Abstract
This article is in our series on Winston Churchill's illnesses
Introduction
Sir Winston and Lady Churchill celebrated their 48th wedding anniversary on 12 September 1956. Four days later, Lord Moran
1
visited the Churchills and ‘found Winston playing bezique with Clemmie, a happy picture’. Churchill had planned to revisit La Pausa, a villa in Roquebrune-Cap-Martin, in the Alpes-Maritimes, for a working holiday, for some time. Churchill had confirmed to his hostess on 4 September that on Monday, therefore, the 17th of September, I will re-visit Pausaland [Churchill's name for La Pausa]. I hope I may bring Montague Browne [Private Secretary] with me, and I shall indeed look forward to finding you and Emery safely ensconced in the villa. The only thing that might alter my plans will be WAR [this was at the time of the Suez crisis]. In that case I should have to attend Parliament, and whatever sittings may be necessary.
2
Churchill had suffered his first stroke in 1949, 3 further cerebrovascular episodes in 1950–1952, 4 a second stroke in 1953 5 from which he recovered, 6 and a cerebellar stroke in June 1955, again with excellent recovery. 7 We describe a left hemisphere stroke suffered by Churchill on 20 October 1956 in the South of France.
Methods
Information regarding Churchill's stroke in 1956 was available from various sources. Foremost were those of Churchill's personal physician, Lord Moran 1 and Sir Russell Brain Bt, the eminent neurologist whom Moran consulted on multiple occasions regarding Churchill. 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. Martin Gilbert (Churchill's main biographer),8,9 Anthony Montague Browne (Private Secretary)10,11 and Sergeant Edmund Murray (Churchill's bodyguard)12,13 added further important details, as did Churchill's daughter, Mary (Lady Soames).14,15
La Pausa
The villa, some 6 miles east of Monte Carlo, stands high on the shoulder of the mountainside above Cap Martin and commands sensational views towards Menton on one side and Monte Carlo on the other. 14 It 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 once again.
Murray,
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Churchill's bodyguard, has explained why Churchill found the villa so attractive, though he had some personal reservations: Its setting, in green and well-tended gardens full of Mediterranean flowers and lavender, shaded by olive trees, was quite superb. It was perched several hundred feet above sea-level, adjacent to the mediaeval village of Roquebrune, a noted tourist attraction, with to the east a fine view towards the Italian mountains … it was a house furnished with an eye to taste of the high order, but, despite this and the Rodin statues and the highly valuable paintings, a sense of coldness, or soullessness was always present, to me, at least.
17 September–19 October 1956: Working holiday
Churchill wrote to Lord Cherwell on 19 September telling him ‘the weather is beautiful-sunny yet cool’ and inviting him to come to La Pausa.
8
Churchill also wrote to his wife on the same day, Dr Roberts [Roberts was to become Churchill's regular doctor in the South of France] has examined me and finds me in very good health. I have started resolutely on the Baruch hearing aid, and am getting very used to wearing it. I can even hear the bird talk when I am alone.
8
Here all is peaceful and I am glad to say that the whole book team [this included Alan Hodge, Editor of History Today, and Maurice Shock (see below)] is hard at work. I am wearing Bernie's [Baruch] hearing aid every day when in company and I find it a great relief. It is complete and in perfect order and I think I should get used to the habit of using it. I quite agree that it is a necessity. I have not tried any painting yet, although there has been plenty of sunlight … I had a letter from Anthony [Eden, Prime Minister] thanking me for the cigars, and incidentally showing a robust spirit. I am so glad they are going to the Security Council immediately … I must say I am very glad the burden does not rest on me … I am very glad with the way the book [History of the English-Speaking Peoples] is getting on, and I think you will be both pleased and surprised at the way the work is going.
15
… I have done a great deal of work at the book and not painted yet. Mr Shock [Maurice Shock, Politics Fellow, University College, Oxford], who brings this letter this afternoon, has done me a very good note on the first Gladstone and Disraeli chapter, and I look forward to receiving another fertile wodge in a fortnight … There are only three more chapters in the last book to be composed after which there will be only bits and pieces of final revise. I am keeping the printers and my whole outfit very busy. The Prof [Lord Cherwell] arrived last night. It was nice of him to face the journey …
8
Churchill wrote again to his wife on 15 October. The time has passed v[er]y quickly & I am now within a week of coming home – five weeks to a day it will be. It has been a v[er]y pleasant spell, quiet and peaceful. I wish you had come for a week or so … I have begun painting one picture – a large long one of the view to the Eastward; and have progressed so well that after three days it is still an attraction to me … I hope the Queen was not too vexed at being beaten. It was just as well I wasn't there as there w[oul]d have been embarrassing cheers and counter-cheers.
8
20 October 1956: Collapse in the bathroom
Churchill's detective, Sgt Murray,
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recalled: At about 8:30 am, Sir Winston got out of bed to go to the bathroom. A few minutes later, the male nurse who had been on hand since his illness a year or more earlier, went into the bathroom and found him sitting on the floor, blue in the face and unable to move. The nurse quickly got him back into bed, piled hot water bottles round him and administered the prescribed treatment [nikethamide] decided on by his doctor, Lord Moran, at the time of the earlier stroke. The nurse immediately telephoned Dr David Roberts the English doctor who attended Lord Beaverbrook when he was at La Capponcina, and who was also one of the doctors in attendance on Prince Rainier and his family in Monaco. Sir Winston very quickly returned to his usual self, and when I went in to see him I found him sitting up in bed, a grave look on his face, but reasonably well.
On 20 October, Moran was staying with the Lieutenant Governor of the Isle of Man, Sir Ambrose Dundas Flux Dundas. Dundas told Moran, ‘France wants you on the telephone.’ Moran
1
could not hear what Churchill said and so spoke with Roberts. Roberts was guarded on the telephone, but I gathered Winston had some kind of black-out this morning. No, he did not think it was necessary for me to see him. He was already much better. All day I have had a feeling of disquiet. When Winston telephoned, did he want to see me? As you will know from my telephone conversation with you, Sir Winston has had an attack of cerebral spasm. During the attack he lost the use of right leg, right arm, left side of face and Broca's area [the area of cerebral motor cortex responsible for the initiation and control of speech]. After an injection of 3 cc's [mL] of Coramine [nikethamide] the signs of spasticity passed off. I put him on a fat-diminished diet, vitamin pp [niacin, vitamin B3], papaverine and aminophylline. He has made very good progress, and has even been out in the garden. Today I have taken blood tests for cholesterol, urea and coagulation time, and I shall forward the results of these tests to you with Sir Winston on his return.
17
I hear from France that Winston has had an attack of cerebral spasm. During the attack he lost the use of his right leg, right arm, left side of face and Broca's area. It appears that he fell down and lost consciousness for about 20 minutes.
21–28 October 1956: Recovery
Murray
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records the challenges during Churchill's recovery: Life with the Old Man himself was almost as difficult, because, frankly he was not cut out to be an ideal patient. Luckily his diet was only slightly restricted by his illness, but at lunchtime on the first day, when his doctor was just playing safe, his meal consisted of nothing but a piece of cheese, and he reacted strongly. ‘Only cheese for lunch. Only cheese for lunch’.
The stroke delayed Churchill's return to England by more than a week, and the illness drew the inevitable reaction from the press all over the world. Murray
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wrote, Life became tiresome as we contended with hordes of international reporters and constantly ringing telephones. I did my best to cope with my side, but it was impossible to stop bits of idle gossip, much of it incorrect, appearing in the newspapers. Sir Winston Churchill who is on holiday on the Riviera has a slight cold but is going on well, it was learnt at his London home yesterday. Lady Churchill is flying out to join him today. It is expected that she will travel from London Airport. Sir Winston Churchill has been on the Riviera for a month. He is staying at Roquebrune, Cap Martin. According to messages from Reuters and Associated Press on Saturday [20 October], he cancelled a booking to fly back to England today. She said her visit was connected with her husband's health and she did not know yet how long she would stay. Sir Winston Churchill has suffered from a chill since Friday, but today he was reported to be ‘very well’.
19
On 20 October he had suffered a stroke, or more accurately, perhaps, a ‘spasm’, in the South of France, where he was staying with Wendy and Emery Reves. He recovered sufficiently rapidly to travel home a few days later, and just four days after the incident he was walking in the garden. He seemed to have these ‘spasms’, minor strokes in effect, as other people catch colds, and to suffer extraordinary little harm from them, though one must suppose that the cumulative effect, after the stroke of 1949 and the much more severe one in 1953, must have been considerable. Certainly on this occasion WSC's intellectual powers seemed none the worse and his interest in the development of the Suez crisis remained lively.
28 October 1956: Return to London
The Churchills returned to London on 28 October in an Elizabethan airliner on a scheduled British European Airways flight. ‘Sir Winston Churchill … looked well when he arrived at London Airport. He was driven to his London home.’ 20
1 November 1956: Assessment by Sir Russell Brain
Brain recorded that Churchill was seen with Moran on 1 November, though Moran did not record this assessment.
1
Twelve days ago while in the South of France, he got up to go to the lavatory, found his right leg was weak and fell down, and does not remember anything more for twenty minutes. He thinks he was alright after this, but Dr Roberts, who saw him, reports that he had loss of speech, and weakness of the right arm and leg. He also mentions weakness of the left face, but that is probably a relic of the previous attacks. He complains of no symptoms now. I thought he was slightly dysarthric, but there was no weakness of the face or tongue or limbs. Both plantars were extensor. It was difficult to feel any carotid pulse on either side of the neck.
2–4 November: Return to political activity
Montague Browne
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has written, I was the more surprised when, on 2 November, WSC said that he felt too tired to draft a public message of support for the Government's action over Suez. The Private Office at Number 10 had asked me to convey this request from the Prime Minister. Did WSC not wish to support the operation? Yes, he said, he definitely did want to support it. Would I please draft in that sense? My dear Winston, I cannot thank you enough for your wonderful message. It has had an enormous effect, and I am sure that in the US it will have an even greater influence … These are tough days – but the alternative was a slow bleeding to death.
10
Since our return, Winston seems really on the whole well. He is being very good about the diet. I want you to know the gratitude I feel for all you have done for him, not only for your professional skill, but for your infinite kindness and patience.
21
4 November 1956: Assessment by Lord Moran
In an entry dated 4 November, Moran
1
records that Churchill was still breakfasting at Chartwell when he entered his room, though it was after 10 o’clock. Churchill began a sentence then lost the thread. Churchill said, ‘I find it difficult to write letters. I mean to compose them. I find it difficult to do anything.’ Moran recorded, I noticed that he was drowsy and apathetic. He gazed at me blankly, so that I was not sure whether he had heard what I had said, but when I told him it looked as if Dulles had cancer he woke up.
Moran
1
discussed Churchill with his daughter and son-in-law, Mary and Christopher Soames. Mary Soames said, ‘I know there is nothing to be done.’ She had noticed a marked deterioration in her father when he came back from France. What I find sad, Charles, is that he doesn't seem interested in anything any longer. He doesn't want to do things … Of course, he varies a good deal. Last night, though we all bellowed, it seemed as if he heard nothing. And then – not very often now – he will perk up and for a short time take an interest in the conversation.
1
Pretty soon he [Churchill] was back in action, making his way regularly to his special seat in the House of Commons, immediately below the Treasury Bench, after question time each day. But despite this activity, his latest stroke had thrown a shadow of doubt across his path, as I realised soon afterwards from an incident at Chartwell.
Shortly after this Churchill was having an extension to his studio built. Murray found Churchill placing a foot on the first rung of the ladder the builders were using. Murray told Churchill, ‘you can't go up there, Sir Winston’. Churchill remonstrated with Murray. ‘You know this is not the first time I have gone up a ladder.’ Without further ado Churchill began to ascend slowly but with great determination. At the top he walked around a narrow plank and complimented the workmen on the way they were tackling the job. For the next two days Churchill repeated his climb to inspect the progress of his new building. 13
Churchill's doctors
Sir Russell Brain Bt (1895–1966)
Brain was a Consultant Physician at the (then) London Hospital and the Maida Vale Hospital for Nervous Diseases. Brain 22 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. He was President of the Royal College of Physicians from 1950 to 1956, succeeding Lord Moran.23,24 Brain had assessed Churchill previously at Moran's request on 5 October 1949, 15 October 1949, and 8 December 1949 following Churchill's first stroke 3 and on multiple occasions in 1950–1952 for further episodes of cerebrovascular disease 24 and in June 1953 after Churchill's second stroke. 5
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 (1882–1977)
Charles Wilson (Figure 1) 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. 25 He treated Churchill for chest pain in December 1941 in Washington, 26 for pneumonia in London in February 1943, 27 for pneumonia and atrial fibrillation in Carthage in December 1943, 28 and for pneumonia in London in August 1944. 27 Moran also treated Churchill in 1949 when he suffered his first stroke 3 and was primarily responsible for managing the further episodes of cerebrovascular disease in 1950–1952, 4 his second stroke in 19535 and Churchill's recovery from it 6 and the cerebellar infarction in June 1955, again with an excellent recovery. 7
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). 26
Dr Dafydd (‘David’) Myrddin Roberts (1906–1977)
Roberts qualified from Cardiff in 1933 and was commissioned on 7 February 1941 as Flying Officer, Medical Branch RAF Volunteer Reserve, with home postings. He relinquished his commission on 5 January 1943 because of ill health. 29 Gilbert 9 states that he had been invalided out of the Royal Air Force with a 90% disability pension. Roberts moved to the Alpes Maritime in 1953 and practised medicine in Monte Carlo, with the permission of the French authorities on condition that he treated only British patients. 9 Roberts continued to practice in Monaco at Le Victoria, and as Physician at Princess Grace Hospital until the 1970s when he returned to England. 29 He died on 28 July 1977 at the Querns Hospital, Cirencester of bronchopneumonia, Parkinsonism, and cerebrovascular disease. 29
His first professional contact with Churchill was in 1956. Mary Soames 15 quotes the letter of 3 March 1956 from her father to her mother: ‘Nursing a sore throat with aid of Dr Roberts who I think is a good man (I had him last time you will remember).’ The ‘last time’ refers to an earlier visit in January 1956, although there is no record of that attendance. Thereafter, Roberts looked after Churchill whenever he stayed on the Riviera and was responsible for Churchill's care when he developed pneumonia, pleurisy, and jaundice in 1958, 30 as he was on this occasion. Montague Browne 11 described Roberts as ‘conscientious and prompt’. Mary Soames 15 wrote: ‘Both WSC and CSC liked him very much.’
Discussion
Churchill suffered either a further left cerebral hemisphere stroke on 20 October 1956 consisting of a right hemiparesis and dysphasia, or a focal epileptic fit. By the time Roberts saw Churchill on the day of the onset of this stroke, his dysphasia had largely or completely resolved. When Brain saw Churchill on 1 November, he recorded that the mild weakness of the left side of the face noted by Roberts was probably a residual sign of the previous acute left hemiparesis, though this sign was not found by Brain in his own examination. Indeed, Brain found no weakness, but did record bilateral extensor plantar responses. Improvement from this cerebral event was rapid, and although it was recorded by Murray that, for a time between 21 and 28 October, Churchill needed to be carried down the stairs, he was walking independently in the garden four days following the acute onset.
There was a period of 20 min following the acute ictus during which Churchill apparently could not remember events, and this was interpreted by Moran as a period of ‘unconsciousness’. However, amnesia for events following an acute event of this sort, in the absence of any objective examination findings, does not necessarily equate to loss of consciousness. Piecing together the sequence of events now from the evidence available, it seems most likely that Churchill suffered an acute small left cerebral hemisphere cortical or subcortical ischaemic attack, with rapid though incomplete resolution within 24 hours, thus probably amounting to a small completed stroke. Infarction due to thrombosis in situ, in keeping with small vessel disease, was the likely pathology. As in some of Churchill's previous cerebrovascular episodes, cerebral arterial ‘spasm’ was invoked by his doctors, but this mechanism would not be today's preferred likely mechanism.
An alternative explanation of the event is that Churchill suffered a focal epileptic fit, with a subsequent Todd's paresis. However, Churchill's mobility was affected for several days, evidenced by the need to carry him down the stairs, and this would be in favour of a small completed stroke rather than a focal fit. Against this were the 20-minute period of amnesia and the rapid initial recovery. It is interesting that Brain did not commit himself to a diagnosis of this episode.
At any rate, Churchill's recovery was rapid, leaving little residual deficit. Nevertheless, it is clear from Moran's observations when he saw Churchill on 4 November 1956, two weeks following the stroke, that Churchill's cognitive state was notably variable, and this was substantiated by Mary Soames' account of her concerns about her father. In keeping with his remarkable resilience to such events, Churchill resumed some activity in the House of Commons following this probable stroke. His determination to recover in the aftermath of the stroke was also alarmingly demonstrated to his bodyguard, Murray, by his insistence on climbing a ladder to assess the progress of building works at home, much to Murray's concern. And finally, Churchill's artistic creativity was clearly also not at an end at this time, despite his own prediction shortly following the small stroke.
In defiance of advancing cerebrovascular disease, at the age of 81 years, Churchill bounced back yet again.