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| Obituary: Sir John Crofton Leading figure in respiratory medicine and the treatment of tuberculosisSir John Crofton, who has died aged 97, was a world leader in respiratory medicine for more than 60 years and was at the forefront of the modern treatment of tuberculosis, smoking control and medical education.Born in Dublin, where his father was a doctor, he went to Tonbridge school, Kent, and then Sidney Sussex College, Cambridge, graduating in 1933. In the same year, along with MS Cumming, he was credited with the first ascent of a difficult rock-climbing route on Garbh Choire of Beinn a'Bhùird in the Cairngorms, still known as the Cumming-Crofton route.From Cambridge he went to St Thomas' hospital, qualifying in 1937, and after junior posts, he served as a medical specialist in the Royal Army Medical Corps in France, Egypt, Greece, Eritrea, Malta and Germany, using his experiences of typhus for his MD thesis in 1946.After demobilisation, he worked at the Royal Brompton hospital, London, from 1947 to 1949, partly in the tuberculosis unit of the British Medical Research Council, and was in charge of early trials of the antibiotic streptomycin. This was a crucial time in the battle against tuberculosis. The disease was rife, and until that time, the only available treatment was the "sanatorium regime" of prolonged rest, fresh air and good food, plus the occasional use of surgery – all of very limited effectiveness.John moved to the Royal Post-graduate Medical School at the Hammersmith hospital from 1947 to 1951, first as lecturer with Guy Scadding, who became a lifelong friend, then as senior lecturer with consultant status. In 1951 he was appointed professor of respiratory diseases and tuberculosis at Edinburgh University, later becoming dean of the faculty of medicine and then vice-principal.When he moved to Edinburgh, the treatment of TB was in a desperate state. There were huge waiting lists for hospital admission, many deaths, and the correct use of the new drugs PAS (para-aminosalicylic acid) and isoniazid in relation to streptomycin was unclear. TB physicians were suspicious of the new agents, and also of an outsider from the south seeking to make changes. But within a year or so John had revolutionised the situation, getting more beds and more consultant appointments, and with the support and enthusiasm of his colleagues, the Edinburgh model of multiple drug treatment was developed.The triple-drug regime ensured that the TB organisms did not become resistant to the treatment, and people could be cured without the need for surgery. Indeed, a cure was possible without the need for a stay in hospital, and despite some initial disbelief at the remarkable results, the Edinburgh system was adopted worldwide. New TB cases were sought using a mass miniature radiography campaign in 1957, and the prevalence of TB fell rapidly – nowhere more so than in Edinburgh.The control of tuberculosis globally remained a major concern for John, and he continued to advise and motivate people, publishing in 1992 a low-cost text on clinical tuberculosis with Norman Horne and Fred Millar, intended for the developing world. This has gone to new editions and several reprints, in 22 languages. He was also a founder and honorary president of TB Alert, Britain's national tuberculosis charity, launched in 1999, and was an active advocate, fundraiser and supporter of the organisation.For much of his time in Edinburgh, John worked in partnership with Andrew Douglas, and it was plain to all those who worked as their trainees, as I did, that they held each other in great respect and affection and provided a model of how to work harmoniously and effectively together. This was evident when they published the major textbook Respiratory Diseases (1969), which went into several editions.During his time in Edinburgh, John's research and public health interests broadened, particularly towards the prevention of disease by reducing smoking. He was one of those responsible for starting Ash-UK (Action on Smoking and Health) and also Ash Scotland (in 1973), of which his wife Eileen, whom he married in 1945, became the first director. He was delighted when these medically-based organisations helped achieve legislation restricting tobacco promotion and the ban on smoking in public places, with Scotland leading the way in the UK. In 2002, with David Simpson, he published Tobacco, a Global Threat – another low-cost book, this one aimed at encouraging tobacco control and the cessation of smoking in the developing world.John's great skill was to know what needed to be done in whatever field he had investigated, and then to make it happen by taking his teams with him, building and inspiring their loyalty and enthusiasm, and achieving the objectives without compromise. He respected all those who contributed from every discipline, and all those who worked with him became aware of his support. Many of his trainees felt that they were continuing to work for him and his causes long after leaving his department, and were very conscious of the privilege of having John as their mentor.He never ceased to work and develop ideas for improving people's lives, and a list of his other initiatives and achievements is almost endless. It should certainly include brokering the amalgamation of the British Thoracic Association with the Thoracic Society to create a single British Thoracic Society; a distinguished presidency of the Royal College of Physicians of Edinburgh; involvement in the founding of Scottish Health Action on Alcohol Problems (Shaap); some 50 years as a council member of Chest Heart and Stroke Scotland; and prominent roles in the Britain-Nepal Medical Trust and the International Union Against Tuberculosis and Lung Disease. He accepted many richly deserved honours modestly, and continued to work and influence people until his peaceful death at home.John and Eileen were delightful and sociable people, regularly inviting staff and students to their home. They had an astonishing knowledge of the arts and a wide interest in people, which made them easy and stimulating company in any gathering. While he will be greatly missed, the achievements of this small but wonderful man will continue to benefit millions around the world. A sense of thanksgiving for a life is not often so widespread and overwhelming as it is for his. He is survived by Eileen, their five children and 11 grandchildren.• John Wenman Crofton, respiratory physician, born 27 March 1912; died 3 November 2009Medical researchSmokingLung cancerScotlandDrugsguardian.co.uk © Guardian News & Media Limited 2009 | Use of this content is subject to our Terms & Conditions | More Feeds guardian.co.uk |
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