JOHN CROFTON

John Crofton

[Autobiographical details provided for The James Lind Library, September 2004].

Born 27 March 1912, in Dublin, Ireland. Most schooling in England.

Medical education at Cambridge University and St Thomas’s Hospital Medical School, London. Qualified MB ChB in 1937.

1937-1939: Junior posts at St Thomas’s Hospital. Admitted to Membership of the Royal College of Physicians.

1939-1945: Medical specialist in the Royal Army Medical Corps, with service in France, Egypt, Eritrea, Greece, Malta and Germany.

1947-1952: Half-time Medical Research Council Research Fellow in charge of first streptomycin trials at the Brompton Hospital, London, and half-time lecturer (later senior lecturer) at (Royal) Postgraduate School of Medicine of London at Hammersmith Hospital.

1952-1977: Professor of Respiratory Diseases and Tuberculosis, Edinburgh University.

1977 onwards: Many post-‘retirement’ activities (see below).

Research on tuberculosis, 1947-1960

Big postwar tuberculosis epidemic in Scotland. Became responsible in 1952 for 400 tuberculosis beds and 30 non-tuberculosis beds in Edinburgh. Other consultants shortly appointed (Ian Grant, Norman Horne, Ian Ross, Jimmy Williamson). Our group participated in subsequent MRC tuberculosis trials but, through the Tuberculosis Society of Scotland (later Scottish Thoracic Society) we initiated controlled trials of treatment at work versus bedrest; preventive chemotherapy for tuberculosis of doubtful activity; corticosteroids plus chemotherapy in pulmonary tuberculosis; and variable dosage of isoniazid in pulmonary tuberculosis (all world firsts).

Our major tuberculosis research identified the causes of failed drug treatment, which was due to drug-resistance resulting from bad or risky therapy, or failed adherenece to therapy. We found triple drug treatment uniformly successful in new patients, and were the first team to claim that 100% treatment success was possible.

As result of widespread disbelief in this claim, we initiated, with Noel Rist of Pasteur Insitute Paris and through the International Union Against Tuberculosis and Lung Disease (IUATLD), a 23-country trial of “causes of failure in advanced pulmonary tuberculosis” (1963) using triple chemotherapy. (I believe this may have been the first international collaborative trial of therapy in any disease. The study was coordinated by Reg Bignall of the Brompton Hospital). Treatment failures were virtually all due to participating doctors breaking the treatment protocol.

Also, through chairmanship of IUATLD Scientific Committees: first international study of drug resistance prevalence; international trial of reliability of X-ray diagnosis (which was poor) and sputum diagnosis (which was more reliable).

Research on respiratory diseases other than tuberculosis

As tuberculosis beds were converted to care and investigation of patients with other respiratory diseases, studied causes of pneumonia in the community, first at Postgraduate Medical School in London, then in Edinburgh; treatment and long-term prognosis in bronchiectasis; causes of exacerbations in chronic bronchitis and trial of rehabilitation procedures; prevalence and prognosis of sarcoidosis; bronchial muscle function in asthma. Later (with Barry Kay) immunology of asthma and bronchitis.

Other Edinburgh activities, 1963-1976

1963-66: Dean, Faculty of Medicine, Edinburgh University.

1966-69: With Andrew Douglas, edited first three editions (1969, 1975, 1981) of postgraduate textbook – Respiratory Diseases (4th and 5th editions edited by other authors. Russian, Spanish, and Italian editions).

1969-71: Vice Principal of Edinburgh University during period of global student militancy!

1973-76: President of Royal College of Physicians of Edinburgh.

Activities after ‘retirement’ from clinical medicine, 1977-present (2004)

Tobacco

One of the founders of UK Action on Smoking and Health (ASH) (through Royal College of Physicians of London) and Scottish ASH (through Royal College of Physicians of Edinburgh).

1984-88: First chairman of Tobacco or Health Committee of IUATLD. Booklet for action by doctors and national member associations and review of their subsequent actions. Pamphlet for politicians in association with WHO. World survey (41 countries) of tobacco habits and knowledge of medical students. Survey of deans of European medical schools (jointly with WHO Europe) regarding their action on tobacco. Major effort to stimulate action by WHO. Membership of WHO advisory committee to plan 5-year programme, including addressing World Health Assembly on behalf of NGOs in 1988.

1996: With Richard Doll, co-edited British Council multi-author book on tobacco.

2002: With David Simpson, wrote basic book – Tobacco: A Global Threat – for third world countries, central and eastern Europe. Editons so far in French (for francophone Africa), Hungarian and Bulgarian (other editions being prepared). Sponsored by Teaching Aids at Low Cost (TALC), International Agency on Tobacco and Health, IUATLD, and Swedish Heart Lung Foundation.

2003-4: Advisor to lawyers in Scottish litigation case against a tobacco company.

Tuberculosis

Three multi-month visits for WHO to Nepal 1978, 1981, and 1985 (including a brief visit to Thailand). Extensive work for WHO Geneva in 1990s. Chaired committee to produce first Guide on Treatment for National Control Programmes (DOTS programmes), and later for initiation of DOTS Plus for dealing with multi-drug resistance. Wrote initial draft on this.

With Norman Horne and Fred Miller, wrote Clinical Tuberculosis, a simple book for third world countries. English editions in 1990 and 1999. Editions in 21 other languages so far. Sponsored by TALC and IUATLD.

Health Education

1981-86: Chaired Scottish Office committee to coordinate health education in Scotland.
Produced reports on desirable action regarding tobacco, alcohol, and multiple deprivation, for NHS and Local Authorities in Scotland. Considerable amount of later work, including publications, on all three problems. Helped to launch first Community Health Project in Edinburgh.

Honours, honorary degrees, prizes, medals and honorary appointments

Civil honour: Knight Bachelor, 1977.

Honorary Fellowships/Memberships: Australasian, Irish and American Colleges of Physicians; Faculty of Public Health; Royal Society of Edinburgh; Royal Society of Medicine, London; and Kings College London. Academies of Medicine of Argentina, Singapore, and Catalonia, and of IUATLD.

Honorary degrees: Doctor Honoris Causae, University of Bordeaux; Doctor of Science, Imperial College London.

Prize: Weber-Parkes Prize, Royal College of Physicians, London, 1966.

Medals: Finnish Tuberculosis Society, 1987; WHO (Tobacco), 1988; Edinburgh Medal and Prize for Science and Society, 1995; British Thoracic Society, 1997; Leverhulme Medal, School of Tropical Medicine, Liverpool, 2000; Galen Medal in Therapeutics, Society of Apothecaries of London, 2001.

Honorary appointments: Chair, Research Committee, British Tuberculosis Association (now British Thoracic Society), 1955-61. IUATLD: Chair Antibiotics and Chemotherapy Committee 1957-63, Diagnostic Scientific Committee 1968-72, Tobacco and Health Committee 1984-88. President of Scottish Thoracic Society; Thoracic Society (UK); British Tuberculosis Association; Edinburgh Medicochirurgical Society; (Hon) TB Alert.

Sir John Crofton Lecture: TB and tobacco control: their role on the global health agenda.

Talk delivered by Thomas Frieden, at the 41st Union World Conference Inaugural Session, 12 November 2010. https://www.theunion.org/what-we-do/conferences/world-conference-on-lung-health/41st-union-world-conference-on-lung-health/video/day-2-opening-of-the-world-conference