Bright, Richard (DNB00)

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BRIGHT, RICHARD (1789–1858), physician, born at Queen Square, Bristol, on 28 Sept: 1789, was the third son of Richard Bright, a merchant and banker of that city. The father belonged to the family of the Brights of Brockbury, Herefordshire, who trace their descent from Henry Bright, D.D. (d. 1626), master of the King's School at Worcester in Queen Elizabeth's time. In 1808 he matriculated at the university of Edinburgh in the faculty of arts, attending the instructions of Dugald Stewart, Playfair, and Leslie in their respective subjects, and in the next year entered the medical faculty, where his teachers were Hope, Monro, and Duncan.

In the summer of 1810 he was invited to join Sir George Stuart Mackenzie and Mr. (afterwards Sir Henry) Holland on a visit to Iceland, which occupied some months. To the account of this voyage, written by Sir George Mackenzie ('Travels in Iceland,' Edinburgh, 1811), Bright contributed chapters on botany and zoology. He also brought back with him a large collection of dried plants; and though this journey must have been a serious interruption to his professional studies, doubtless it had its use in training his great powers of exact observation.

On returning from Iceland, Bright pursued his medical studies in London, living for two years in the house of one of the resident officers of Guy's Hospital. Here he attended the medical lectures of Dr. W. Babington and James Currie, and studied anatomy and surgery in the united school of Guy's and St. Thomas's, under Astley Cooper, the two Clines, and Travers. It is supposed that from Astley Cooper he imbibed a sense of the value of morbid anatomy in the study of disease ; and even at that time he executed a drawing, since preserved, of the appearance of the kidney in that malady, by the investigation of which he afterwards made himself famous. At the same time he became interested in the study of geology, probably through the example of Dr. William Babington, and in 1811 he read a paper to the Geological Society on the strata in the neighbourhood of Bristol.

In 1812 Bright returned to Edinburgh, where the celebrated Dr. Gregory was his principal teacher in medicine, and where he still pursued the study of geology and natural history under Professor Jameson. He graduated M.D. on 13 Sept. 1812, with a dissertation, 'De Erysipelate Contagioso.' It was at that time his intention to graduate also at Cambridge, and accordingly he entered at Peterhouse, of which college his brother was a fellow ; but after having kept two terms he found residence in college incompatible with his other pursuits, and left the university. Bright then returned to London, and became a pupil at the public dispensary under Dr. Bateman. But his love of travel again carried him away from London, and in 1814, when the continent became open to English travellers, he made a tour through Holland and Belgium to Berlin, where he spent some months, attending the hospital practice of Horn and Hufeland, besides profiting by the acquaintance of other eminent men of science. From Berlin he passed to Vienna, where he spent the winter of 1814-15.

What is known as the old Vienna School of Medicine was then in high repute, and Hildenbrand was the chief clinical professor ; but Bright was also much impressed by the then celebrated John P. F. Frank. The political interest of the congress then sitting also engaged much of Bright's attention, and he refers to it in an account of his travels which he afterwards published. In the spring he extended his journey to Hungary, but returned in the summer in time to reach Brussels a fortnight after the battle of Waterloo. Here the immense military hospitals, crowded with sufferers after the great battle, supplied matter of professional interest which naturally delayed his homeward journey.

On 23 Dec. 1816 Bright was admitted a licentiate of the College of Physicians. Soon after he was made assistant physician to the London Fever Hospital, and filled the same office for a short time at the Public Dispensary. In the fever hospital he contracted a severe attack of fever which nearly cost him his life. Whether in consequence of this illness, or from other reasons, it is curious to note that Bright was in 1818 again induced to set out on continental travel, and spent the greater part of a year in a tour through Germany, Italy, and France. In the year 1820, however, he finally settled down in London, in Bloomsbury Square; and being in the same year elected assistant-physician to Guy's Hospital, he commenced that course of arduous clinical study and indefatigable industry as a teacher which made his own reputation, and contributed much to raise that of the school in which he worked. In 1824 he was made full physician, and occupied this post till 1843, when, on resigning, he was made consulting physician.

Bright's energy and industry in his hospital work were very remarkable. For some years he is said to have spent six hours a day in the wards or post-mortem room, and he was an active lecturer in the medical school. In 1822 he gave a course on botany in relation to materia medica, which was continued for three years. In 1823 he began to give clinical lectures; in 1824 he took part in the medical lectures with Dr. Cholmley, and afterwards for many years shared the course with Dr. Addison. The outcome of their joint labours was the commencement of a text-book, 'Elements of the Practice of Medicine,' of which, however, only one volume appeared in 1839, and this was understood to be chiefly the composition of Addison.

In 1827 he published the first volume of a collection of 'Reports of Medical Cases,' intended to show the importance of morbid anatomy in the study of disease. In this he gave the first account of those researches on dropsy with which his name is inseparably connected, though his first observation on the subject was made, he says, in 1813. While the symptom dropsy, or watery swelling, had been known from the earliest period of medicine, it had been, shortly before Bright's time, shown by Blackall and Wells that it was in many cases connected with a special symptom, namely, that the urine was coagulable by heat, from the presence in it of albumen. But these two symptoms were not traced to their source, or connected with a diseased condition of any organ. Bright, by his investigations of the state of the body after death, ascertained that in all such cases a peculiar condition of the kidneys was present, and thus proved that the symptoms spoken of were really those of a disease of the kidneys. The explanation once given seems as simple as 'putting two and two together;' but the importance of the discovery is shown by the fact that no one before had suspected the kidney to be the organ implicated. It proved Bright not only to be an acute observer, but to possess the much rarer Bright faculty of synthesis, which makes an observer a discoverer. The truth and importance of his researches were soon generally recognised. In a short time Morbus Brightii, or Bright's Disease, was a familiar appellation over the whole of Europe, and will doubtless preserve the memory of Bright so long as the disease is known by a separate name. Next to Laennec's discoveries in chest diseases, this of Bright's is perhaps the most important special discovery made in medicine in the first half of the nineteenth century.

The volume of medical reports contained, besides those on dropsy, other observations, which would alone have made the book a very valuable one. It was followed in 1831 by a second volume, in two parts, containing reports on diseases of the brain and nervous system, full of observation of the highest value. Both volumes are illustrated with admirable plates, and taken together form one of the most important contributions to morbid anatomy ever made in this country by one person.

In 1836 appeared the first volume of the well-known 'Guy's Hospital Reports,' to which Bright was from the first a copious contributor. The first and second papers in the first volume, on the 'Treatment of Fever' and on 'Diseased Arteries of the Brain' respectively, are by him, as are also six other papers in the same volume, of which the most important are 'Cases and Observations illustrative of Renal Disease,' and 'A Tabular View of the Morbid Appearances in One Hundred Cases of Albuminous Urine.' The two last mentioned extend and support his great discovery by several additional developments, which subsequent research has done nothing but confirm. In the second volume are two papers by Bright one on 'Abdominal Tumours,' which was the first of an important series continued by two papers in the third volume of the 'Reports,' one in the fourth, and one in the fifth. This same fifth volume also contains an important paper entitled 'Observations on Renal Diseases: Memoir the Second.' In the first volume of the second series (1843) appears an account of observations made under the superintendence of Bright by Dr. Barlow and Dr. Owen Rees on patients with albuminous urine; but after this Bright's name does not appear in the reports.

Bright's professional success, apart from his hospital work, was steady, if not rapid. On 25 June 1832 he was promoted from being a licentiate to the fellowship of the College of Physicians, at that time a rare distinction. He was Gulstonian lecturer in 1833, and took as his subject 'The functions of the abdominal viscera, with observations on the diagnostic marks of the diseases to which the viscera are subject.' In 1837 he was Lumleian lecturer, his subject being 'Disorders of the brain.' He was censor in 1836 and 1839, and a member of the council 1838 and 1843. He was elected fellow of the Royal Society in 1821, and received the Monthyon medal from the Institute of France, In 1837, on the accession of Queen Victoria, he was appointed physician extraordinary to her majesty. In the earlier part of his career it is said that his practice was not large ; but as his reputation rose he took the leading position as consulting physician in London, and was probably consulted in a larger number of diffcult cases than any of his contemporaries. Bright was twice married ; first to the youngest daughter of Dr. William Babington [q. v.] The only son by this marriage took holy orders, but died young. His second wife was a daughter of Mr. Benjamin Follett, and sister of Sir William Webb Follett. She survived him, as did three sons and two daughters. His eldest son is now (1886) master of University College, Oxford ; his youngest a physician in practice at Cannes. He died at his house, 11 Savile How, on 16 Dec. 1858, after a very short illness, which, however, was shown by post-mortem examination to have been the consequence of long-standing disease of the heart. He was buried at Kensal Green cemetery, and a mural monument was erected to his memory in St. James's Church, Piccadilly. The College of Physicians possesses his portrait in oils, and also a marble bust ; another bust is at Guy's Hospital, and his portrait is engraved in Pettigrew's 'Medical Portrait Gallery.'

Bright was by general admission a man of fine and attractive nature. From early manhood he was animated by a genuine love of truth and unswerving sense of duty. He was of an affectionate disposition and uniformly cheerful. He was widely accomplished, a good linguist (when this kind of knowledge was less common than it is now), well versed in more than one science, a creditable amateur artist, and possessed of much taste in art ; well cultivated on all sides by travel and society. In his intellectual character the first feature which strikes us is a certain simplicity. Beyond most observers he succeeded in viewing objects without prejudice. Not putting forward any theories himself, he was not biassed by any of the prevailing systems of medicine. Next, he had a remarkable tact, which appeared to be exercised unconsciously, of picking out the important facts in any subject, and, perhaps half unconsciously also, of combining them together so as to explain each other. He is said not to have perceived the true value of his own observations, and this is quite credible, but his genius guided him to the right result. Moreover, his industry was indefatigable. He amassed hundreds and thousands of facts, and his minute accuracy of observation was never or rarely at fault.

Bright was not generally regarded as a brilliant man ; he had little power of exposition, and in his own school, while his fame was rapidly spreading over the civilised world, he was less popular and impressive as a teacher than his brilliant colleague Thomas Addison [q. v.], though the latter was much less known bo the outside public. 'Bright could not theorise,' says Dr. Wilks, 'and fortunately gave us no doctrines and no "views ;" but he could see, and we are struck with astonishment at his powers of observation. ... I might allude to the fact that he was one of the first who described acute yellow atrophy of the liver, pigmentation of the brain in miasmatic melanaemia, condensation of the lung in whooping-cough. He was also the first, I believe, who noted the bruit in chorea, and he made also many other original clinical observations' (Wilks, 'Historical Notes on Bright's Disease,' &c., Guy's Hosp. Reports, xxii. 259). These minor researches display the same powers as his master work, and have been thought to show even greater originality. It is the importance of its subject and the powerful influence which it has had, and continues to have, on the progress of medicine in all countries, that give to this discovery its classical position, and place Bright among the half-dozen greatest names in the honourable roll of English physicians.

His writings were, besides those mentioned above: 1. 'Travels from Vienna through Lower Hungary, with some remarks on the State of Vienna during the Congress in 1814,' 4to, Edinburgh, 1818. 2. 'Address at the Commencement of a Course of Lectures on the Practice of Medicine,' 8vo, London, 1832. 3. 'Clinical Memoirs on Abdominal Tumours,' edited by G. H. Barlow, M.D. (from 'Guy's Hospital Reports'), New Syd. Soc., 8vo, London, 1860. 4. 'Gulstonian Lectures on the Functions of the Abdominal Viscera,' in 'London Medical Gazette,' 1833. In the 'Medico-Chirurgical Transactions :' (1) 'Case of unusually Profuse Perspiration,' xiv. 433. 1828 ; (2) 'Cases of Disease of the Pancreas and Duodenum,' xviii. 1,1833; (3) 'Cases illustrative of Diagnosis when Adhesions have taken place in the Peritoneum,' xix. 176, 1835 ; (4) 'Cases of Spasmodic Disease accompanying Affections of the Pericardium,' xxii. 1, 1839. In 'Guy's Hospital Reports,' vol. i. : 'Case of Tetanus successfully treated;' 'Account of a Remarkable Displacement of the Stomach;' 'Observations on Jaundice;' 'Observations on the Situation and Structure of Malignant Diseases of the Liver.' Vol. ii.: 'Cases illustrative of Diagnosis where Tumours are situated at the Base of the Brain.' In 'Transactions of the Geological Society:' 'On the Strata in the Neighbourhood of Bristol,' 1811, and 'On the Hills of Badaeson, Szigliget, &c., in Hungary,' 1818.

[Pettigrew's Medical Portrait Gallery, pt. viii. 1839 (the original source); Medical Times and Gazette, 1858, ii. 632, 660; Lancet, 1858, ii. 665; Lasegue, in Archives Generates de Medecine,' 1859, i. 257; Munk's Coll. of Phys. Hi. 155; private information.]

J. F. P.