Lennox Johnston in his own words

BBC Timeshift: This is not Lennox Johnston

Some of you may have watched the BBC 4's Timeshift programme last night (The Smoking Years, available on the iPlayer and to be repeated several times in the next week). Aside from the last ten minutes, I thought it was a very good piece of television with some excellent archive footage and some fine guests, ahem.

If I had a quibble—and of course I do—I would say that it greatly exaggerated the impact of the anti-smoking group GASP, which was fairly inconsequential, while downplaying the influence of ASH, the BMA, and the government in changing behaviour.

I was pleased to see a bit of coverage about Dr Lennox Johnston for what I believe to be his first television appearance. Readers of Velvet Glove, Iron Fist will be familiar with him and I'd like to add some more flesh to the story by reproducing some of his correspondence in the British Medical Journal. These letters are fascinating for what they tell us about a zealous anti-smoker born before his time as well as what they show us about the medical establishment in the mid-twentieth century.

The first letter is a reply to Johnston from another doctor. By 1950, Johnston felt vindicated by the work of Austin Bradford Hill, Richard Doll and Ernest Wynder showing a clear association between smoking and lung cancer. Many rank-and-file GPs remained largely unmoved, however, and this letter is typical in its focus on moderation (no talk of "no safe level" in those days!). He goes on to make light of the issue by comparing smoking with tea-drinking and kissing.

October 7 1950

Dr. A. LEWIS (London, W.9) writes:

Your correspondents, Drs. Lennox Johnston and F. C. Morgan (September 9, p. 630) would be far less likely to find themselves in a minority crusade if they were a little less sweeping in their assertions. Few doctors could fail to join them in a campaign against excessive smoking, nor could many fail to agree that the inhalation of tobacco smoke is unlikely to do good to any kind of cough whatever its aetiology.

But how far are Drs. Johnston and Morgan justified in announcing that failure to get rid of tobacco is probably the main cause of failure to get rid of tuberculosis ? The pathogenicity, infectivity, and chronicity of tuberculosis depend on several factors, and the extent to which these may be affected by smoking may not be so great as they would have us believe...

Not satisfied with this, Drs. Johnston and Morgan go on to argue that, because of its bad effect on tuberculosis (which most of us admit) and because of other ill effects of excessive smoking, all tobacco smoking could (and should) be abolished to the advantage of the community. Perhaps it could. But it is only one of the so-called " evils " with which a civilized community indulges itself. I feel, for instance, that a strong case could be made against tea...

I have no doubt that Drs. Johnston and Morgan could if they tried bring a good case on a sound scientific basis for the abolition of kissing. But if they charged all who failed to join them with promiscuous lasciviousness they could hardly be surprised if their accusations were met with ribald cries of " Whack ho ! "...

Until Drs. Johnston and Morgan can show that a little of what I fancy does me harm I hope the world will still find me willing to appreciate anything from a pipe and a glass of beer to a Havana cigar and a vintage brandy.

Johnston was more than a GP and amateur scientist. He was, above all, an anti-smoking campaigner. He was the president of the National Society of Non-Smokers for many years and bitterly resented the failure of epidemiologists to grasp the nettle and campaign for legislation (how times change). He hated Doll and Hill for stealing his thunder, but also for not taking what he saw as the obvious next step of demanding the abolition of smoking.

Johnston was overly optimistic about the chances of turing Britain smokefree. Despite being acutely aware of nicotine's addictive potential, he felt that if he was put in charge of a national stop-smoking campaign, he could get most smokers to quit at a stroke.

In this letter, he applauds Ernest Wynder's epidemiological research while taking a side-swipe at both him and Doll & Hill. He then outlines his own plan of action which will culminate in prohibition. Unlike modern anti-smoking campaigners, he does not pretend that smokers are a net burden on the health service. He accepts that smoking cessation will require nonsmokers to pay more in tax.

January 26 1957

Sir,
Dr. E. L. Wynder's masterly deployment of the evidence in support of the carcinogenicity of smoking (Journal, January 5, p. 1) contrasts with the timidity of his "practical aspects of solving the tobacco-cancer problem." There is, of course, but one "practical aspect," one solution, as he must know, but, like Doll and Bradford Hill, he has avoided—very wrongly, in my view—stating plainly that tobacco-smoking should be stopped and that it is our duty to stop it, quickly. Instead, we continue to fiddle while Rome bums.

"All a physician can do," says Wynder, "is to present the facts to the public." He can do much more. He can state plainly what action should be taken and crusade his utmost for that action. Moreover, the mode and frequency of the presentation of the facts are important. Because of the inaccessibility of smokers to the facts against smoking, nothing less than their very frequent and blunt presentation by a non-smoker over a long period using every modern publicity device would be effective in eliminating tobacco-smoking, and in the end there would have to be compulsory prevention of smoking to cure a considerable hard core of addicts...

Taxation would have to be equitably redistributed, present-day smokers paying much less, and non-smokers much more, than in the past; and the tobacco labour force, buildings, and equipment would have to be redeployed and put to socially valuable work. Individuals can stop smoking, so also therefore can nations. Notwithstanding my criticisms, I recognize fully and gratefully Dr. Wynder's pre-eminent contributions to the cause of non-smoking.
I am, etc.,

Wallasey, Cheshire. LENNOX JOHNSTON.

By 1958, the Medical Research Council (MRC) had accepted a causal link between smoking and lung cancer, but, much to Johnston's chagrin, had called for little in the way of remedial action.

Johnston had form with the MRC. After being refused funding, he accused them all of being nicotine addicts, an allegation he repeats in this letter. Once again, he criticises Doll and Hill—who he continued to view as moral cowards—and repeats his belief that, "The nation's smoking could be cured almost overnight" if only the government were committed to abolishing tobacco as it had opium.

June 21 1958

SIR,-Tobacco consumption in England and Wales last year went up 4.8 million lb. (2.18 million kg.) and reached the record figure of 304.3 million lb. (138 million kg.).'

In its statement on "Tobacco Smoking and Cancer of the Lung" the Medical Research Council accepted the evidence associating smoking with a major part of the increase in lung cancer. This was tantamount to accepting the view that a major part of the epidemic of lung cancer now upon us is readily preventable because tobacco-smoking is readily preventable—it is no more difficult to prevent than opium- or hashish- smoking (which we now prevent), and large numbers of smokers stop smoking voluntarily. Yet the M.R.C. made no recommendations in this statement for preventing lung cancer by stopping people smoking. They were thus guilty, it seems to me, of a grave act of omission.

They followed the precedent established by their chief investigators on this subject, Dr. R. Doll and Professor A. Bradford Hill, of merely setting out the evidence and their conclusions, which carried an implied warning for smokers. But tobacco is far too powerful a drug of addiction to be abandoned, except by a small minority of smokers, in response to mere implied warnings about a remote risk—as the tobacco consumption figures testify. Such warnings have often, indeed, an immunizing effect. Many smokers have acquired such a degree of immunity to fear of lung cancer, as a result of repeated inadequate warnings over the past seven years, that they are quite unscarable: their protective emotion, fear, no longer fulfills its normal function where lung cancer is concerned.

In the absence of any recommendations from the M.R.C., the Government, a lay body which consists mainly of smokers, put in hand measures of its own devising for ending the epidemic of lung cancer. These are a complete farce: the Government merely passed the buck to the local authorities. Cancer of the lung is not, of course, a local but a national problem, and only the national Government has the power to deal with it effectively.

The nation's smoking could be cured almost overnight and the great bulk of lung cancer prevented by a national anti-smoking campaign followed by legislation aimed at doing away with tobacco-smoking within a matter of months. The campaign would consist of educational talks at peak listening times on T.V. and sound radio on the effects of tobacco smoking on the human organism. Blunt warnings about the damage smoking does, coupled with firm injunctions to smokers to stop smoking, could be interposed from time to time between programmes. Everything connected with the campaign should be in the hands of non-smokers, since smokers are obviously pro-smoking, and anti-smoking words on their lips must be hypocritical, however much smokers may protest their sincerity. There is no objection to frightening smokers about the effects of smoking just as there is none to frightening children about the effects of fire.

The economic effects of the nation's stopping smoking would be a problem primarily for the Chancellor of the Exchequer. For too long have successive Chancellors shamelessly exploited the smoker's craving for tobacco to extort from him enormous sums in the form of taxation.
-I am, etc.,
Wallasey. LENNOX JOHNSTON,
President. National Society of Non-smokers

Three months after the previous letter, Johnston writes again. This time, he is responding to a doctor who has said that Johnston's anti-smoking campaign is unrealistically ambitious. He refutes this and calls for smokers to be scared and coerced out of their habit. Again, he cites the precedent of drug legislation.

September 6 1958

SIR,-The suggestion by Dr. B. J. Bouchd (Journal, July 12, p. 106) to the effect that a recommendation to prevent the major part of the present epidemic of lung cancer by stopping the smoking of tobacco would be outside the scope of the Medical Research Council is unfounded. " The [Medical Research] Council, by its constitution, has full liberty to pursue an independent scientific policy.... The programme [of research work undertaken by the Council] . . .includes . . . clinical, and laboratory studies of disease; its nature and causes, and methods for its prevention..."

I assure Dr. A. C. Woodmansey (Journal, July 5, p. 46) that my scheme for curing the nation's smoking in months was put forward seriously. He describes it as unrealistic. But what is there unrealistic about urging on the Government a (real) anti-smoking campaign followed by legislation aimed at, doing away with tobacco-smoking? We prevent the smoking of other drugs, notably opium and hashish, so why not tobacco? Dr. Woodmansey does not believe in deliberately frightening people. Nor do I, unnecessarily. But many smokers are so inaccessible to reason where their drug is concerned that the only hope of cure lies in scaring them (if you can!) sufficiently to break down their inaccessibility.

I am, etc.,
LENNOX JOHNSTON,
President, National Society of Non-Smokers

In this letter from 1971, Johnston is rightly keen to take credit for setting up the UK's first stop-smoking clinic. He admits that it was short-lived due to his belief that he could "turn the whole country for a time into a vast anti-smoking clinic." Although he begins by talking about nicotine addiction as a clinical addiction, he soon slides towards more emotive language.

Incidentally, it should be noted that Johnston uses the term "anti-smoker" in this letter and "anti-smoking" in many of his letters. It is occasionally claimed today that these terms were invented by the tobacco industry as more negative-sounding alternatives to 'tobacco control advocates' or 'smokefree campaigners'. As these letter show, that is not true.

4 September 1971

DR. LENNOX JOHNSTON (Wallasey, Cheshire) writes: It is perhaps worth recording that the first anti-smoking clinic in the world was started in Britain by me in November 1957. The application of the word "clinic" to a centre for the treatment of tobacco-smoking was crucial. It helped to respectabilize such treatment by bringing it into the orbit of clinical medicine. Previously, smoking had been generally regarded as merely or, at any rate, primarily a vice, and getting rid of smoking as a matter of "conversion"; and this, regrettably, was often sneered at as the province of goody-goodies.

My book firmly taught that smoking was a disease, a drug addiction; like most diseases, an intoxication by (in this case) nicotine, carbon monoxide, tar particles, and the other volatile toxic products of tobacco combusion.

Smoking is also, however, a vice. It is antisocial (or vicious) to pollute the air-space of a fellow man. I ran the clinic for over six months, then gave it up. My reasons were lack of medical and financial support, and increasing realization that it was not too much use curing a few smokers, then turning them loose in our tobacco-addicted society where many would be sure to be psychologically reinfected. I felt that the way to deal with tobacco addiction was to turn the whole country for a time into a vast anti-smoking clinic: give anti-smokers carte blanche on T.V. and on the radio, and stop all tobacco advertisements at a stroke...

When I was researching Velvet Glove, Iron Fist (2005-2008), I was unable to find out when Lennox Johnston died. Since then, I have been able to locate his BMJ obituary. He died in 1986 at the age of 86.

29 March 1986

Obituary:

Dr. L. Johnston, a retired general practitioner and antismoking pioneer, died on 18 January aged 86.

Lennox Johnston was born in 1899 and was educated at Ayr Academy and Glasgow University. He graduated MB, ChB in 1921, having served as a medical student in Royal Navy minesweepers in the North Sea during the first world war. He started to smoke at the age of 16 and continued for 12 years. Having thought about his compulsion to continue, he "wondered what would be the effect of stopping." It proved easier than expected, and what surprised him most was how much better he felt. A year or so later he relapsed, and on that occasion it took him "two agonising years" to give up. The salutary experience of the addictive nature of nicotine led him to carry out experiments on himself. In the days when well over half the adult population smoked, and before the mass of technical writings on the subject appeared, he published a book in 1958 entitled The Disease of Tobacco Smoking and Its Cure. In it there is a startling description of the systemic effects of acute nicotine poisoning when he accidentally sprayed a few drops of 40% nicotine solution on his hand, with almost fatal consequences.

After various experiments with nicotine to prove its addictive nature he did everything he could to promote non-smoking, his researches having left him in no doubt that tobacco smoking was "the biggest killer in the world." He carried on a singlehanded fight against the BMA initiated at the annual representative meeting at Brighton in 1956 and continued at the special representative meeting in May 1957, when he spoke against the suspension of a standing order that prohibited smoking at BMA meetings. He became a positive thorn in the side of the Medical Research Council as he conducted his active campaign: it is alleged that as a result of his persistence the council was stimulated to research the effects of smoking on health. Nowadays we realise how courageous his efforts were, but in those times he must have seemed to the uninspired like a latter day Don Quixote tilting at windmills. Only he could see the reality of his cause, and his dedication proved that he was fully justified.

It was fitting that Lennox and his wife were guests of the Royal College of Physicians in 1976 in honour of his pioneering work on smoking. In his address Sir Cyril Clarke likened Dr Johnston to Semelweis, whose discovery of the cause of a big epidemic of puerperal fever that resulted in many deaths in Budapest was not accepted or acted on by his colleagues until after his death. Fortunately, Lennox survived long enough to see his pioneering efforts bear fruit. As past president of the National Society of Non-Smokers he always took an active interest in its work even after his retirement.

In his home life Lennox was devoted to his wife, Frieda, and family. They enjoyed 55 years together. Besides his wife and son, Ivor, he is survived by two daughters, Heather and Sandra, and 10 grandchildren and one great grandchild.

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