Winston Churchill: two mild left hemisphere strokes, finger gangrene and syncope in 1959

This article is in our series on Winston Churchill's illnesses

Introduction

Despite Sir Winston Churchill's severe illness in 1958 while holidaying in the South of France,¹ he planned a four-week visit to Roquebrune-Cap-Martin, a two-week sail to the Canary Islands on the yacht belonging to Aristotle Onassis (shipping magnate and owner of Olympic Airways) and a five-week visit to Morocco.

On 12 January 1959 at 11.30 am, Sir Winston and Lady Churchill flew to Marrakech in an Olympic Airways Douglas DC 6, arranged by Aristotle Onassis, for his sixth and final visit to that city. The Churchills were to spend their holiday in Morocco at the Hotel Mamounia, during which time Churchill painted two pictures, one from the hotel terrace and one in the gardens.² The Churchills were accompanied on the flight by ‘Jock’ Colville (former Joint Principal Private Secretary) and his wife, Lady Margaret, by Lady Monckton (Conservative Peer and wife of Sir Walter who had been Churchill's Minister of Labour and National Service in his last Government), by Anthony Montague Browne (Principal Private Secretary) and his wife Nonie, Miss Doreen Pugh (Personal Secretary), Sergeant Edmund Murray, Churchill's bodyguard, Mr and Mrs Ivan Shepherd (nursing attendants), Ms Frieda Abraham (Lady Churchill's maid) and two valets.³ Careful advance arrangements had been made to ensure that Churchill received ten daily newspapers and five Sunday newspapers. In addition, six dozen bottles of Pol Roger and six dozen bottles of hock and five dozen bottles of spirits were also imported with the support of the British Embassy in Rabat; Miss Pugh was responsible for keeping Churchill informed of the amount drunk during the extensive entertaining.⁴

Colville recalled that ‘when we arrived there was an enormous Guard of Honour provided by the King of Morocco, but Winston, aged 84, pulled himself together, strode down the steps of the airliner and inspected the whole Guard of Honour without showing any signs of age or illness’.⁵ Among the welcoming party was the British Ambassador, Sir Charles Duke, and the Governor of Marrakech, in whose Lincoln Churchill was driven to his hotel.² While the Churchills were relaxing at Hotel Mamounia, Murray had to deal with the potential abduction of Churchill by the Berbers who were dissatisfied with their treatment by the new King of Morocco and his Government and who wished to focus world attention upon their plight.⁶

The Colvilles and Lady Monckton returned to London on 23 January 1959.⁷ Colville wrote to Churchill on 26 January 1959:

Meg and I loved our stay at Marrakesh, every minute of it, and are more than grateful to you for including us in such an agreeable party…and are still pining for that delectable view of the Atlas, for our nightly games of poker and for the pleasure of your company…⁵

Lady Churchill wrote to her daughter:

The first ten days were enlivened by Jock, Meg and Biddy Monckton…As for Meg, she and Papa flirted outrageously and almost romped…When they all went away poor Papa fell into the doldrums – he is better now & has started a picture from the terrace outside his bed-room… Thank God Papa is blooming in his health. His memory fails a little more day by day & he is getting deafer. But he is well…⁸

On 19 February 1959, the Churchills left Safi, the port of Marrakech, and joined Aristotle Onassis's yacht, Christina, for a cruise to the Canary Islands and along the Moroccan coast.⁶ Murray recalls that Churchill was in great form and had a very healthy appetite. ‘Most of the time he had an Edwardian approach to meals and often had a sort of mixed grill for breakfast, and possibly a glass of champagne on special occasions’.⁶ Murray also painted the portrait of Christina, Aristotle's daughter.

Churchill returned to London on 2 March 1959.⁵ Churchill then had a very busy four days including a dinner of the Other Club on 5 March, the principal reason for his return to England.⁵ Additionally, he spent the afternoon and evening of 3 March at the House of Commons, he visited the House of Commons again on 4 March to see Harold Macmillan, the Prime Minister. He met his solicitor twice (3 March and 5 March); had appointments with his dermatologist, Dr RMB MacKenna and Lord Moran (4 March); visited the Royal Academy for the one man show of his paintings;⁸ attended a meeting of the Trustees of Churchill College, Cambridge (4 March) and a performance of Gilbert and Sullivan's The Gondoliers (4 March) at the invitation of the Colvilles. Lord Montgomery was also in the party to this performance by the D'Oyly Carte Opera Company. Montgomery was a Director of Portsmouth Football Club and had arranged privately for the theatre to pass him the result of the game. Churchill also knew that he was facing a three-line whip (mandatory attendance at a House of Commons vote) that evening and when he saw a note being passed along the row he stood up – assuming it was his summons to the House – and trooped out, followed by the whole party, including a mystified Lord Montgomery for whom the note had been intended!⁶

On 6 March 1959, Churchill flew at 10.45 am on a British European Airways flight to Nice in the south of France to stay at La Pausa, a villa in Roquebrune-Cap-Martin some 6 miles east of Monte Carlo. The villa was designed and built by the French fashion designer Coco Chanel in the early 1930s and owned by Chanel until 1953, when she sold it to the Hungarian publisher Emery Reves, Churchill's long-time literary associate, who with his future wife, Wendy, were to be Churchill's hosts.

Churchill returned to London on 6 April 1959 and was reviewed by Dr MacKenna and Lord Moran.⁵ He then began to prepare for a considerable ordeal, a speech in his constituency on 20 April.

Methods

Information regarding Churchill's stroke and finger gangrene in 1959 was available from various sources. Foremost were those of Lord Moran,^9,10 Churchill's personal physician since 1941, and Sir Russell Brain, the eminent neurologist whom Moran consulted on multiple occasions regarding Churchill.¹¹ By courtesy of the present Lord Moran and the Library at the Wellcome Collection, we have had access to his grandfather's original papers. However, permission to include information not previously in the public domain was not granted. The present Lord Brain (Michael Brain DM FRCP) has kindly allowed us to access and cite his father's clinical records held by the Royal College of Physicians.¹¹ Martin Gilbert (Churchill's main biographer),⁵ Anthony Montague Browne (Private Secretary)¹² and Sergeant Edmund Murray (Churchill's bodyguard)⁶ added further important details, as did Churchill's daughter, Mary (Lady Soames)⁸ and granddaughter, Celia (Sandys).²

13 April 1959: assessment by Lord Moran

Moran had visited Churchill at Chartwell on his way to London.^9,10 After his visit Lady Churchill had telephoned Moran at 8.00 p.m. and informed him that after Winston had gone to bed (for a rest), he rang his bell and when Shepherd, his valet and trained nurse, answered it he noticed that Winston was not speaking properly. Shepherd reported this to Lady Churchill. Although her husband wanted to stay the night at Chartwell, Lady Churchill had to explain to him that as there were no servants at Chartwell, they had to return to Hyde Park Gate.⁹

Lady Churchill explained to Moran:

Winston is usually very silent in the car, but on the way to London he kept trying to say something. I was not sure whether he wanted to tell me things or whether he was experimenting to find out for himself what he could say and what he could not. When he failed to get the words he exclaimed: ‘Damnation! Is it a stroke, Charles?’⁹

Moran examined Churchill at about 10.00 p.m.

When I asked Winston how he was I could not understand what he was trying to say to me. He knew what he wanted to say, but he could not say it. I gave him my pen and he wrote something very slowly and very carefully. I took the paper from him, but I could not read what he had written. I noticed that his little finger was white and cold. When I asked if it was painful he nodded. I went back to his room and reassured him. He had been like this before, and it had all cleared up. I told him that in a day or two he will be all right. He said he was worried.⁹

14 April 1959: assessment by Lord Moran

After examining Churchill, Moran concluded that it was impossible

to detect that there is anything wrong with his speech… A few days ago I noticed that the pupils of his eyes did not react to light, and now there is this speech defect and the little finger; there seems no end to these wandering clots. I keep wondering what will happen next. But Winston has made up his mind to go to the Other Club on Thursday.⁹

15 April 1959: assessment by Lord Moran and Sir Russell Brain

Moran invited Brain's opinion. Brain and Moran reviewed Churchill at 5.00 p.m.⁷ Brain recorded in his clinical notes:

Seen with Lord Moran. The previous day he had a sudden attack of speech difficulty. Could say very little for an hour or two, then rapid improvement. Now he made only occasional mistakes with words, and slight slurring. About the same time, his right little finger felt dead and became cold. No change in neurological signs. Slight expressive dysphasia. Right little finger was cold and blanched. There have clearly been two small emboli, presumably from an atheromatous plaque in the aorta. WC was due to speak the next day in his constituency which was very important because his adoption as a candidate might depend upon it. He insisted on going and got through it.¹¹

Moran recorded:

When Brain had examined Sir Winston he told me that a small artery had been blocked, cutting off the circulation to his speech centre for a time. But the circulation had been re-established. I had advised Russell to ask Winston if he had made any plans, and if he had, to urge him to cancel them. Winston said that he was speaking to his constituents: ‘I cannot cancel it without giving a reason. I should have to tell them about this, and I could not then take part in the election. Macmillan has asked me to take some part. What does it matter if I do break down?’ He broke out impatiently: ‘I am quite content to die’.¹⁰

According to Moran, Brain ‘could think of nothing to say. He sat looking at Winston for quite a time. Then he half turned to me as if he would say: “Cannot you do something to put an end to this visit?”’¹⁰ Lady Churchill awaited the physicians in the library.¹⁰ ‘Did you persuade him not to speak on Monday?’ Brain told her what had happened. He then asked: ‘Does Sir Winston worry?’ Lady Churchill replied:

No Winston isn't a worrier. But he is profoundly depressed. The days are very long and very dull. It was never like this in the past. He found a hundred things to do. He reads a lot, but he does not enjoy what he reads. He cannot paint now. He painted two pictures in five weeks at Marrakesh. He wants to stay in bed. Today an agreeable, amusing woman came to luncheon. Winston likes her, but at the last moment, he decided to lunch in bed. He has given up America, thank God. But what about this speech? Cannot you do anything, Charles?¹⁰

16 April 1959: forthcoming General Election

Churchill invited his constituency chairman, Alderman Forbes, to lunch. Forbes later recalled:

Being eighty-four Sir Winston wished to make sure that he was correct in offering himself as a candidate at the forthcoming General Election. He graciously asked me to reassure him that by so doing he was not blocking any aspirations I had in that direction. He received that assurance.⁵

Moran assessed Churchill again at 3.15 p.m.

Churchill dined at the Other Club at 8.15 p.m. which Gilbert described as ‘a tenacious gesture, even a defiant one, for someone so recently in pain and unable to speak properly’.⁵ Sir Hartley Shawcross (Barrister, Labour MP and former Attorney General) told Moran on the following day that Churchill scarcely spoke to the man on his left and when something was said to him he seemed to connect for perhaps one or two sentences and then rang off.⁹

17 April 1959

The Engagement Card for April indicates that Dr Roberts (Churchill's doctor in France) came at 10.00 a.m. and Moran at 2.30 p.m.⁷

20 April 1959: constituency speech

Only a week after his further stroke, Churchill was driven to Woodford to speak in his constituency. ‘It is a long time since I have made a speech in public’, he began.⁵ The speech which had been prepared for him by Anthony Montague Browne was delivered in a voice at times barely audible^5,9 and dealt with the Cold War.¹³ At the end of his speech, which lasted for 22 minutes, Churchill told his constituents that he was ready once again to offer himself as a candidate. This announcement was received with ‘tumultuous applause’.⁸ As Churchill came off the platform he turned to Montague Browne with the words ‘Now for America’.¹²

Later that day Churchill told Moran, ‘It needed nerve’. ‘You mean you were nervous’, asked Moran? ‘Oh no. But if you are uncertain whether you will break down, it needs nerve’.⁹

3 May 1959: assessment by Lord Moran

Although on 20 April Churchill had apparently been keen about his forthcoming visit to America, by 3 May he confided to Moran ‘I wish I was not going. I would rather stay in bed and read’. Moran wrote later:

I think it is beginning to dawn on him that to fly across the Atlantic for a few days as things are with him is a bit of a gamble. I told him he was mad to take the risk. But his mind is made up. Anything, I fancy, to break the purgatory of these interminable days. He will not take me. He cannot bear that people should think that he needs a nurse to look after him. When I said ‘Goodbye’ he said: ‘You agree to my going?’ ‘Under duress’, I answered. At this Winston gave me a faint smile.⁹

Moran was clearly disappointed not to be accompanying Churchill to Washington, as a letter he wrote that day makes clear. Montague Browne wrote:

Lord Moran addressed a long, persuasive letter to his Eminent – and by now almost only – Patient, explaining why he should accompany him. WSC was vexed: ‘No, I don't want that bloody old man’, he said. Actually he was rather fond of Moran, but he would have been an encumbrance on this journey.

See Churchill's apology for this remark below.¹²

Moran wrote to Churchill:

I was rather sad when you said this morning that you wished that you were not going on this should trip. I expect you feel that this visit is only worthwhile if you can do it really well. But I believe that this is still possible. Any doubts I have had are not concerns with any vascular accident or emergency; after all, it is good odds against anything of that kind happening. I only wonder if you will be in such good form that people in the States will say: ‘I’d like to remember him like that'.¹⁴

I am sure it is possible to tune your circulation so that you will be in such form. I say this because your circulation still responds to ‘Minors’ [amfetamine sulfate 2.5 mg, aspirin 160 mg, phenacetin 160 mg¹⁵] if used at the right time, and when it is safe to use them judging from the pulse tension – perhaps using more ‘Minors’ than we had done hitherto. So far we have used the ‘Minors’ only before speeches etc. But I had it in mind to use them to keep you in top form throughout your visit (which is short enough to make that possible). I was pretty certain that ‘Minors’ so used would make a difference between your visit being an outstanding success and merely one where your form might be compared sadly with what they remembered in former times.¹⁴

That is why I was very sorry when you decided not to take me. I have learnt so much about your circulation in the last 19 years and what can be done to tone it up that I believe I could have made the difference. I wanted you so much to bring off this trip so that people would talk of it as a wonderful thing in itself and not just talk of your former visits. I wanted them to say how marvellous it was that in your eighty-fifth year you were so much ‘on the spot’ and plainly in a state when you give Ike [President Eisenhower] the advice he so obviously needs.¹⁴

Planning for the visit to the US

Churchill intended to fly to Washington on 4 May 1959 and initially to stay at the White House at the invitation of the President before transferring to the British Embassy, to go to New York on 8 May to see his friend Bernie Baruch (Financier and Presidential adviser) and return to London on 10 May. Montague Browne, Murray, and Shepherd were to accompany Churchill.¹²

Montague Browne wrote that Churchill

prepared himself meticulously for his talks with the President. He had suffered a further, if minor, deterioration in his health, and his family and I feared both that the strain of the trip could have serious consequences and that he might leave a tragically diminished memory with his American friends. But as he was adamant to make this political effort for Anglo-American relations, which proved to be his last, I set out on a damage limitation exercise. WSC was persuaded not to make any major prepared speeches: he was bound to address the dinner or luncheon parties he attended, but this would be impromptu, or impromptu from a draft, and infrequent. I briefed the White House, the Embassy and Baruch appropriately and they were all wonderfully helpful, even the White House suppressing its endemic tendency to leak…¹²

4–10 May 1959: to the US, White House and British Embassy

Montague Browne has described the journey:

Churchill flew in a jet for the first time, a de Havilland Comet. Given the steepness of climb immediately after take-off…I thought that WSC would be disconcerted. Not so; just annoyed at having to put his cigar out. We had headwinds and had to land in Iceland to refuel…At New York, we transferred to the Presidential aircraft, the Constellation Columbine, waiting with a very welcoming number of officials. The occasion was slightly marred by a scruffy customs man who pushed his way through the dignitaries, shouting that he must ask ‘Mr Choichill poisonally what he'd got in his baggage'. Two very large and silent plain-clothes figures picked him up under the shoulders and removed him, his feet paddling furiously.¹²

Stag dinners had been arranged by President Eisenhower at the White House for the evenings of 5 May (15 guests) and 6 May (50 guests);⁷ Churchill spoke briefly at both from a prepared script.¹² During this stay at the White House, Eisenhower and Churchill visited the President's farm near Gettysburg,⁶ taking a Marine helicopter to do so (Figure 1). Churchill gave the President one of his paintings, The Valley of the Ourika and Atlas Mountains, which he had painted in 1948.

Figure 1.

Sir Winston Churchill, Anthony Montague Browne and President Eisenhower on a Marine helicopter on 6 May 1959 © Alamy (F2B5Y6).

On the morning of 7 May, Churchill transferred to the Embassy. A luncheon party took place at which the former President Harry S Truman and his wife, former Secretary of State Dean Acheson and his wife and General Maxwell Taylor (Chief of Staff of the Army) and his wife were the guests.⁷ A stag dinner for 30 people took place at 8.00 p.m., at which the President was the chief guest.⁷

Montague Browne recorded that:

Halfway through the visit, I was sitting by WSC's bedside while he finished his breakfast. ‘Look at this’, he said suddenly, holding out a finger. A small area at the tip was jet black. ‘I burnt my finger the other day while I was lighting a cigar, and now it has gone numb’. The first doctor to see it look concerned. After we had left the room, he told me that it was gangrene. I asked if it would spread. It might, he replied; the patient circulation was obviously bad. Here was a pickle. WSC was as brave as you could be, but he was something of a hypochondriac, and the word gangrene would conjure up terrible visions of the deadly First World War gas gangrene. Should he fly home at once, cutting short his programme? I communicated with Lord Moran in London, who was neutrally reassuring, but the matter was taken out of our hands by WSC himself: ‘I don't care what's wrong with my bloody finger’, he said, ‘I feel very well and I won't have my programme changed’. And that settled it.¹²

When Montague Browne telephoned Moran to inform him, Moran impressed upon the doctor to whom he spoke ‘the need for secrecy’.⁹

Moran wrote:

I hear he went off in good heart. He has a feeling that for the moment he is on the map again. Perhaps, after all, life is not quite over. But I am full of forebodings. I cannot get the thought out of my head that I may not see him again.⁹

Churchill travelled to New York once again on the Columbine on the morning of 8 May and the pilot took the party on a rooftop-high tour of Manhattan Island in perfect weather.¹² Churchill stayed with his friend Bernie Baruch.¹² Churchill left New York to fly home by Comet at 9.00 p.m. on 10 May.⁷

9 May 1959: Lord Moran visits Lady Churchill

Moran drove to Chartwell to inform Lady Churchill of the news before Churchill returned. ‘What is the worst that can happen?’ Before Moran could answer her daughter, Diana said: ‘Oh, of course, Papa might have his hand off for gangrene’.⁹

11 May 1959: assessment by Lord Moran

Churchill landed at Heathrow at 10.15 a.m., and Moran saw him just before noon, but he was so tired after the flight he could hardly keep awake.⁹ On reflection, and despite her previous misgivings, Lady Churchill concluded: ‘I am very glad Winston went to America, though I was against the journey at first. He loved the visit. I think he wanted to go to America before he died, because of his mother’.⁹

12–24 May 1959: assessment by Professor Rob

Moran invited Professor Charles Rob (vascular surgeon at St Mary's Hospital, London) to give an opinion on Churchill's finger on 12 May. Rob proceeded to explain ‘very clearly and even a little bluntly’ that there had been a clot in the artery of his little finger. There was a black spot because not enough blood could get to the finger. If Churchill rested, he would probably lose only a bit of the finger. The black spot was dead tissue; it might take months – even a year – to dry up and come away. Churchill responded: ‘A year! A year! You are asking too much. I have an appointment tomorrow. I am not going to deny myself this’.

Rob again reviewed Churchill's finger at 9.00 a.m. on 13 May.⁹ Churchill was still asleep, but when he awoke he gave Moran a ‘sour look’⁹ as he was sure he intended to try and prevent him lunching with the Prime Minister, Harold Macmillan.⁹ ‘Rob said there was a risk if he went, but that risk was small’.⁹ ‘What is it?’ demanded Churchill. ‘If you don't rest you might lose the hand’, Rob told him.⁹ Churchill attended luncheon with Macmillan.

On 14 May, Churchill announced his intention of attending Lord Beaverbrook's annual dinner.⁹ He asked Rob what were the odds that this would make his finger worse. Rob replied fifty-fifty.⁹ Churchill arrived at the dinner in a ‘bad temper; he sat silent, brooding’.⁹

Although Moran had given Churchill a finger-stall to hide the black spot, he had been showing it to everyone, even exciting the interest of Macmillan who wanted to know its significance.⁹ Rob reviewed Churchill again on 21 May at 6.30 p.m. On 24 May, Churchill removed the finger-stall and said to Moran: ‘It's a poor sight. I have never seen anything like it before’.⁹

Rob later recalled his visits to Churchill: ‘He was, I thought, an alert, very interesting and somewhat deaf man, whose age, about 84 or 85, was in good health and mentally still exceptional. I thought he was bored by retirement’.⁵

22 July–13 August 1959: sailing in Greek and Turkish waters

On 22 July, the Churchills set sail again on Christina as a guest of Aristotle for a cruise of Greek and Turkish waters. Moran, Montague Browne and Murray were among the passengers.^5,6 In Capri, Gracie Fields, the singer, came on board and sang several songs, and on departing sang Come back to Sorrento…or I die.⁶ She was a great success and Lady Churchill ‘clapped her hands repeatedly, and her eyes shone with an enthusiasm I had rarely seen in her…’⁶ Throughout the cruise Moran would not let his patient swim: ‘Oh no, you might get a chill’.⁵

The cruise involved sailing through the Dardanelles at night (4 August). Murray surmises this had been intentional to spare Churchill's feelings.⁶ As Nonie Montague Browne later recalled ‘they knew it would upset him’.⁵ In fact, Churchill instructed his nurse to fetch Murray and together they watched the distant outline of the shore for two hours.⁶ ‘…judging from Sir Winston's reactions then and immediately after, it was an experience which had considerable impact upon him, and during the next two or three days, he was in silent, retrospective mood’.⁶

13–30 August: Monte Carlo

On 13 August, Christina berthed at Monte Carlo, and Churchill went to La Capponcina, Lord Beaverbrook's villa at Cap d’Ail, across the bay from Monte Carlo. Montague Browne flew back to London on 14 August. On 15 August, Churchill showed Moran his finger tip ‘with a touch of pride. The black tip had come away. “You could not tell that anything was wrong. It took three months, and they talked about a year!”’⁹ So within four months the necrotic black tip had come away and the rest of the finger remained healthy.

Montague Browne returned to La Capponcina on 19 August. Lady Churchill flew to London on 20 August to undergo an operation on her eyelid at Queen Victoria Hospital, East Grinstead by Sir Benjamin Rycroft (consultant ophthalmic surgeon); the eyelid droop was the result of a prolonged attack of shingles.⁸ Churchill transferred to La Pausa on 23 August and returned home on 30 August.

29 September–21 October 1959: adoption at Woodford as the Conservative candidate and General Election on 8 October 1959

Churchill went for his adoption meeting at Woodford on 29 September. He had left Chartwell at 5.00 p.m., given his adoption speech on arrival, dined with his Constituency Chairman, Alderman Donald Forbes, at 6.30 p.m. He then gave a major speech at Hawkey Hall at 8.00 p.m.⁷ Churchill reminded his constituents at his adoption that:

I am much touched by your action, Ladies and Gentlemen, in doing me the honour of adopting me as your candidate for the ninth time. We have had eight victories running, and I am sure that if everyone plays his part as you have always done, we shall increase our score on 8 October.¹⁶

The major speech, written by Montague Browne, told his constituents of the way out of the deadlock caused by the confrontation of the nuclear and conventional capacity of the Great Powers.¹⁷

In the General Election on 8 October, the Conservatives were returned with an overall majority of 100 seats, but Churchill's majority though substantial (14,797) was down. Later his daughter Mary suggested that: ‘It may well be that the feelings of discontent among some of his supporters were reflected in this result’.⁸ For some time Parliamentary Questions on behalf of Churchill's constituents had been raised in the House of Commons by the Conservative Member for the neighbouring seat of Walthamstow, John Harvey MP, and Constituency correspondence was dealt with by Churchill's secretariat and Agent, Colonel Hugh Barlow-Wheeler.⁸

17 October 1959: planting of an oak tree at Churchill College, Cambridge

Churchill flew from Biggin Hill airfield to Cambridge, accompanied by Lady Churchill and Montague Browne, a flight of 30 minutes which saved a journey of more than three hours by road, to plant an oak tree to mark the foundation of Churchill College.⁵ After luncheon at King's College, the party proceeded to the site designated for the new College for the tree planting, and Churchill gave a speech drafted by Montague Browne but much edited by him.¹⁸ After his speech, Churchill attended a meeting of the College Trustees and was informed that just over £3 million (Equivalent in 2018 of some £568 million) had been raised, enough to enable the Trustees to proceed with the building of the College.⁵

22 October 1959: assessment by Sir Russell Brain and Lord Moran

This evening, Montague Browne was talking to Churchill when he ‘yawned twice, went white, face and hands, and became unconscious…I thought he was dying’. As Moran could not be contacted immediately (he was in Bath for a series of meetings in the West Country), Montague Browne telephoned Sir Russell Brain and told him that Churchill ‘had suddenly become unconscious…would [he] go at once?’

Montague Browne was later able to contact Moran. Moran asked him how long it was before Churchill came round?

Oh, I suppose it was not more than a few minutes. When he did come round, he seemed dazed. He said he felt very ill, as if he had been turned upside down. I don't know if I did right, but when I couldn't get you I telephoned Sir Russell Brain, and he'll be here any minute. I will ring again when Sir Russell has seen Sir Winston.⁹

Brain recorded in his clinical notes:

I got to Hyde Park Gate in about twenty minutes, by which time they had got him upstairs and into bed. Mr Browne said that they had both been sitting in the same room when Sir Winston said he felt ill. He looked very pale, and his eyes turned up. He was unconscious. There was no convulsion. Sir Winston was in bed; he looked rather pale. His pulse and respiration were normal. He could be roused to speak and at my request, moved both arms and legs and grasped my hands. There was no paralysis, and I concluded that he had had a minor epileptic attack. I stayed for an hour or more and had tea with Lady Churchill, who said that they had lunched at the Savoy with Randolph and Sir Winston had seemed normal then but perhaps a little silent. He was more conscious when I left but drowsy. No paralysis had developed, and the plantar reflexes were flexor. I rang up later to find that he was sitting up having some dinner.¹¹

Moran's record of a visit later that night conflicts somewhat with Brain's account. Moran decided that ‘I must see him tonight. It doesn't sound too good’.⁹ On reaching Hyde Park Gate, Moran found that Churchill could not answer his questions. Churchill was

propped up in bed looking at his dinner on the bed-rest; he was not interested in food. He had a quiet pulse, his colour was good, and he was falling asleep as we left him. I do not think anything will happen.⁹

23 October 1959: assessment by Sir Russell Brain and Lord Moran

Brain assessed Churchill again at 9.15 a.m. with Moran. Churchill told his doctors

that he had had a good night, and felt quite normal. He was sorry to have caused so much trouble. He did not remember much about the attack but said it felt as if he were being turned upside down. He seemed as usual. He is to take 3/4 grain of sodium phenytoin (phenytoin sodium 50 mg) each morning.¹¹

Moran recorded that:

…when Russell and I saw Winston he seemed much as usual. He did not feel ill. Russell thought his attack was due to petit mal…it was not uncommon as a sequel to a sluggish cerebral circulation. Even if there were was a recurrence, the risk that he would die in one of these attacks was small, but Russell did not think that he would be alive in six months time.⁹

24 October 1959: assessment by Lord Moran

Moran observed that Churchill was playing bezique with his wife. Lady Churchill said that ‘he is much better’.⁹ Churchill himself, when questioned by Moran, admitted that he felt ‘worse’ because of ‘muzziness’.⁹ Churchill told Moran that he had put Tolstoy aside to read the second volume of Alan Brooke's autobiography. Churchill then apologised for forgetting that he had called Moran ‘a bloody old man’.⁹

30 October 1959: unveiling of a statue of Sir Winston Churchill in Woodford

Churchill returned to Woodford on 30 October for the unveiling by Lord Montgomery of his statue, generously donated by his constituents, which was not to Churchill's liking!⁶

17 November 1959: assessment by Sir Russell Brain and Lord Moran

Lady Churchill telephoned Moran to tell him of her concerns regarding Winston. After lunching with Beaverbrook, he ‘got out of the car [and] lurched to the right; he would have fallen but for Bullock [chauffeur]’.⁹ Moran telephoned Beaverbrook and was informed that during lunch Churchill ‘could not get the words he wanted’.⁹ When Moran saw Churchill an hour later ‘he still had difficulty in finding his words’.⁹ When Moran asked Churchill how he felt he replied: ‘Frightfully stupid’.⁹ Churchill had planned to see Adenauer (Chancellor of Germany) that afternoon, but Moran told him that he would not be able to do so as he might use wrong words and it might be very noticeable.⁹ Churchill told Montague Browne not to cancel any of his appointments for the moment.

Moran invited Brain to assess Churchill again. Brain's clinical notes stated:

Moran telephoned me in the afternoon and asked me to come at once. I got to Hyde Park Gate in a quarter of an hour. Churchill had come up from Chartwell that morning and went to lunch with Beaverbrook. When he tried to get out of the car, he had to be supported, and he had sat through lunch looking pale and saying little. When I got there, he was sitting in the library, drowsy and yawning. He could be made to respond, but his speech was slurred, and he had some expressive aphasia. Adenauer was due at six o'clock. Moran wanted me to persuade Churchill that he was not fit to see him. This was not difficult, and the Adenauer visit was cancelled. Churchill was got up to bed while Moran and I had tea with Lady Churchill. After that, he seemed to be reviving. He said that he would like to play cards. Lady Churchill said she wished he would play something other than six pack Bezique. She added: ‘Winston is now starting to cheat!’¹¹

Lady Churchill told Brain that Winston was very disappointed that he could not see Adenauer. ‘You see, Sir Russell, there will not be many of these occasions in the future’.⁹ Brain confided in Moran that he thought one day Winston would be found in bed unable to speak. The right carotid artery had been blocked before, and it looked now as if the left was affected. ‘You mean he will have a stroke in the night?’ Moran enquired. Brain nodded in agreement.⁹

18 November 1959: assessment by Lord Moran

Lady Churchill told Moran: ‘You wouldn't know anything had happened’. Adenauer had expressed a great desire to see Churchill and this had been arranged. Later Moran was told how well the encounter had gone.

The first quarter on an hour he was hesitant, and his voice was not very strong, though his answers were all sensible. Then he blossomed. His voice got stronger, and he asked a lot of intelligent questions … I think Charles it went off very well.⁹

Moran saw Churchill an hour after Adenauer's visit. ‘I saw…I saw…that man’. ‘Adenauer’, Moran asked? Churchill nodded.⁹

19 November 1959: assessment by Sir Russell Brain

Moran had gone to Oxford, leaving Brain in charge. Brain was telephoned at lunch time and went along at 3 p.m. to see Churchill.¹¹ Churchill

had got up as usual, but while waiting for lunch, they found him with several volumes of Edgar Allan Poe, and he said he wanted to know what happened to Marie Antoinette. He did not believe she was executed. He slept through most of lunch, and then ate some, but was still preoccupied with the problem. Eventually, Lady Churchill got an encyclopaedia to convince him. She was catechised and remembered most of the details. I found him drowsy but recovering. Blood pressure 110/70. He had had a bad night with confusion, exhausted by the Adenauer visit which took place yesterday. Bed and then better.¹¹

Brain recorded in his notes:

Talking these episodes over with Moran, I suggested that we ought to think of the possibility of a cardiac origin for these episodes, and as a result, he asked John Richardson to see Churchill. I wrote to Richardson on January 28th 1960, giving him an account of what had happened, and ended my letter as follows: ‘I am sure all of these episodes have been circulatory, and I thought that the cerebral ones were probably due to a fluctuating blood supply through thickened cerebral vessels. It was the attack of syncope which made me suggest to Moran that a cardiac dysrhythmia might be at the bottom of it’.¹¹

Richardson wrote back on February 1st: ‘I enclose the electrocardiogram as I think it might interest you with its highly variable pace-maker. I would like to have it back as it is the only one I have got the other I sent to Moran. I think the finding is important as it would obviously be better for him not to be on digitalis unless the indications are extraordinarily strong’.¹¹

21 November 1959: assessment by Lord Moran

Moran went to see Churchill again and found him reading Zurig's Marie Antoinette, but Moran was not sure how much Churchill had taken in, particularly as Miss Pugh (Personal Secretary) had shown Churchill some papers and ‘he did not seem to take them in as he usually does’.⁹

30 November 1959: Sir Winston Churchill's birthday

Churchill celebrated his 85th birthday by attending the House of Commons where the Leader of the Opposition, Hugh Gaitskell, and the Leader of the House, RA ‘Rab’ Butler proposed their warmest and most heartfelt good wishes.⁵

Churchill's doctors

Lord Brain (1895–1966)

Brain (Figure 2) was a Consultant Physician at the (then) London Hospital and the Maida Vale Hospital for Nervous Diseases. Brain earned his living primarily from his private practice and as the author of Diseases of the nervous system, Clinical neurology, and other medical and non-medical books.¹⁹ He was President of the Royal College of Physicians from 1950 to 1956, succeeding Lord Moran.^20,21 Brain had assessed Churchill previously at Moran's request on 5 October 1949, 15 October 1949 and 8 December 1949 after Churchill's first stroke²² and on multiple occasions in 1950–1952 for further episodes of cerebrovascular disease²³ and in June 1953 after Churchill's second stroke.²⁴ Brain was also involved in treating the cerebellar infarction Churchill suffered in June 1955²⁵ and a left hemisphere stroke in October 1956.²⁶

Figure 2.

Sir Russell Brain Bt © NPG (86467).

Brain was knighted in 1952, made a baronet on 29 June 1954, and on 26 January 1962 was created Baron Brain of Eynsham in the County of Oxford. In March 1964, he was elected a Fellow of the Royal Society.

Lord Moran MC (1882–1977)

Charles Wilson (Figure 3) was appointed Dean of St Mary's Medical School in 1920, a post he held until 1945. He became Churchill's doctor on 24 May 1940 and remained his personal physician until Churchill's death in 1965.²⁷ He treated Churchill for chest pain in December 1941 in Washington,²⁸ for pneumonia in London in February 1943,²⁹ for pneumonia and atrial fibrillation in Carthage in December 1943³⁰ and for pneumonia in London in August 1944.²⁹ Moran also treated Churchill in 1949 when he suffered his first stroke²² and was primarily responsible for managing the further episodes of cerebrovascular disease in 1950–1952,²³ his second stroke in 1953²⁴ and Churchill's recovery from it,³¹ the cerebellar infarction in June 1955 again with an excellent recovery²⁵ and a left hemisphere stroke in October 1956.²⁶ In 1958, he treated Churchill for pneumonia, atrial fibrillation and jaundice¹ and in 1962 coordinated treatment for Churchill's hip fracture.³²

Figure 3.

Lord Moran © Sybil Richardson by courtesy of Anne Stafford and Clare Wales.

Wilson was knighted in 1938, created Baron Moran of Manton in the County of Wiltshire in 1943 and was appointed Treasurer (1938–1941) then President of the Royal College of Physicians of London (1941–1950).²⁷

Lord Richardson (1910–2004)

Richardson (Figure 4) undertook his clinical training at St Thomas’ Hospital, London, where he won the Bristowe Medal and Hadden Prize, before qualifying in 1936 and being awarded a Perkins Fellowship.³³ His career was interrupted by being called up into the Royal Army Medical Corps in August 1939.³³ He saw service at Dunkirk and was later posted to North Africa as a lieutenant colonel medical specialist, where he looked after King George VI on a visit to the troops in 1942.³³ It was here that he met Harold Macmillan who was travelling with the royal party, which he described as ‘the greatest good fortune of my life’; he was to act as Macmillan's personal physician for over 40 years. After World War II, Richardson returned to Thomas’ and, apart from an initial year off with pulmonary tuberculosis, spent 28 years there as a consultant physician.³³ He was President of the Royal Society of Medicine (from 1969 to 1971), President of the British Medical Association (from 1970 to 1971) and recipient of its gold medal, and Master of the Society of Apothecaries (from 1971 to 1972) and President of the General Medical Council from 1973 to 1980.³³ He gave the Harveian Oration at the Royal College of Physicians in 1978 on Harvey's exhortation, in which he emphasised William Harvey's exhortation to Fellows to keep their house in order. As Richardson's unpublished autobiography states,³⁴ Richardson provided expert advice to Moran on Churchill not only on this occasion but also on several others.

Figure 4.

Dr John Richardson LVO.

Richardson was made a Member (fourth class) of the Royal Victorian Order (MVO) in 1943, which was reclassified as Lieutenant (LVO) on 31 December 1984, for treating King George VI for sunburn. He was knighted in 1960, was made a baronet in Macmillan's resignation honours in 1963 and was created a life peer in 1979, taking the title Baron Richardson of Lee in the County of Devon.³³

Professor Charles Rob MC (1913–2001)

At Cambridge, Rob joined the university air squadron, gained his wings and received a reserve commission in the RAF.³⁵ He went up to St Thomas' Hospital, London for his clinical training and graduated in 1937. At the outbreak of World War II, he returned from Montreal to London where he worked throughout the Blitz. When St Thomas' took over Hydestile Hospital, near Godalming, he was made resident assistant surgeon.

In April 1942, he joined the RAMC and was posted to the 1st Parachute Brigade as a surgical specialist. In November of that year, the 1st Parachute Battalion was ordered to seize the airfield at Souk el Arba and the road junction at Beja, 90 miles east of Tunis. On 20 November 1942, Beja was bombed, causing many civilian casualties, and Rob performed more than 150 operations in a makeshift hospital in a former school. While he was treating his patients, a bomb fell outside the building and Rob suffered fractures to his left tibia and kneecap. He continued to work and the next day performed 22 more operations. For this, Rob was awarded the Military Cross. After the action in Tunisia, he went on to serve in command of a field surgical unit in Sicily and Italy, rising to the rank of Lieutenant Colonel.

After the war, he returned to the surgical staff of St Thomas'. In 1950, he was appointed Professor of Surgery at St Mary's Hospital, London. He became consultant vascular surgeon to the British Army. At a meeting of the British Medical Association in 1957, discussing the control of pain in a gangrenous limb, Rob told his audience:

The best treatment for the condition is rest. The best way to rest is to sleep. The best way to get sleep is to relieve pain, and the best way to relieve pain is to give whisky – big and rapid doses up to the maximum tolerance of the individual.

His most famous patient would no doubt have approved!

In 1960, he moved to America, to take up an appointment as chairman of the department of surgery at the Strong Memorial Hospital in Rochester, New York. In 1978, he moved to East Carolina University in Greenville, North Carolina, as Professor of Surgery, and in 1983 joined the Uniformed Services University of the Health Sciences at Bethesda, near Washington DC.

Discussion

This detailed account, assembled from medical and non-medical sources, describes two further mild strokes, in April 1959 and in November 1959. In the first of these, with onset at around 8.00 p.m. on 13 April, although there was rapid improvement of acute expressive dysphasia within two hours (Churchill was able to tell Moran at 10.00 p.m. that same evening that he was worried), when Brain examined him on 15 April there was still mild nominal dysphasia. We can conclude that this was a small completed stroke rather than a transient ischaemic attack, but with minimal residual neurological deficit.

In the second episode on 17 November, Churchill lurched to the right on getting out of a car and again developed expressive dysphasia. Brain examined Churchill within hours of the onset, when he recorded expressive dysphasia and some slurring of speech. Although this had improved by 19 November, Churchill was unable to find Adenauer's name. This was probably within 24 hours of the onset, and because there is no specific comment about Churchill's speech in the days that followed, it is possible that the dysphasia had recovered fully within 24 hours and was, by definition, a transient ischaemic attack.

The first of these episodes coincided with signs of ischaemia affecting the little finger of the right hand, leading Brain to propose that both the cerebral and digital events were due to emboli arising from the aorta. However, as we have discussed already in relation to Churchill's numerous previous strokes,^{22,24–26,31} it seems at least as likely that the left cerebral ischaemia in April 1959 was also due to cerebral small vessel disease.

Furthermore, although the right little finger was noted to be pale and cold by Moran on 13 April, it was not until 7 May that Churchill noticed that the tip was black, drawing Montague Browne's attention to this and attributing the appearance to a burn sustained as a result of lighting a cigar. The lesion was apparently painless. This was some three weeks after the finger was first noticed to be blanched and cold. An embolic occlusion at the onset would have been likely to have produced a more rapid line of demarcation between viable and non-viable tissue. Thus it seems more likely that the digital ischaemia resulted from local digital artery stenosis and subsequent occlusion rather than embolism. This, in turn, throws doubt on Brain's conclusion concerning an aortic source of emboli. Rob later referred to a ‘clot’ in the finger artery, without committing himself to any more specific pathological causation. At any rate, the digital ischaemia was minor and seemed to trouble Churchill very little, resolving satisfactorily with loss of only a small amount of tissue from the tip of the finger within four months.

The small completed stroke in April 1959 and the later transient ischaemic attack in November affected the same left hemisphere area, producing expressive dysphasia. It is possible that a cardiac source of emboli could have been responsible for both episodes, but for the reasons argued above, we feel that local occlusive cerebral small vessel disease was more likely. Furthermore, neither Moran nor Brain commented on any irregularity of Churchill's pulse and specifically, there was no mention of atrial fibrillation at any time during this period of several months, during which Churchill was examined repeatedly. As we discuss below, an ECG done in January 1960 did not demonstrate atrial fibrillation. As far as we are aware, ECGs were not performed at the times of the two cerebrovascular episodes in 1959.

The episode of loss of consciousness on 22 October 1959 requires comment. We do not have a complete account of this episode, which was preceded by pallor and a sensation described by Churchill as being ‘like being turned upside down’. Churchill's posture at the start of this episode is not known for certain, but it seems likely that he was sitting in a chair and was thus semi-erect. If so, it is reasonable to assume that he probably remained seated during the period of unconsciousness, during which no convulsion occurred. Brain's account does not clarify whether Churchill was subsequently in bed when he examined him. According to Montague Browne, unconsciousness lasted not more than a few minutes and Churchill seemed dazed when he came round. When Brain arrived, probably with an hour or so of the onset, Churchill was conscious, drowsy and ‘very pale’. The pulse was normal, but there is no record of the blood pressure. Churchill had recovered sufficiently to eat his dinner later that evening.

Brain concluded at the time that this was a ‘minor epileptic attack’ and Churchill was treated with a small dose of phenytoin. However, in November 1959, following the second episode of left cerebral hemisphere ischaemia, discussed above, and ‘some confusion’ during the night of 18 November, Brain referred to the episode on 22 October as ‘syncope’.

On 28 January 1960, Brain wrote to Richardson, questioning whether there might have been a cardiac basis for this episode and possibly some other recent symptoms. Richardson performed an ECG and wrote, with some concern, explaining the finding of a ‘highly variable pacemaker’, advising avoidance of digitalis treatment. From this limited evidence, it seems possible that Churchill had developed what would now be recognised as a sick sinus syndrome, which could well have been the basis for the episode of syncope, and the later period of confusion, the latter on the basis of reduced cardiac output and an already chronically compromised cerebral circulation. Churchill's presumed sitting, rather than recumbent, posture during the attack might have been responsible for prolongation of the episode if it was indeed due to bradycardia and hypotension. On the balance of the evidence now available, syncope seems more likely than epilepsy as the explanation for this episode.

There is little doubt that Churchill's cognitive function was gradually deteriorating, most probably on the basis of increasing cerebrovascular disease. Memory impairment, boredom, periods of apathy, mood swings and loss of interest in matters at times, including in painting were all noted by Lady Churchill and others during this period, as described here. But despite this, at the age of 84, Churchill's schedule of public and private engagements was at times hectic and would have been challenging even at a much younger age. As previously, Churchill demonstrated that he could rise to the occasion and that when he really wanted to do something, he still could, most notably at this time his visit to Washington, which was clearly a great success.

Declarations

Competing Interests

None declared.

Funding

None declared.

Ethics approval

Not applicable.

Guarantors

JWS and JAV.

Contributorship

JWS and JAV wrote the paper.

Provenance

Not commissioned; peer-reviewed by David Werring.