Abstract
This article is in our series on Winston Churchill’s illnesses
Introduction
Sir Winston Churchill, then Prime Minister, suffered an acute stroke on 23 June 1953, causing a left hemiparesis, after his earlier cerebrovascular episodes occurring in 1949 and 1950–1952. Our earlier paper 1 followed Churchill’s recovery until the end of August 1953 when he had chaired his second Cabinet meeting since his stroke.
On 26 August 1953, Moran
2
wrote that, ‘It is now my job to try to persuade the P.M. to be sensible about his health. I do not look forward to the task. He is a poor listener unless you agree with him …’ Moran
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recorded that he told Churchill, We have taken a good many risks together. But now it’s my job as your doctor to warn you bluntly that if you are not willing to think out a new way of being Prime Minister, you would be wise to resign before October.
This paper will follow Churchill’s recovery from the stroke he suffered in June 1953, his holiday in the South of France, preparation for his major speech at the Conservative Party Conference in Margate on 10 October 1953, and review his return to work as Prime Minister.
Methods
Information regarding Churchill’s illness in 1953 and his recovery was available from various sources. Foremost were those of Churchill’s personal physician, Lord Moran2–7 and Sir Russell Brain, 8 the eminent neurologist whom Moran consulted on multiple occasions. By courtesy of the present Lord Moran and the Library at the Wellcome Collection, we have had access to his grandfather’s original papers regarding this illness. 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 his father’s clinical records held by the Royal College of Physicians. Lady Soames 9 (Churchill’s daughter) added further details, as did Martin Gilbert10–12 (Churchill’s main biographer), John Colville 13 (Joint Principal Private Secretary), Harold Macmillan 14 (Housing Minister and future Prime Minister), ‘Rab’ Butler 15 (Chancellor of the Exchequer) and Sgt Edmund Murray 16 (Churchill’s bodyguard).
31 August 1953: Dinner with Macmillan
On 31 August, Harold Macmillan was summoned by Churchill to dine at Chequers. Macmillan had not seen Churchill alone since he had dined with the Prime Minister on 2 July, though of course he had been present at two Cabinet meetings. But in the open, and moving, is a more severe test. His recovery has certainly been remarkable. He walks pretty well, although he still drags the left leg slightly. The arm seems recovered; the face shows no or little sign. The speech is as clear as before … On the other hand, if you happen to look towards him when he is off guard, he looks – as he is – a very old man.
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1–2 September 1953: Further discussions with Macmillan and assessment by Moran
On 1 September, Macmillan had further discussions alone with Churchill. He concluded: (a) the P.M. intends to remain P.M. as long as he can ‘face’ the Party Conference and the House of Commons. ‘Face’ means, of course, meet the physical strain. He is what he calls ‘bad on his pins’ still – but this is improving. If he maintains the progress he has made since I last saw him, he thinks he can do it. (b) His purpose is not merely (or so he protests and no doubt persuades himself) to prolong his tenure of office. He thinks he can contribute something – perhaps something vital – in the next six months or so to the world situation.
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When Churchill did get out of bed, his gait was very unsteady. 2 Moran asked Churchill at what time he had gone to bed. He admitted he had talked to Macmillan and Eden until 1.45 am. 2 Moran remonstrated with Churchill ‘It won’t do.’ Churchill responded ‘Now, Charles you must not fuss me.’ Moran 2 responded ‘Well if you want to be fit for the party meeting you are not going the right way about it. I don’t think you’ve got hold of the way Brain and I are thinking.’ Moran said he would put it on paper. ‘Oh, don’t do that,’ said Churchill peevishly, ‘I know what’s bad for me. I must get into bed by midnight.’ 2
After dinner Moran found Churchill dictating to a secretary and told Churchill that he was overtired and ought to go to bed. After a few minutes Churchill rose wearily, swayed as if he might fall and walked unsteadily to his room. 2
The following morning (2 September), Moran 2 recorded that Churchill was rested after ‘nine hours “beautiful sleep”…’ Churchill got out of bed to demonstrate to Moran how well he could walk when he gave his mind to it. Churchill had nothing on but a silk vest, so that as Moran followed him along the passage and out into the great Hall, Moran could see how much more steadily Churchill walked now that he was rested. ‘But why was I so unsteady last night? Can you explain that, Charles?’ Moran replied, ‘Probably a combination of fatigue and alcohol.’ Moran explained to Churchill why he thought alcohol affected his gait since his stroke. When Churchill was tired, alcohol made his walk very unsteady. Churchill did not think there was much in this. 2
Churchill invited Moran to see how he got into his bath. 2 Churchill stepped in, and grasping both sides of the bath, slowly sat down. Churchill then found he could turn the tap even with his left foot. Moran asked Churchill if he had noticed any difference since the stroke. Churchill hesitated then said, ‘Yes my memory is not so good. I sat between two people last night during dinner and I could not remember their names though I knew them quite well. I find it very embarrassing.’ 2
8–11 September 1953: Further assessments by Lord Moran
On 8 September, Churchill said to Moran, 2 ‘I have taken a step forward, Charles. This morning’s Cabinet was a considerable advance on the first two … Of course, I am tired now.’ (It was 3 o’clock) ‘Come and see the Chancellor.’ 2 Churchill addressed Rab Butler, ‘I thought that I was all right this morning. Did you think so?’ 2 Butler agreed that he felt the Prime Minister had ‘really done the Cabinet well’. 2
In August, The Queen had invited the Churchills to be her guests at the Doncaster Races on 11 September for the St Leger, and then to travel with her and Prince Philip on the Royal train to Scotland and to spend the weekend at Balmoral. 9 Churchill had accepted this invitation immediately, but as the date drew near, Moran and Mrs Churchill thought the expedition would be too tiring and indeed might jeopardise his recovery. 9
On 3 September, Lady Churchill wrote to her husband:
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I would like to persuade you to give up Doncaster and Balmoral.
Before Churchill left for Doncaster on 11 September, Churchill’s first public appearance since his stroke, he was assessed by Moran. Churchill was in good form. ‘I’ll give you an exhibition.’ 2 In his vest and reading jacket, Churchill proceeded to walk very carefully across the room with a ‘determined, concentrated expression on his face’. As he turned he swayed, but repeated the movement. When Churchill reached his bed, he stood on his right leg, and then on his left, when he was a little unsteady. Then he bent both knees, dropping down until he nearly sat on the floor. 2 ‘I’m pretty steady don’t you think, Charles? There is a longish walk at the station, but I think I can manage it.’ 2
Churchill then sat on the edge of the bed and picked up his slippers using his left big toe and second toe. Churchill said proudly, ‘Not everyone can do that even if they were all right.’ 2 Churchill reported that Lord Camrose had visited the day before and saw a great improvement in his condition and particularly that Churchill was less emotional. 2 Churchill arranged for Moran 2 to assess him again on his return from Balmoral on 15 September at 5 o’clock after the Cabinet meeting.
11–15 September 1953: Churchill at the St Leger and at Balmoral
At the Doncaster Races, the Queen invited Churchill to appear in the Royal Box before the crowds ‘They want you,’ Her Majesty said. 2 ‘I got as much cheering as she did,’ Churchill reported. 2 From Doncaster, Churchill travelled in the Royal Train to Balmoral (Scottish home to the Royal Family) with The Queen and Prince Philip. While Churchill was staying at Balmoral, he went to Crathie Church (which he had last visited 45 years before when he was President of the Board of Trade) and walked for three-quarters of a mile in the heather.
When Churchill got out of the aircraft on 15 September, on his return from Balmoral, Churchill inspected the guard of honour and shook hands with those present. Later that day, Moran assessed Churchill again as planned. After getting out of bed and walking across the room a little unsteadily, Churchill said to Moran, 2 ‘You see, I am a little shaky, but I am tired now; I have done a very long day … You see I am not behaving like an invalid. I am doing everything I should normally do.’
16 September–30 September 1953: Holiday at La Capponcina, Cap d’Ail
On the morning of 16 September, Churchill chaired the Cabinet and, after lunch with the Irish President, Eamon de Valera, he chaired a further Cabinet meeting. He informed Moran 2 later that day that ‘I was on top of the Cabinet business.’ The Queen had told Miss Gilliatt (Churchill’s secretary and daughter of Sir William Gilliatt, Gynaecologist to the Royal Household) that the improvement Churchill had made since she last saw him was ‘astonishing’. 2
Later on 16 September, Churchill flew to Nice to stay at Lord Beaverbrook’s (Lord Privy Seal 1943–1945 and newspaper proprietor) villa, La Capponcina at Cap d’Ail, across the bay from Monte Carlo for a recuperative holiday. Churchill was booked on the flight under the name ‘Mr Hyde’. 16 A French journalist who had discovered the flight details was barred from the flight by British European Airways at the request of Special Branch after she had sought an interview with Churchill the previous day. When her request was declined, she informed a colleague that she planned to confront the Prime Minister on the flight. British European Airways informed the journalist that there was no room on the flight. 16
Churchill was joined by Mary, his daughter, and her husband Christopher Soames and the Colvilles (John Colville [Churchill’s Joint Principal Private Secretary] and Lady Margaret Colville [née Egerton].
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Churchill’s supporting team were also present, including Jane Portal (Churchill’s secretary) and Sgt Edmund Murray (bodyguard). Murray has written that the holiday passed peacefully and uneventfully, the Old Man [Churchill] wishing to do nothing else but paint for most of the time, which meant that I was much in demand setting out his easel, paints and brushes, and discussing subjects and the state of the weather, and going out to find suitable sites.
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Churchill’s first handwritten letter while on holiday was to The Queen, the second to his wife. Madam I must express to Y[ou]r Majesty the keen pleasure which my wife and I derived from our Northern journey, and still more for the kind and gracious thought that led to its being planned. Balmoral was indeed a happy scene of youth and joy – all the brighter on the background of Premonition [the horse had won the St Leger] … I am now here in warm sunshine and the delightful villa built by the dressmaker, Molineux, with much taste and care, and I shall not often leave its garden where I am installing my painting tackle … The sense of crisis in Security and Finance which oppressed me when two years ago I was asked by your dear Father to form a Government has subsided into a tangle of detail in which there lie many difficulties, tho[ugh], if my judgement is right, no grave immediate dangers.
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My darling one, The days pass quickly & quietly. I have hardly been outside the garden, and so far have not had the energy to paint in the sunlight hours. [Somerset] Maughan who lunched yesterday said that we had left it late in the year to come here. But the climate is mild and cheerful, but for one downpour and thunderstorm. I do not think I have made much progress, tho[ugh] as usual I eat, drink & sleep well. I think a great deal about you & feel how much I love you. The kittens [Mary and Christopher Soames] are v[er]y kind to me but evidently they do not think much of my prospects. I have done the daily work and kept check on the gloomy tangle of the world, and I have dictated about 2,000 words of a possible speech for Margate in order to try & see how I can let it off when it is finished to a select audience. I still ponder on the future and don’t want to decide unless I am convinced.
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Papa is in good health – but alas, low spirits – which Chimp [Christopher] and I are unable to remedy. He feels his energy and stamina to be on the ebb tide – He is struggling to make up his mind what to do. I'm sure you know the form – you have been witnessing it all these months.
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On the whole he inclines to do so or at any rate to see what he can do. He certainly wants to, but is a little doubtful of his capacity to make long speeches. He thinks he will take the big one he has to make on October 10th, at the Conservative Conference Margate, as the test. His conversation at Cap d’Ail Dial was of little else …
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The P.M. has been in the depths of depression. He broods continually whether to give up or not. He was exhausted by Balmoral and the Cabinets and the journey. I sometimes feel he would be better engaged on his History of the English-Speaking Peoples which is already very remarkable. He greatly likes your messages telling him all the news and you are in high favour. He is preparing his speech for the Margate conference but wonders how long he can be on his pins to deliver it. He has painted one picture in tempera from his bedroom window.
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Churchill found the time to reread his book A History of the English-Speaking Peoples following comments received from Alan Hodge (editorial assistant on the project) about restructuring the book. Churchill returned from the south of France on 30 September; on the same day, he approved the final preface to the final volume (Volume 6) of his war memoirs, entitled Triumph and Tragedy. 10 This was published in the US on 30 November 1953 (60,000 copies) and in the UK on 26 April 1954 (200,000 copies). 10
1–9 October 1953: Preparation for the Conservative Party Conference
On the morning of 1 October, Churchill saw Anthony Eden (Foreign Secretary).
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Eden had been away from his post since an operation on 12 April 1953 to remove gallstones; his bile duct was damaged, leaving Eden susceptible to recurrent infections, biliary obstruction and liver failure.17,18 The meeting was to discuss both Eden’s own future and the future of Churchill’s initiative for a great-power summit.
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Eden wrote in his diary: Made it clear to W[inston] that I was ready to serve in any capacity, but he made it evident he wanted me to stay on at F[oreign] O[ffice]. Asked about plans and he said he wanted to try himself out, first in Margate and then in the House. Have some doubts as to how that will go physically.
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On 2 October, Churchill presided at the first Cabinet meeting since his return from France. That evening he wrote to Eden, It was a great pleasure to me to see you in your place today and I’m sure it was right that you should resume your high office on Monday as we have arranged … The important thing for you (and me) is to make a good impression on the Margate Conference and upon Parliament when we meet. I hope you will give first place in your thoughts to your speech next Thursday, and I should myself much like to see any draft beforehand so as to shape my remarks accordingly. I also think when Parliament meets there will have to be a Foreign Affairs debate which may well take a couple of days. In this case I would speak either the first or the second day as you wished.
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2–9 October 1953: Lord Moran’s assessments and prescription of amfetamine
Moran 7 reviewed Churchill on 2 October. Churchill told Moran 7 he had written 4000 words ‘enough for an hour’s speech’. Moran 7 recommended a 50 min speech and Churchill did not demur.
Churchill requested that Moran should prescribe a medicine to ensure that he gave a successful speech at the Conservative Party Conference on 10 October, on which his Premiership depended. ‘You must give me something to take before my speech at Margate’. 7 This was requested primarily because of ‘muzzy feelings’ in the head, 7 which followed Churchill’s second stroke on 23 June 1953. 1 As Lovell 20 has reported, Moran prescribed either Edrisal (amfetamine sulfate 2.5 mg, aspirin 160 mg, phenacetin 160 mg; ‘minors’) or Drinamyl tablets (amfetamine sulfate 5 mg and amylobarbital 32 mg; ‘majors’); in all probability it was the ‘minor’. This opinion is based on Moran’s statement in a letter to Churchill in May 1959 that, ‘so far we have used the “minors” only before speeches etc.’ 12
On 8 October, Churchill had a dress rehearsal. He ate a dozen oysters, two mouthfuls of steak and half a glass of champagne at noon. Moran 7 had prescribed a test dose of an amfetamine-containing drug for Churchill at 1 o’clock. At 2 o’clock Churchill got on his feet and gave the speech in 36 and a half minutes, without a pause. His wife sat behind him. ‘… I had not the stimulus of an audience. But I know now that I can stand that time. I feel it is alright.’ 7 The amfetamine ‘cleared my head and gave me great confidence’. 7
10 October 1953: Conservative Party Conference
Colville accompanied Churchill to Margate on 9 October. The second dose of amfetamine was administered 1 h before Churchill’s speech on 10 October. 7 Mr CP Wilson, Churchill’s otolaryngologist, was in attendance to spray his throat before the speech. 7
Churchill spoke for 50 min without losing his place or his concentration, standing throughout (Figure 1). Churchill concluded his speech by saying:
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One word personally about myself. If I stay on for the time being bearing the burden at my age it is not because of love for power or office. I have had an ample share of both. If I stay it is because I have a feeling that I may through things that have happened have an influence on what I care about above all else, the building of a sure and lasting peace. Let us then go forward together with courage and composure, with resolution and good faith to the end which all desire.
21
Sir Winston Churchill’s speech at the Conservative Party Conference 10 October 1953. Source: © Getty Images. with complete success. He had been nervous of the ordeal: his first public appearances since his stroke and a fifty minute speech at that; but personally I had no fears as he always rises to occasions. In the event one can see but little difference, as far his as his oratory went, since before his illness.
13
How would Churchill come through this ordeal? The answer was really magnificent. He spoke for 50 minutes, in the best Churchillian vein. The asides and impromptus were as good as ever. His voice seems sometimes still weak, and once or twice flagged. But this happens to everybody in the course of a long speech. Altogether, the old man has triumphed once more by sheer persistence; and the public, in and out of the conference hall, shared almost ecstatically in his triumph.
14
Winston got over the Conservative conference at Margate magnificently. After his speech he sent for me in the Green Room of the Hall and ordered me away for a week’s change and holiday. He said, ‘You have been doing too much and I am now finding my strength again’. Very few men can have got over such a paralysis in so lion-hearted a manner.
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That evening, Moran
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returned by train from Bath and called at No. 10 after 10 o’clock. He found Churchill, his wife and their daughter Diana, son-in-law Duncan Sandys and Colville listening on the radio to the account of the day’s events at Margate.
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A glance at Churchill’s face told Moran that ‘it had come off’. Churchill greeted Moran
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affectionately. Churchill said, The pill was marvellous. What was in it? Did you invent it? Now, Charles, I know you don’t like medicines, but you see what good they can do. You must have given a lot of thought to this pill. I won’t ask for it often, I promise. Perhaps once a month when I have a difficult speech in the House … I owe a great deal to you, my dear Charles.
7
Mary Soames wrote that her father’s speech was an unqualified success: The Times wrote of a ‘triumphant return to public life’; doctors, closest colleagues, loving relations – all others had been confounded. As we looked back over the harassments and anxieties of the past months, it seemed miraculous. There was no more talk, for the present, of resignation or retirement, as Winston once more took up the normal load of his work as Prime Minister. But Clementine, deeply thankful though she was at the return of his health and strength knew that he was working, if not living, on borrowed time, and that any moment he might be struck down again.
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On 20 October, Churchill went to the House of Commons for the first time since his stroke to answer Prime Minister’s questions. Before his attendance he took a ‘Moran’, presumably a ‘minor’ (amfetamine sulfate 2.5 mg, aspirin 160 mg, phenacetin 160 mg). Moran recorded that he asked Churchill whether jumping up and down for nearly a quarter of an hour answering supplementary questions tired him. ‘Oh, no, not at all; but it did make me rather short of breath … You hit the bull’s-eye with the pill.’ 5
Henry (Chips) Channon MP wrote in his diary on 20 October:
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We saw Winston’s long-awaited (and some prophesied never-to-be) return acclaimed. He seems self-confident, though a touch deaf in spite of his hearing aid, but apparently more vigorous than before. But I doubt whether he can carry on for long. The added strain of the House of Commons will be too much.
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He [Churchill] promised me that he would retire when Anthony [Eden] was fit to carry on, and now when Anthony is perfectly fit he just goes on as before … You know, Christopher [Soames MP and son-in-law] is very fond of Winston, and he has promised to tell me if his stock falls in the House of Commons. He has given me his word that I should be told if they want to get rid of him. But the trouble is, Charles, that his stock has actually risen … They cannot make it all out, Charles. They have heard all kinds of rumours about a stroke and paralysis, and now he seems in better form than ever. They described how he strode up a long corridor in the House of Commons, swinging his arms as if he was 20.
Channon described the scene:
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In the house, Winston, who had not been present at the opening of Parliament this morning, rose amidst cheers, and it was immediately clear that he was making one of the speeches of his lifetime. Brilliant, full of cunning and charm, of wit and thrusts, he poured out his Macauley-like phrases to a stilled and awed house. It was an Olympian spectacle. A supreme performance which we shall never again which we shall never see again from him or anyone else. In 18 years in this memorable house I have never heard anything like it … then he sought refuge in the smoking room and, flushed with pride, pleasure, and triumph sat there for two hours sipping brandy and acknowledging compliments. He beamed like a school-boy.
22
His performance on November 3rd was really remarkable. It was the first speech he had made in the House of Commons since May 11th. He was far more confident than Margate. Indeed, he was complete master of himself and of the House. It seems incredible that this man was struck down by a second stroke at the end of June. I would not have believed it possible at any time during the summer or even in the early autumn.
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His face was grey. I wanted him to go back to No. 10 to rest. But he was worked up and was all agog to hear what they were saying in the lobbies about his speech. ‘The house like it I think’… He emptied his glass and, rising with an effort from his chair, tottered out into the Lobby. I am getting better every day, Charles. Don’t you think it is a remarkable recovery? Have you ever seen any similar case? I take things for granted now which even a fortnight ago worried me. I still become lachrymose at times, and if some of the thoughts in my speech had occurred to me for the first time in the house I should have been tearful. But I’d been over it all before, so I wasn’t troubled.
Lord Moran (1882–1977)
Charles Wilson (Figure 2) 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.
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He treated Churchill for chest pain in December 1941 in Washington,
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for pneumonia in London in February 1943,
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for pneumonia and atrial fibrillation in Carthage in December 1943
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and for pneumonia in London in August 1944.
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Moran also treated Churchill in 1949 when he suffered his first stroke
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and was primarily responsible for managing the further episodes of cerebrovascular disease in 1950–1952
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and second stroke in 1953.
1
Lord Moran. Source: © Yousuf Karsh, Camera Press, London.
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). 23
Discussion
Summarising these events, Brain wrote: In 1953, when he was Prime Minister, he had a left hemiplegia – ‘my stroke’ – as he later called it in a speech in the House. This occurred in the latter part of June and in October he spoke at the Annual Conference of the Conservative Party. I well remember watching it on television and wondering what would happen. His stroke had not been made public and I don’t think anyone who did not know could have guessed what his condition had been four months previously. All he was left with was a slight limp with the left foot, which he called ‘a halt in my gallop’. When he had been at his worst, I was asked by Christopher Soames, what I thought the outlook was, and said, while not quite believing it, that I thought that he had a fifty percent chance of recovery. Optimism was never better justified. And when I saw him vigorously stumping up and down at Chequers, I learnt something about what a hemiplegic patient can do for himself.
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Churchill’s cognitive function and emotional state require comment. On 2 September 1953, some nine weeks after the stroke, in response to questioning by Moran, Churchill stated that he had had difficulty in remembering the names of two people he knew ‘quite well’. Many would regard this observation by Churchill, seen in the context of his large circle of friends and acquaintances and the particular circumstances, as being quite normal.
Much has been made of Churchill’s emotional state at this time. We have commented on this already 3 and have concluded that there has probably been over-diagnosis of the establishment of persistent emotional lability at that time. On the day following his speech in the House of Commons on 3 November 1953, Churchill remarked to Moran that he still became lachrymose at times, implying an increased recent tendency, perhaps following the stroke four months previously. Again, we feel it is not justifiable to read too much into this symptom as Churchill had a long history of lachrymation, with well-documented episodes occurring in 1897, 1921, 1930 and on several occasions during World War II. 29 This tendency was clearly part of Churchill’s personality, and one could speculate that it reflected his deep sense of caring and commitment to personal friends and matters he regarded to be of great importance.
In this context, the change in Churchill’s mood in the period following the stroke, observed by Moran, Churchill’s secretaries and the Labour member cited by Moran, following the great Commons speech on 3 November 1953, is insufficient to indicate a ‘pseudobulbar affect’, as suggested by some. 30 So-called pseudobulbar affect, as produced by bilateral cerebral hemisphere vascular disease, is accompanied by dysarthria, dysphagia and very commonly if not invariably, some degree of cognitive impairment. These additional features were not present in Churchill. It seems at least equally likely that the emotional and behavioural change resulted from a shift in Churchill’s outlook, on the background of his long-standing characteristic pattern of emotional response to certain situations, following the further reminder of his own mortality, leading to a less combative, more reflective and more benign outlook.
Churchill complained of a ‘muzzy head’, as recorded by Moran before the Conservative Conference party speech on 10 October, but he had reported this intermittent symptom some three years previously. 3 Again, it is difficult to put a causative interpretation on this symptom, without further description. It is perhaps too easy to attribute it to the transient effects of either alcohol intoxication or hangover in a habitual drinker. Churchill reported it to Moran again in 1953, possibly partly in order to get Moran to prescribe a stimulant to be taken before his speech. It would be facile to ascribe Churchill’s barnstorming and much admired performance at the Conference to the amfetamine prescribed. Moran’s approach to Churchill’s request was admirably cautious: a test dose, probably of amfetamine sulfate 2.5 mg, given on 8 October 1953, accompanied by oysters, steak and a little champagne, led to an excellent dress rehearsal of the speech, and does not appear to have caused adverse effects. It was probably this dose that Churchill took before giving the Conference speech on 10 October 1953.
The regular administration of amfetamines shortly after stroke, at much higher doses than those employed by Moran, has not been shown to be of benefit in improving motor function, disability or cognition.31,32 However, Moran’s use of amfetamine sulfate 2.5 mg as a single dose before major speeches seems to have been successful in clearing Churchill’s ‘muzzy head’ and giving him confidence. Evidence for the effectiveness of single low dose treatment of amfetamine on cognitive function in individuals of Churchill’s age is lacking. Cognitive improvement has been demonstrated in much younger individuals with single doses of amfetamine some seven fold larger than the dose in Churchill’s ‘minors’. 33 It is also worth noting that in a recent double-blind crossover trial in healthy young individuals, no significant cognitive enhancement by amfetamine was demonstrated, though participants believed their performance had improved, perhaps reflecting in part the difficulty of adequate blinding in such a study. 34
The accounts of Churchill’s scintillating performances at the Conservative Party Conference on 10 October 1953 and in the House of Commons on 3 November 1953, described here, can leave no doubt that he continued to be capable of functioning cognitively at an extremely high level. We conclude that it is extremely unlikely these outstanding presentations, from an accomplished orator, were attributable to amfetamine treatment.
Although the use of daily aspirin would be expected to be of benefit in the secondary prevention of stroke, the administration of aspirin 160 mg stat as a constituent of a ‘minor’ would not have been of benefit except in acute ischaemic stroke.35,36
Following his stroke in June 1953, Churchill undoubtedly recognised that he was teetering on the brink, and knew that his days in high office were numbered. Nevertheless, with his characteristic sense of duty, combined with intellectual and linguistic brilliance, style, panache and the ability to rise to the occasion, he confounded the less optimistic forecasts of his medical advisers, family and colleagues.
Footnotes
Declarations
Ethics approval
Not applicable.