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. □