Colin Currie: Hail the modern hero who beat TB

Professor John Crofton. Picture: TSPL
Professor John Crofton. Picture: TSPL
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PROFESSOR John Crofton saved millions of lives worldwide with his ‘Edinburgh method’, writes Colin Currie

Sixty years on, it is almost impossible to imagine how tuberculosis and the fear of TB gripped Edinburgh in the early 1950s. The incidence in the capital was among the worst in Europe. Though the city’s TB service deployed 400 beds, there was a waiting list a year long. Treatment of the disease was ineffective, and the care of its sufferers sometimes scandalous. One patient later recalled that a senior doctor had come into the ward and told all the young women there: “You are rosy apples, rotten to the core.”

Professor John Crofton, who took charge of the service in 1951, later wrote of that encounter: “What a horrifying thing to say to girls in the grip of a disease that would probably kill at least half of them. And there was worse…”

Crofton, born in Dublin in 1912, had trained in medicine in Cambridge and London and served in the Royal Army Medical Corps throughout the war. Appointed to the chair of tuberculosis and respiratory diseases at Edinburgh University, he set to work with a wealth of talents – intellect, energy, leadership, determination, diplomacy and compassion – that within a few years not only transformed the service but produced the world’s first-ever truly effective treatment for tuberculosis.

A rigorous trial of triple therapy – giving three drugs at once and thus preventing the development of drug resistance – produced results so good that at first they were widely disbelieved. All the patients who complied with the treatment were cured, and the “Edinburgh method” became the standard treatment for decades.

Crofton never boasted about his achievements – quite the opposite – but it is no exaggeration to say that millions of lives were saved globally by the treatment he and his team pioneered in Edinburgh in the 1950s. He went on to many other campaigns and achievements, nationally and internationally, slowing up a little only in his nineties. He died in 2009.

In memoirs just published, he describes what kept him going in his “battle with the bug”.

“The disease was particularly cruel in its cat-and-mouse course: the patient’s spirits might be thrilled by an apparent improvement, only all too often to be grimly shattered by successive relapses and ultimate death. Never was a dragon more worth slaying. These horrors were always at the back of my mind.”

He was a superb clinician and, as a consequence, a superb clinical teacher, and throughout his career his patients were people first: not just cases or, worse, X-rays. His interest in patients was immediate, unfeigned, humane and intensely practical, as I saw for myself as a student in 1968. In clinical work, teaching and research his style was crisp and positive – reflecting a dictum he once quoted from his army days: “Leadership isn’t making the chaps do what you want them to do – it’s making them want to do what you want them to do.” Many of his trainees went on from the City Hospital at Greenbank to careers of distinction in respiratory medicine across the world.

He was always generous with his time, efforts and his vast knowledge of his specialty. Once the menace of TB was largely tamed in the UK and Europe, he travelled widely and remained active for decades after his nominal retirement, campaigning internationally to optimise TB management as resistant strains emerged in recent decades.

Lung cancer today still carries a prognosis even worse than TB did in the 1950s. The best hope lies in prevention, and John Crofton – with the vigorous and effective support of Eileen, his wife – took up the “war on the weed” with all the energy and determination he had applied to the “battle with the bug”. Beginning with the foundation of Scottish Action on Smoking and Health, and advancing the campaign against smoking more widely through international committees and eventually, in the 1980s, via the World Health Organisation, once more Crofton did his bit in a vast and now increasingly effective initiative.

His commitments nearer home did not suffer. As Dean of the Edinburgh University Medical School in the mid-1960s he presided over a period of change, rivalry between senior professors, and between the complacent Royal Infirmary and the rising Western General – all bringing much inevitable strife, all frankly and sometimes amusingly described in his memoirs.

More happily, in the later 1960s, his appointment as a university vice-principal was highly successful. Approachable, sensible, constructive and happily blessed with a large brood of around student age, he was well prepared for the heady days of 1968. He arranged early-morning meetings with students, on the grounds that extreme radicalism was rarely compatible with early rising. He launched a student welfare committee, and eventually a counselling service. He persuaded university teachers to learn to teach – a concept astonishing to many of them – and brought students on to faculty committees, a practice that soon became the norm. And throughout all this, he notes wryly, “I had far more trouble from conservative colleagues than ever I had from radical students”.

He made and kept friends, whom he seemed to value more highly than the various honours that came his way, including a knighthood and many honorary degrees. Despite his huge commitments, throughout his long life he cherished his family; his children, as one of them told me shortly after his death, “led a charmed life” of adventurous holidays and endless affection and support.

What made him tick? Many of his friends and colleagues, his students and junior doctors, must have asked that question over many decades, and the real appeal of these memoirs lies in the little post-scripts to various sections that answer it. In a page or so there is reflection on what was going on, what was at stake, what worked, and what was learned: thoughtful and modest summaries that do not in any simplistic way explain the many remarkable achievements; but a record of a remarkable mind at work – taking thought, evolving, learning, growing.

• Colin Currie is a retired geriatrician.

• Saving Lives and Preventing Misery by John Crofton can be ordered from Fast Print Publishing at www.fast-print.net bookshop/1308/saving-lives-and-preventing-misery. Proceeds from sales will go to the charity TB Alert, which Sir John Crofton helped set up.