April 24, 2013

FINEST HOUR 150, SPRING 2011

BY JOHN H. MATHER MD

Dr. Mather, a past governor of The Churchill Centre, has spent over two decades researching Sir Winston’s medical history. This article is adapted and updated from his paper in Churchill Proceedings 1996-97

There is much to be learned from his tenacious spirit, well into old age. Yet, as in so many other areas, Churchill was one of a kind. 

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 Speaking of the imperiled British race in World War II, Churchill said, “We have not journeyed all this way across the centuries, across the oceans, across the mountains, across the prairies, because we are made of sugar candy.” That famous line typifies our abiding image of the leader who galvanized free peoples with his famous maxims: never stop, never weary, never give in. He summoned the call to hold fast and never to despair. But we give little thought to where he found his strength and energy.

Was Churchill immune from the frailties that accompany advancing age? He was not. Yet, he did seem to possess innate physical, mental and spiritual strengths which he was able to call upon at will. His physical resilience and mental hardiness did not desert him until his eighties.

Churchill’s first quarter century had been marked by numerous illnesses and accidents, some of them close calls, none enough to incapacitate him: pneumonia, a concussion, appendicitis, a near-fatal encounter with a car, a dislocated shoulder. But the period following his first premiership was the most significant, medically as well as politically. The physical and mental stress of World War II, causing several forced rests from illness, mark important transition periods.

THE WAR YEARS (AGE 65 TO 70)

At the request of the Cabinet, Dr. Charles Wilson (Lord Moran from 1943), devoted himself to looking after Churchill’s health. Highly dedicated, Moran was willing to do whatever he could to maintain and restore his patient. At an age when most men are happily retired, Churchill seemed to be not only indomitable but indefatigable. He had enthusiastically assumed the greatest job of his life. He maintained a tremendous work schedule with verve, relish, and zest which might have exhausted a man of his age, and indeed wore out some younger colleagues. During the war he may have suffered a heart attack, and had several bouts of pneumonia which in earlier days would surely have disabled or killed him.

With America in the war after Pearl Harbor, Churchill felt the need to consult urgently with Roosevelt, and arrived in Washington shortly before Christmas 1941. OnDecember 27th Moran, at his hotel, was summoned to his patient at the White House. Churchill explained that he had experienced some shortness of breath with a dull pain over the left side of his chest and down his left arm, but that it had passed. Moran examined his patient, finding little amiss, but was convinced that Churchill had experienced either a heart attack or coronary insufficiency (angina). The doctor then made what may have been the most important decision of his professional career.

Charles Wilson was acutely aware of the political and military arguments against doing what was clinically orthodox: hospitalizing his patient, confirming his diagnosis with an electrocardiogram, and calling in a heart specialist. Impossible! Yet, should Churchill have a second and perhaps fatal coronary attack he might be held responsible.

But Wilson opted to refrain from conventional therapy. He simply warned his famous patient to slow down, to do no more than was absolutely necessary. Such were Churchill’s recuperative powers that he survived this apparent first warning signal that his circulatory system was beginning to fail. Later Churchill was seen in London by a cardiologist, Sir John Parkinson, who determined that the PM had possibly had a brief episode of angina, and proposed no special treatment.

An alternative and reasonable medical conclusion is that Churchill’s pain was no more than a muscle spasm, or a strain of the bony and cartilaginous chest wall. This is suggested by the lack of adverse effects—Churchill soon resumed his very fast pace, with effective speeches in Washington and Ottawa. It is usual for someone who experiences an episode of angina to have additional attacks when he resumes stressful activity. Churchill did not, and had no such attack in later life.

Churchill’s next medical episodes were not so private. In North Africa in February 1943 he had a mild pneumonia associated with a cold, which he was able to shrug off quickly. Later that year Churchill flew from London to North Africa to meet Roosevelt and their military advisers. In mid-December 1943 at Tunis, he developed a fever. Wilson, now Lord Moran, suspecting trouble, sent for nurses, a pathologist and x-ray equipment. Pneumonia was diagnosed and treatment was promptly started. One of the sulfa drugs (May and Baker or “M&B”) was administered. It took a little more than a week for the inflammation of his lungs to begin subsiding. However, there were several episodes of cardiac fibrillation, which sometimes accompanies pneumonia. To combat this and strengthen the heart action, Moran briefly administered digitalis. This illness seriously debilitated Churchill.

Because of his public location and the need to bring in medical assistance, news of Churchill’s indisposition could not be suppressed; press bulletins were issued and the nervous Cabinet reassured. But the combination of sulfa drugs, his own resilience, and excellent medical and nursing care enabled Churchill to weather the storm. Fortunately, major decisions on battle plans were already well advanced and his illness had no effect on the war’s progress.

Late in August 1944, a tired Churchill returned from conferences and inspections in Italy running a high temperature. A case of pneumonia was again diagnosed, though described as a “mild one” by Moran. Churchill was confined to bed for a few days, received newly developed penicillin, and continued to work, preparing for another trip to Washington and to Quebec for the second conference there.

Before Quebec in September, 1944, American Ambassador to Britain Gilbert Winant informed Roosevelt adviser Harry Hopkins that Churchill had been ill again. His temperature had returned to normal, Winant noted, but each journey had taken its toll, and the frequency of illness had increased.

The effects of alcohol and drugs on Churchill’s mental capacity remain a matter for debate. The image of him as a heavy drinker persists, thanks in part to his frequently expressed taste for whisky, wine, champagne and brandy. During World War II his physician provided him with various medications such as “reds” (barbiturate capsules) for insomnia, which were also used for his afternoon naps. Several visiting military officers told of Churchill, awakened early into a nap, being wobbly and apparently the worse for alcohol. More likely, what they observed were the continuing effects of barbiturates.

Despite his reputation for indefatigability, Churchill was noticeably beginning to fail. After each recovery from his three wartime pneumonias, he pursued a grueling schedule with few periods of relaxation, apart from his regular afternoon naps. He used sleeping pills frequently, and seemed to have increasing dif- ficulty remembering that he was using them.

During periods of tension Churchill often had transitory elevations of temperature, but these seldom lasted more than a day. Awakening in the morning, he always took his own temperature, indicating his preoccupation with his health, a mild form of hypochondria. One morning he called Moran after reading his temperature at 106 degrees. Moran said to double check the reading because if it were accurate he should be dead, and asked if the PM was speaking from the grave. The reading proved to be 96!

DEFYING THE ODDS (AGE 70 TO 80)

After Churchill left office in July 1945, Moran did his best to make his patient take a prolonged rest. Churchill enjoyed a holiday in Italy, painting on the shores of Lake Como. Though shocked by Labour’s election victory, he avoided depression through his devotion to painting and the family that surrounded him.

His physician had good reason for believing Churchill was exhausted, even unable at times to concentrate. WSC, he wrote, was little interested in politics, and Churchill himself speculated on whether his energy would ever return.

On 5 September 1945, Churchill summoned Moran to look at a swelling in his groin which proved to be a “rupture.” When he was a schoolboy a surgeon had warned him about the possibility of a hernia. A truss proved only a temporary palliative. His surgeon Sir Thomas Dunhill insisted that operating was necessary, but a reluctant Churchill put it off until 11 June 1947.

Churchill’s susceptibility to pneumonia, coupled with Moran’s observation of hardening blood vessels in the retinal arteries and a “sluggish” circulation, made the surgery risky, so the operation was not without difficulties. Normally a 20-minute procedure, it took two hours because of a large mass of adhesions in the abdominal cavity, the aftermath of a 1922 appendectomy. Churchill’s convalescence was prolonged. He had begun to write his massive memoirs of World War II, but he did not work at it continuously. When Britain’s weather began to turn cold, Churchill went south to the more balmy climate of Marrakesh, Morocco.

On 24 August 1949, Moran was called from London to Lord Beaverbrook’s villa in Monte Carlo where a holidaying Churchill needed him. Playing cards at 2 am, he had noticed a cramp in his right leg and right arm, still present when Moran arrived the next morning. Churchill also seemed to have some difficulty in writing, but no slurring of speech was noted. As his physician proceeded with his examination, Churchill asked if he had a stroke. Moran replied that most think of a stroke as a burst artery but that Churchill had only had a small blockage of a small artery— the beginning of his doctor’s downplaying of WSC’s circulation problems. In fact it was a small stroke, involving structure of the left side of the brain but no major artery, since speech was not affected. (See “Churchill’s Dagger,” by Beaverbrook colleague Michael Wardell, FH 87, Summer 1995.)

Systematic cover-ups followed after this first in a series of strokes which ultimately ended Churchill’s life. Despite apparent recovery, Churchill’s blood vessels had become “old” and later strokes progressed to the severely debilitating syndrome known as multi-infarct “vascular” dementia.

In early 1950, just five months later, Churchill had a sensation of hazy vision and experienced difficulty reading: a transient episode, but consistent with poor circulation in the blood vessels that reach the posterior brain. Churchill later complained of stiffness in his shoulders and neck, which suggests a partial or total occlusion of these vessels. If there is truth to the old canard that a man is “as old as his arteries,” then Winston Churchill was an “old man” as he began to write his wartime memoirs.

Victory in the General Election of 26 October 1951 meant no respite for Churchill, who was again Prime Minister with an apparent new lease on life. Yet on 21 February 1952, he told Moran he was having difficulty remembering words he wanted to express. This aphasia was transitory but is evidence of a more generalized insufficiency of the blood supplying a large area of the lateral portion of the left brain. These episodes were not true strokes but transient ischemic attacks (TIAs) where the circulation is briefly reduced and then returns.

In January 1953, just before the inauguration of Eisenhower as U.S. President, Churchill crossed the Atlantic to see his old comrade in arms. Another meeting was planned for the summer in Bermuda, but it did not materialize. On 23 June, following a London dinner for the Prime Minister of Italy, he had difficulty rising from his chair and some thought he had had a bit too much alcohol. Moran was called, but by the time he arrived, Churchill was at home in bed. He carefully examined his patient, who had slurred speech and an unsteady gait. It was Churchill’s second major stroke.

By now the Prime Minister had become increasingly dependent on drugs. Typically, he named his tablets: “majors, minors, reds, greens,” and “Lord Morans.” He sometimes took these medications, especially sedatives and tranquilizers, with alcohol, which, being a central nervous system depressant, can accentuate their effects, producing lapses of memory and confusion. Though beset with various levels of insomnia, Churchill had previously fought off depression by intense exercises such as hunting, polo and swimming, and through writing, bricklaying and painting. His creative impulses probably gave him an extended political life. His desire for bright and sunny climes—highly suggestive of a variety of depression known as Seasonal Affective Disorder or SAD Syndrome—increased in his later years, when he spent long months in the South of France. Some of these trips were taken on very short notice, when London was dreary and damp. But in later years it was much harder for him to escape his depressive predisposition, owing to the onset ofan impaired blood supply to his brain.

His driving desire still to make a contribution forced Churchill to demonstrate a public image of vigor and robust health. His verbal skills had been honed over a lifetime of oratory. Meticulous preparation, bolstered by medical stimulants, allowed him to demonstrate a vitality at Cabinet meetings and Conservative Party conferences, such as Margate in October 1953. While cerebral arteriosclerosis was probably the principal cause of Churchill’s progressive dementia, even the modest use of alcohol and drugs ironically hastened his decline and magnified his problems with memory and recall.

“NOTHING IN THE END” (AGE 80 TO 90)

Convinced finally that his long-desired hope for a summit and “settlement” with the Russians could not happen during his tenure, Churchill retired as Prime Minister in April 1955, but continued to work on his final multi-volume work, A History of the English-Speaking Peoples, and to seek the sun in the South of France. In April 1958, he had an episode of dizziness and fell. He developed pneumonia and pleurisy, and took several weeks to recover.

In May 1959 he made his penultimate trip to the United States, spending much of the time with Eisenhower, who lamented, “You should have seen him in his prime.” He fell asleep on the flight home. Awakening as the aircraft landed, he noticed a throbbing pain in his right little finger. Moran referred him to Professor Charles Rob, a cardiovascular surgeon at St. Mary’s Hospital and Medical School. Somehow, Churchill had crushed the blood supply to the finger, possibly from a ring acting as a tourniquet, and eventually he lost its tip to dry gangrene. Here was further evidence of the fragility of his vascular system and the generally advanced state of his arteriosclerotic arteries. Shortly afterward, he stopped painting.

He continued his trips to the South of France and on 28 June 1962 at a hotel close to Lord Beaverbrook’s Monte Carlo villa, he slipped on a rug and fell heavily on his right hip. The x-ray taken in his hotel room showed a broken upper femur. He was transferred to Monaco Hospital, where a large plaster cast was applied, extending from his chest down his right leg, which allowed him to be flown to England. He was admitted to the Middlesex Hospital where his right hip was pinned by Philip Newman, Britain’s leading orthopedic specialist for this condition. He was discharged fifty-five days later after a prolonged recovery period, having given the medical and nursing staff a difficult time due to his intermittent confusion and irritability.

This hip fracture is not uncommon in the elderly after a fall. But notably, Churchill survived the surgery, the anesthetic and the rehabilitation without any major problems such a thrombosis in his legs from poor circulation.

Over the next two and a half years Churchill showed less and less interest in life, retiring as a Member of Parliament 28 July 1964 after a phenomenal political career that stretched back over sixty years. After another transient episode of impaired blood supply to the brain in December, Churchill had a massive stroke and slipped into a coma. He died on 24 January 1965.

THE EFFECTS OF AGING ON PERFORMANCE

While the progression of dementia was probably faintly understood by Churchill, his behavior over these final years was entirely consistent with a continuing diminution of mental powers. His prescient “Sinews of Peace” speech, at Fulton in March 1946, had galvanized him with the conviction that he could, through his own brand of personal diplomacy, achieve his final goal of world peace. Alas, he could not get Eisenhower— or, despite a few false hopes, the Russians—to the conference table, and the failure weighed deeply: “I have worked very hard and achieved a great deal,” he said to his private secretary, “only to achieve nothing in the end.”

From the 1930s, unlike his earlier career, Churchill’s focus was heavily devoted to international affairs. In later life he had little time for difficult and intractable domestic and economic issues. His ability to concentrate for extended periods of time, to assimilate data and sift through critical background information, was gradually lost. When his col leagues complained he sometimes regarded them as disloyal, and this led increasingly to episodes of melancholy and soul-searching.

While much of his decline was hidden from the public, Churchill’s lowering interest in government led to pressure to resign. While some saw his continuing prestige as an advantage for the Tory Party, others wanted him “gracefully” to retire. When he resisted, they backed off but remained pessimistic. When it was thought that he was prepared to go in the spring of 1953, his heir-apparent, Anthony Eden, fell seriously ill. This emboldened Churchill for new attempts at detente with Russia, but no sooner had he begun to pursue them than a major stroke saw his colleagues quietly assume many of his functions. (See Terry Reardon’s preceding article.)

Throughout these years of frustration and decline, Churchill’s family and friends never wavered. His wife, always anxious for him and their family life, maintained a strong partnership and attempted, sometimes with spectacular lack of success, to ensure that he ate properly, rested well, and had convivial company.

A representative conversation occurred at Chartwell when Sir John Anderson, WSC’s wartime Home Secretary and deviser of the Anderson Shelter, admitted to Churchill that he had been “vegetating”—staying in bed late.

Churchill: “What time do you have breakfast, and do you get up?”
Anderson: “Yes, I always get up to breakfast.”
Churchill: “Are you shaved and booted?”
Anderson: “Yes, I’m shaved and booted and ready to go out.”
Churchill: “What do you eat for breakfast?”
Anderson: “Twice a week I have bacon—the other days porridge.”

Ava, Lady Anderson, widow of the late Ralph Wigram, the foreign office official who had helped Churchill learn of German rearmament: “Yes, porridge with salt.”
Churchill: “Good God.”
Ava: “What do you have for breakfast, Winston?”
Churchill: “An egg often—sometimes a fried sole—some cold chicken and cold ham with coffee. I always have it in bed—never with Clemmie. I tried that once or twice but no marriage could last if you breakfast together and it nearly wrecked mine—so never again.”

Aside from a glimpse of the care his wife took of him, this is an example of Churchill’s continued humor and wit well into old age. The role of laughter and fun in his life went a long way towards his overall good health and longevity. There are many stories which show that he did not take himself too seriously, and often poked fun at himself, along with his friends and political enemies.

Winston Churchill stands out among statesmen, yet despite his towering image, from a medical standpoint he was as human as any of us. Indeed if he had lived and died simply as a “mere mortal,” his medical problems would be of interest to no one except perhaps his doctor. At the sunset of his life he was medically impaired with vascular insufficiency; yet there can be little doubt about his essential physical resilience and mental hardiness. There is much to be learned—and emulated—from his tenacious spirit well into old age; yet, as in so many other areas, Winston Churchill was one of a kind.