Sir John Crofton: Physician whose research revolutionised the treatment of tuberculosis and lung dis

Author: By Tam Dalyell

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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