Allister Vale and John Scadding
Frontline Books, 2020 pp 522
Book review by Adrian Crisp
A 16-year-old boy shuffled past the coffin in Westminster Hall on a cold January evening in 1965 and, a day or two later, stood in the crowds outside St Paul’s Cathedral at his funeral. Fixed in my memory as a fly in amber is the deep silence broken only by the crump of marching boots and by the squeaks of the gun carriage bearing the body of our “greatest Englishman”. In 2013 near to St Paul’s I stood in the less dense crowds at the funeral of Margaret Thatcher.
Five decades after Winston Churchill’s funeral British society had moved on: well-meaning shouts of “Well done, Maggie” from supportive “mourners”, ripples of clapping and the stroboscopic effect of flashing cameras convinced me that I was more comfortable in the twentieth century. Churchill’s personal physician, Lord Moran, and his neurologist, Lord Brain, predicted imminent death following a stroke but Churchill defied “the darkness for another fourteen days” with no more sustenance than occasional sips of orange juice. This final struggle against the medical odds epitomised his lifelong refusal to surrender when prospects seemed bleak.
One year later in 1966 the furore erupted with the publication of Moran’s recollections of Churchill’s fitness to lead Britain through the darkest days of the Second World War and during the opening salvoes of the Cold War. Moran claimed that the Cambridge historian, G M Trevelyan, and Churchill’s close friend, Brendan Bracken, had entreated him to place on record his account of Churchill’s illnesses. Many doctors considered this a crime against the sacred confidentiality of the doctor-patient relationship. Lord Brain was disturbed by Moran’s description of his professional relationship with their patient and considered legal action against Moran. Mary Soames, Churchill’s daughter, regarded the book as “an outrageous thing in complete breach of a doctor’s ethics”.
Over five decades later with the attenuation of raw sensitivities and in the interest of full historical disclosure, Vale and Scadding have written the most detailed and definitive account of Churchill’s health with the forensic skills of two distinguished physicians who have mined all available sources and integrated them in the light of both contemporary medical practice and the practice of the early twenty first century. The portraits of the doctors and nurses who attended Churchill bring them to life and their interactions provide evidence – if any further evidence is required – of his wit and humour. This is far from a medical textbook although all doctors will nourish their professional roots by reading it. It exposes the resilience and courage of one man who defied those medical challenges and continued to serve and lead his country until the end of his premiership in 1955.
Churchill, fond of cats, escaped death on more than nine occasions. Pneumonia in pre-antibiotic days was a common cause of death at all ages. He survived his first attack at the age of 11. The diagnosis of a “weak chest” was the curse of many a young life and Harrow School was chosen for its bracing hill in contrast to the dank riverside mists of Eton. Before moving on to Sandhurst Churchill leapt from a bridge to escape two chasing friends and fell 29 feet suffering concussion and injuries to his cervical spine, right shoulder and kidney. The resulting instability of his shoulder prevented him from wielding a sabre at Omdurman in 1898 but his less dashing pistol was arguably more effective and saved his life. In 1931 he was struck by a car in New York with the force equivalent to falling 30 feet onto a hard surface, as calculated by his slide rule wielding friend, “the Prof,” later Lord Cherwell. Churchill escaped serious injury and he exploited his spell of enforced immobility by writing profitable articles.
In December 1941, when visiting the White House soon after America’s declaration of war, he opened a window with great effort and developed dull chest pain which his physician, Sir Charles Wilson (later Lord Moran) interpreted as a heart attack. In 1941 six weeks of strict bedrest was conventional management. Wilson decided to underplay his diagnosis as it would have diminished Churchill and Britain in the eyes of the world. Back in England John Parkinson, a cardiologist, found no evidence of heart disease and the absence of any later episodes argues that his opinion was correct. Churchill considered his symptoms to be of musculoskeletal origin and he was probably right. Yet the myth of Churchill’s ischaemic heart disease at this critical point in the war has persisted to the present. This can now be discounted.
Recurrent episodes of pneumonia during the war could easily have ended the life of Britain’s inspiring leader. In February 1943 two nurses from Moran’s hospital in London, St Mary’s, were seconded to care for the prime minister. Moran considered it wise to warn them that “the PM does not wear pyjamas”. Churchill expressed his gratitude to Doris Miles, who had been a gold medallist in her nursing training, by awarding her a metaphorical “bar to her gold medal”. When she brought him a red capsule on a silver tray at Chequers he responded: “the price of a good woman is above rubies”. Geoffrey Marshall, the respiratory physician, explained to Churchill that pneumonia was called “the old man’s friend” because it could waft the patient away from life almost before he realised he was ill. Churchill, never the most compliant patient, began to listen to his doctors. His fluid balance chart, one focus of the conscientious nurse, included “Champagne 10 oz (284 ml), brandy 2 oz (57 ml), whisky and soda 8 oz (227 ml) and orange juice 8oz”.
The most critical episode of pneumonia was in December 1943 in Tunis following an exhausting tour of the Mediterranean theatre. Many physicians converged on the ailing prime minister, not least the co-author’s father, John Guyett Scadding. Penicillin, full of therapeutic promise, was summoned urgently but not administered as his physicians had no experience of its use. They relied on the trusty sulfonamides, “M and B”, after the makers May and Baker, and these proved effective. Churchill characteristically took a detailed interest in his white cells and wished that his “armies were doing as well as my leucocytes to combat the enemy”. He also nicknamed his two physicians, Moran and Bedford, “M and B” with typical humour.
There were further respiratory scares, not least at Yalta in early 1945, where “Staleen’s” plans for a communist eastern Europe were promoted with the acquiescence of Roosevelt, enfeebled by uncontrolled hypertension and cerebrovascular disease which would kill him within months. The American direction of the last acts of the war was more impaired by its president’s health than British leadership by Churchill’s health. He anticipated the Soviet menace to post war peace long before his American counterpart and fellow British ministers, all mesmerised by Russian success on the battlefield.
It was in 1949 when leading the opposition to Attlee’s post war Labour government that Churchill suffered his first stroke and recurrent cerebrovascular episodes were the leitmotif of his final decades. In 1952, after his first election to the office of prime minister, he made a rapid recovery from a further stroke. The fact that he was able to continue at the pinnacle of government in spite of neurological deficit is a tribute to his “considerable cognitive reserve”.
In June 1953 a more severe stroke incapacitated him for two months, but with the collaboration of the press barons the news was shielded from the public. Medical bulletins were diluted by political intervention. Government was effectively shared between Rab Butler, Lord Salisbury, “Jock” Colville (his private secretary) and Christopher Soames MP (Churchill’s son-in-law). Defying his doctors, Churchill bounced back with a remarkable recovery and would not relinquish the reins for another two years to Anthony Eden, his long anointed successor, who was himself in poor health and, in retrospect, unfit for the highest office. The analysis of these neurological episodes is masterly and red meat to historians.
Few would disagree, in the interests of good government and of his political reputation in this critical period of the Cold War, that Churchill should have retired in 1953. Under adverse pressure from Eden, some senior Conservatives and his family, he remained convinced that only he could charm the Russians into some form of world co-operation in the interests of peace.
The role of medication is of great interest. Moran prescribed drugs which influenced Churchill’s private and public performances. He took both “majors” (amfetamine 5mg, amylobarbital 32 mg) and “minors” (amfetamine 2.5 mg, aspirin 160 mg, phenacetin 160 mg) on many occasions but it is unclear how frequently these were ingested. Certainly he excelled in his speech to the Conservative party conference in Margate after his stroke in 1953. They “cleared my head and gave me great confidence”, which would be the stimulant effect of amfetamine. With the risk of addiction, amfetamines are no longer prescribed. One could speculate that Churchill’s intake of amfetamines might have contributed to his determination to hold on to prime ministerial office much longer than a more circumspect judgment might have permitted.
There is no clear evidence that Churchill’s ingestion of aspirin alone or as a component of his “minors” was sufficient to reduce his risk of future cerebrovascular episodes and prolong his life, but this is another interesting speculation. This valuable action of aspirin was unknown to his doctors in the mid twentieth century.
Moran diagnosed clinical depression which has become accepted lore: Churchill’s “Black Dog”. To his credit Moran always weighed physical as well as psychological factors in his patients. His book, “The Anatomy of Courage”, based on his experiences as a regimental medical officer in the First World War trenches, illustrates this. Anthony Storr, a psychiatrist, reached the same conclusion but relied on Moran’s observations and never participated in Churchill’s medical care. David Owen, both politician and doctor, also claimed that there was “a manic as well as a depressive side to him”.
Tears were never far from the surface throughout Churchill’s life but do not themselves raise the suspicion of depression. Lord Brain noted his emotional lability and considered whether this indicated the presence of focal frontal lobe lesions secondary to vascular impairment. CT and MRI scans, which could help answer these questions, were decades in the future. The chapter, co-authored with Anthony Daniels, a psychiatrist, demolishes this shibboleth of depression with convincing arguments. This book – unmissable for all interested in Winston Churchill – is worth reading for this contribution alone.
Churchill’s experiences of reversals in life’s fortunes, both private and public, would be sufficient to drag down many men. The authors do not record that the death of his daughter, Marigold, in 1921 left a permanent scar on both Winston and Clementine, bequeathing perhaps a lifelong vulnerability to transient despairs in so many situations. These personal factors, alongside his appreciation of the perils to his country, triggered appropriate mood reactions but “these features were presumably the fleeting accesses of despair that can overtake anyone and do not constitute a diagnosis any more than accesses of joy constitute a diagnosis”.
Although the authors do not clearly conclude that the diagnosis of osteoporosis can be added to Churchill’s medical history there is strong circumstantial evidence. His background of age, smoking and alcohol ingestion presents a combination of powerful risk factors. In 1960 Sir Herbert Seddon, an orthopaedic surgeon, described fractures of T5, T8 and T9 vertebral bodies after a fall, typical features of osteoporosis. In 1962 Seddon admitted Churchill to the Middlesex Hospital in London with a fractured hip, another event typical of osteoporosis.
It is clear that Churchill and Seddon shared a very close patient-doctor relationship, although Seddon asked Philip Newman to perform the required surgery presumably because he judged that Newman had more recent and active experience of the procedure. Newman would also have appealed to Churchill having won the MC and DSO as a surgeon who “stayed behind” with his patients during and after the evacuation at Dunkirk in 1940. Churchill wrote appreciatively to his surgeons. Seddon replied with the words of the sixteenth century surgeon, Ambroise Pare: “I bandaged him and God healed him”. This scene at the Middlesex Hospital also brought me one of my favourite stories in this intensely human book.
A carpenter entered Churchill’s room to repair a window blind.
“Thank you, my man,” Churchill spoke, offering his hand. They shook hands.
“I was at El Alamein with you, sir”.
The carpenter’s eyes welled up and he fumbled for his handkerchief. The eyes of the nurse in attendance also moistened. Although it is not recorded, I am convinced that Churchill too would have been moved. The description of Churchill’s final days at home at Hyde Park Gate is well told. When he was lying in his coffin, Jock, his cat, jumped into the coffin onto his chest, looked at his master and jumped down never to return to the room.
An objective reviewer must rustle up some shortcoming. Moran set his clinical insights in the historical context of the Second World War and its aftermath. Vale and Scadding have assumed that the reader will already have a detailed understanding of these decades but a Moran-esque synthesis of medicine, war and politics would have far exceeded their brief. A timeline of principal background events would be valuable in a revised edition. But this is a mere quibble in a book which will appeal to historians, readers with historical antennae and doctors who appreciate the interplay between diseases and their patients’ lives. And what a life.
Adrian Crisp is an emeritus consultant in Rheumatology and Metabolic Bone Diseases at Addenbrooke’s Hospital, Cambridge. He is Chair of the Churchill Archives Committee and Fellow of Churchill College, University of Cambridge. He is the author of an historical novel, “Colonel Belchamp’s Battlefield Tour”.
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