Crofton, Sir John Wenman (1912–2009), physician, scientist and public health campaigner, was born on 27 March 1912 at the family home, 55 Merrion Square South, Dublin, the only son (between two sisters) of William Mervyn Crofton, physician and bacteriologist, and his wife Mary Josephine (née Abbot). Residing at 32 Fitzwilliam Square from 1916, Crofton was educated in various Dublin prep schools serving the Anglo-Irish protestant community, before boarding at Tonbridge School, Kent, from September 1925, where he played hockey and became passionately interested in biology.
From September 1930 he studied medicine at Sidney Sussex College, Cambridge University, graduating with first-class honours in the natural science tripos (BA, 1933; B.Chir., 1937), and beginning clinical studies at St Thomas's Hospital, London, in September 1933. His father's distinct views on the biological transmission of disease, although not shared by John, nonetheless spurred his engagement with rigorous research practice. Working as a clinical assistant, casualty officer and house physician at St Thomas's, he gained membership of the RCP of London (1939) and revelled in London's cultural life, especially the theatre. He also enjoyed mountaineering in the Scottish highlands; the 'Cumming-Crofton' route on the Mitre Ridge of Beinn a' Bhùird in the Cairngorms is named after his 1933 ascent.
After exposure to exotic tropical medical cases at Queen Alexandra Military Hospital in London, the apex of the British military medical system, Crofton joined the RAMC as a medical reservist in May 1939 and was mobilised as a lieutenant in the BEF, screening reservists in France. He later operated his own mobile pathology laboratory in Egypt, and served in Greece, before being evacuated back to Egypt. After recovering from typhoid, he served at Ismailia and Geneifa on the Suez Canal, being mentioned in dispatches. Transferring to Asmara, Eritrea, he climbed extensively in the elevated hinterland before returning to Geneifa to take charge of a typhus ward, where he worked with Guy Scadding for eighteen months. In February 1944 he was promoted lieutenant-colonel and served briefly in Malta. He was then posted to Bangor, Co. Down, where he met (May) Eileen Mercer, an Oxford-educated RAMC medic, whom he married at St John's Presbyterian Church, Kensington, on 13 December 1945, a month after his demobilisation.
In 1947 he was awarded a Cambridge MD for his thesis 'Clinical and pathological aspects of typhus in the services in Egypt'. That year he became a registrar at the Brompton Chest Hospital and lecturer (later senior lecturer) in medicine at the Royal Postgraduate Medical School at the Hammersmith Hospital, London, coordinating the Brompton's participation in a major Medical Research Council (MRC) trial evaluating streptomycin as a treatment for pulmonary TB (1947–8). One of the first randomised controlled trials (RCTs), establishing both the efficacy of the treatment and the propensity for TB drug resistance to emerge, it set new methodological standards for therapeutic evaluation and profoundly influenced Crofton's career. Appointed to the chair of respiratory diseases and tuberculosis at the University of Edinburgh (1952), he assumed control of TB treatment across the city, assembling a team of physicians, bacteriologists, public health workers and medical administrators. He centralised services, devised a patient-centric prioritisation formula to address chronic TB, engaged with local GPs, health visitors, nurses and medical social workers, and established the efficacy of out-patient chemotherapy, preventing treatment failures by ensuring rigorous supervision of patients taking their prescribed drugs. Keenly aware of the social stigma associated with TB, he deliberately shook hands with his patients to undermine its effect.
Crofton led a series of MRC trials during the 1950s that established the efficacy of isoniazid, which, in combination with para-aminosalicyclic acid (PAS) and streptomycin, constituted what became the world-famous 'Edinburgh method' of TB treatment. These meticulous RCTs addressed the efficacy of various permutations (to preclude drug resistance) of streptomycin, PAS and isoniazid against TB. Dedicated and persuasive, Crofton revelled in teamwork, recognising its value in building coalitions and minimising medical and academic politics, giving others credit at every opportunity. Within eight years of his arrival in the city, Crofton and his team had cured the vast waiting list of patients of TB. Working with the WHO from 1954, he gave British Council lectures across Europe, Africa and the Middle East for the next two decades, and travelled the globe to improve TB treatment regimes worldwide. In 1957 Crofton led a major twenty-three-country RCT organised by the International Union Against Tuberculosis (IUAT) to counter residual professional opposition to mounting irrefutable evidence and address poor adherence to drug treatment regimes by doctors and patients. Its findings were widely accepted and overcame any remaining medical scepticism of the Edinburgh method.
As TB prevalence declined through the 1960s, Crofton turned to other respiratory diseases. A joint 1963 British Medical Journal paper with his wife, an epidemiologist, comparing the impact of smoking on mortality and respiratory diseases between Scotland and England, engendered a growing interest in tobacco control. Crofton was a founding member of ASH (Action on Smoking and Health) in both England (1972) and Scotland (1973), Eileen chairing the latter. His significant clinical workload, duties as dean of the faculty of medicine (1963–6) and vice-principal of Edinburgh university (1969–71), and the writing of works such as Respiratory diseases (1969) with Andrew Douglas (a standard textbook widely translated, later known as Crofton and Douglas's respiratory diseases) left little time for a family or social life. He did, however, enjoy engaging with mild student unrest from 1968, noting in his memoirs that he endured 'far more trouble with conservative colleagues than with militant students' (Saving lives, 251).
Crofton was president of the Royal College of Physicians of Edinburgh (1973–6) and of the British Thoracic Society (1974–5), and chaired the Scottish Office committee to coordinate health education (from 1981). Increasingly involved from the late 1960s with the IUAT (reconstituted in 1984 as the International Union Against Tuberculosis and Lung Disease (IUATLD), of which he was an important progenitor and chairman (1984–8)), he retired from the university (September 1977) and from clinical practice (1981). Exposure to community development and public health practice saw Crofton rigorously examine the interplay among inequality, poverty, housing conditions, stress, addiction and ill health – what came to be termed 'multiple deprivation' – through the 1980s. A trustee of the International Agency on Tobacco and Health, Crofton campaigned against the shift of tobacco companies' interest into developing countries, as regulation in developed countries undermined their profits.
He continued to maintain a keen interest in the treatment of TB. From the mid 1990s, the WHO estimated that a quarter of avoidable deaths worldwide were caused by the disease, and he urged governments to combat growing multi-drug resistance to TB, decrying the lack of appropriate research funding. Especially resurgent in developing countries, but also apparent in the UK and elsewhere, such resistance contributed to deaths caused by the HIV epidemic. Crofton advised the WHO and World Bank on TB technical assistance and monitoring programmes, especially the formulation of treatment guidelines, to combat epidemics in Russia and India. With Fred Miller and Norman Horne, he co-wrote Clinical tuberculosis (1992) (known as Crofton's clinical tuberculosis). Aware of the need to educate paramedics working in developing countries in the benefits of rigorous application of TB treatments, Crofton ensured that a subsidised low-cost edition was published in 1993 (by the IUATLD), and it was later made freely available online.
As well as being an innovative physician, researcher, teacher and campaigner, Crofton was a tenacious and gifted organiser, making significant contributions to both TB treatment and tobacco control, and stands in the first rank of twentieth-century medical practitioners. In demonstrating the efficacy of a multi-drug approach in curing pulmonary TB and recognising the necessity to counter emergent drug resistance, he created a clinical template for combination therapy that remains in widespread use. Receiving numerous fellowships and professional distinctions, he was knighted in 1977, after which all of his work was undertaken voluntarily. He served on a multiplicity of national and international governmental, scientific and advisory committees (listed in his 'Munk's Roll' entry), wrote over 170 scientific and other papers (being most proud of his co-written paper in the British Medical Journal (11 December 1948), 'Streptomycin resistance in pulmonary tuberculosis'), and was awarded the gold medal of the British Thoracic Society and the IUATLD, and the Edinburgh Medal, among a range of honours and awards. Crofton died 13 November 2009 at his home, 13 Spylaw Bank Road, Colinton (Collington), Edinburgh; his funeral took place at Mortonhall crematorium. The IUATLD organises a John Crofton memorial lecture at their annual world conference. His autobiography, Saving lives and preventing misery, was published posthumously in 2013.