Sir John Crofton in 2008. Picture by Murdo Macleod.

Saving Lives and Preventing Misery

Tuesday November 26 2013

Chris Holme chronicles the key role of the Church of Scotland in the fight against tuberculosis.

LIKE other significant revolutions, it started with the Kirk.

Edinburgh Presbytery to be precise. It appointed a special committee to investigate the scourge of tuberculosis (TB) in Scotland’s capital. Reporting in December 1951, it revealed there were only 360 beds for 700 new cases a year while 390 families with TB were waiting for a new council house.

The Presbytery urged all authorities concerned to class this as an emergency and to “spare neithermoney nor material in the fight to wipe out this disease from our City’s life”. The Church and Nation Committee was equally alarmed, urging “all ministers and elders to do their utmost to rouse public opinion on this matter…”

It may seem strange now, but those most at risk then were young women and men. More than half of those diagnosed would die.

All of this presented the ideal challenge for John Crofton, appointed also in December 1951 to the chair of tuberculosis at Edinburgh University after an unconventional interview over lunch in the New Club preceded by the largest sherry he had ever seen.

Although born in Dublin, he had a plummy English accent and was tactfully warned not to open his mouth for the first few months. But in that time he made quick allies within the Kirk whose campaign generated huge and much-needed publicity.

The reality on the ground was even grimmer than the Presbytery thought. Scotland, almost uniquely in Europe, was then in the middle of a rising epidemic of TB and the NHS service in Edinburgh was not working effectively. One consultant combined misogyny with sadism, telling young girls on his ward: “You are all rosy red apples, rotten to the core.”

Crofton changed all that. He brought in new consultants – Norman Horne, Ian Grant and Ian Ross. Jimmy Williamson was the last to arrive in 1954. The group was well supported by two able bacteriologists, Archie Wallace and Sheila Stewart, and a superb administrator, Alec Welstead.

What happened next prompted a revolution in medicine, a story well chronicled in Crofton’s memoirs Saving Lives and Preventing Misery, newly published by his daughter Alison and son-in-law Dave.

His Edinburgh group achieved what appeared impossible – they found the first 100% cure for TB, John Bunyan’s “Captain of all these men of death” which had plagued mankind for millennia.
Previously, patients would be given drugs, often one after the other. It cured some – like the future rugby commentator Bill McLaren at East Fortune Hospital. But many others would develop drug resistance and never recover.

The Edinburgh group drew heavily on the relatively new concept of evidence-based medicine founded on randomised controlled trials. They started giving all three drugs simultaneously from the outset and discovered to their astonishment that they were curing everyone, even those with advanced TB.
Good bacteriology was essential for keeping close tabs on how the TB bugs changed in patients. Using all three drugs at the start stopped drug resistance in its tracks.

Previously rising TB notifications in Edinburgh were halved between 1954 and 1957 – a feat not achieved anywhere before or since. The group’s success was so dramatic that many did not believe their results. It took one of the first international trials, organised via colleagues at the Pasteur Institute in Paris, to establish the “Edinburgh method” as the gold standard for treating TB.

Waiting lists disappeared. Residual TB in Edinburgh was rooted out with the mass x-ray screening programme in Princes Street Gardens in 1958. Despite the arctic weather, it was one of the most successful public health campaigns in history with the active support of the media – and the Church of Scotland, which had started the whole process.

This is an extract from an article in December's Life and Work. Subscribe here.