By 1948 tuberculosis (TB) was killing someone every two hours in Scotland.

More worryingly, Scotland was virtually the only country in Europe where new cases of TB were continuing to rise unchecked.

Although forever the disease of poverty and crowded slums, wealth provided no barrier. Pulmonary TB was the most common form – where half of those diagnosed would be dead within five years.

Young men and women were particularly at risk and TB meningitis was certain death for babies and toddlers.

TB patients could spend a year or more resting in a sanatorium to give their bodies the chance to fight the disease. Surgery or treatment to collapse the lung sometimes did more harm than good.

It was a dreadful time – made worse by the appalling stigma attached to the disease.

Then came the wonder drug streptomycin – the first real cure. It was developed from samples taken from a dung heap and a sick chicken’s throat. William Feldman, a Glasgow-born vet, helped refine it into acceptable form at the Mayo Clinic in Minnesota.

The author George Orwell, then a TB patient at Hairmyres Hospital, obtained a supply. Health Minister Aneurin Bevan, his friend and former editor at Tribune, personally approved his application to import the drug.

Streptomycin didn’t help Orwell. Nor most of the 81 most seriously ill patients in Scotland put on the trial treatment. More than half of them were dead by September 1948.

Two new drugs, para-aminosalicylic acid (PAS) and isoniazid also became available but no-one knew how to use them to best effect and overcome drug resistance.

The advent of the NHS enabled a co-ordinated approach to pool all available resources against the disease. This was exploited by Sir John Crofton’s Edinburgh group which brought various chaotic and competing services together.

They demonstrated that with meticulous bacteriology and monitoring of each patient’s progress a 100% cure for tuberculosis was a reasonable objective. The radical step was to give new patients all three drugs at the outset.

Between 1954 and 1957 TB notifications in Edinburgh were more than halved – a feat unmatched anywhere before or since.

Many did not believe the results. A trial was arranged in 23 leading centres – one of the first international collaborative trials of any treatment. Not named as such, the Edinburgh method was introduced as the standard treatment. After the trial, it became the gold standard treatment around the world.

Progress was also made on other fronts. The BCG vaccine was finally introduced in Britain. More pasteurisation removed TB from milk supplies.

The new NHS brought mobile x-ray units from across England to help the hugely successful mass x-ray campaigns in Scottish cities to root out hidden cases of TB.

Drug treatment was providing not only cure but the best form of prevention.

Ringo Starr, Tom Jones, Tina Turner, Yusuf Islam (then Cat Stevens), Carlos Santana, Desmond Tutu and Nelson Mandela were among prominent survivors.

The real challenge remained overseas. Landmark trials by the Medical Research Council (MRC) provided a range of effective drug treatments. A 1959 MRC trial showed people could be treated just as well in the worst slums of Chennai (Madras) as in sanatoria.

But promising work was halted by the advent of HIV and the growth of multidrug resistant (MDR) and now extreme drug resistant (XDR) TB. In an age of increasing international travel, TB still does not recognise any frontiers.

Chris Holme
Communications Manager

Tuberculosis Patients, Occupational Therapy 1952. 
Credit: SCRAN

Audio clip 1

Sir John Crofton
TB and the NHS

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Audio clip 2

Professor Jimmy Williamson
The agony faced by TB patients

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Dublin-born John Crofton arrived at Edinburgh University in 1951.

The arrival of Jimmy Williamson in 1954 completed what became known as the Edinburgh group - five consultant physicians supported by two bacteriologists.

Nurses, medical social workers and health visitors played a critical role. A patient was not a collection of symptoms but a person who needed broader support and help. In Alec Welstead, they also had a brilliant NHS administrator who liked to sort out their problems rather than shelve them.

Crofton is recognised around the world as the leading international figure in fighting tuberculosis.

But he was more at home supporting community health workers in Pilton.

Over the last 30 years he has made tireless contributions to improving public health in Scotland, tackling the problems caused by poverty, deprivation, smoking and alcohol abuse.

And at the age of 96, he remains almost as active as ever.