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Bright, Richard

Full Name: Richard Bright

Achievements: Bright’s disease (nephritis)

Born: September 28, 1789; Bristol, Gloucestershire, England

Died: December 16, 1858; London, England (Aged 69)

Field & Discipline: Medicine; Physician

Language: English

Father: Richard Bright

Mother: Unknown

Siblings: Two elder brothers

Spouse: 1) Martha Babington (m. 1822, d. 1823); 2) Elizabeth Follett (m. 1826)

Children: by Babingon: William (b. 1823). By Follett: six children

Education: Dissenting School, Bristol (1796-1807); University of Edinburgh (1808-10 & 1812-13); Guy's Hospital, London (1810-12); University of Cambridge (1813-14)

Major Work:

“Reports of Medical Cases,” 2 vols., 1827-31

Life & Times:

Bright’s father was a keen amateur botanist, geologist and inventor, numbering amongst his close friends [met] Joseph Priestley*, [met] Watt*, [met] Davy* and Dr. Thomas Beddoes of the Pneumatic Institute in Bristol, and the young Bright was thus brought up within both a financially comfortable and an intellectually rich environment.

At Edinburgh, in the spring of 1810, Henry Holland arranged for both him and Bright to join Sir George Steuart Mackenzie as naturalists on an expedition to Iceland for the purpose of minerealogical research.

On his return, Bright's work was included as chapters on zoology and botany in Mackenzie's “Travels to the Island of Island” (1811), bringing him a measure of early fame.

In October 1810, Bright moved to London in order to begin his clinical

training at Guy's Hospital, where he became the pupil of Dr. William Babington, and studied anatomy and surgery under the renowned surgeon Astley Cooper.

In 1812 Bright returned to Edinburgh for a year, and received his M.D. for

his thesis on "Contagious Erysipelas" in September 1813.

He then entered Peterhouse College, Cambridge, where he intended to complete his medical studies, but remained there for only two terms, finding both the facilities

and course disappointing. Returning to London, he spent some time assisting

Dr. Thomas Bateman at the Caley Street Dispensary, before deciding to embark

on an extensive European tour (1814-15), during which he attended the Congress of

Vienna, and which he documented in his masterly “Travels from Vienna through

Lower Hungary” (1818), which contains a valuable account of the Hungarian

Gypsies.

In 1820 Bright was elected a fellow of the Royal Society, and obtained the prestige appointment of assistant physician to Guy's Hospital. From 1822 to 1825 he gave a botanical course on materia medica, and in 1823 he began his clinical lectures.

Meanwhile, in 1822 he had married Martha Babington, the daughter of his old tutor, who unfortunately died the following year of childbed fever, leaving him with an infant son. In 1824 he was promoted to full physician at Guy's, a post he held until 1843, and in 1826 he married Elizabeth Follett, with whom he had six children.

The major thrust of Bright's clinical research was to make meticulous clinical observations and then systematically to correlate (in the tradition of [influenced by] Morgagni*, Gaspard Bayle and [influenced by] Laennec*) these with careful post mortem examinations in extensive and detailed reports, so that meaningful patterns relating the signs and symptoms of a given disease to the underlying pathology at post mortem might emerge.

The basis of Bright's achievement was his discovery that by taking urine from a patient with oedema (accumulation of fluid in the body, known then as "dropsy") and boiling it in a teaspoon over a candle one could demonstrate proteinuria (the presence of albumin in the urine), which he then correlated with diseased kidneys at autopsy. Thus Bright identified a new disease pattern that tied together pathological changes, chemical alterations, and clinical signs, and that oedema and proteinuria as the primary clinical symptoms of the serious kidney disorder that is now known as "Bright's Disease,” or

nephritis.

Bright's achievement also includes the introduction of the diagnostic test for albumin in the urine in cases of dropsy, which furthered the use of biochemical techniques in

diagnosis and would be extended in the 1840s by, among others, the work of

the French physician [influenced] Andral*.

During the 1830s, while continuing his clinical research, Bright was elected a fellow of the Royal College of Physicians (1832) and helped both to found the journal “Guy's Hospital Reports” (1836), to which he was a prolific contributor, and to reform the educational methods at the hospital, doing much to encourage both research and the then-new concept of bedside teaching.

Meanwhile, Bright also continued his studies on renal disease, examining many specimens of the kidney microscopically, and by the 1840s the histological appearances of kidney disease were being widely published from many sources in Britain and the Continent, one of which was by the famous French physician Rayer who coined the term “Bright’s Disease.”

During the 1830s he devoted much time on a collaboration with the brilliant physician [worked with] Thomas Addison* on a textbook for students, “Elements of the Practice of Medicine,” the first volume of which (written mainly by Addison) was published in 1839 and contained the first accurate descriptions of appendicitis and acute peritonitis.  By 1837 Bright had been appointed physician extraordinary to Queen Victoria, and had acquired a large private practice.

However, owing to the deterioration of his health, in 1844 he retired from Guy's and clinical research and entered full-time private practice. During the 1840s the prestige of his practice grew, and aside from treating the royal family he also attended Lord Macaulay,  [treated] Isambard Kingdom Brunel*, the poet [treated] Tennyson* and [treated friend] John Snow*, one of the fathers of modern anesthesia, with whom he also founded the Epidemiological Society.

In 1851 he diagnosed himself as having aortic valve disease. He continued his general practice, however, and was awarded an honorary doctorate by the University of Oxford in 1853. However, by January 1858 he was breathless and suffering from severe angina, and he died at home.

Extra Connections:  He knew [knew] Benjamin Richardson*

His was physician to Sir AP [was doctor to] Cooper*

Assessment: His “Reports of Medical Cases” (1827-31) established the systematic approach of accurately marrying clinical findings to morbid anatomy.

Oneliner: Richard Bright,  discoverer of Bright’s Disease

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