Sir John Crofton: Physician whose research revolutionised the treatment of tuberculosis and lung disease
Thursday 05 November 2009
For seven decades John Crofton conducted a professional and public battle against tuberculosis and lung disease.
For a quarter of a century, from 1952 to 1977, he held the Chair of Respiratory Diseases in the University of Edinburgh. A world authority, from 1984 until 1988 he was Chairman of the International Union against Tuberculosis and Lung Disease.
John Wenman Crofton was born into a medical family, the son of a GP. After a rigorous education at Tonbridge, for which he was forever grateful, he went up to Sidney Sussex College, Cambridge, where, under the direction, among others, of the Nobel Prize winner C.T.R. Wilson, the originator of the Cloud Chamber used to detect particles of ionising radiation, he graduated with First Class Honours in the Natural Science Tripos in 1933. His undergraduate career gave more than a few hints of what was to follow, with many prizes and awards. He then went to St Thomas's for clinical training until 1937.
Three years after qualifying, Crofton found himself a captain in the Royal Army Medical Corps with the British Expeditionary Force south of Dunkirk. In the field hospital he learned how to operate at great speed – a speed which his professional colleagues have told me they really admired. Suddenly, he received an order to move, field ambulance unit and all, to an area south of Dieppe. The casualties stopped coming. Crofton did not know that most of his colleagues had been cut off in the Dunkirk enclave.
All medical specialists were transported to Brittany; there he had to help deal with the aftermath of an ammunition train hit by the Luftwaffe, resulting in many casualties. As soon as the most urgent casualties were helped as best the doctors could, Crofton and the other specialists were ordered to St Malo. "I did not manage to get all the blood off me until we scrambled into Portsmouth," he said.
With no leave, he was on another boat, around Africa, bound for the Western Desert and Wavell's Army. Sent to the Eritrea Campaign, he then returned to Malta, where more permanent medical facilities allowed him to hone his surgical skills on wounded British and American troops evacuated from Italy. He ended the war in Germany, going into Belsen – later he was to spend a day in 1946 at the second Belsen Trial – and Auschwitz, where he was taken round by a Polish doctor. "It was the only time in my life when I could not sleep at night."
Upon leaving the services he moved fast; he was awarded his MD in 1947 and became a lecturer in medicine at the Royal Postgraduate Medical School at the Hammersmith. This was a dramatic and exciting time. Scientific method had for decades and even centuries been widely applied in the physical and natural sciences. But with all but a few shining exceptions, medicine had been an art, immune from such analysis.
While the cobwebs of history were to linger on in many places, the Hammersmith and a few other institutions were stressing the application of scientific method: sort out the basic science; understand the physiology; critically analyse whether your treatments actually do work, rather than just remembering the apparent successes and conveniently forgetting the many, many failures. Then learn the lessons and move on.
Into this academically critical environment were thrown intellects of the calibre of Crofton. And here was the truly happy coincidence, because it was at this time that the tools were becoming available to treat the pre-eminent global scourge, tuberculosis. The first drug, streptomycin, was primarily an American discovery. What made Crofton's name, laying the foundation for an international reputation, was his landmark 1950 British Medical Journal paper on the treatment of pulmonary TB with streptomycin – and the subsequent investigation, in which Crofton played a leading part, a controlled trial of combined therapy with streptomycin and para-amino salicylic acid. There was another trial of intermittent therapy with streptomycin, and then trials of isoniazid. These studies, which ultimately continued for almost 40 years, set the standards for the treatment of TB throughout the world.
He was elected one of the youngest-ever Fellows of the Royal College of Physicians – most have to wait a little after consultant status before that happens. Plainly the Royal College thought they ought to get in a bit quick, and they were right to do so because he had been a Senior Lecturer for just a year before he was appointed to the Chair of Respiratory Diseases and Tuberculosis in Edinburgh, one of the two established chairs in the UK.
They plainly thought in Edinburgh, let's not worry about a wise old head; let's get a brilliant young one. And they got it, with a vengeance. So a look at the job titles of the authors of his papers is instructive. Crofton J., streptomycin registrar, takes just four years to metamorphose into Crofton J., Professor of Respiratory Disease.
Crofton took tuberculosis in Edinburgh and its treatment by the scruff of the neck and shook it, and did the same to much else besides. He continued to contribute to the multi-centre studies and all that they achieved; this bustling, small-of-stature man galvanised the hospitals, to the extent that he was able to close over 90 per cent of the TB beds in Edinburgh. Among many other therapeutic achievements he showed, to the everlasting gratitude of the working man, that you could continue to work while being treated for TB. The late Michael McGahey, Communist president of the Scottish Miners, told me that when Crofton was made a knight, it was the first and last time he had ever congratulated anybody on a deserved ennoblement, such was the gratitude of the mining community in Fife and the Lothians.
Crofton soon became a major power in the University of Edinburgh, serving on the University Court, the Senatus, the Committee of Patronage, and much else. He was so well organised that he was one of those rare people who could be Dean of the Medical Faculty as well as driving on with his own research. It says a lot about Crofton that unlike most of the university establishment of the day, who were apoplectic about a young student called Gordon Brown getting himself elected as Rector of the University, Crofton opined that Brown was proving himself a good chairman of the University Court. He was quick to spot what he liked to call "over-reaction".
He expressed himself strongly in support of the General Medical Council in the wake of the Shipman Affair, contending that good systems should not be destroyed by unique cases – "I would not like to think there are too many Shipmans around!"
Never going anywhere without a TB related purpose, Crofton travelled the world. Having close connections with Basra, he set up a scheme by which the brightest Iraqi young doctors could come to Edinburgh and other British universities to improve their qualifications. He was in the Baghdad Hospital in the late 1970s when Saddam came on a visit at 9 o'clock, ordering the doors to be locked and ordering (temporarily) that all medical staff who were due to be in the hospital and were late, should be sacked.
My abiding memory is of travelling to northern France with Crofton and his doctor-wife of 60 years, who had written an excellent History of the Scottish Nurses and Doctors of Royaumont, 1917-1918, where they performed miracles for wounded returning from the Front. They knew more than I did about Dr Elsie Dalyell, my mother's friend and cousin, who was an Anzac physician at Gallipoli, in Serbia and finally in France. But then the Croftons, both life-enhancers, knew so much about so many things.
As a mid-nonagenarian Crofton took three holidays in the Scottish highlands. He enjoyed an active social life with friends, concerts and lectures. He also continued with his professional commitments. His book on tuberculosis for high-prevalence countries, which he wrote with two colleagues, has appeared in 22 languages and he was working on a third edition when he died. His book on tobacco for a similar readership has been translated into six languages, including Chinese, and he was helping with the planning of going into yet more languages.
In 2001, Dr John Moore-Gillon of the Department of Respiratory Medicine at Bart's, presenting Crofton with the Galen Medal for Therapeutics from the Worshipful Society of Apothecaries of London, said: "This award recognises, above all, contributions to therapeutics, and so it is with particular pleasure that this evening the Society of Apothecaries is able to honour somebody who is actually a master clinician, a remarkable teacher, an academic administrator of consummate ability, a leader in campaigning on a global basis on health issues, and on top of all that has had such an influence on the ways in which we make progress in therapeutics."
At 94 Sir John Crofton was still being consulted on the problems of global TB and engaged in international TB advocacy and fund-raising. He was presented with the "chairman's award" from the vast European Respiratory Society at its Glasgow conference in 2004. Few have extended their working life up to three-quarters of a century.
John Wenman Crofton, physician: born Dublin 27 March 1912; RAMC 1939-1945; Professor of Respiratory Diseases and Tuberculosis, University of Edinburgh, 1952-77; Kt 1977; married 1945 Eileen Chris Mercer (two sons, three daughters); died Edinburgh 3 November 2009.
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