He went to almost fatal lengths to prove the link between tobacco and cancer, yet Dr Lennox Johnston, way ahead of his time, was ignored by the establishment. Allan Brown tells the story of a Scottish pioneer
UNLESS you operate a pub, a tobacconists or a First World War troop ship, chances are you consider the smoking ban the gift that keeps on giving.
Its legacy just gets richer. By 2007, a year after the ban in Scotland took effect, the incidence of heart attack had dropped a reported 17%. The prevalence of “chronic wheezing” among bar workers fell too, a problem we knew of only once it had been solved. Even last week, timed nicely for National No Smoking Day this coming Wednesday, came news that the ban has occasioned a dramatic reduction in the number of premature babies.
Cue, however, a ghostly sound; the polite clearing of the throat that tends to say I Told You So. To ingest nicotine by means of bronchial infumation is harmful to us. A global industry has developed to tell us this. But the first person to tell us this was an eccentric Troon GP whose achievements have vanished from history. His name was Dr Lennox Johnston, and this year sees the 70th anniversary of his discovery, made during an otherwise innocent age when smoking was thought to harbour all the sinister potential of consuming Sherbert Dib Dabs.
“He was an extraordinary character; he said it all decades before it was being admitted by the government,” says Christopher Snowdon, smoking researcher and author. “He was ignored in his own lifetime, he’s forgotten about completely now, yet he was so far ahead of his time.”
Dr Johnston MB ChB was indeed a singular fellow, if perhaps an obsessive and mildly tyrannical one. Born in 1899, he was by his thirties an alumnus of Ayr Academy and Glasgow University, formerly a medical student on a Royal Navy minesweeper in the North Sea and a GP with a new practice on Merseyside. He was a smoker also and had been for more than a decade. He couldn’t help noticing, however, the generally parlous state of his patients’ bronchial and respiratory systems. And he was attempting to kick the habit personally, a process that lasted, he wrote, “two agonising years”.
Crunching these realities together, Johnston reasoned smokers couldn’t curtail their self-harming behaviour essentially because they weren’t being allowed to; the very chemical composition of tobacco must harbour a compound whose mind-altering malignancy could only be guessed at.
And so was born a mission. Johnston alighted upon the idea that nicotine had to be addictive and, by extension, the cause of the lung cancers he was treating in his surgery every day. He had no time for the consensus that the rise in lung cancers resulted from petrol fumes. Johnston’s new theory was heretical, socially and medically, but he was prepared to defend it to his last breath, safe in the knowledge that his messianic zeal had postponed its arrival indefinitely. He embarked upon a series of extreme, Dr Phibes experiments, in which he injected himself hypodermically with doses of liquid nicotine. The purpose was to establish the true effect of the substance on the central nervous system. It became apparent that one such effect was to cause the subject to fall over and come within inches of death as his wife slapped his face hysterically.
“Father’s study was a rather dark part of the house, completely off-limits to us children,” says Lennox’s son Ivor, a retired GP in Hampshire “He had a somewhat heavy presence in the house; as children we knew his work preoccupied him and that mother was the buffer between him and us. I grew up with a slight stammer, which I’m sure resulted from being rather cowed in front of father.”
After his brush with rolling maniacally on the ground, Johnston changed tack. This time, he would monitor the effect of nicotine injections on a test group of 35 volunteers. When the injections were withheld the patients developed cravings. The inference was obvious: the social pleasures of smoking were fig-leafs concealing the fact that smokers were little better than hopeless, hollow-eyed addicts.
Johnston outlined his case in The Lancet in 1942, but he remained a lone voice. For some mysterious reason, the medical establishment proved resistant to the claims of a Scottish GP who frothed from the mouth as his wife summoned paramedics. Johnston spent a decade hammering at a locked door. He grew embittered. He was denied funding by the Medical Research Council (MRC). The British Medical Journal, whose chairman, Johnston noted wryly, was a pipe-smoker, turned down his papers repeatedly.
Meanwhile, Johnston developed a notion to burn down the offices of the British Medical Association in Tavistock Square (abandoned, presumably, on discovering he’d given away his lighter). Publicity was the key to progress, he reasoned, and he took to consulting Sylvia Pankhurst, daughter of the suffragette Emmeline, a dab hand at furthering difficult causes. She suggested Johnston approach Winston Churchill at a public event and slap the cigar from the prime ministerial mouth.
In 1948, Johnston made a final, desperate bid to the MRC for funds to prove the link between smoking and lung cancer, only to be told that two epidemiologists had just been tasked to undertake similar research. In 1950, Richard Doll and Bradford Hill announced that lung cancer had been linked definitively to tobacco use. In the process they did for the anti-smoking cause what Watson and Crick would go on to do for DNA, with an equal claim to posterity: “The funny thing,” says Ivor Johnston “was that father wasn’t upset as such. Rather, he was pleased his point had been accepted. He was interested more in people’s health and the evils of smoking than in his own reputation, which says a great deal about him, despite his quite intense single-mindedness.”
Lennox Johnston died in Hampshire aged 87, his final years taken up as a GP in Lymington and as president of the National Society of Non-Smokers. As Ivor recalls, he would have preferred to withhold treatment from those of his patients who smoked, prefiguring recent moves by the NHS in Hertfordshire. Prevented by the Hippocratic oath from doing so, though, he settled for shooting those patients really frosty looks. Similarly, Johnston never quite forgave his son for following him into general practice, not when there was a war to be fought. Yet he would have been gratified to know that his grandson, Professor Sebastian Lennox Johnston, became one of Britain’s leading lights in asthma research. History may have forgotten his pioneering grandfather – but the family’s clean-lunged legacy is one flame that won’t be extinguished any time soon.
• National No-Smoking Day is on Wednesday