Sir John Crofton, physician and pioneer of tuberculosis treatment

Born: 27 March, 1912, in Dublin. Died: 3 October, 2009, in Edinburgh, aged 97.

JOHN Crofton was born in Dublin in 1912, the son of a doctor, and his earliest recollection was of hearing the bullets hitting the ceiling of his nursery in the Easter Rebellion in 1916.

He was educated at Tunbridge School and proceeded to Cambridge University and St Thomas's Hospital in London, qualifying in medicine in 1936. He served in the Royal Army Medical Corps from 1939-45 in France, the Middle East and Germany. He was mentioned in Dispatches in 1941 and finally attained the rank of Lt Colonel. His experience in typhus was the subject of his MD thesis in 1946.

Following demobilisation, he worked with Guy Scadding at the Brompton Hospital who recruited him to one of the first clinical trials of the antibiotic streptomycin, when he experienced the early benefits of chemotherapy and the disasters which attended the subsequent appearance of drug resistant organisms.

In 1951, he moved to Edinburgh as Professor of Respiratory Diseases and Tuberculosis. The first new antibiotics were producing patchy results among more than 50,000 tuberculosis patients in a depressed, post-war Britain. While some recovered, many more relapsed and died. Crofton inherited responsibility for 400 tuberculosis beds in three hospitals, with a waiting time for admission of one year. He obtained more beds, negotiated for new consultant appointments and patiently but persistently unified the system so that within a year of the service operating, the waiting list had disappeared.

Crofton was quick to realise that tuberculosis would only be cured by the use of at least two drugs to which the tubercle bacilli had been shown to be sensitive. He led a team of dedicated physicians and bacteriologists to prove this was so, using streptomycin and para-aminosalicylic acid. With the introduction of isoniazid, therapy became standardised using the three drugs. Crofton also showed the treatment was as efficacious when given to out-patients as when given to in-patients, thus reducing demand for in-patient beds.

With the use of appropriate chemotherapy, the number of resistant organisms declined rapidly, mortality and notification rates fell more sharply in Edinburgh than in any other centre in the world, and the need for surgical intervention diminished dramatically. The success of the Edinburgh method of treatment was at first greeted with some disbelief but eventually was adopted in 23 European countries and America.

Aside from his infectious enthusiasm and meticulous attention to detail, John Crofton's other great gift was as an organiser, capable of bringing out the best in others. It was a team effort and he took trouble to involve all his medical, nursing, paramedical and scientific colleagues as well as treating the patient as an individual. He travelled to all continents, lecturing, advising and sharing his experience with colleagues and politicians alike. Later, it was Crofton, too, who pioneered the global method now used to fight terrifying new drug-resistant strains requiring ever more complex and expensive cocktails of antibiotics, if indeed they are treatable at all.

Following the decline of tuberculosis in Britain, Crofton's research activities widened, resulting in publications covering a wide spectrum of respiratory medicine, including co-authorship in a postgraduate book on Respiratory Diseases, now in its fifth edition.

He also founded Scotland's Action on Smoking and Health (ASH) of which his wife, Eileen, was the director. This led, after 30 years of groundwork, to Britain's first public smoking ban in Scotland.

When Michael Bloomberg, mayor of New York City, wanted to spend $200 million of his own money for the good of developing countries, Crofton was asked for advice. In reply, he told him to fight smoking, focusing on high-incidence countries and funding a major effort in the media, all of which have come to pass. More recently Tobacco, co-authored by Crofton, is a campaigners' handbook.

Despite an intensely active participation in medical research, he was Dean of the Faculty of Medicine from 1964-66 and a Vice Principal of the university in 1969-70. He was successively president of the Scottish Thoracic Society, British Thoracic Association and Thoracic Society. He was also an adviser to the World Health Organisation on tuberculosis and he served on a number of national scientific and advisory committees in relation to higher medical training and the future of respiratory services. He was president of the Royal College of Physicians of Edinburgh from 1973 to 1976. In recognition of his distinguished contribution to the management of tuberculosis and to medicine, he was knighted in 1977, the year of his retirement.

Shortly after retirement, he set out for Nepal to advise on tuberculosis, which he continued to do until he was 77. Increasingly, John and Eileen Crofton were able to pursue major interests in other health problems of the multiply-deprived. In 1992 John initiated and co-authored a book on Clinical Tuberculosis aimed principally at developing countries with tuberculosis problems. This met with outstanding success, with 22 languages in many countries.

John Crofton was the recipient of many awards and honours in Britain and worldwide, including the gold medal of the British Thoracic Society and the gold medal of the International Union Against Tuberculosis and Lung Diseases. The most recent of these was the Edwin Chadwick medal in 2008 for outstanding contributions to the advancement of public health.

Among the successes of respiratory medicine during the past half century, the control of tuberculosis would clearly head the list. John Crofton's pre-eminent contributions to this success as innovator, researcher and teacher will remain an inspiration for those who follow in this field in the future.

John's special leisure activity was hill climbing, which he enjoyed well past retirement age.

Right to the end, the enthusiasm which characterised his life's work never waned.

He leaves a wife, Eileen, five children, one of whom is a consultant physician, 11 grandchildren and two great-grandchildren.

(Reproduced with kind permission of the RCPE)