Richard Bright, the father of nephrology

Richard BrightTwo centuries will soon have passed since Richard Bright, of Guy’s Hospital, London, described the disease that came to bear his name. Within a few years of his original publication, the term Bright’s Disease became virtually synonymous with kidney disease—in England, Germany, France, and the United States. In its full-blown formulation it consisted of four main features:

1) the spilling by the diseased kidneys of large amounts of albumin or protein in the urine,
2) swelling of the legs or entire body, the result of albumin deficiency in the circulation causing the escape of fluid into the tissues,
3) thickening of the walls of the left ventricle of the heart, indicating elevated blood pressure, and
4) abnormal-looking kidneys at autopsy, too large or shrunken, very white or coarsely granular.

Earlier physicians had made some of these clinical observations but failed to recognize or articulate their significance. For his contributions Richard Bright has long been called the father of nephrology, and to this day this picture adorns the walls of many departments of nephrology in universities and hospitals.

Already as a young man Richard Bright exhibited the curiosity that later led to his observations and fame. He studied medicine in Edinburgh and at Guys and, at the age of 21, in 1810, went on an geological expedition to study the volcanoes of Iceland. In 1814 he visited famous physicians and hospitals in Holland, Belgium, Germany, and Austria. The next year, in 1815, he traveled to Hungary and published his observations in a book that became a bestseller. He was present at the Congress of Vienna, and later at the battle of Waterloo, where he helped tend the wounded.

Appointed full physician at Guy’s in 1824, he established the first true research unit in England. There much work was done correlating what was seen in life with what was revealed at autopsy. Several publications emanating from Guy’s hospital have remained classics and are quoted to this very day. During life, Richard Bright achieved a great reputation. He gave many prestigious lectures, was physician to Queens Victoria and Adelaide, retired from the hospital in 1844, and died in 1858. Rumor had it that he succumbed to the very disease he had described.

 

References

Kark, RM and Moore DT. The life, work, and geological collections of Richard Bright, MD (1789-1858); with a note on the collections of other members of the family. Archives of Natural History 1981; 10:119.
Kark, RM. A prospectus of Richard Bright on the centenary of his death, December 16, 1858. American Journal of Medicine, 1958;25:819.

 


 

GEORGE DUNEA, MD, Editor-in-Chief.