May 7, 2015

Finest Hour 117, Winter 2002-03

Page 44

By JOHN H. MATHER, M.D.

The death of Lord Randolph Churchill at age 45 cast a pall over his early fame, and the notion that the cause was syphilis is one of the most enduring myths of the Churchill saga. In fact, his main symptoms are more consistent with a less titillating but far more logical diagnosis. It is not possible to say with certainty what killed Lord Randolph; but it is no longer possible to say he died of syphilis.

Even as a young man, his health had been unreliable. He was a heavy smoker and a hard worker, with a frenetic energy that led to exhaustion, followed by periods of fatigue and melancholia. He fell seriously ill with exhaustion in 1890; the following year he experienced an episode of severe confusion, which suggests acute high blood pressure. In mid-1893 the family physician, Dr. Robson Roose, told a distraught Jennie that a heart condition had been cured. But around this time, Randolph began to have speaking difficulties, associated with hearing and balance problems.

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Over the next two years until his death in 1895, he complained of dizziness, palpitations, and intermittent numbness in his hands and feet. He died in a coma, with pneumonia and, probably, kidney failure. Many of his biographers, including his son (in conversation, not in print), attributed his deterioration and death to syphilis.

The deterioration in his health and behavior in his last three years might support a diagnosis of dementia paralytica of late or tertiary syphilis, which affects the brain and appears in about ten percent of those instances after the primary infection. Naturally, there was speculation over when Lord Randolph became “infected.” The most notorious account was by journalist Frank Harris in his 1924 autobiography, My Life and Loves, who related a story told by Louis Jennings, Randolph’s friend and political colleague. After a drunken party, Jennings said, fellow students put Randolph with an “old hag”—in due course a “red pimple” appeared, and treatment was made.

Jennings’s story is highly questionable: 1) the physical manifestation described is not that of a primary syphilis chancre, but of herpes. 2) the chance of contracting syphilis in one sexual encounter is less than 1%. 3) Jennings, who was dead when Harris wrote the story, had an axe to grind: he had angrily deserted his friend when Randolph attacked the Tory party and several of its members in 1893. Jennings’s account has never been corroborated. 4) By 1924, Harris himself had fallen out with Churchill, for whom he had been a literary agent. Harris had a preoccupation with syphilis, making the same assertions concerning Oscar Wilde (which were incorrect), and Guy de Maupassant.

The spirochete responsible for syphilis was not discovered until 1905 and the definitive blood test was unavailable until a couple of years later. Since initial and secondary manifestations of syphilis are highly contagious, Dr. Roose would have been mindful of current medical practice, requiring him to determine if Jennie and the two boys were infected. There is no indication that they were. Neither son was born with infections resembling secondary syphilis, nor did they have late hereditary syphilis, manifested by deafness, partial blindness and/or notched teeth. There is likewise no evidence that Jennie’s subsequent husbands ever contracted the disease.

In the late 19th century there was a predisposition toward syphilis in clinical diagnosis. In 1889, Dr. William Gowers, a respected neurologist, emphasized this in his Lettsomian Lecture, “Syphilis and the Nervous System,” to the Medical Society of London. The same preoccupation was noted later by neurologist Dr. F. M. R. Walshe, who said: “The belief that syphilis is the commonest single cause of organic nervous disease dies hard.”

It certainly did in Randolph Churchill’s case. In mid-1893, with Lord Randolph suffering intermittent problems with speech and concentration, depression, and outbursts of violent temper, Dr. Roose conferred with Dr. Buzzard, Dr. Gowers’s colleague. Buzzard was an expert in managing neurosyphilis, or late syphilis of the brain. It was his opinion that 95 percent of his patients had it.

Roose’s and Buzzard’s preoccupation with syphilis is understandable. There was then no definitive blood or neurological test, no effective treatment, no imaging techniques such as CAT scans or MRIs. Untreated syphilis, particularly dementia paralytica, manifests itself in many ways, and without careful diagnosis may be confused with many other diseases. At the end, Roose and Buzzard were fully convinced: Randolph had “general paralysis,” which many take as a code word for syphilis of the brain.

What diagnoses other than syphilis might explain Lord Randolph’s symptoms? Dr. Roose himself hinted at some. Two years after Randolph’s death he wrote: “…‘want of tone’ is the characteristic feature of disorders in general and in none is it more obvious than in those which peculiarly affect official and professional men working at high pressure. Excessive smoking, too much alcohol, tea, and coffee, often resorted to by overworked persons, are frequent causes of sleeplessness.” Lord Randolph’s personality was intense; one psychiatrist concluded he was a manic depressive. Brilliant in many ways, he was also brisk and impatient. Thus much of his behavior during his last five years could be no more than an accentuation of his prior personality, associated with real medical problems.

Lord Randolph had always had a slight speech impediment, and as a youngster he had had hearing problems. So it is difficult to single out problems with his speech, once thought to be a clear and common symptom of syphilis in its late stage, affecting the brain. In the same sense, muddled thoughts, memory lapses and profound confusion, all features of syphilis’s paralytica dementia, were absent from Randolph’s writings until the end of 1894. He wrote more lengthily, and his script became shaky, but it was never unintelligible. Until the last, when he was in a coma, his written thoughts were rational; they include a cogent letter to Winston while on his world tour in August 1894.

In a letter to his mother on 8 October 1894, Lord Randolph described how he cured the numbness in his hands and feet by putting them in hot water. If he had been suffering from dementia, he would not have been able to write such a cohesive letter. A likely cause for his longstanding circulation problems is his chain-smoking. Spasms in the arteries reduce circulation, which causes numbness and pain due to lack of oxygen in the tissues: Raynaub’s or Behcét’s Disease.

His speech problems caused Randolph great frustration. “I know what I want to say but damn it, I can’t say it,” he told his friend Wilfrid Blunt in May 1894. At several times he expressed similar anxiety over the difficulty of articulating his words. These fugue states or “psychic seizures” are strongly suggestive of a variety of epilepsy found in the deep parts of the brain, close to the speech area. The progressive march of the disease process strongly suggests a steadily expanding lesion or mass.

Consistent with his right handedness is the possibility that Lord Randolph developed a left side brain tumor, for which no surgery was available. This would also be consistent with the circulation problems in his hands, which in turn would be related to his intermittent heart problems and arterial spasms from nicotine in cigarettes. Even Dr. Buzzard might have agreed when he wrote, “…intense pain in the head, when it is coupled with amaurosis (or prostration) is very suggestive of the presence of an intra-cranial tumor…If instead of atrophy of the discs we had found optic neuritis, this condition, when taken in connection with the intense severity of the pain in the head, would have gone far towards enabling us to pronounce a somewhat confident diagnosis of intracranial tumor.”

If Dr. Buzzard was convinced that Lord Randolph had advanced syphilis, he would certainly have treated him with mercury and potassium iodide, which he strongly espoused for neurosyphilitic patients. But Buzzard makes no mention of such treatments in any of his papers during Randolph’s illness—and, had Randolph taken these, their toxic effects, such as kidney failure, would have been evident.

Indeed, the only medications Lord Randolph received that can be documented were for pain (laudanum) and heart failure (belladonna and digitalis). Dr. Buzzard’s reference to “general paralysis” in Randolph’s case is not diagnostic of advanced syphilis, although it suggests this was his eventual conclusion. While syphilis may have been a reasonable diagnosis in the absence of modern techniques, the patient’s temperament, combined with his speech and articulation problems and absence of dementia, is more consistent with a tumor deep in the left side of his brain. It is not possible to be certain; but this is far more likely to be the proper diagnosis.

Winston Churchill long accepted the common rumors about his father’s illness. Late in life he told his private secretary, “You know my father died of locomotion ataxia, the child of syphilis.” When did WSC pick up the story? The likely time seems to be 1924, when Frank Harris’s book was published, and when Winston left the Liberal Party and reverted to the Conservatives. Incensed at the return of someone they cordially disliked, die-hard Tories attempted to blacken his name, calling him a drunkard and saying that he was infected with syphilis. This same year, his 11-year-old nephew, Peregrine Churchill, was confronted by a classmate at Summer Fields Prep School, Oxford, who charged, “My daddy says all you Churchills have revolting diseases and are quite mad.”

Dr. Mather directs oversight and research for the United States Veterans Administration. This article is condensed from his original, footnoted piece in Finest Hour 93, Winter 1996-97. The author thanks Wylma Wayne, Celia Sandys, Peregrine Churchill, Sir Robert Rhodes James, Mark Weber, and Linda Wood for their kind assistance.