Bright , Richard , 1789-1858 , physician

Richard Bright was born on 28 September 1789, the third son of Richard Bright, a Bristol merchant and banker. He attended a school in Bristol, run by a Unitarian minister, and subsequently went to Exeter. In 1808 he left for Edinburgh to study first in the faculty of arts, and from 1809 in the medical faculty. He graduated MD in 1813. In 1810 he interrupted his medical education to join Sir George Mackenzie's scientific expedition to Iceland, where he contributed to the knowledge of the flora and fauna of the island. He then spent two years in London, studying at the medical school of Guy's and St Thomas's Hospitals. He returned to London in 1814, after graduating, and became a pupil at the Carey Street Dispensary, under Thomas Bateman. Here he gained wide experience in skin disorders, which was Bateman's specialty, and general medicine.

Bright visited Holland and Belgium before traveling to Germany in 1814, and then Austria and Hungary during the winter of 1814-15. During his trip he met many physicians and observed the medical practice in the hospitals of Horn, Hufeland, Berlin and Vienna. On his way home from Hungary he stopped at Brussels, about a fortnight after the Battle of Waterloo, visiting the military hospitals and seeing many of the wounded. He became a Licentiate of the Royal College of Physicians in 1816, and a Fellow in 1832. In 1817 he was elected assistant physician to the London Fever Hospital, where during a severe epidemic he contracted fever and narrowly escaped with his life. Bright returned to the continent in the autumn of 1818, visiting Germany, Italy, Switzerland, and France. During this trip he visited many hospitals and post mortem rooms. He returned in the summer of 1819 to continue work at the Fever Hospital.

In 1820 he became assistant physician to Guy's Hospital and then, in 1824, full physician. He took an active part in teaching, in both the wards and the lecture room. In 1822 he lectured at Guy's on botany and materia medica, and in 1824, on the theory and practice of physic. Despite the lack of interest shown by Bright's seniors in morbid anatomy, Bright worked undeterred in the post mortem room before his rounds of the wards. It was said that over the years Bright worked at Guy's, he spent at least six hours a day carrying out his research, `constantly and with untiring patience, whenever he could do so, to the ultimate test of the morbid appearances after deaths' (Munk's Roll, vol. III, p.157).

Bright is best known for his description of dropsy - oedema associated with kidney disease - in which the urine can be coagulated by heat owing to the presence of albumin. Observation of albumin in the urine had already been made, but it was Bright who made the connection between the presence of albumin and glomerulonephritis, and thus made the synthesis of the symptoms. Before this it was thought that the liver and the spleen were responsible for dropsy. The condition subsequently became widely known, from the 1840s, as Morbus Brightii, `Bright's disease', establishing his reputation at home and abroad.

He described the disease in the first volume of his illustrated Reports on Medical Cases, Selected with a View to Illustrate the Symptoms and Cure of Diseases by a Reference to Morbid Anatomy (1827), in which the clinical picture during life is correlated with the pathology of the internal organs of the several parts of the body. A second part to this work was published in 1831 and is entirely concerned with the nervous system, with the illustrations appearing in a separate volume. Upon all the various subjects covered by Bright in this work, he showed `the most sagacious observation, untiring industry, and wonderful powers of investigating truth, the end and aim of all his work' (ibid).

Bright's writings were numerous and important. Although best known for his work on diseases of the viscera, especially the kidney, Bright also made numerous observations on neurological conditions, both in the above-mentioned publication, and in papers he contributed to the Guy's Hospital Reports. He also wrote articles on pancreatic diabetes, acute yellow atrophy of the liver, acute otitis and pathological lesions in typhoid fever. He was a frequent contributor to the Medico-Chirurgical Transactions. Bright collaborated with Thomas Addison, his colleague at Guy's, in a textbook of medicine for students, entitled Textbook: Elements of the Practice of Medicine (1839).

Bright's professional success was steady. He was Goulstonian lecturer in 1833, Lumleian lecturer in 1837, Censor of the College in 1836 and 1839, and member of the Council, 1838 and 1843. In 1837, on the accession of Queen Victoria, he was appointed physician extraordinary to the queen. As his reputation rose he took the leading position as consulting physician in London. Amongst his patients were Lord Macaulay, historian and Whig MP, John Snow, anaesthetist, famous for his theory that cholera was communicated through a contaminated water supply, and Isambard Kingdom Brunel, civil engineer, who was suffering from nephritis. Bright was `probably consulted in a larger number of difficult cases than any of his contemporaries' (DNB, vol. VI, p.336). He held the post of full physician to Guy's Hospital until 1843 when he retired to devote his time to full practice, remaining active in his profession right up to his death in 1858. In 1838 he was honoured with the Monthyon medal of the Institute of France, awarded in recognition of his work on the kidney. At home he was honoured with a Doctorate of Civil Law by Oxford University in 1853.

Bright was a widely accomplished man. He was a good linguist, knowledgeable about more than one science, an amateur artist of some credibility, indeed his ability to draw accurately enabled him to produce fine diagrams of pathological anatomy, and well cultivated, due to his experience of travel and his wide social circle. He was elected Fellow of the Royal Society in 1821. His great skills were his acute observation and aptitude for synthesis, over his ability to theorise or to put forward his views.

Bright was married twice, first to Martha Babington in 1822. Martha died in 1823, shortly after giving birth to their only son, who died in early manhood. His second marriage was to Elizabeth Follett, sister to Sir William Webb Follett, attorney general. Bright had five surviving children, two daughters and three sons. He died at his house in Savile Row on 16 December 1858, at the age of 69, after an illness lasting just four days, associated with a longstanding disease of the heart. He was buried at Kensal Green, and an inscribed monument was erected in the Church of St James, Piccadilly.

Publications:
Travels from Vienna through Lower Hungary, with some remarks on the State of Vienna during the Congress in the year 1814 (Edinburgh, 1818)
Reports of Medical Cases, Selected with a View to Illustrate the Symptoms and Cure of Diseases by a Reference to Morbid Anatomy (2 volumes, London, 1827; 1831)
Address at the Commencement of a Course of Lectures on the Practice of Medicine (London, 1832)
Elements of the Practice of Medicine, Volume I Richard Bright and Thomas Addison (London, 1836)
Papers on Physconia by Bright, in Clinical Memoirs on Abdominal Tumours and Intumescence (London, 1860)

Publications by others about Bright:
Dr Richard Bright, 1789-1858, Pamela Bright (London, 1983)
Physician Extraordinary: Dr Richard Bright (1789-1858) Robert Manoah, R. Johnson (ed.) (Montpelier, Vermont, 1986)
Richard Bright, 1789-1858: Physician in an Age of Revolution and Reform D. Berry and C. Mackenzie (London, 1992)