Eminent doctors: Their lives and their work; Vol. 2 of 2

by G. T. Bettany

In 1810 Dr. Bright, with Dr. (afterwards Sir Henry) Holland, accompanied Sir George Mackenzie in his journey through Iceland, and contributed notes on botany and zoology, as well as other portions, to “Mackenzie’s Travels in Iceland” (Edinburgh, 1811). Mackenzie acknowledges Bright’s cheerful and ready exertion and undeviating good-humour in the many cross accidents that befel the party. Several times the two medical friends were in imminent danger, and we cannot but be thankful that these lights of medicine were spared to do their life-work.

Returning from Iceland, Bright’s clinical hospital work was commenced at Guy’s Hospital, London, where he lived in the house of a resident officer for two years, a foretaste of the forty years’ residence which he practically made within its walls. Astley Cooper was then in his best form, and young Bright was at once attracted to pathology and post mortem observation. At this early date he made a drawing of a granular kidney, one of the morbid conditions which he was afterwards to do so much to elucidate. In 1812-13 Bright was again a student at Edinburgh, where Gregory was still in full vigour: and he graduated on the 13th September 1813, producing a thesis on Contagious Erysipelas. With the idea of graduating at Cambridge, he entered at Peterhouse, where his brother was a lay-fellow, but he only resided two terms, finding his studies impeded by college discipline. In 1814 Bright was one of the crowd of English voyagers upon the Continent, and made himself conversant with French and German, attending professional lectures especially at Berlin and Vienna. In the spring of 1815 he travelled considerably in Hungary, and the result of his observations, for he was emphatically an observer, was given to the world in his large quarto volume of “Travels from Vienna through Lower Hungary, with Remarks on the State of Vienna during the Congress of 1814,” published at Edinburgh, 1818. This was a most valuable contribution on the social condition, statistics, and natural history of that country, then so little known in England. In all this it is evident how much Dr. Bright’s career was facilitated by the comfortable circumstances in which he was placed pecuniarily: not that money gave him his talent, but that it prevented him from suffering from the obstacles and disadvantages which have attended the career of so many physicians.

Meanwhile, Dr. Bright, in the winter of 1814, had been studying cutaneous diseases under Dr. Bateman at the Dispensary. On his return home through Belgium, about a fortnight after Waterloo, he saw many interesting cases of disease among the sick and wounded from the late contending armies. In December 1816 he was admitted a Licentiate of the London College of Physicians, and was soon after elected assistant-physician to the London Fever Hospital, paying the frequent price of a severe attack of fever, which almost cost him his life. In the summer and autumn of 1818 he again visited the Continent, spending a considerable time in Germany and Italy, and returning through Switzerland and France.

From 1820 we may date Bright’s full entry upon his professional career; for he now took a house in Bloomsbury Square for private practice. His election the same year to the assistant-physiciancy to Guy’s Hospital led him to give up the Fever Hospital and concentrate his attention on the work at Guy’s. He became speedily noted for his diligent attendance in the wards, and for tracing the causes of his patients’ symptoms in the post mortem room when they unhappily arrived there. For many years he spent six hours a day in his beloved scene of investigation; and long afterwards, when private practice absorbed more of his time, he longingly looked back upon the past years of cheerful research and successful toil. His progress, well prepared for, was now rapid. In 1821 he was elected F.R.S.; in 1822 he began to lecture on Botany and Materia Medica; and in 1824 he lectured on Medicine, in conjunction at first with Dr. Cholmeley, later taking the whole course alone. Some years afterwards Dr. Addison became associated in this lectureship, and the two famous men for many years upheld and raised the fame of Guy’s by their copartnership.

Bright was not a theorist, was devoid of special doctrines and “views,” but as Dr. Wilks[1] well puts it, “he could see, and we are struck with astonishment at his powers of observation, as he photographed pictures of disease for the study of posterity.” From this Dr. Wilks infers that he did not thoroughly perceive the value of his own work, and that he attached no more importance to diseases of the kidney than to those of the liver and brain, which he also described. Dr. Wilks even regards many observations of Bright as more novel and original when they were published than those relating to the kidney, but the latter were of more value, and their greater significance was at once recognised. It should be distinctly understood that Bright was not simply a specialist in kidney disease, but a clinical physician of rare excellence, who followed his cases into the post mortem room, and carefully observed not only the changes which had taken place in the organ whose disease had caused death, but also the state of all the other organs of the body. He was one of the first, if not the first, to describe acute yellow atrophy of the liver, pigmentation of the brain in melanæmia (or pigmented blood) due to miasma, condensation of the lung in whooping-cough, unilateral convulsion without loss of consciousness in local brain diseases, the bruit of the heart in chorea, the small echinococci on the interior of hydatid cysts, &c.

It is strange indeed that dropsy should have existed so long and its cause have been undiscovered; and that renal disease, as we now understand it, should have been almost unknown. For more than a century before Bright’s work was published the occurrence of albumen in the urine of dropsical persons had been known; and cases had been noted where convulsions and blood-poisoning had occurred when the kidneys had been found small and granular after death. Dr. Blackhall had written a treatise on dropsy in 1813; but though he found the urine albuminous, he rarely went to the post mortem room and examined the kidneys, which indeed might often at that time remain untouched. But until Bright’s first quarto volume of “Reports of Medical Cases,” 1827, appeared, renal disease had not been recognised as an important malady; he was at once hailed as a discoverer, and the malady called after his name. He first showed how to recognise a common form of disease, and systematised what was known about it, and he further demonstrated that there were three or four varieties of it, a view which subsequent investigation has most fully confirmed and developed in most important directions. He proved that not only was there a continual withdrawal from the blood of most important albuminous constituents, but that this was frequently attended with a failure to remove by the kidneys that natural product of waste, namely urea, which remaining in the blood in excess became poisonous, and often produced convulsions and inflammations at a distance from the kidneys. This latter view of the consequences of retained secretion was not adopted without considerable opposition, but fuller inquiry only made its truth more evident. And the adoption of a new truth had its reflex effects in other departments of investigation. Diseases of other excretory organs might possibly be caused in the same way; and so the effects of diseased liver in causing retention of the bile and its circulation in the tissues became anew illuminated; and bile-poisoning and blood-poisoning were placed on a new footing.

Although a large amount of time for many years was given to the investigation of renal cases, many other departments of research were the objects of Dr. Bright’s careful attention. We have already referred to some of these. Perhaps one series of phenomena that he was as much interested in as any was the various tumours of the abdomen, and the means of diagnosing between them. He published in Guy’s Hospital Reports an extended set of monographs on these subjects, which have been published in a collected form by the New Sydenham Society. They are chiefly clinical, illustrated by well-grouped cases, observed and recorded with great care and accuracy, and abounding in important suggestions as to diagnosis and function.

The second volume of “Reports of Medical Cases” appeared, in two parts, in 1831, and contained principally narrations of cases of cerebral and spinal diseases, including paralysis, epilepsy, tetanus, hydrophobia, and hysteria, with observations on their nature and pathology. The many coloured plates in both volumes are of great excellence and authority, being executed under Dr. Bright’s own superintendence. He was afterwards associated with Dr. Addison in the production of the first volume of the “Elements of the Practice of Medicine.” The first volume of Guy’s Hospital Reports, published in 1836, contains no fewer than eight papers from Bright’s own pen. In 1832 Dr. Bright was elected a Fellow of the Royal College of Physicians, and in 1833 gave the Gulstonian lectures at the College, on the Functions of the Abdominal Viscera, with observations on the diagnostic marks of the diseases to which the viscera are subject. In 1836 he was censor, and in 1837 gave the Lumleian lectures on Disorders of the Brain.

In his early years Dr. Bright’s practice was not very extensive. He was disinclined to use any adventitious aids to popular reputation, and was content to pursue his tireless investigations. His publications on renal disease gradually attracted general attention, and the profession found him a most reliable and valuable consultant, so that in his later years he commanded a first-class practice. A few years before his death he resigned his post at Guy’s Hospital, and was made Honorary Consulting Physician. He died on the 11th December 1858, from the consequences of extensive and long-standing ossification of the aortic valves of the heart, the exit for the blood being reduced to a mere chink. He had long suffered very considerably, but was never thoroughly examined in life. However, he believed considerably in the value of medicine, and took large quantities of some kinds. He was buried at Kensal Green.

Bright is described as having had “a remarkably even temper and cheerful disposition: he was most considerate towards the failings of others, but severe in the discipline of his own mind. He was sincerely religious, both in doctrine and practice, and of so pure a mind that he never was heard to utter a sentiment or to relate an anecdote that was not fit to be heard by the merest child or the most refined female. He was an affectionate husband and an excellent father, not only taking the most lively interest in the welfare of his children, and in their pursuits, but never so happy as when he had them around him; so that half the pleasure of the long vacation was lost, unless he had as many members of his family as possible for his companions.” He married, first, the third daughter of Dr. Babington, senior; and secondly a sister of Sir William Follett, by whom he left surviving three sons, one being Dr. Bright of Cannes, and another the Rev. James Franck Bright, the well-known historian, and Master of University College, Oxford.