Crofton, Sir John Wenman
(19122009), physician and public health campaigner
, was born on 27 March 1912 at 55 Merrion Square, Dublin, the son of William Mervyn Crofton, medical practitioner, and his wife, Mary Josephine, née
Abbott. A happy childhood included education at schools in Ireland, then at Tonbridge School, Kent, and Sidney Sussex College, Cambridge, from where he graduated in 1933 in the natural science tripos. Of short, wiry build, he played rugby and hockey for his college and became an enthusiastic climber. On holiday in Scotland after his last term at Cambridge he was among a group of friends who pioneered several previously unclimbed routes; with Stephen Cumming he was the first to ascend Garbh Choire of Beinn a'Bhuird in the Cairngorms by what became known as the CummingCrofton route. They climbed in leather boots with nailed soles; as Crofton wryly noted years later, those using rubber boots were considered a deeply inferior species in those days, and their methods analogous to cheating at cards (autobiography, Cambridge, 25).
Crofton completed his medical education at St Thomas's Hospital, London, qualifying in 1937. After serving in junior medical posts he enlisted with the army, serving in the Royal Army Medical Corps, first with the British expeditionary force in France, where he saw his first action, and later in Egypt, Greece, Eritrea, Malta, and Germany. He served almost entirely overseas, and his experiences varied from being machine-gunned and bombed and dodging between slit trenches between enemy attacks to check on the welfare of his patients, to reading medicine or Shakespeare by a pool, or studying languages; he bought an Italian primer to occupy himself in case of capture. In Northern Ireland in May 1945 he met Eileen Chris Mercer [see below]
, another doctor, and a month after Crofton's demobilization they married on 14 December that year at St John's Presbyterian Church, Kensington, and had two sons and three daughters.
After hospital jobs in London, in 1947 Crofton was recruited by the respiratory specialist John Guyett (Guy) Scadding, under whom he had served in Egypt, to work at the Royal Brompton and Hammersmith hospitals. There he pioneered a then innovative research tool, the randomized controlled trial, to test the use of a new antibiotic, streptomycin, to treat tuberculosis. The results, published in 1948, showed that while it reduced tuberculosis deaths, drug resistance often set in, which prompted Crofton to explore whether its effects might be sustained by combining it with other drugs.
In 1951, when Scotland was in the grip of a tuberculosis epidemic, he was appointed professor of tuberculosis and respiratory diseases at the University of Edinburgh, where he started work at the beginning of 1952 and remained until his retirement in 1977. He combined his grasp of randomized controlled trials with a relentless drive to research the efficacy of different drug regimens, how to prevent drug resistance, and whether people suffering from tuberculosis needed to be in-patients (lengthy stays in sanatoria were the norm at the time). His research showed that para-aminosalicylic acid and isoniazid combined with streptomycin, provided that the treatment was given until no trace of disease remained, could produce an unprecedented cure rate, and that most patients did not need to be treated in hospital. The resulting Edinburgh method quickly led to the decline of the epidemic, and became a model worldwide, though the possibility of a 100 per cent success rate took time to be believed in some quarters. Further studies confirmed that with meticulous bacteriology and adherence to good drug combinations established by careful controlled trials all new tuberculosis patients, however ill, could be cured. Rigorously efficient, Crofton was also an encouraging mentor, particularly of keen and able young staff, though quick to address any lapse in the high standards he demanded in medical and nursing care, and few colleagues could match his energy.
Over the next half century Crofton worked tirelessly for improvements in health both at home and abroad. He was frequently ahead of the times in patient care, humanizing the way patients were dealt with, as well as involving other health professionals and social workers at a time when this was rare. He believed in giving credit to others wherever possible, describing this as a highly successful policy for gaining co-operation, though possibly selfish, as in due course, credit seems to have a habit of returning to base (autobiography, Battle with the bug, part 1, 38). He also favoured publishing comparative results for the implementation of policies, to reward the leaders and stimulate the laggards to action (autobiography, War with the weed, 6).
Like many chest physicians, as tuberculosis rapidly declined in the UK and diseases from tobacco increased Crofton threw his energies into smoking prevention, helping to found Action on Smoking and Health (ASH) and, later, ASH Scotland, of which his wife, Eileen, became the first director. Meanwhile his tuberculosis work spread to international activities with the World Health Organization and the International Union Against Tuberculosis and Lung Disease, setting up the first large-scale international randomized control trial, involving twenty-three countries. He travelled widely, lecturing, advising governments, helping to write the World Health Organization's treatment guidelines to beat drug-resistant tuberculosis, and encouraging the development of tobacco control policy at international as well as national level.
In addition to scientific publications Crofton was the co-author of several influential books. In 1969, with his close friend and Edinburgh colleague Andrew Douglas, he published Respiratory Diseases
, which became a standard textbook on the topic, going into several editions and to be found on the shelves of respiratory specialists all over the world.
Despite undiminished commitment to demanding clinical and academic work Crofton was dean of the faculty of medicine at Edinburgh from 1964 to 1966 and served on committees at the highest levels of university governance, being vice-principal in 196970. Outside the university he was particularly active in respiratory medicine, serving successively as president of the Scottish Thoracic Society, the British Thoracic Association, and the Thoracic Society. His authority and his courteous, diplomatic style helped to negotiate the merger of the latter two organizations into the British Thoracic Society in 1982.
Crofton was a highly active and acclaimed president of the Royal College of Physicians of Edinburgh from 1973 to 1976; and in recognition of distinguished service to the management of tuberculosis and to medicine he was knighted in 1977, the year of his retirement. Augmenting the honour came an unexpected, related tribute, testimony to his humility and the inclusive way he dealt with people. The communist president of the Scottish miners, Michael (Mick) McGahey, aware of Crofton's pioneering achievements, in particular those leading to tuberculosis patients being treated without lengthy time off work, made an exception to a personal rule about establishment honours, expressing approval of the honour.
Retirement brought little change to Crofton's work and travel commitments, now all unpaid, to which he added visits to Nepal for the World Health Organization and becoming active in the British Nepal Medical Trust over the next dozen years. He served on numerous national scientific and advisory committees on medical education and the future of respiratory services. In 1988 he addressed the World Health Assembly, the World Health Organization's annual governing meeting, on the need for greater action on tobacco. He also co-authored two low-cost books aimed at low-income countries, on tuberculosis and tobacco respectively. Through his influence and fund-raising efforts both were published, translated, and widely distributed either free or at cost. In addition to continuing service on many medical committees, his public health interests widened, in particular to include ill health associated with multiple deprivation. He was the prime mover in efforts to set up a new, independent group on alcohol abuse. He realized that, as with tobacco, it was unlikely that groups working on the problem could ever be effective lobbying organizations if they relied, as they did at the time, on funding from the very industry whose sales were at stake. After years of work Scottish Health Action on Alcohol Problems was duly set up in 2006 by the Scottish Medical Royal Colleges and Faculties.
John and Eileen Crofton led a rich social life, taking an avid interest in literature, music, and art. Staff, students, and friends invited to their home at 13 Spylaw Bank Road, Colinton, which looked south over a steeply sloping garden to the Pentland Hills, were rewarded with a warm welcome and stimulating conversation. Crofton's enthusiasm and energy were coupled with a fascination with the world and a delight in its cultural diversity and its cumulative treasury of learning, of which he had a polymath's breadth and depth of knowledge. Always superb company, he was also a generous listener, rewarding a good story with a bark of heart-warming laughter. The Croftons enjoyed holidays at home and abroad in a camper van. If bad weather was encountered, it simply meant more time for reading. This included taking turns to read to each other, a practice resumed when having baths at home.
Despite some ill health in their later years the Croftons continued their enthusiastic attendance at concerts and art exhibitions, and John Crofton continued to participate in important public health meetings, often to be bestowed with honours. Among these were the gold medals of the British Thoracic Society and the International Union Against Tuberculosis and Lung Disease, and the Edwin Chadwick medal, awarded in 2008 for outstanding contributions to the advancement of public health. He was a stalwart supporter of Eileen's activities, in tobacco control and medical history. They took great pleasure in their eleven grandchildren and two great-grandchildren. They also took a keen interest in news and current affairs, and were delighted by the election of President Barack Obama in the United States and the live television broadcast of his inauguration ceremony. John Crofton died of heart failure on 3 November 2009 at his home in Colinton.
Crofton's wife, Eileen Chris Crofton [née Mercer]
, Lady Crofton (19192010), physician and public health campaigner
, was born on 28 March 1919 at 2 Guernsey Road, Liverpool, the daughter of Richard Mercer, then a telephone engineer, later a patent agent, and his wife, Edith Mary, née
Mackay. She was educated at North London Collegiate School then studied medicine at Somerville College, Oxford, graduating in 1943. After a year's training in a local hospital she joined the Royal Army Medical Corps; it was while working in a military hospital in co. Down that she met John Crofton. After their marriage she worked as a part-time clinical assistant at the Brompton Hospital, London, meanwhile developing research into the epidemiology of heart disease. After the family's move to Edinburgh in 1952 she at first concentrated on bringing up their five children, but from 1963 to 1973 she was county medical officer of the Midlothian branch of the British Red Cross Society, and an honorary research fellow at Edinburgh University, where she produced a series of reports on bronchitis and lung cancer. After she and her husband had helped to set up ASH in 1971 and then ASH Scotland in 1973, she served as first medical director (and initially sole staff member) of the latter from 1973 to 1984. She travelled widely, lecturing on the dangers of smoking and the need for regulation of the tobacco industry, and she was appointed a member of the World Health Organization's expert committee on smoking. She formally retired from ASH Scotland in 1984, and was appointed MBE the same year, but she remained an active supporter of the organization. In 1984 she set up, and for the next six years convened, the ASH working group on women and smoking. Always interested in history, in 1997 she published The Women of Royaumont: A Scottish Women's Hospital on the Western Front
. She lived to see the inauguration of the Sir John Crofton chair of medicine at Edinburgh University, in 2010. The Crofton award of the Royal Environmental Health Institute of Scotland, first presented in 2009, was named after her as well as her husband. She died on 8 October 2010 at the Royal Infirmary, Edinburgh; she and her husband were survived by their five children.