Sir John Crofton, professor of respiratory diseases and tuberculosis at the University of Edinburgh, established the first effective regime of combined chemotherapy for the cure of tuberculosis, and devoted many years after retirement to combating the deadly effects of smoking, alcohol and social deprivation.
John Wenham Crofton was born in fashionable Merrion Square, Dublin, where his father, William Mervyn Crofton, was in practice as a consultant bacteriologist. His mother was Mary Josephine Crofton née Abbott. He spent his early years in Dublin, but moved to the country at the time of the Easter Rising in 1916. When he returned home, a bullet was found in his bedroom ceiling. His parents eventually moved to London and he attended Tonbridge School and Sidney Sussex College, Cambridge.
As an undergraduate he made his first expeditions with friends to climb in the Scottish Highlands, which became a lifelong love. With Stephen Cumming he made the first ascent of the mitre buttress of Beinn a'Bhuird in the Cairngorms.
His clinical training was at St Thomas's Hospital Medical School, and he qualified MRCS LRCP in 1936 and MB BChir in 1937. At that time the threat of war was increasing and he did not delay in obtaining his MRCP in 1939, shortly before the outbreak of the Second World War. He remembered the long and short cases he was shown during the examination and recorded them in his autobiography. Possession of the MRCP meant that he could be graded as a medical specialist when he joined the RAMC at the beginning of the war.
His experience of matters medical and military in the early years of the war was wide, progressing from the ‘phoney war’ in the UK and France to the hasty retreat from France at the time of Dunkirk. He distinguished himself by saving soldiers from a burning ammunition train, and was eventually posted to the Middle East. A quiet period In the Canal Zone and Egypt contrasted with the stress of the British withdrawal from Greece and Crete in 1941, and with a posting to Ethiopia and Eritrea following the expulsion of Italian forces by the British Army.
Among the wide variety of clinical material which came his way was a series of cases of typhus, which he eventually wrote up to form his MD thesis. He was mentioned in despatches. A turning point in his career was his posting to a hospital where J Guy Scadding [Munk’s Roll, Vol.XI p.501] was in command of the medical division.
After demobilisation, his friendship with Scadding bore fruit when he was appointed in 1947 to the Medical Research Council’s tuberculosis unit at the Brompton Hospital, with a joint attachment to the Postgraduate Medical School of London in Sir John McMichael's [Munk’s Roll, Vol.IX, p.341] department.
In 1948 it had been discovered that streptomycin had activity against M tuberculosis, but it soon became clear that the organism could readily become resistant to the drug. It was necessary to investigate this by means of clinical trials, coordinated by Marc Daniels, and at this time Crofton came into association with Sir A Bradford Hill [Munk’s Roll, Vol.IX, p.234], whose skill led to the establishment of the definitive scheme for randomised clinical trials, which became a standard for the future.
In 1952 John Crofton was appointed to the chair of tuberculosis at the University of Edinburgh. The chair had been established in 1917 and the first holder was Sir Robert William Philip [Munk’s Roll, Vol.V, p.332]. At the time of Crofton's appointment it was the only such chair in the British Empire.
On his appointment, tuberculosis was highly prevalent in central Scotland, and the problems Crofton faced were not only the establishment of effective chemotherapy, but also the logistical problem of a large waiting list of patients at all stages of the disease. He was able to put together a team of enthusiasts (IWB Grant, Norman Horne, JD Ross and J Williamson among them) and to complete a trial of triple chemotherapy with streptomycin, para-aminosalicylic acid (PAS) and isoniazid (INAH), the results of which were so strikingly successful that they were initially met with disbelief, until confirmed by studies elsewhere. The waiting list melted away; therapy was coordinated between inpatient wards and outpatient supervision with a team of health visitors, who also traced contacts. A mass miniature chest X-ray survey of the population of Edinburgh was carried out.
In the 1950s and 1960s respiratory medicine developed rapidly and the chair in Edinburgh became the chair of tuberculosis and respiratory diseases. Crofton's department expanded and, with Andrew Douglas, he published in 1969
Respiratory diseases (Oxford, Edinburgh, Blackwell Scientific Publications), the first comprehensive British textbook on the subject.
The successful chemotherapy scheme became established worldwide, and, with the encouragement of the International Union Against Tuberculosis, he published a short textbook with Norman Horne and Fred Miller [Munk’s Roll, Vol.X, p.335], which remains in wide circulation (Clinical tuberculosis, Macmillan, 1992).
He gave service to the University of Edinburgh in many ways. From 1963 to 1966 he was dean of the faculty of medicine, when he had to deal with frequent struggles to reconcile competing heads of departments. His success as dean was recognised by his appointment as vice principal of the university (from 1969 to 1970). It was a time of student unrest and he had to confront groups of militant students. On one occasion, accompanied by Morris Carstairs, a psychiatrist, he was asked by one of an aggressive group whether the encounter did not make him anxious. His reply was that, as clinicians, both were accustomed to dealing with disturbed patients. To another group he joked that if he was to be hanged, he would demand a silken rope. These responses exemplify the spirit of what he described as ‘Hibernian hyperbole’, which infused his entire life.
After completing his period as vice principal, he served as vice president (from 1972 to 1973) and president (from 1973 to 1976) of the Royal College of Physicians of Edinburgh. He records this as a time of benign progress, contrasting with the turmoil of the academic world. He notes only one occasion when he had to pour oil on troubled waters. He was knighted in 1977, the year he retired from his chair.
Retirement did not mark the end of his activity. He put great effort into the campaign against smoking, giving support to the establishment of Scottish ASH (Action on Smoking and Health), where he liaised with Charles Fletcher [Munk’s Roll, Vol.X, p.146], who was active in the London-based ASH. In later years he focused on health problems caused by alcohol and social deprivation. He travelled and lectured world-wide. I remember his disappointment when the World Health Organization refused to support him on a world tour solely on grounds of age, his medical examination having revealed him to be extremely fit.
He received many honours, including the Weber-Parkes prize of the Royal College of Physicians, awarded in 1966, the BTS medal of the British Thoracic Society and the union medal of the International Union Against Tuberculosis and Lung Disease, awarded in 2005. A memorial lecture has been established to mark his achievement.
He was outgoing, cheerful and considerate to all, his approach always coloured by a light Irish touch. He lived a long life fully to the end. In 1945, as the war was ending, he had married Eileen Chris Mercer, a doctor. They had two sons and three daughters. One of their sons, Richard, became a physician.
From 2002 to 2004, after he had reached the age of 90, Sir John wrote his autobiography, recording his life and the struggle against the scourges of tuberculosis and tobacco. The manuscript is held by the Royal College of Physicians of Edinburgh, was edited by his son-in-law, David C Kilpatrick and published in 2013 (Saving lives and preventing misery: the memoirs of professor Sir John Wenham Crofton, Peterborough, Fastprint Publishing).
Ross McHardy
[The Independent 5 November 2009; The Guardian 18 November 2009; The New York Times 19 November 2009; The Telegraph 1 December 2009; The Royal College of Physicians of Edinburgh www.rcpe.ac.uk/obituary/sir-john-wenman-crofton-hon-frcp-edin – accessed 27 January 2014]