Obituaries

James Scott Robson

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3535 (Published 07 July 2010) Cite this as: BMJ 2010;341:c3535
  1. Andrew Doig,
  2. Anne Lambie,
  3. Robin Winney

    Clinician who ended hepatitis epidemics in dialysis units

    In 1958 dialysis was beginning to be used in the treatment of acute renal failure, and James Scott Robson and his surgical colleague Hugh Dudley were asked to organise an acute renal failure service at the Royal Infirmary of Edinburgh. The service, one of the first in the United Kingdom, started in 1959 and needed unprecedented collaboration among the medical, nursing, and laboratory services. Robson died recently aged 88.

    The service resulted in an immediate 50% reduction in deaths from acute renal failure and paved the way for the first successful kidney transplantation in the UK, which was performed in 1960 by Michael Woodruff. Initially, transplantation was carried out in the Royal Infirmary, and Robson played an important part in the care of the patients before and after operation.

    Government report

    In 1964 chronic intermittent dialysis for patients with end stage renal failure was established in Edinburgh by Robson at about the same time as similar programmes in other centres in the UK. Between 1969 and 1971 an outbreak of viral hepatitis in the unit resulted in several deaths among patients and staff. The mode of spread was identified by bacteriologists, enabling Robson and two bacteriology colleagues to devise a code of practice for dialysis units that was designed to prevent further outbreaks. Their recommendations formed the basis of those made in a government report. Adherence to the practices advocated ended epidemics of viral hepatitis in intermittent dialysis units.

    The renal unit attracted young doctors who Robson trained in clinical practice and research methods. Several consultants in British renal units were trained under him, and some became professors of nephrology. Despite heavy clinical and teaching commitments, however, Robson initiated research on topics such as dialysis disequilibrium, disturbances of acid-base balance, glomerulonephritis, and hospital infection.

    In the 1950s while a senior registrar in Stanley Davidson’s professorial medical wards, he had carried out research on the renal concentrating mechanism, measurement of glomerular filtration rate and renal plasma flow, and the conservative management of patients with advanced renal failure. Then, with his wife, Mary MacDonald, a pathologist, he established Edinburgh’s renal biopsy service. Examination by light, immunofluorescence, and electron microscopy of the tiny samples of tissue resulted in better diagnostic accuracy and showed previously unrecognised forms of kidney disease that responded to different forms of treatment. As a result of their experience Robson and MacDonald played an important role in establishing Medical Research Council trials in the treatment of glomerulonephritis.

    Ship torpedoed

    Educated at Hawick High School, he came to Edinburgh to study medicine at the outbreak of war in 1939. Three years later he was awarded a Rockefeller Foundation studentship and sailed to the United States to complete his medical training. The ship was torpedoed off the Canadian coast, and he was one of the survivors. He became a student at New York University Medical School, where he completed his medical course and in 1944 graduated as a doctor of medicine. He worked for a brief period at Bellevue Hospital, where he was introduced to clinical research, and this influenced the direction of his medical career. He completed his studies in Edinburgh and was awarded the degrees of MB ChB with honours in 1945 and doctor of medicine with commendation 18 months later for his thesis on the causal factors of fluid retention in chronic liver disease. From 1945 to 1948 he served as a captain with the Royal Army Medical Corps in India, Palestine and Egypt.

    After demobilisation he worked for a few months in Edinburgh Royal Infirmary Clinical Chemistry Laboratories with Dr C P Stewart. From then until Stewart retired they collaborated on the investigation of metabolic problems and the training of PhD students. In 1949 he was awarded a Rockefeller travelling fellowship, which he held in the department of nutrition and biochemistry at Harvard.

    Robson became reader in therapeutics in 1961, reader in medicine in 1969, and professor of medicine in 1977. In these posts he, with Professor Henry Walton, played a leading role in the modernisation of the undergraduate medical curriculum at Edinburgh. He also contributed to postgraduate education and training. His main contribution to the Royal Colleges of Physicians in Edinburgh, Glasgow, and London was that of an examiner of candidates for the membership diploma of the colleges. According to several co-examiners his questioning of candidates brought to their attention recent advances in internal medicine.

    Robson was a gifted writer. His contribution to Davidson’s Principles and Practice of Medicine on disturbances of water and electrolyte balance was said to be the best short account of a subject that most students find difficult. With Reg Passmore he became editor in chief of A Companion to Medical Studies. This comprehensive ground breaking work gave undergraduate and graduate students an exciting account of modern medicine and clinical science. These three weighty volumes, published in 1968, 1970 and 1974 sold in large numbers throughout the world until the 1980s. His writings on medicine and science continued in 1986, when he was appointed as an adviser to the New Encyclopaedia Britannica.

    He enjoyed gardening, literature, theatre and contemporary art. Always well informed on current affairs, Robson’s opinions invariably attracted attention.

    In the past few years his health deteriorated, and he was unable to walk. With the devotion of his wife and community support he was, however, able to stay at home. Robson died at home after a period in hospital. He leaves his wife and two sons.

    Notes

    Cite this as: BMJ 2010;341:c3535

    Footnotes

    • James Scott Robson, kidney specialist (b 1921; q MD New York 1944, MB ChB Edinburgh 1945, MD Edinburgh 1946, FRCPEd 1960, FRCP 1977), died on 14 March 2010.

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