Colles-Stokes Contributions to the Concept of Heart Failure

Abstract

“Colles fracture,” “Colles law,” “Stokes-Adams syndrome,” “Cheyne-Stokes respiration,” and “Corrigan pulse” are some of the contributions of the Irish school that are utilized for teaching purposes in medical schools and training programs, as well as in daily practice of medicine. We wish to add an important description by Drs. Colles and Stokes that personifies the considerable personal contributions of these 2 physicians in our understanding of the pathophysiologic expression of the syndrome of heart failure. The clinical–pathologic correlation of the disease that affected Dr. Colles is well described by Dr. Stokes in his treatise Diseases of the Heart and the Aorta. He recognized the cyclical nature of frequent decompensations in heart failure, the relation of clinical worsening in conjunction with reduced urine output, as well as the importance of reestablishing urinary flow to achieve a decrease in dyspnea. Dr. Colles also demonstrated a profound clinical insight when he noticed, first, that his affliction was “eventually a fatal disease and that remedies that work may lose effect over time,” illustrating an observation that has stood the test of time and, secondly, when he told Dr. Smith “… I would direct particular attention to the heart and the lungs … and the swelling in the right hypochondrium … I suspect that there is some connexion between this swelling of the hypochondrium and the diseased state of the heart.” We believe that the Colles-Stokes contributions, both in the clinical as well as the clinical–pathologic arenas, are one of the landmark descriptions that helped to evolve the concept of the syndrome of heart failure.