Nephrology in A Medicinal Dictionary of Robert James (1703-1776)

Robert James was a member of the College of Physicians at Cambridge and a practitioner. He was considered one of the "three best known characters in London--perhaps in Europe. The other two being the lexycographer Samuel Johnson and the Shakespearean actor David Garrick." James became famous for his powerful ability to write and publish, which produced many books, including the ponderous A Medicinal Dictionary, With a History of Drugs, in 3 volumes in folio, published in London in the years 1743-1745, and dedicated to the famous professor and royal physician John Mead. The Dictionary was translated into French by Denis Diderot, François-Vincent Toussaint and Marc Antoine Eidous, and was revised by Juliene T. Busson, president of the University of Paris. During the translation, Diderot learned much biology and medicine, which he used subsequently in developing his Encyclopédie. Interesting chapters are devoted to urine, predictions from urine, bloody urine, good urine, bad urine, urine portending death, diabetes, dropsy, nephritis, stone, ischury, dysury and urine incontinence. In general their strength resides in their accurate clinical descriptions. The paragraphs on urine are concise and clinically sound, and the description of procedures for urine analysis and the utilization of results (quantity, quantity, colors, sediments and consistency) in diagnosis and prognosis of bloody urine is accurate. The section on diabetes is excellent and is comparable to that of Desault written decades later in the Encyclopédie of Diderot. In the chapter on dropsy (he does not use the word oedema), patients are well described and their remedies are appropriate for the time. The contributions of kidney and liver are clear. The plants for renal treatment can be traced to Dioscorides. Concerning dosage, he is precise and helpful to his readers. The chapter on stones is a real masterpiece, clinically well centered and giving all the pertinent information to localize them, their medical treatment and the risks of surgery. The entry on nephritis is short and rather confusing. Here James even lacks the usual accurate description of cases which could have made it understandable. Blood letting was extensively used in those days, and he is a man of his time, but James was aware of the clinical conditions where it fails. It is understandable that he underlines its role in certain bloody urines in patients with a plethoric constitution. Was James referring to patients with acute nephritis and possibly high blood pressure.