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This Month in Medical History - A founding father of nephrology

December 11, 2014
Dr. Richard Bright
From the December 2014 issue of HealthCare Business News magazine
One way to mark your place in medical history is to have an ailment named after you. Bright’s disease, a renal condition named after Richard Bright, is fitting for the physician who is often referred to as one of the founding fathers of nephrology. Richard Bright was born on September 28, 1789 in Bristol, England. His father was interested in sciences, and encouraged his children to pursue the study of medicine. When he turned 19, Bright began studying anatomy at the University of Edinburgh. In the summer of 1810, Bright got the opportunity to accompany a respected geologist, Sir George Mackenzie, on a scientific expedition to Iceland. The trip marked his first experience abroad and also sparked his interest in geology and botany.

Following the expedition, Bright published a book about his travels with detailed illustrations of Icelandic plant life and scenery. Upon his return, Bright continued his medical studies at Guy’s Hospital in
London, where he attended lectures, shadowed surgeons, and learned about the importance of anatomy in identifying and treating disease. During his time at Guy’s Hospital, he used his artistic talents to render the anatomic appearances of healthy and diseased organs in great detail. In 1813, he received his medical degree.

In 1816, he was admitted to the Licentiate of the Royal College of Physicians. At the time, he was working as an assistant physician at the London Fever Hospital, where he caught a severe fever that nearly took his life. In 1818, he embarked on a trip through Europe. In between sightseeing, he visited clinics in Germany, Switzerland, and France. He published a 762-page book about his travels upon his return.

In 1820, Dr. Bright established a private practice in London and was elected to the Royal Society. (In those days, a physician with his experience was considered to be well-trained.)The private practice was a success, and Dr. Bright was soon was named Physician Extraordinary to her Majesty Queen Victoria.

Dr. Bright also dedicated a lot of time to research and teaching at Public Dispensary at Guy’s Hospital. He primarily focused on the chemistry of the kidney, liver, and the brain. In 1842, Guy’s Hospital set aside a section of beds for a semester so Dr. Bright could study renal disease. He spent hours examining the urine samples of those suffering from renal conditions. He was the first physician to identify the method for diagnosing patients with kidney disease and edema (swelling caused by fluid buildup).

One of Dr. Bright’s patients was a 34-year-old sailor named John King. When Bright boiled a sample of King’s urine over the flame of a candle, he noticed that the urine coagulated. Bright hypothesized that if the urine curdled in the spoon, physicians could confirm their diagnosis.

When King passed away, an autopsy did indeed reveal that his kidneys were uneven and damaged. One of the easiest ways to determine which patients suffered from kidney disease and edema “is the application of heat” to a urine sample, Dr. Bright concluded.

The news of Dr. Bright’sdiscovery and successful linkage of kidney disease with edema quickly spread throughout Europe. In 1827, he published his first volume of works on kidney disease called “Reports of
Medical Cases,” followed by numerous articles and other publications on renal conditions. In a second volume, Dr. Bright focused on the diseases of the brain and the nervous system. He included various hand-colored illustrations of brain pathologies. In a textbook that he co-wrote with Dr. Thomas Addison,

Dr. Bright was also the first physician to accurately describe appendicitis. Dr. Bright died on December 11, 1858 at the age of 69, due to complications of heart disease. Today, aspiring nephrologists can pay respects to Dr. Bright at the Kensal Green Cemetery in London where he is buried.

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