Dr. Bright’s Patient

William Goodrich Jones

Read before the Chicago Literary Club

February 15, 2010

 

The names Bloom, Edwards, Lynch, Roger, and Stevens will be familiar to us as common surnames, but perhaps with no particular association.  If I add Addison, Cushing, Hodgkin, Paget, and Salmon you will recognize them as illnesses.  They are some of the more than 350 “eponymous” diseases, named for the most part after those who have first or most fully described them.   Eponymous diseases may also be named after people who suffered from them such as Lou Gerhrig, Hartnup, and Mortimer.  Other diseases may be associated with place names, such as Lyme, Ebola, and Brooklyn, although these are not eponymous.

 

Current practice has been to move away from the use of eponyms.  The eponymous disease says nothing about the cause of the disease, and more than one eponym may refer to the same disease.  Nonetheless they have their uses, the eponym sometimes being shorter than the medical name, and the medical name itself sometimes proving to be misleading, because it implies a cause that has not been verified.  “Eponyms may disguise the distressing aspects and stigmata of a disease; obviously one would rather have Hansen’s Disease than be a ‘leper.’”  Sir James Paget (for whom Paget’s disease is named) remarked, “So long as a disease carried a man’s name it shows we know little about it.”

Richard Bright

Our interest this evening lies with Dr. Richard Bright and one of his patients.   Bright was born September 28, 1789 to a prosperous, dissenting family in Bristol, England.   Bristol was not a seaport, but it had a large harbor and was the center of the British slave trade in the West Indies.  The family's fortune was to a large extent derived from this trade.  Bright's father was a cultivated man.  He had a wide circle of friends, including the dissenting clergyman, Joseph Priestly, one of the discoverers of oxygen.  When Bright was young, his father took him to Hotwell Spa in nearby Clifton, where both the healthy and the ill sought aid from its supposed curative waters.  From an early age the young Bright seemed particularly sensitive to the sufferings of others.  In Bristol he was exposed to the ideas of Thomas Beddoes who established a pneumatic institution in Bristol in 1799.  There, consumptive patients could be treated by the inhalation of various gases.  Some of Beddoes more original ideas included the introduction of cows into the rooms of patients where they could inhale the cows’ breath, a cure surely less injurious than the common practices of bleeding and purging.

 

By his teens Bright expressed an interest in becoming a physician. His father was opposed to the idea, doubting that his son had the drive to succeed in the demanding and competitive practice of medicine.  The young Bright persevered, and his father eventually gave his consent.  After schooling in Exeter, Bright enrolled at the University of Edinburgh, then a center for those wishing to “improve their education and broaden their knowledge of the world,” travel to the continent for study prohibited by the Napoleonic wars.  Bright had not distinguished himself during his early school years, but as he grew older he began to develop a pleasing personality, perhaps aided by his friendship with the charismatic Henry Holland, a friend from his time in Exeter.  Holland, later Sir Henry, became a distinguished society physician, and he and Bright maintained a lifelong friendship. At Edinburgh Bright was awarded top prize in mathematics, also studying geology, chemistry, physics and ethnology.  The curriculum placed emphasis on fossilized bones and minerals, because concoctions of these materials were often used in the treatment of patients.  By 1809 Bright had completed his first degree and was qualified then to pursue a degree in medicine.  During that time, Holland arranged for Bright and himself to accompany Sir Steuart Mackenzie of Could on an expedition to Iceland with the purpose of undertaking mineralogical research and to assess the theories of Werner and Hutton on whether the origins of the earth were by fires or were aqueous. 

 

Sir Steuart published a history of this trip, and in its preface he noted that Bright had gathered most of the plant specimens, and that he “shall ever retain a grateful remembrance of the cheerful and ready exertion he always displayed, and the undeviating good humour, with which he submitted to the cross accidents which sometimes befel us.”  Bright’s parents also saw that the trip had changed him into a man of “greater enthusiasm and vigour.”

 

Bright was a skilled draftsman, and he used his skills to record the appearance of healthy and diseased organs.  He could note very small details in the capillary web of sectioned organs.  He drew a granular kidney in 1811 at the age of 22, where “he first observed the altered structure of the kidney in a patient who died dropsical.”.   He excelled in the closeness of his observation in post mortem examinations, writing to his father, “For my part I am very fond of seeing.”

 

After receiving his medical degree in 1813, he applied for the post of house surgeon at the Lock Hospital, Westminster, but he had to wait for a year before he could begin there.  In the interim he joined his brother Henry at Cambridge, and intended to graduate from there also.  He found that the curriculum didn’t suit him and that the library wasn’t as good as the one at Edinburgh, and he began working at Dr. Bateman’s public dispensary in January 1814.  That winter brought epidemics of bronchitis and pneumonia to London, and at the dispensary Bright saw firsthand the impact of poverty on the nation’s health.

 

We should note that not only were the resources available for cure very limited, there were few diagnostic tools; no way to measure blood pressure, no thermometers to measure body temperature, and, until 1816, no stethoscopes.  Also, the conditions in which the poor lived were appalling.  London had grown from a city of around one million people at the beginning of the 19th century to 4 ½ million by the end.  People were crowded in tenements and cheap lodging houses.  “In some places the excrement lay scattered about rooms, cellars and yards so thick that it was barely possible to move.”  Much of this excrement then found its way to the Thames and was then pumped back into cisterns or standpipes.

 

As the son of a wealthy and supportive father, Bright was able to spend the winter of 1814 in Vienna and saw many of the figures assembling for the Congress of Vienna.  He went to Waterloo shortly after Wellington’s victory, where he “concerned himself with the problems of dysentery, pneumonia and tetanus, but at others times he cared for the wounded and acted as a dresser assisting at the surgical operations.”

 

On his return to London, he worked again at the dispensary, and then began working at the Lock Hospital caring for syphilitic patients.  By 1817 he was working at the Willan Fever Hospital, where he encountered, among other diseases, dysentery, consumption and typhus.  It was during a typhus epidemic that Bright contracted the disease himself, severe enough that he “was unable to rise from his bed.”  In 1818 after a lengthy convalescence, he returned to Europe.  On these travels, he “began to suspect a link between dropsy, the collection of fluid in the soft tissues, and the function of the kidney.”  The established practice on the continent of post-mortem examination yielded an abundance of material for him to study.  By 1820 he was nominated for membership in the Royal Society and in the same year was appointed as assistant physician at Guy’s Hospital, a prestigious position.  Guy’s had been established in 1721 by Thomas Guy, a publisher of “unlicensed Bibles” who had made a fortune in the South Sea Bubble.  The hospital was established to treat “incurables” who had been discharged from St. Thomas Hospital where Guy was both a benefactor and a member of the board of governors.    There Bright also came into contact with Thomas Addison and Thomas Hodgkin, although Hodgkin never found a permanent place on the hospital’s staff.  Both had studied at Edinburgh and both were themselves honored by the names of the diseases they described.

 

Guy’s hospital exposed Bright to almost every disease.  Most of the patients admitted were in advanced stages, and many were terminal.    The usual treatments consisted of blood-letting, cold affusion, blisters, and tartar emetic.

 

Bright’s interest in the causes of dropsy grew, and he focused on 23 patients that he thought had kidney disease, paying attention to those in which renal insufficiency dropsy occurred.  Seventeen of the 23 eventually died, and Bright then studied each organ of those who had died, recording everything he knew about them and their diseases.  In spring 1827 Bright had written up these cases and published the first of two volumes, Report on Medical Cases, selected with a view of illustrating the symptom and cure of diseases by a reference to Morbid Anatomy.   By 1831 Bright had assembled enough material to publish a second work, one that dealt with diseases of the brain and nervous system.  These two volumes were his “great work,” although it was his work on renal diseases that eventually led to the designation of “Bright’s Disease.”  Bright recognized three basic types of pathological changes in the kidney at autopsy, and this alone was a quantum leap that would carry renal research into the next century.

 

As noted, treatment lagged behind diagnosis, and nephritic patients were encouraged “to take a light diet, cut down on wine and liquors, wear flannel next to the skin, avoiding riding on the outside of the carriage and if ‘horse exercise’ is taken eschew any ‘severe exertion to the loins.’”

 

Bright’s reputation grew, and in 1837 he was appointed “Physician Extraordinary to Her Majesty.”  He was one of many physicians holding that title, but I did not read of his ever having cared for the queen.  More significantly, in 1838 he was awarded the Monthyon Medall by the Institut des Sciences in Paris, and the recognition of his work by the expression “Maladie de Bright.”

 

Bright left Guy’s Hospital in 1844 and opened a flourishing practice in Savile Row.  Henry Holland, now Lord Holland, became a patient, as did his wife, Thomas Macaulay, the historian, and Alfred, Lord Tennyson.

 

Bright’s health began to decline in the final years of his life.  By 1858 he was suffering from severe angina and frequently breathless, and, following a short period where his spirits and health improved, on December 16, 1858, he died at the age of 69, a post mortem showing that he had “calcific congenital bicuspid aortic valve disease,” a condition Bright himself had diagnosed some 8 years previously.  He was not considered brilliant, but he was careful, meticulous in his observations, and thorough, and this was enough to ensure him a place in medical history. 

 

Isambard Kingdom Brunel

 

Among Bright’s important and influential patients was one of the greatest engineers of his age and, indeed, of any age, Isambard Kingdom Brunel.  The Literary Club last met Brunel in the 2008 paper, “The Houses in Between.”  Brunel was a member of the selection committee for a building to house the 1851 Great Exhibition of All Nations and had submitted an entry of his own.  Joseph Paxton’s inspired design for a glass house won the competition and became what was popularly known as the “Crystal Palace.” When the building was moved to Sydenham in 1854, it was Brunel’s design for two massive water towers that provided water and power for Paxton’s elaborate system of gardens, ponds, cascades, and fountains with their 250-foot high jets, Paxton’s own designs having collapsed.

 

Isambard was the son of Marc Isambard Brunel, a Frenchman of remarkable talents.  Born in 1769, Marc’s family intended him for the priesthood and sent him to a seminary in Rouen. But he showed greater ability in drawing, the making of mechanical devices, and in mathematics.  He continued his studies with a family relation, the American consul in Rouen and an ex-sea captain, with whom he learned hydrography and draughtsmanship.  He then served as a naval cadet with plans for a career in the French navy, making several trips to the West Indies.  In 1793 he was compelled to leave France for more favorable conditions, having made some impolitic remarks about Robespierre.  He emigrated to the United States and by 1796, after travels to Philadelphia and Albany and involvement in a project to join the Hudson with Lake Champlain by canal, he became a United States citizen and was appointed Chief Engineer of the city of New York.   In 1798, reportedly at a dinner party, he learned of a shortage of pulley blocks for use on British ships, the Admiralty purchasing 100,000 blocks each year during the Napoleonic Wars.  Marc sketched a design for a machine to automate the production of these blocks, and in 1799 he sailed for England, intending to submit a proposal to the Admiralty.  There Marc met Henry Maudsley, a maker of precision machine tools and the inventor of the slide rest lathe, the first modern machine tool.  Maudsley constructed working models of Marc’s machine, and it was with these models that Marc was able to secure a contract with the Admiralty to produce blocks for the British Navy.   Unskilled workers could operate this machine, and there were claims that it could do with six workers what had required sixty before.  Eventually a plant was built and by 1808 it was producing 130,000 blocks a year, an enterprise from which Marc eventually realized 17,000 pounds, the Admiralty, like the State of Illinois, not proving itself punctual about payment.  Marc was not a very good businessman, and he had financial difficulties all his life, resulting from engagement in enterprises that were ingenious but not profitable.  In 1821, deeply in debt, he was taken to debtor’s prison where he was confined for 88 days.  While there, he offered his services to Czar Alexander of Russia.  Eminent friends, including the Duke of Wellington, persuaded the government to offer a grant of 5,000 pounds to clear his debt on the condition that Marc not leave England.

 

Marc was fortunate in his personal life to fall in love with and marry Sophia Kingdom, an Englishwoman whom he had met while she was living in Rouen.  She herself had narrowly escaped execution as an English spy during the Reign of Terror, but she avoided this fate with the fall of Robespierre.  On April 9, 1806, their third child and first son, Isambard Kingdom Brunel was born. 

 

Isambard also showed himself to be mechanically gifted, an able draughtsman, and skilled in the use of tools.  He attended various schools in England before attending schools in France, including time in the workshop of Louis Breguet, one of the outstanding watchmakers of his day.  Watches bearing the Breguet label are still in production, and watches from the Breguet workshop still command impressive prices at auction. 

 

In 1822 when Isambard was 16, Marc brought him back to England to assist in planning the construction of a tunnel in London under the Thames.  There was much debate at the time as to whether soil conditions would permit any tunnel under the river to be built.  Marc intended to use a tunneling shield that he had designed for the River Neva in St. Petersburg.   The shield found its inspiration from the shipworm, Teredo navalis, whose hard shell of a head enables it to penetrate a ship’s timbers without injury to itself.  The shield, a massive devise employing many workers at its face, could be forced forward a few inches at a time.  Bricklayers would follow the advancing shield and line the tunnel with bricks. 

 

Funding problems, illnesses of the workers from contact with the Thames polluted waters, really an open sewer, as well as some serious accidents delayed the project.  Marc had planned that the tunnel would only run 14 feet below the riverbed at its lowest point, and there were frequent instances of water pouring into it.  Several workers died from the noxious atmosphere, and the methane gas from raw sewage frequently caused the workers’ lamps to flare.  Marc became too ill to continue to manage the tunneling, and Isambard took over as resident engineer at the age of 20.   His energy was “legendary” He required little sleep, and he was able to supervise operations both underground and on the surface.  In 1827, the tunnel was completely flooded with no lives lost, but in 1828 another flood killed six workers, and Isambard was seriously injured, almost drowning.   His leg was hurt, and he suffered severe internal injuries.  His treatment included bleeding and the application of leeches, and recuperation took many months.  He was sent to Brighton, but the illness, whatever it was, recurred, and he returned to London where he “languished until the spring.”  Still not fully restored to health, he did not return to the tunnel project.  His parents decided that Brighton was not the best place for him, and this time sent him to Bristol.

 

The tunnel was not completed until 1843 long after the Brunels’ association with it had ended, having used some seven and one-half million bricks.  An American visitor hailed it as the “eighth wonder of the world.”   Unfortunately the tunnel was not a commercial success.  It had been designed to carry horse drawn carriages, but the funding to construct the ramps could not be raised, and traffic was confined to foot.  When Nathanial Hawthorne visited it in 1855, he wrote,

 

“It consisted of an arched corridor of apparently interminable length, gloomily lighted with jets of gas at regular intervals ... There are people who spend their lives there, seldom or never, I presume, seeing any daylight, except perhaps a little in the morning. All along the extent of this corridor, in little alcoves, there are stalls of shops, kept principally by women, who, as you approach, are seen through the dusk offering for sale ... multifarious trumpery ... So far as any present use is concerned, the tunnel is an entire failure.”

 

Perhaps not an “entire failure.”  In 1869 the tunnel became part of the London Underground.  You may have travelled through it on the South London Line.

 

In Bristol, Isambard, hereafter referred to as Brunel, began an association with its wealthy merchants that was to occupy his energies for many years.  In 1831, he submitted a winning design for a suspension bridge across the River Avon in Clifton.  Riots in Bristol around the same time cooled the city’s commercial climate, and construction was delayed until 1836.  Only the bridge’s two towers were completed before lack of funding stopped the project altogether. Several years before this, Brunel had begun to advise the Bristol Docks Company on the improvement of their floating harbor, a project that improved the flow of water through the docks and avoided the creation of shoals that could impede shipping.  In 1833, not quite 27 years old, Brunel was appointed engineer to the Great Western Railway, initially to construct a line from Temple Meads in Bristol to Paddington in London.  Brunel’s structures for the Great Western in his lifetime included the viaducts at Hanwell and Chippenham, the Box Tunnel (at just under two miles it was then the longest railway tunnel in the world), and the Chepstow and Maidenhead bridges, the latter being the longest and the lowest arch in Britain at the time.

 

Brunel designed both the Temple Meads and Paddington Station, and his offices at Paddington may still be seen looking down on the tracks.  Not one to make little plans, Brunel saw no reason why the Great Western Railway system should not provide a link to New York, with ships sailing out of Bristol, and in due course Brunel became the chief engineer of the Great Western Steamship Company.  In this capacity, the young engineer with no particular training in nautical matters designed an iron-strapped, wooden-hulled side-wheel steamer, the Great Western, the first Atlantic steamship built for the purpose.  At the time it was thought that any steamship capable of crossing the Atlantic would of necessity use all of its cargo space for fuel.  Brunel’s particular genius was to recognize that, in the simplest terms, the larger the ship, the more efficient its engines became and the less fuel required to drive it.  Great Western had four sails, keeping it stable in rough seas and with both wheels in the water.  She made her maiden voyage in 1838 and arrived in New York with fuel to spare.

 

The Great Western was a commercial success, and, recognizing that she would need a sister ship, Brunel, conceived of an even larger ship, one constructed of iron.  There had been iron ships before, but none of this size and none, oceangoing.   At 322 feet in length, she was one-third again as large as the biggest ship in the Royal Navy.  Brunel initially conceived of her as a side-wheel paddle steamer, but government sponsored tests of screw propulsion led him to alter the design in favor of a single iron screw, 15 ½ feet in diameter and weighing 3 tons.  She carried six masts, and, in favorable weather, fuel could be conserved when under sail. There were luxurious accommodations for passengers and 1,000 tons of cargo capacity.   In July 1843, the Great Britain was floated out of the dock in which she was built.  The tireless Prince Albert was on hand to perform the honors.  He had traveled with Brunel from Windsor in the cab of a Great Western locomotive, and he returned the same day.  She performed commendably on her first Atlantic crossing, taking 14 days and 21 hours.  Unfortunately, Brunel’s design for the propeller was not up to the manufacturing capabilities of the time, and its blades fell off during the second voyage.  In 1846, after only 5 voyages, and probably a result of incompetence by her captain, she ran aground in Dundrum Bay in Ireland.  There she sat for almost a year, virtually abandoned.  Finding action by the directors to refloat her inadequate, Brunel involved himself, complaining that his ship was “left…lying like a useless saucepan kicking about on the most exposed shore that you can imagine, with no more effort than the said saucepan would have received on the beach at Brighton.”   Brunel designed a breakwater system to help the ship withstand the winter gales, and the Great Britain was refloated after passage of almost a year.  She was underinsured and sold to the firm of Gibbs, Bright and Company, the firm that had underwritten her construction.  The firm’s Robert Bright was Richard Bright’s brother.

 

The Great Britain finally achieved success on the Australian run and briefly transported troops to the Crimea and during the Indian Mutiny in 1857.   In 1877, she was converted entirely to a sailing ship and the hull covered in wood.  In 1886 she was condemned and for 47 years served as a wool and coal storage ship near Stanley in the Falkland Islands before finally being scuttled and abandoned.  The most astonishing part of the entire story is that in 1970, through the efforts of dedicated marine preservationists, the Great Britain was towed back to England on a pontoon barge, then refloated, and towed up the Avon to Liverpool to the dock where she was built.  She has been carefully restored and is now one of the city’s principal tourist attractions.

 

Brunel’s third great shipbuilding achievement was the SS Great Eastern, launched in 1858.  Initially called “Leviathan,” she could carry 4,000 passengers around the world without refueling.  She was 692 feet long (Brunel called her the “Great Babe”) and it was not until the end of the century that she was surpassed in length and tonnage.  Owing to the success of the Crystal Palace exhibition in 1851, many people saw the United States as a country of wealth and abundant natural resources.  With the support of John Scott Russell, a naval architect and ship builder himself, the two approached the Eastern Company, an enterprise formed to take advantage of the increase in trade and emigration to America.  Although Brunel had estimated the cost of the ship at 500,000 pounds, Scott Russell offered a low bid, and Brunel accepted his estimate.     Difficulties abounded in constructing a ship of such great size and complexity, where to build it, how to launch it.  Eventually a building yard was found in the Thames on the marshy and desolate Isle of Dogs.  Because her great length argued against the usual bow first entry, the decision was made to launch the ship sideways.  The keel was laid on May 1, 1854.  She was the first ship to have a double hull, also incorporating both longitudinal and transverse bulkheads.  A double-hulled ship was not built again for 100 years, although now all ocean-going ships are double-hulled.  The Great Eastern would have survived a collision with an iceberg like the one that sank the Titanic. 

 

Unfortunately Scott Russell’s relationship with Brunel deteriorated, and in addition he could not build the ship at the costs he promised.  He declared bankruptcy.  After prolonged negotiation with the bank, the Eastern Company managed to complete the construction.  Brunel’s original designs for launch proving too costly, an alternative method tried on January 3, 1858 failed.  Two more attempts on the 19th and the 28th also failed.  A fourth attempt on January 31 succeeded using powerful hydraulic rams.  The Great Eastern was fitted out and began her maiden voyage down the Thames and into the English Channel.  After passing Hastings, a huge explosion in the forward deck threw the No. 1 funnel into the air.  Five stokers died and several others were badly injured, including one who had jumped overboard and was lost.  The explosion would have destroyed a lesser ship, however, the Great Eastern was able to continue on its voyage.  Responsibility for the error that caused the explosion could never be determined.    The ship was not a commercial success.  Her engineering design was thorough and well in advance of contemporary practice; however, there was not enough demand from either passengers or cargo for a ship of that size, and the American Civil War prevented the rush of emigrants foreseen for her.  A use for which she was perfectly suited emerged in 1865 when she was modified to lay transatlantic cable, the only time she was ever profitable.   Between 1865 and 1878 she laid 26,000 nautical miles of submarine telegraph cable.   She eventually was used as a showboat, a concert hall, a music hall, and a gymnasium.  She was broken up in 1889 and 1890, so strongly was she built that the job took 18 months.  A persistent but unfounded rumor had it that the skeleton of a riveter and his assistant were found inside the double hull.

 

Physically Brunel was described as “A little, nimble, dark-complexioned man with a vast deal of ready, poignant wit.”  He was just over 5 feet tall and is often shown wearing a tophat, perhaps to make him appear taller.  No records reveal when Brunel first became a patient of Richard Bright.  Marc and Richard Bright’s father were friends years before Isambard became Dr. Bright’s patient.  At the time of the Thames tunnel accident in 1828 Dr. Bright’s wife wrote that she was “worried about his health and the demands that his profession laid upon him such as having to rise from his sick bed to attend the Brunels, father and son who had suffered internal injuries whilst working on the construction of the Thames tunnel.”

 

In 1839, when the Great Western was preparing to make her maiden voyage, Brunel almost lost his life when a fire broke out in her boiler room.  Brunel began to descend a ladder into the room when he fell 18 feet, the charred rungs of the ladder giving way.  His friend Christopher Claxton, broke his fall, and he later reported that he found Brunel lying with his head up to his ears in a pool of water.

 

Although Brunel led an active life, he was never robust.  He had several bad falls from his horse, and on one occasion injured his knees.  In 1838 he wrote to a friend,  I am not particularly well in body or mind.  I don’t get strong.  I am still lame in the left foot and my back is weak.  I don’t write this letter without leaning back to rest and, in consequence I suppose of the state of my stomach, I am nervous anxious and unhappy, in fact blue devilish, an infinite number of things crowing before me requiring attention and thoughts, all in arrears.  I am quite incapable of getting through them, everything seeming to go wrong…I suppose I want a dose of salts.  Yours very sincerely, I. K. Brunel.”

 

In 1843, while performing magic tricks with his children he swallowed a half sovereign that lodged in his windpipe and remained there several weeks.  The surgeon Sir Benjamin Brodie devised a pair of forceps (probably designed by Brunel) and performed a tracheotomy, but he was unsuccessful in removing the coin.  Brunel’s father thought of strapping him to a board and “jerking the coin free,” a successful stratagem.   The historian Macaulay is said to have rushed through the Athenaeum Club shouting, “It’s out!”

 

In 1852 the Great Eastern steamship “began to occupy his time and thoughts.”  Its troubled history has already been mentioned   In addition, Brunel had invested heavily in the company, leading him to defer plans for constructing a country house in Devonshire.  By 1857, Brunel’s son, in his biography of his father, noted that, “He paid for his exertions a heavy price, for they left him in broken health and already suffering from the disease of which in a little more than eighteen months afterwards he died.”  In September 1858 Sir Benjamin Brodie and Dr. Bright were called in, ordering him to spend the winter in Egypt.  On his return, Brunel devoted all his, by now, failing energies, to preparing the Great Eastern for launch.  A photograph taken of Brunel at the site shows him with a smooth and somewhat puffy face, a symptom of his disease.

 

By August 1858 it was clear that Brunel had become seriously ill.  He was obsessed with the completion of the ship, and he visited it every day.  He was accustomed to having complete control over all aspects of construction, and he attempted to continue that practice even as his health declined.  The last photograph taken of him on the ship shows a man appearing far older than his 53 years, supported by a cane and with bags under his eyes.  The Great Eastern was scheduled to sail on September 6, but on the 5th, while on the ship, he suffered a stroke, was paralyzed, and taken to his home.  Brunel died there on September 15 in time to learn of the disaster on the ship. 

 

The disease that killed Brunel probably began as a strep infection, triggering an immune response that damaged the renal glomeruli, the part of the kidney that filters waste products from the blood.  Other existing conditions, perhaps high blood pressure and incipient heart disease may have exacerbated his illness.   His consumption of 40 cigars a day cannot have helped.

 

During his career, Brunel designed and built 25 railway lines, over 100 bridges and tunnels, including 5 suspension bridges, 8 pier and dock systems, 3 ships, 1200 miles of railway in England and Wales, and a pre-fabricated army field hospital for use in the Crimean War on which he consulted Dr. Bright.  Many of these works remain and are in use today.

 

Brunel’s last great bridge was the Royal Albert crossing the Tamar at Saltash.  It rises 260 feet above its foundation; its two main spans each of 455 feet having been raised into place from the river below.  Prince Albert was on hand to open the bridge in May 1859, but Brunel was too ill to attend the ceremony.  Following his death the directors of the railway placed a memorial to him on the bridge.

 

Brunel demanded much of his apprentices and much of himself, but woe to those who fell short of his standards.  He was courageous almost to the point of recklessness.  No one did more in England to establish the art of engineering as a profession.  He could embark on endeavors that did not prove productive, but he never did so without careful reasoning and thorough planning.

 

Upon his death, a long-time friend and colleague wrote,

           

“On September 15 1858 I lost my oldest and best friend in the death of Mr Brunel…By his death the greatest of England’s engineers was lost; the man of the greatest originality of thought and power of execution, bold in his plans but right.  The commercial world thought him extravagant, but altho’ he was so, great things are not done by those who sit down and count the cost of every thought and act.  He was a true and sincere friend, a man of the highest honour, and his loss was deeply deplored by all who have the pleasure to know him.”

 

Brunel’s death moved the Institution of Civil Engineers to complete the construction of the suspension bridge at Clifton “as a fitting monument to their great friend and colleague.”  The original piers remained, and the firm of Hawkshaw and Barlow modified the design somewhat, strengthening it and adding weight to the roadbed for greater stability.  Chains from Brunel’s Hungerford Bridge, by then demolished, were purchased and used in the construction.  Work began in 1863, and the work completed by December 1864.  Brunel intended that the bridge reflect an Egyptian influence with sphinxes capping the piers.  The sphinxes were abandoned, but the bridge still reflects some of the original concept.  All other major suspension bridges of the era have either been removed, replaced, or reconstructed.  The bridge at Clifton remains in use today, and in its superb setting above the Clifton Gorge, it is wonderful to behold. 

 

In 2006, the bicentennial of Brunel’s birth, England showed its appreciation for Brunel’s achievements by holding events and ceremonies all over the country.  Perhaps the most spectacular of these were held at the Clifton Bridge, where an extended display of fireworks lit the evening sky.

 

I have recognized two people this evening whose lives were linked medically, professionally, and socially.  Of them we may aptly say,  We are like dwarfs sitting on the shoulders of giants.  We see more, and things that are more distant, than they did, not because our sight is superior or because we are taller than they, but because they raise us up, and by their great stature add to ours.”

 

Sources

 

For information about Richard Bright I have relied primarily on Pamela Bright’s Dr. Richard Bright (London: Bodley Head, 1983) and Diana Berry and Campbell Mackenzie’s Richard Bright:  1789-1858; physician in an age of revolution and reform (London: Royal Society of Medicine Services, 1992).  For Isambard Kingdom Brunel, two major monographic resources are L. T. C. Rolt’s Isambard Kingdom Brunel (New York:  St. Martin’s Press, 1959) and R. A. Buchanan’s Brunel:  the life and times of Isambard Kingdom Brunel (London: Hambledon & London, 2002) The Oxford Dictionary of National Biography is also a source of information on the two men.  The number of Internet links relating to Brunel and his achievements are too numerous to list, and these multiplied on the occasion of the bicentenary of his birth in 2006, including the site “Brunel 200.”

 

I shall always be grateful to the late Richard S. Hartenberg, Professor of Mechanical Engineering at Northwestern University, for pointing out the connection between Bright and Brunel.

 

 

 

William Goodrich Jones ã

February 2010

Resources added, November 2010