"I think I know him"

[John Wheat]

Not when you realize the connection with kidney disease.

Gull–Sutton Syndrome (chronic Bright's disease)


In 1872, Sir William Gull and Henry G. Sutton, M.B., F.R.C.P. presented a paper^[36] that challenged the earlier understanding of the causes of chronic Bright's Disease.

The symptoms of Bright's Disease had been described in 1827 by the English physician Richard Bright who, like Gull, was based at Guy's Hospital. Dr. Bright's work characterised the symptoms as caused by a disease centred on the kidney. Chronic Bright's disease was a more severe variant, where other organs are also affected.

In their introduction, Gull and Sutton point out that Dr. Bright and others "have fully recognised that the granular contracted kidney is usually associated with morbid changes in other organs of the body" and that these co-existent changes were commonly grouped together and termed "chronic Bright's disease." The prevailing opinion at the time was that the kidney was the organ primarily affected, inducing a condition that would spread to other parts of the body and thereby cause other organs to suffer.

Gull and Sutton argued that this assumption was incorrect. They presented evidence to show that the diseased state could also originate in other organs, and that the deterioration of the kidney is part of the general morbid change, rather than the primary cause. In some cases examined by Gull and Sutton, the kidney was only marginally affected while the condition was far more advanced in other organs.

Gull and Sutton's main conclusion was that the morbid change in the arteries and capillaries was the primary and essential condition of the morbid state known as chronic Bright's disease with contracted kidney. They stated that the clinical history may vary according to the organs primarily and chiefly affected; the condition could not be expected to follow a simple and predictable pattern.

Interesting stuff. But again it's not evidence.