarpus appear to be thrown backward so much, as on first view to excite a suspicion that the carpus had been dislocated forward.
‘On viewing the anterior surface of the limb, we observe a considerable fullness, as if caused by the flexor tendons being thrown forwards. The fullness extends upwards to about one-third of the length of the fore-arm, and terminates below the upper edges of the annular ligament of the wrist. The extremity of the ulna is seen projecting towards the palm and inner edges of the limb; the degree, however, in which this projection takes place, is different in different instances…’
Portrait of Abraham Colles in later life.
Though today Colles is primarily known for his surgical work he also devoted much time and energy to research into effective measures to treat venereal disease. His textbook on the subject, Practical observations on venereal disease and on the use of mercury which was published in 1837 and translated into German two years later, made his name in this particular field. In it he formulated what is known as Colles’ Law: ‘One fact well deserving our attention is this: that a child born of a mother who is without any obvious venereal symptoms, and which, without being exposed to any infection subsequent to its birth, shows this disease when a few weeks old; this child will infect the most healthy nurse, whether she suckle it or merely handle and dress it; and yet this child is never known to infect its own mother, even though she suckle it while it has venereal ulcers on the lips and tongue.’. As Little (2006) correctly states, Colles’ Law was wrong, but it should be remembered that it was not appreciated at the time that the reason the mother did not seem to be infected was because she already had the disease in latent form, nor that the cause of syphilis was the spirochete treponema pallidum (a discovery of 1906).
In any case, Colles’ Law was not the main focus of the work which centred on the appropriate treatment methods for syphilitic patients. Colles outlined the ‘new’ non-mercurial treatment of syphilis which he stated had been put on trial in Dr Steevens’ Hospital. He was not, however, impressed by the results:
When this plan first attracted the notice of the surgeons of Great Britain both my colleagues and myself adopted it in our hospital. In general we confined this treatment to men who had not used any mercury; but as in Dublin it is extremely difficult to meet with venereal cases in hospital who have not applied to some apothecary, or received medicines at a dispensary, we could not adopt it as the general practice of the institution. However, we tried it until we all became convinced of this fact – that it was not suited to patients who were obliged to earn their bread by labour; for we saw that after they had left the hospital and got into employment they generally found themselves weak, and unequal to their usual labour; and often, at the end of two or three months, they returned emaciated, pale, and enfeebled, in consequence of the hectical form of fever which was about to usher in a new series of venereal symptoms. Their stay in the hospital also proved in general very protracted; so that they then became impatient of this treatment, especially when they saw others with similar symptoms in the same ward have their complaints more quickly cured by the use of mercury….
For Colles, mercury was either ‘a valuable medicine or a dangerous poison’ depending on how it was used. In his own view, it was the ‘specific’ treatment for syphilitic patients in Dr Steevens’ Hospital during his time there. In this he was not alone: as Siena (2004) makes clear, mercurial salivation was the normal treatment in London hospitals during the later eighteenth century.
If Colles had been the pre-eminent surgeon in Dr Steevens’ Hospital in the first decades of the nineteenth century, one of the most influential nineteenth-century physicians was Thomas Wrigley Grimshaw (1839-1900). Grimshaw was educated at Trinity College Dublin in the early 1860s before becoming physician to Cork Street Fever Hospital and Dr Steevens’ Hospital where he lectured on botany (1862-5), and materia medica (1865-78). In 1870 he was appointed junior physician at Dr Steevens’ and was later elected as Professor of Medicine at Dr Steevens’ in 1878. His impact at Dr Steevens’ Hospital was thus in a number of fields – though perhaps his most lasting impact as regards Dr Steevens’ was his championing of the establishment of a nursing school in the 1878 report on nursing education which bears his name.
Though important in the context of Dr Steevens’ Hospital he has not, however, received the attention accorded Abraham Colles. Overshadowed by Colles, he nonetheless deserves recognition not only for his work at Dr Steevens’ but also for his work in statistical medicine. In this he was following in the footsteps of earlier physicians of Dr Steevens’, most notably John Crampton (c. 1840), whose report on the fever epidemic of 1817-1819, examined in the ‘Fever’ page of this website, contained much detailed analysis of statistics from the cases provided by Dr Steevens’.
At the age of forty Grimshaw was appointed Registrar General for Ireland and for the last twenty years of the nineteenth century provided detailed analysis of disease outbreaks across Ireland for the central government. His career as a medical statistician inevitably impacted on his work at Dr Steevens’ and he had been forced to resign his professorship when he was appointed Registrar General. However, in the following year (1880) he was appointed a consulting physician to the hospital and a year later was elected to the Board of Governors. As Breathnach and Moynihan (2009) point out, Grimshaw significantly influenced the debate about infectious diseases in Ireland: while his earlier research had focused on what in the nineteenth century were called ‘zymotic diseases’ (i.e. acute infectious diseases such as small pox, measles, and typhoid fever) his findings on the spread of phthisis (tuberculosis) caused him to reassess his data and push for greater efforts to be made to contain this deadly infectious disease. Armed with the 1881 census he began to study the spread of diseases in urban and rural areas. By focusing on death rates Grimshaw began to see that the ‘predominant cause of sickness and death in towns are lung diseases, not as many suppose, infectious fevers’. In particular, he noted that the rate of tuberculosis was higher in Belfast than in Dublin and surmised that this spike was due to the working conditions of young women as factory hands. His seminal paper of 1887 ‘On the prevalence and distribution of phthisis and other diseases of the respiratory organs in Ireland’ plotted the statistical rise and scope of the disease. The increase of deaths from tuberculosis was carefully tabulated and Grimshaw provided suggestions as to how the epidemic should be tacked: cleanliness and isolation were the two key strands of his prevention policy. Though perhaps placing more trust in notified figures than was warranted, Grimshaw used the statistics he was provided with to try and reshape public health policy.
Sources
Andrews, Helen (2009), ‘Colles, Abraham’, Dictionary of Irish Biography.
Bettany, G. T. (2004) ‘Colles, Abraham (1773-1843), rev. Patrick Wallis, Oxford Dictionary of National Biography.
Breathnach, C. S. and Moynihan, J. B. (2009), ‘Thomas Wrigley Grimshaw (1839-1900). Registrar General 1879-1900’, Ulster Medical Journal 78 no. 1, pp. 43-50.
Coakley, Davis (1992), Irish Masters of Medicine (Dublin: Town House).
Colles, Abraham (1814), ‘On the fracture of the carpal extremity of the radius’, Edinburgh Medical and Surgical Journal, X, pp. 182-5.
Colles, Abraham (1837) Practical observations on venereal disease and on the use of mercury (London).
Fernández Vásquez, Juan Manuel, Fernández Paolomo, Luis Justino, Camacho Galindo, Javier (2005), ‘Abraham Colles’, Acta Ortopédica Mexicana 19 (1), pp. 39-40.
Kirkpatrick, T. P. C. (1924; reprinted 2008) The History of Doctor Steevens’ Hospital Dublin, 1720-1920 (Dublin).
Little, Miles (2006), ‘The Gordon Gordon-Taylor Memorial Lecture: surgical giants and giants among surgeons – the case of Abraham Colles’, ANZ Journal of Surgery 76, pp. 1115-1120.
Murphy, David (2009), ‘Grimshaw, Thomas Wrigley’, Dictionary of Irish Biography.
Rocyn Jones, Arthur (1950), ‘Abraham Colles’, The Journal of Bone and Joint Surgery 32-B, no 1, pp. 126-130.
Siena, Kevin P. (2004), Venereal Disease, Hospitals and the Urban Poor. London’s “Foul Wards”, 1600-1800 (University of Rochester Press).
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