(b. Bristol, England, 28 September 1789; d. London, England, 16 December 1858)
The first third of the nineteenth century brought forth an extraordinary flowering of medical talent, among whom Bright was a truly outstanding figure. Born to a well-to-do banking family and always in comfortable circumstances, he could devote himself wholly to medical and scientific pursuits without the financial cares of the less fortunate. He began the study of medicine at the University of Edinburgh in 1808. In his second year he interrupted his studies for a few months to serve as a naturalist accompanying Sir George Mackenzie on an expedition to Iceland. Bright contributed notes on botany and zoology. In 1810 he transferred his medical studies to Guy’s Hospital in London, where he spent two years. During this first association with Guy’s, he became deeply interested in pathology and postmortem examinations. In 1812 Bright returned to Edinburgh for a year, receiving his degree on 13 September 1813. He then spent two terms at Cambridge, but he left quite dissatisfied and embarked on a period of foreign study and travel, particularly in Berlin, Vienna, and Hungary. He described his travels in Travels From Vienna Through Lower Hungary, one of the outstanding travel books of the nineteenth century. Of particular interest are his descriptions of Hungary and the Congress of Vienna in 1814.
Returning to England, he became a licentiate of the London College of Physicians in 1816, but he was not elected a fellow until 1832. In 1820 he was appointed assistant physician at Guy’s Hospital, and in 1824 was promoted to physician. For approximately twenty years, besides teaching medicine, he engaged in extensive clinical research and clinico-pathological correlations, always of the highest quality. After 1843 he no longer published papers, and from about 1840 until his death, he was absorbed in practice rather than in research.
We associate Bright’s name particularly with kidney disease, but we must not ignore his broad interest in the entire field of internal medicine. He had an intense concern with diseases of the nervous system, and he also contributed to the knowledge of visceral disease, especially of the pancreas, duodenum, and liver. He wrote extensively on abdominal tumors; and in his textbook, written with Thomas Addison, he provided the first accurate account of appendicitis. In all his investigations he combined meticulous clinical observation and careful postmortem studies.
Bright was, in essence, a “naturalist” who had unrivaled powers of observation. He noted the clinical phenomena of disease. Then, in the tradition of Morgagni, Gaspard Bayle, and Laënnec, he tried to correlate these clinical findings with the postmortem observations, but always on an empirical level. Remote causes or occult properties interested him not at all. Instead, he dealt with facts of observation. Gathering his observations not only at the bedside but also at the autopsy table and in the rudimentary clinical laboratory, he tried to correlate the data so that meaningful patterns might emerge. Constantly he tried to bring together, as he expressed it, “such facts as seem to throw light upon each other.” As a scientist he could select, from the total profusion of facts, those which somehow belonged together.
In 1827 Bright published his first great contribution to kidney disease. He had clearly perceived that some relationships existed between three separate features. Each of them was familiar, but he was the first to connect them; and then he provided overwhelming evidence that the association was valid. He pointed out that of all patients with edema, some showed albumin in their urine, and this albumin was coagulable by heat; futhermore, these patients showed structural changes in their kidneys. Bright, with convincing clinico-pathological studies, thus identified a new disease pattern that tied together pathologic changes, chemical alterations, and clinical signs. Later research showed that this pattern was not a simple disease entity but, rather, a congeries of enormous complexity. But this does not detract from the brilliance of Bright’s initial correlation.
Bright, one of the great men of Guy’s, helped the hospital attain its enviable position among British medical educational institutions. He helped found the journal Guy’s Hospital Reports, which, as a ready medium of publication, proved important in encouraging research, and he did much to popularize the then-new concept of bedside teaching. A neglected part of medical education, he realized, was meaningful contact between the students and the patients. He helped reform the educational methods so that, in 1837, Guy’s Hospital Reports (2 , v-vi) could proudly declare that “each student who has passed three months in the clinical wards is ready to admit that that period has proved the most profitable portion of his medical education…. Under the guidance of the experienced physicians, the student is instructed how to make observations upon the sick, and to interpret the signs of disease….” Then, because of his efforts, the hospital set aside special wards for clinical research.
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 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.
I. Original Works. A complete bibliography of Bright’s work, compiled by William Hill, is in Guy’s Hospital Gazette, 64 (1950), 456 ff.; repr. in Guy’s Hospital Reports, 107 (1958), 531 ff. This includes books, journal articles, and critical and biographical studies.
Among the books by Bright are Travels From Vienna Through Lower Hungary; With Some Remarks on the State of Vienna During the Congress in the Year 1814 (Edinburgh, 1818); and Reports of Medical Cases Selected With a View of Illustrating the Symptoms and Cure of Diseases With a Reference to Morbid Anatomy, 2 vols. (London, 1827–1831). With Thomas Addison he wrote Elements of the Practice of Medicine (London, 1839). A collection of his papers on renal disease is the reprint Original Papers of Richard Bright on Renal Disease, A. A. Osman, ed. (London, 1937). His numerous periodical publications are listed in Hill’s bibliography.
II. Secondary Literature. A vast amount of secondary material deals with Bright. Worthy of special mention are B. Chance, “Richard Bright, Traveler and Artist,” in Bulletin of the History of Medicine, 8 (1940), 909 ff.; F. H. Garrison, “Richard Bright’s Travels in Lower Hungary, a Physician’s Holiday,” in Johns Hopkins Hospital Bulletin, 23 (1914), 173 ff.; Sir William Hale-White, “Bright’s Observations Other Than Those on Renal Disease,” in Guy’s Hospital Reports, 71 (1921), 143 ff., repr. ibid., 107 (1958), 308 ff.; and “Richard Bright and His Discovery of the Disease Bearing His Name,” ibid., 71 (1921), 1 ff., repr. ibid., 107 (1958), 294 ff.; R. M. Kark, “A Prospect of Richard Bright on the Centenary of His Death, December 16, 1958,” in American Journal of Medicine, 25 (1958), 819 ff.; Samuel Wilks and G. T. Bettany, Biographical History of Guy’s Hospital (London, 1892).
Lester S. King
The English physician Richard Bright (1789-1858) discovered the relationship of fluid retention and the appearance of albumin in the urine to kidney disease.
On Sept. 28, 1789, Richard Bright was born in Bristol, the third son of a wealthy merchant and banker. Richard Bright was educated at Exeter, matriculated in Edinburgh University in 1808, and began his medical studies there the following year. In 1810 he joined George Mackenzie on a trip to Iceland and contributed a chapter on botany and zoology to Mackenzie's Travels in Iceland (1811). Two years of training in clinical medicine at Guy's Hospital in London followed, and then he returned to Edinburgh, where he received his medical degree in 1813.
Bright studied in Berlin and in Vienna and first became known for his travelog, Travels from Vienna (1818), which contained his own illustrations. In 1816 he became a licentiate of the Royal College of Physicians and assistant physician at the London Fever Hospital. Four years later he was appointed assistant physician at Guy's Hospital and opened a private practice at the same time. He advanced to full physician by 1824 and became physician extraordinary to Queen Victoria in 1837.
As a student at Guy's Hospital, one of the world's foremost medical schools, Bright was exposed to the best teaching available. He was impressed with the importance of careful descriptions of disease. His instructors also emphasized the need for correlating clinical observations with gross pathological changes of specific organs after death. A reaction to the theoretical systems which had flourished in the previous century, this approach provided the first sound basis for diagnosis and a modern concept of disease; it contributed little to treatment.
In the first volume of Reports of Medical Cases (1827) Bright related dropsy with albuminuria with changes in the kidney and differentiated it from excess accumulation of fluid in cases with heart or liver disease. Although others had demonstrated earlier the presence of albumin in the urine of some patients with dropsy, Bright was the first to relate its presence to kidney pathology. What he described was chronic nephritis, later known as Bright's disease. A collaborative study of 100 cases in 1842, for which two wards and a laboratory were specially set aside, confirmed his thesis. The second volume of Reports (1831) dealt with diseases of the nervous system. Bright also published on other diseases, such as acute yellow atrophy of the liver.
Well liked as a teacher and much sought after as a consultant, Bright devoted most of his later years to private practice. At the time of his death from heart disease on Dec. 16, 1858, he had a worldwide reputation as a teacher of pathological anatomy and medicine, an author, and a physician.
William Hale-White, Great Doctors of the Nineteenth Century (1935), has a detailed account of Bright's life and work. Essays on Bright are in Samuel Wilks and G.T. Bettany, A Biographical History of Guy's Hospital (1892), and in R.T. Williamson, English Physicians of the Past (1923). A contemporary appreciation of Bright is in Thomas Joseph Pettigrew, Medical Portrait Gallery (4 vols., 1838-1840).
Berry, Diana, Richard Bright 1789-1858: physician in an age of revolution and reform, London: Royal Society of Medicine Services, 1992.
Bright, Pamela, Dr. Richard Bright, (1789-1858), London: Bodley Head, 1983. □
English physician and anatomist who described the form of chronic nephritis now known as Bright's disease. Bright made major contributions to the study of morbid anatomy of the living patient. His studies of the retention of urea in the body fluids of patients with kidney failure helped to demonstrate the value of biochemical studies of disease. His studies of various brain and abdominal disorders were also of great value in clinical medicine.