Richard Bright in Guy's Hospital

RICHARD BRIGHT OF GUY’S HOSPITAL By DeLANCEY ROCHESTER, M.D. BUFFALO, N. Y. ^~|| ■MHE latter part of the eighteenth were greatly trained. Upon his return from s and the early part of the nine- Iceland he pursued his medical studies as I teenth centuries formed the one of the medical officers of Guy’s Hospital _il , golden age in clinical medicine as where he attended lectures given by James evidenced by the remarkable activity in Currie and Astley Cooper. From the latter clinical and pathological investigations in he imbibed a sense of the value of morbid France by Pinel, who will always be held in anatomy and even at that time executed the highest regard for his work in putting a drawing of the appearance of the kidney insanity in the category of disease and in that malady in the investigation of which in treating the insane as patients in a he afterwards made himself famous. At hospital instead of as criminals; by Bichat the same time he became interested in who must be considered the founder of geology and in 1811 read a paper to the that remarkable school of pathological and Geological Society on the strata in the clinical investigation of which the two neighborhood of Bristol. shining lights were Louis and Laennec. In 1812 he returned to Edinburgh and In the so-called New Vienna School, the graduated in September of that year, the work of Wunderlich, Rokitansky and Skoda title of his graduation thesis being, “De stand out preeminently. erysipelate contagioso.” Then after two In Great Britain in the Dublin School, terms at Cambridge University he returned remarkable work was being done by John to London and studied in the public dispens Cheyne, Abraham Colles, Robert Adams, ary under Dr. Bateman, but he again William Stokes, Dominic John Corrigan interrupted his medical work to take a trip and Robert James Graves. to the continent through Holland, Belgium, Of special importance was the clinical and to Berlin and then to Vienna where he pathological work which was being done by spent the winter of 1814-15 in study in the the long line of brilliant workers at Guy’s New Vienna School. Hospital in London. Of these Richard In a book descriptive of this tour he Bright was probably the most devoted to described the plight of the insane in Vienna the study of his hospital cases. He was and their inhuman treatment. The Narren- born in Bristol, September 28, 1789. His turm or Lunatic Tower was one of the father was a merchant of that city. He show places of Old Vienna where the public traced his ancestry to Henry Bright, d.d. was allowed to view the insane, like Master of King’s School at Worcester in animals in a menagerie, on payment of a the time of Queen Elizabeth. Richard was small fee. the third son. He entered the University of Edinburgh in 1808. After one year he It is a fanciful edifice and not well con entered the medical department where he structed. Externally, it appears a large round studied under Hope, Minard and Duncan. tower and, on entering, it is found to consist of a hollow circle, in the center of which a square In 1810 he interrupted his medical studies building rises, joined to the circle by each of to take a voyage to Iceland with Sir its angles. The circular part contains the George Stewart MacKenzie and Sir Henry patients and the enclosed building is intended Holland which occupied several months. for the residence of the keepers and surgeons. To the account of this voyage Bright con This building is four stories high, besides the tributed chapters on botany and geology. ground floor. Each story is constructed nearly On this trip his powers of exact observations on the same plan—a passage runs around the inner circumference into which the cells or (1827) contains his original description of chambers open. It contains three hundred essential nephritis with its epoch-making patients, whose condition is far from being as distinction between renal and cardiac comfortable as in many of the institutions for dropsy. the insane which I have visited. Dr. G. H. Barlow says:1 In closing his chapter on Vienna he says, after criticizing the minuteness of some of There has been no English physician— perhaps it may be said none of any country— the Government directions: since the time of Harvey, who has effected not Yet, on a survey of the whole conduct of only so great an advance in the knowlege of the Austrian Government towards its people, particular diseases, but also so great a revolu the excellence of the ruling heart is always tion in our habits of thought, and methods of plainly discerned, nor are the Austrians insensi investigating morbid phenomena and tracing ble to the advantages they thus enjoy, but the etiology of disease, as has the late Dr. repay them with heart-felt sentiments of Richard Bright. affection towards the Emperor, which they To those who have received the knowledge of never fail to express even when they murmur the connections of dropsy, albuminous urine, at his decrees. and disease of the kidney, among the first Later he extended his travels through rudiments of medicine, the facts which establish lower Hungary but returned in the summer that connection may appear so simple and so easily ascertained, that the amount of labour, in time to reach Brussels two weeks after the accuracy of observation, and the rigid the Battle of Waterloo. He remained there adherence to the inductive method which for some time aiding in the care of the sick characterized the whole of Bright’s researches, and wounded with which the hospitals may hardly have been suspected, still less were over crowded. adequately appreciated. In December, 1816, Bright was admitted For some time after the commencement of a licentiate of the College of Physicians. the present century, dropsy was regarded as Soon after he was made assistant physician in itself a primary disease. to the London Fever Hospital. While there In 1811 Wells and in 1813 Blackall he contracted a fever which nearly cost him pointed out the relationship of albuminous his life. urine with dropsy but did not connect In 1818 he again made a continental tour, this coincidence with disease of the kidney. this time through Germany, Italy and France and probably came under the The first volume of the “Select Medical influence of the great French clinicians, Reports” was published in 1824, and in this especially Bichat, Louis and Laennec. The work, which included observations on the great work on “Traitc de I’auscultation morbid anatomy of continued fever, and of mediate” by the last named was first phthisis, which for their carefulness and ac curacy would alone have established his repu published in 1819. tation as a morbid anatomist and pathologist, In 1820 he finally settled down in London Dr. Bright investigates the pathology of dropsy. and in the same year was elected assistant Observations upon diseased liver in dropsy physician to Guy’s Hospital where he are also detailed; and these, whilst they point continued on the staff for 23 years being out the connection of ascites with obstructed made full physician in 1824. In 1843 was portal circulation, show also that the necessary made consulting physician at Guy’s Hospi connection with diseased liver is limited to that tal. While attending physician he is said particular form of dropsy. The most important to have worked for six hours a day in the series of cases consist of fatal cases of dropsy wards and post-mortem room, besides in which the urine was albuminous and on which lecturing on materia medica and clinical transactions of the New Sydenham Society, medicine. His “Reports of Medical Cases” Vol. vi, Preface. autopsies were held, and by these observations he was active on the staff of the hospital. was the connection of diseased kidney, albumin He is said not to have been a very brilliant ous urine, and dropsy established. It is but just lecturer having little power of exposition. to Dr. Bright, as well as to those who have This seems remarkable because he is sup followed him in the same path of discovery, posed to have had an unusual faculty of to state that he described three, or, at the most, picking out as by intuition the important four forms of disease, with which the train of symptoms constituting what is now generally facts of any subject and so combining known as Bright’s disease were associated; and them that they explain each other. He that, having done this, he has left the investiga amassed thousands of facts and his minutest tion of the minute structural changes to be accuracy of observation was very rarely, worked out by others, whilst he devoted himself if ever, at fault. mainly to the completion of the clinical history. He died December 16, 1858, at the age of sixty-nine. While these investigations were going on in regard to the kidney, his active At the autopsy, the heart was found to be mind was also directed to other points of somewhat enlarged, the cavity dilated and the pathology. walls flabby. The aortic valves were replaced by a ring of bony matter which closed the Diseases of the brain, of the liver, and of the cavity of the artery entirely except by a small pancreas received from him much attention longitudinal slit the edges of which were and elucidation. Disease of the abdominal perfectly rigid except in about one-third of the viscera was, perhaps, always a favorite object extent where part of the original texture of research with Dr.

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