Biography of Richard Bright
The first third of the nineteenth century brought forth an extraordinary flowering of medical talent, among whom Richard Bright was a truly outstanding figure. In his day, Bright was the leading medical consultant in London and the most famous of the "great men of Guy's", a name given to a succession of eminent workers at Guy's hospital. A student of Sir Astley Paston Cooper (1768-1841) and James Currie, Bright's powers of observation marked him as a true follower of Thomas Sydenham (1624-1689). Although Bright advanced no new theories of disease and did little original classification in pathology, he collected and recorded an extraordinary amount of data from which he was able to draw his conclusions and to base his assumptions.
The list of original description attributed to Bright includes those for pancreatic diabetes, unilateral convulsions, laryngeal phtisis, condensation of the lung in whooping cough, and glomerulonephritis (Bright's disease).
A man of means
Bright was the third son of Richard Bright, a wealthy merchant and banker, and Sarah Bright. Both his maternal and fraternal ancestors were important figures in Bristol's golden age of merchant venturers who made substantial fortunes in the West Indies during the eighteenth century. Bright always lived in comfortable circumstances, he never had to care about the financial sides of his career and could devote himself wholly to medical and scientific pursuits.
In addition to being an astute businessman, Richard Bright, Sr., was keenly interested in science, encouraging his son's interest in science and medicine. At the young age of six, Richard Bright was sent to the school of Dr. John Prior Estlin, near Bristol. Later he transferred to the school of Reverend Lant Carpenter in Exeter. In 1808, at the age of nineteen, Richard Bright enrolled at the University of Edinburgh, where he at first studied moral philosophy, political economy, nature philosophy and mathematics in 1808. The next year he changed to medicine.
From Iceland to Guy's
In the summer of 1810 Bright accompanied Sir George Mackenzie (1780-1848) and the later Sir Henry Holland (1788-1873) as a naturalist on an expedition to Iceland where he conducted studies in botany and zoology. He also assisted Mackenzie with the natural scientific parts in the writing of his book "Travels in Iceland" – a clenod frequently found in antique bookshops – if other collector of travel books have not already raided the shelves. This was Bright's first scholarly publication.
Back from Iceland in the autumn of 1810 he continued his medical studies at Guy's Hospital in London, attending lectures of among others William Babington (1756-1833) on practical medicine and Astley Cooper on pathological anatomy. Pathology and post-mortem examinations became his great interests, besides clinical work.
In 1812, after two years at Guy's Bright returned to Edinburgh where, in September 1813, he was conferred doctor of medicine with a dissertation titled De erysipelate contagioso. He then spent two terms at Cambridge, but he left quite dissatisfied, and in the summer of 1814 went for a study tour to Berlin. On his return journey he arrived in Brussels two weeks after the battle of Waterloo, where he had the opportunity to watch the treatment of the wounded
In the winter of 1814/1815 Bright visited Vienna where he followed the proceedings of the Vienna congress with great interest. In the spring of 1815 he travelled in Hungary. He published his observations from his visit to Vienna and his journey in Hungary in Edinburgh in 1818 in a work illustrated with his own drawings, titled Travels from Vienna through Lower Hungary with some remarks on the state of Vienna during the congress in the year 1814 - a 642 page work with an appendix of 102 pages.
Returning to England, Bright became a licentiate of the Royal College of Physicians, London, on December 23, 1816, but he was not elected fellow until 1832, In early 1817 he became assistant physician at London Fever Hospital, where he developed a severe fever and nearly died, but in 1818 went on another travel to Germany, Italy, and France. Two years later he was established in practice at 14 Bloomsbury Square, a well-trained physician for those days and the same year, 1829, was elected to the Royal Society. In 1824 was promoted to physician at Guy's Hospital, where he worked as teacher and physician until 1843, where after he devoted himself to private practice.
The three great men of Guy's
Bright's time at Guy's was one of the best in the history of the hospital. In a period of twelve years, from 1825 to 1837, Thomas Addison (1793-1860), Thomas Hodgkin (1798-1866), and Richard Bright worked simultaneously at Guy's. In these years Bright and Addison won international renown for their series of lectures. The three "great" had much in common. They have all had a disease named after themselves, together and separately they have renewed clinical research by making painstakingly accurate notes on clinical observations, and, by completing these with post-mortem findings. All three had their doctoral promotions in Edinburgh, though for different reasons: Hodgkin, a Quaker, was denied access to Oxford or Cambridge, Addison could not afford it, while Bright seems to have preferred quality over tradition.
In 1833 Bright held both the Gulstonian and the Lumleian lectures at the College of Physicians. In 1837, upon the ascending of the crown by Queen Victoria, he was appointed her personal physician.
Within few years after the description of "his" disease, Bright's name was known everywhere. The complex of symptoms of oedema with albuminuria and affections of the kidneys soon was known as Morbus Brightii, even though other names had been suggested. A large number of articles and books tell of the intensity of the research.
In the spring of 1842, the authorities at Guy's set aside two clinical wards of twenty-one beds each for six months for Bright to carry on intensive study of renal disease; there were included in this area a small clinical laboratory, a consulting room, and office. This was the first clinical experimental unit established in England. The results were reported in Guy's Reports for 1843 by Bright's associates, G.H. Barlow and G.O. Rees.
Morbus Brightii - several diseases
Between 1827 and 1836 Bright produced three classic publications linking dropsy and coagulable urine with disease of the kidney. The chemical analyses were undertaken by a chemist, John Bostock (1773-1846). The early publications were mainly about chronic kidney diseases, but later he suggested that such cases were the result of an initial, sometimes invisible attacks of nephritis.
Already Bright himself was well aware that dropsy connected with albuminury and damages to the kidneys might be considered different types of diseases of the kidneys. He considered the findings of organic derangements reason for "the establishment of three varieties, if not three completely separate forms, of diseased structure, generally attended by a decidedly albuminous character of the urine". He described three different conditions of changes of the kidneys, but added that thereby he risked a guessing the correctness of which he was not sure. Over the years he discovered new variances, among them postinfectional forms. It is long agreed that Bright's disease is not a defined condition but just a common term for different diseases of the kidneys, like nephrites, nephroses, nephroscleroses, etc.
Bright's apparatus to detect protein in urine was a spoon. In his own words "one of the most ready means of detecting albumin is the application of heat by taking a small quantity of urine in a spoon and holding it over a flame of a candle. If albumin is present, you perceive before the fluid reaches the boiling point that it becomes opaque, sometimes presenting a milky appearance at the end of the spoon, which extends inwards till it meets in the centre and then breaks into a white curd".
Bright, standing at a crossroads in medical history, exemplified the transition between old and new - the tradition, on the one hand, that emphasized observation with virtually unaided senses, and, on the other hand, the tradition that emphasized laboratory and other technical aids to knowledge. Bright used the most rudimentary technique to identify albumin in the urine, heating a sample in a teaspoon held over a candle flame. But even at that very time analytic tools of considerable precision were being forged for chemistry, physiology, anatomy, and pathology. These new tools, and the theories to which they gave rise, became increasingly significant in medicine. Bright ceased active research just at the threshold of a new era.
His link with the past is clearly visible in the textbook written with Thomas Addison, which looks backward rather than forward. But his spirit of inquiry, respect for evidence, careful observation, critical acumen, and restrained conclusions, all were forward-looking.
On the 11th of December, 1858, Richard Bright, who had known for some years that he had valvular disease of the heart, was seized with great prostration, dyspnoea, and sigmoid pains. He failed to rally and died on the 16th, aged 69.
- «To connect accurate and faithful observations after death with symptoms displayed during life must be in some degree to forward the objects of our noble art.» Reports of Medical Cases, Vol. I.
«The great rule is, to avoid everything which obviously deranges the stomach.» Guy’s Hospital Reports, 1836; 1: 338.
«I have never yet examined the body of a patient dying with dropsy attended coagulable urine, in whom some obvious derangement was not discovered in the kidneys .... In all the cases in which I have observed the albuminous urine, it has appeared to me that the kidney has itself acted a more important part, and has been more deranged both functionally and organically then has generally been imagined.» Reports of Medical Cases, 1827.
«It is quite impossible for any man to gain information respecting acute disease, unless he watch its progress. Day after day it must be seen; the lapse of eight.and-forty hours will so change the face of disease .... Acute disease must be seen at least once a-day by those who wish to learn; in many cases twice a-day will not be too often.»
Address delivered at the Commencement of a Course of Lectures on the Practice of Medicine.