Sir Winston Churchill KG: hip fracture in Monte Carlo (‘Remember,I want to die in England’) on 28 June 1962,femoral vein thrombosis and jaundice in London

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

Introduction

In Churchill's later years, the Mediterranean warmth and light, particularly that of the south of France, became more and more important to him. ¹ Aged 87, on 26 June 1962, Churchill flew from London to Nice for a fortnight's holiday in an eighth-floor suite at the Hôtel de Paris. Churchill was accompanied by Celia Sandys, his granddaughter, Anthony Montague Browne, his Private Secretary, two nurses (Roy Howells and Miss Robin Powell) and Sgt Edmund Murray, his detective.

Methods

Information regarding Churchill's hip fracture in 1962 was available from various sources. Foremost were the medical records of Professor Sir Herbert Seddon CMG, held by the Royal College of Surgeons of England ² and those of Dr Davis Evan Bedford CBE held by the Royal College of Physicians. The clinical records of Seddon are in two parts. Handwritten notes written by the main clinicians involved, though principally by Seddon, and a shorter typewritten summary prepared by Seddon that also included personal reminiscences. Both sources have been used to provide the detail set out here.

Lord Moran, Churchill's personal physician, did not record the accident in his book. Mary Soames (Churchill's daughter) ³ and Celia Sandys (Churchill's granddaughter) added further details, ¹ as did Martin Gilbert (Churchill's main biographer), ⁴ Anthony Montague Browne (Churchill's Joint Principal Private Secretary 1952–1955; Private Secretary 1955–1965), ⁵ Roy Howells (Churchill's personal nurse),^6–8 Sister Gill Morton (née Keefe) of the Middlesex Hospital ⁹ and Detective Sergeant Edmund Murray (Churchill's bodyguard). ¹⁰

28 June 1962: the accident

The accident happened shortly before 6 am on 28 June. ¹¹ Nurse Powell was on duty and was sitting outside Churchill's room reading a book when she heard a crash and a thud in the bedroom. ⁶ She ran in and found Churchill lying on the floor. ⁶ The crash Powell heard was the noise of the anglepoise lamp being knocked off the glass-topped bedside table; the thud was Churchill hitting the floor. ⁶

Powell telephoned Howells who was asleep on the third floor. ⁶ Howells told her to telephone Montague Browne and Dr Roberts (Churchill's general practitioner in Monte Carlo), who lived at Cap d'Ail, 2 miles away. ⁶ Howells ran upstairs to Churchill's suite. He found Churchill lying on the floor in his bedroom covered by a blanket with his head propped up by a mound of pillows. ‘He seemed reasonably calm and, smiling benignly, said, “I think I’ve hurt my leg”.’ ⁶ Howells ⁶ has written that,

A great wave of depression swept over me as I realised the possible repercussions of the accident. Sir Winston, despite all the constant care and attention to see that he came to no harm, had fallen and broken his left leg. I knew what this could lead to; further complications which did not bear thinking about. ⁶

Montague Browne recorded that Howells woke him up and told him that Churchill had had a fall and was seriously injured. ⁵ ‘I found WSC lying silently on the floor, propped up on pillows. He was conscious and dignified, but obviously in pain. The rather trite analogy of a wounded stag crossed my mind’. ⁵

Roberts arrived at the hotel and after a brief examination telephoned the Princess Grace Clinic just outside the town and asked them to bring over a portable X-ray unit. ⁶ It was set up in the bedroom half an hour later, and Dr André Fissore took a series of X-rays. ⁶ The X-rays confirmed that the fracture was in the upper third of the femur. Churchill, still lying on the floor, was made as comfortable as possible. Roberts put his leg in a splint, and by the time the ambulancemen got up to the eighth floor, the whole of the hotel knew about the accident. ⁶ As Churchill was wheeled on a trolley to the hotel lift, dozens of maids and hotel staff gathered in the corridors. The lift was too small to accommodate the stretcher, so Churchill had to be carried down to the ground floor. Howells has written, ‘He was quite a weight and the stretcher-bearers and I had to take rests on the stairs’. ⁶

Churchill was carried out of the rear door of the hotel and smiled and waved to a small crowd. He was driven to the Princess Grace Clinic and was taken up in the lift and wheeled into a private side room (Room 102). ⁶ Lady Churchill was telephoned in England and the doctors responsible for Churchill's care announced that Lord Moran had said the operation should be carried out in London, where he would be in attendance (but see below). ⁶ ‘Loud was the fury of the local doctors, with the notable exception of Dr Roberts’ Montague Browne recorded.

Did I realise that the move might kill WSC, a man of eighty-seven who had suffered many strokes? Yes, I realised only too clearly; but I also knew that it was the only course to take, and CSC [Lady Churchill] concurred on the telephone without hesitation.

An hour later, Churchill was taken to the operating theatre and given an injection. A temporary immobilising plaster was applied under the direction of Dr Chatelin, the senior surgeon at the Princess Grace Clinic, to prevent movement of the fracture. After about an hour, Churchill was wheeled back to his room. ⁶

Celia Sandys has recalled that:

I went down to the hotel lobby and was immediately struck by the heavy atmosphere of doom and gloom. My cheerful bonjours were received with astonished glances, prompting me to ask what had happened. I was told that my grandfather had had an accident, and was in hospital… The hordes of reporters outside the hospital were a clear indication of the anxiety that had been engendered by the news. ¹

Montague Browne has recorded that when Churchill

had recovered from the application of a huge plaster cast, I went to see him. I thought he was dozing, but after a minute he greeted me with a smile. I sat in silence and after a further interval he asked, quite courteously, that the others present should leave the room. He told me in an almost inaudible voice to make sure that they had gone, then said in a strong tone: ‘Remember, I want to die in England. Promise me that you will see to it’. I gave the required promise unhesitatingly, but privately wondered if I would be able to carry it out, for he seemed mortally stricken. ⁵

Howells recalls another aspect of Churchill's recovery from the anaesthetic. Churchill ‘roared in typical Churchillian fashion, “You monsters! You monsters! Leave me alone. Get out of here- all of you!”’ ⁶ Churchill was furious when he discovered that he was in plaster. ⁶ At 7 o’clock that evening he had a light meal, a brandy and a cigar which the French doctors had advised against. ⁶ These supplies had been brought in by Howells. The ‘British’ (though Nurse Powell was from New Zealand) nursing team completely took over from the French hospital staff in looking after Churchill's immediate needs, not least because so few of the French nurses spoke English. ⁶

Celia Sandys remembers ‘how vulnerable my grandfather looked in his hospital bed with his leg newly plastered’. ¹

28–29 June 1962: preparation for Churchill's return home

Montague Browne telephoned Number Ten (the Prime Minister's Office and residence) on 28 June, and within a very short time, Harold Macmillan (Prime Minister) had ordered an RAF Comet ambulance, based at RAF Lyneham, Wiltshire, to fly to Nice to bring Churchill home on 29 June. The Comet of No. 216 Squadron, Transport Command, left Lyneham at 7 pm on 28 June for Nice. ¹¹

Montague Browne read a bulletin to journalists in the Hôtel de Paris on 28 June:

Sir Winston Churchill is suffering from a simple fracture of the shaft of the femur. He will return to London by air on June 29 for further treatment. His general condition is good. Sir Winston has been attended by Dr David Roberts, Prof Chatelin, head surgeon at the Princess Grace Clinic, Dr André Fissore [radiologist] and Dr Gramaglia [anaesthetist]. ¹¹

Montague Browne wrote to thank Roberts on 24 July:

…I should like to take this opportunity once again of expressing to you all our very warm thanks for your devoted and skilful help, and the speed with which you anticipated difficulties. I literally do not know what we should have done without you… ¹²

Churchill himself wrote on 24 August:

Now that I have returned home, I should like to express to you my warm thanks for the speedy and effective care you gave me when I broke my leg. I am really much indebted to you for all the trouble you took. I look forward to seeing you again soon. ¹³

Accounts were sent from Roberts, ¹⁴ Fissore ¹⁵ and Gramaglia ¹⁶ for NF 500 (equivalent to £660 in 2018) and from Chatelin for NF 1500 (equivalent to £1980 in 2018). ¹⁷ Fissore and Chatelin also requested a cigar ‘Churchill’ on their fee notes!^15,17

Other reports from Monaco said that Churchill's resistance was ‘remarkable – positively Churchillian’. ¹¹ Chatelin said Churchill was given an anaesthetic, and his left leg was encased in plaster from hip to ankle and that he was ‘doing very well and is resting comfortably’. ¹¹ Moran released a statement in London stating that he was keeping in touch with the situation and had received a bulletin from Monaco saying that this ‘was not a life-and-death matter’. ¹¹ He would be waiting at London Airport to meet Churchill. ¹¹

The first messages of sympathy came from Prince Rainier (Ruler of the Principality of Monaco) and the Queen and Duke of Edinburgh. ¹¹ The Prime Minister, Harold Macmillan, spoke in the House of Commons of the regret at news of the accident. ¹¹ The Speaker of the House of Commons, Sir Harry Hylton-Foster QC, sent a 150-word telegram to Churchill containing the verbatim passage from the proceedings in which Mr Macmillan, Mr Gaitskell (Leader of the Labour Party) and Mr Grimond (Leader of the Liberal Party) sent him their good wishes. ¹¹ Churchill replied, ‘I am deeply obliged to the House for the solicitude with which it has honoured me. May I ask you, Mr Speaker, to convey my gratitude’. ¹⁸ The Prime Minister spent half an hour with Lady Churchill at Hyde Park Gate after he had an audience with the Queen. ¹¹

29 June 1962: transfer to the Middlesex Hospital

Howells recorded that Churchill left the Princess Grace Clinic on a stretcher, with one of his cigars wedged in his mouth. ⁶ The hospital staff crowded at the windows to watch the departure of Churchill who waved and smiled at them. ‘He was in fine form and showed no signs of the pain he must have been suffering’. The crowd clapped when they saw Churchill carried out and there were cries of ‘Bon voyage!’ ⁶

Roberts sat in the back of the small ambulance with his patient and Howells sat in front with the driver. ⁶ As they drove the 13 miles of twisting Riviera road to the airport, a French TV camera team drove in front of them shooting a film from the top of the van. ⁶ Churchill gave his famous V-sign on departing Nice Airport at 11.00 am and a team of RAF nurses looked after Churchill during the flight. ¹⁹

Sqn Ldr Yetman, Captain of the Comet, said they had flown across Europe at 28,000 feet, 10,000 feet lower than was customary. ¹⁹ This made it possible to reduce the cabin pressure considerably and so make it easier for the patient to breathe. The weather was excellent and there were no more than 10 s of turbulence during the whole journey. ¹⁹

Celia Sandys wrote that ‘strapped into the stretcher bed in the body of the Comet, he looked even more fragile. I sat and held his hand, and could only hope and pray that he would make it home’. ¹ Churchill was given pethidine 100 mg by intramuscular injection at 12.40 pm. On the journey home, Churchill is said by Montague Browne to have made only one remark to him: ‘I don't think I'll go back to that place, it's unlucky’.

Celia Sandys told reporters in London that her grandfather had had a comfortable flight. ¹⁹ His only refreshment during the 1-h trip was a whisky and soda, described by one of the crew as a ‘very weak one’. Churchill read newspapers carrying reports of his accident and talked to his secretary and the medical staff. He appeared to be cheerful and in good spirits. ¹⁹

Lady Churchill, her son Randolph, Lord Moran and Mr Philip Yeoman (senior orthopaedic registrar) had been waiting at the airport North Terminal for half an hour before the aircraft touched down and taxied to the apron at 1.30 pm. ¹⁹ Celia Sandys waved to Lady Churchill from the cabin of the Comet as it came to a halt. ¹⁹ Once the cabin door was open, Lady Churchill hurried up the steps accompanied by Moran, Yeoman and Randolph Churchill. She greeted senior RAF medical officers and then moved forward to the specially equipped cabin where Churchill lay on a stretcher immediately behind the flight deck. ¹⁹

On the other side of the aircraft, the door of the forward cabin was opened and a forklift truck was driven into position. ¹⁹ Medical orderlies stepped on to the truck platform and eased the stretcher through the doorway. In the background, a group of onlookers clapped and waved as Churchill raised his right hand to give them the V-sign. ¹⁹ Celia Sandys recalls that when Churchill was carried off the plane, he spotted the crowd that had gathered to see him, and ‘with characteristic spirit and typical determination raised his hand and gave the V-sign. It was worth the effort. Hugely relieved, they clapped and clapped, and he smiled as he was gently lifted into the waiting ambulance’. ¹

Howells recalls that the journey to London was most touching because every time the ambulance was caught up in a traffic jam, people ran into the road, tapped on the ambulance windows and shouted, ‘Get well soon Sir Winston’. ⁶ On arrival at the side entrance of the Middlesex Hospital, the street was jammed with people and Churchill ‘received a fantastic reception when he was carried out giving his familiar V-sign’ (Figure 1). ⁶ Reuters journalist, Robert MacNeil, recalls the event:

I was outside the hospital as they brought him out. I leaned close to the ambulance window to see his face and judge how ill he was. Two feet away from me, the old boy opened his eyes and smiled. He raised his hand to me to me in the famous ‘V’ sign of the war years. Evidently history couldn't claim him yet. ²⁰

Figure 1.

Sir Winston Churchill being admitted to the Middlesex Hospital on 29 June 1962. © Alamy EOWD8E.

29 June 1962: admission to the Middlesex Hospital

The Middlesex Hospital had made careful arrangements to look after Churchill. He would be accommodated in a room on B floor of the Woolavington Wing (private wing). On arrival at 2.30 pm, Churchill found the room was filled with flowers sent by family, friends and admirers. ⁷

Apart from Howells and two female private nurses, the Middlesex had a team of three sisters, three staff nurses and two other nurses rostered to look after Churchill. Among them was Sister Gill Keefe who has recently published her memories of her special patient. ⁹ Murray patrolled up and down the corridor outside keeping a watchful eye on everyone who went into the bedroom. ⁹

Before Churchill's arrival, Miss Marjorie Marriott, Matron of the Middlesex Hospital, told Sister Keefe that she was to ‘special’ Churchill.

She told me…that I was never to leave Churchill's room when on duty and, if I needed anything, I must ring the bell…I remember Miss Marriott looking at me, with those piercing eyes, and saying, ‘When the ambulance arrives, you must go out and greet him, and I will take care of Lady Churchill’. ⁹

Sister Keefe found herself trapped in a noisy, jostling crowd and, with difficulty, pushed her way through to the stretcher coming out of the ambulance. ⁹

29 June 1962 at 18.00: operation undertaken by Mr Newman and Professor Seddon

Montague Browne has recorded that:

I was much relieved when Prof Sir Herbert Seddon [in fact Seddon was not knighted until 1964] took him in charge [Seddon had treated Churchill in November 1960]. He was considered to be the greatest authority on broken hips, and was additionally a sympathetic and wise man. Determined too. He told me that his colleague Philip Newman was to carry out the operation. ‘Why not you’, I demanded rather brusquely. ‘Because Newman will do it twice as well as I can’, replied Seddon. ‘Now stop fussing and leave us with our patient’. ⁵

On arrival, Seddon recorded that Churchill was ‘cheerful and not ill’ and that ‘he has no pain in the back’. ‘No food today’. ² The front half of the hip spica was removed. Bladder palpable. Reflexes: R knee + ; L knee + ; R ankle jerk + ; L ankle jerk not examined. Colour of feet normal. Remove rest of plaster under anaesthetic. ²

Churchill was prepared for surgery. He was examined by Dr OP Dinnick, senior anaesthetist, at 3.15 pm who documented that Churchill was

pale but not grossly dyspnoeic. Not coughing. Impossible to examine chest properly because of plaster. Breath sounds heard on left well-less clear on right-râles on left. BP140/80 peripheral veins reasonably full. Pethidine 30 mg IV for pain. No fall in BP. Pulse full but occasional ectopic beats on ECG which shows a very prolonged PR interval and flattened T waves in some leads …with atrial premature beats. No immediate bar to urgent surgery as soon as blood is available. ²

The decision was made to operate at 6 pm. Premedication of pethidine 75 mg and scopolamine (hyoscine) 0.3 mg was administered at 4.45 pm. ²

The X-ray of Churchill's left femur which accompanied him from France was reviewed by Seddon and showed a ‘basal fracture of the neck ?valgus of upper fragment: no displacement. Translucency in the shaft of the femur up to a point 3½ inches below the lower rim of the trochanter’. ² Investigations showed that the serum proteins were normal and no Bence-Jones protein was present to suggest myeloma. ²

The operation began at 6 pm and Newman performed the procedure with Seddon assisting. The general anaesthetic was administered by Drs Dinnick and Cope. Induction was uneventful using thiopentone (thiopental), followed by nitrous oxide/oxygen and halothane. ² There was some fall in the blood pressure (to 60 mmHg) after Churchill was moved on the table. The blood pressure was restored with blood (1 pint), dextrose saline and switching anaesthetic to Trilene™ (trichloroethylene) and pethidine. ² The systolic blood pressure on the trolley at 8 pm was 140 mmHg. ²

Seddon recorded that the fracture was easily reduced with slight internal rotation. During insertion of the pin, an area of outer cortex of the greater trochanter separated, but a repeat X-ray revealed no displacement of the fracture site. ² A four-hole plate was connected with the nail and attached to the femoral shaft with 9/64 inch screws. The wound was closed, with suction bottle drainage, after installation of chloramphenicol 1 g. ² A dressing was applied (there was considerable discussion over this because of Churchill's ‘possible sensitivity to Elastoplast™’), and Churchill returned to his room in the private wing of the hospital at 8 pm, ‘condition satisfactory’. ² Lady Churchill returned to the hospital at 7.55 pm with her daughter, Diana; Montague Browne left 40 minutes later. ¹⁹

A bulletin was issued that evening (at 9.05 pm) by the Superintendent of the Middlesex Hospital, Brig. Hardy-Roberts which stated: ‘The fixation of the fracture of the neck of the femur was carried out this evening successfully, and Sir Winston's condition after the operation is at present satisfactory’. ¹⁹ The bulletin was signed by Lord Moran, Prof HJ Seddon, Mr PH Newman, Dr OP Dinnick, Dr DH Cope and Dr Campbell Golding (senior radiologist). ¹⁹

29 June–21 August 1962: post-operative course

At 8.30 pm on 29 June, the foot of Churchill's bed was placed on 9-inch blocks as his blood pressure was recorded as 100/50 mmHg; dextran and dextrose saline were prescribed as ongoing intravenous fluids. ² His respiratory rate was 22/min. ‘Pulse-some fibrillation’. ² During the night, Churchill's blood pressure rose to 150/60 mmHg, and his pulse became ‘full and regular’. ² Pethidine 25 mg was administered for pain relief. Most of the night Churchill slept well. ²

During 30 June, four formal ward rounds took place; Seddon was present at 10 am, 2 pm, and 6.15 pm and stayed the night. Moran noted Churchill's temperature was 99.4 °F (37.4 ℃), that he was coughing well, and arranged a chest X-ray. ² This showed an area of consolidation (suggesting pneumonia) and some evidence of a slight pleural effusion on the left side. ² Churchill was lifted into a chair at 5.30 pm, ‘a manoeuvre not acceptable to the patient, but accomplished without any apparent pain’. ² The respiratory rate increased and at 10 pm was 30/min. ² The day after the operation, Lady Churchill arrived. Churchill was dozing but, when he heard his wife's voice, his face lit up. ‘My darling Clemmie, darling!’ ⁹

Howells recorded that,

Two days after the operation Churchill developed bronchitis. The doctors were not unduly worried…The morning they discovered this, he was propped up in bed smoking one of his giant cigars. When Moran tried to examine him, he found Churchill unwilling to part with the cigar, wedged firmly between his teeth, so that he could listen to his chest with his stethoscope. ⁷

On 1 July, Churchill had enjoyed a lunch of soup and fish and had been helped out of bed into a chair by two nurses, ²¹ where he sat for 2 h. ²² Lady Churchill and her daughter, Diana, visited for 1 h 10 min in the afternoon. ²¹ Lady Churchill told reporters that her husband, ‘is very much better’. ²¹ A 32-strong Salvation Army Band also played Onward Christian Soldiers outside, which Howells states was thoroughly enjoyed by Churchill.^7,21 The official bulletin issued at 11 am on 1 July stated: ‘Sir Winston Churchill has had another good night and his progress is maintained’. The bulletin was signed by Moran, Seddon and Newman. ²¹

Lady Churchill visited her husband on two occasions on 2 July, and during one of these visits, Churchill had smoked a cigar. ²² She told reporters, ‘He is looking very well today and has been sitting up in bed’. Moran and Newman also visited their patient. ²² A bulletin issued on 3 July stated, ‘There have been no complications so far’. Churchill was allowed out of bed. ²³ The press representatives added to Churchill's stock of his favourite brand of cigars with the message, ‘With good wishes from reporters and photographers downstairs, to whom news of your progress has been of more than purely professional concern’. ²⁴ Montague Browne responded on 3 July,

Gentlemen, Sir Winston Churchill has asked me to express to you all his very warm thanks both for the excellent cigars and the sympathetic and helpful way in which you have carried out your duties. He sends you his very good wishes, and hopes that you will understand if he does not sign this personally. ²⁵

A Hospital Sister told the journalists, ‘He thinks it is quite wonderful of you. He is very touched’. ²³

On 3 July, Churchill's pulse was ‘averaging 90 instead of 68’ and he was commenced on digoxin 0.25 mg daily. ² Based on the evidence of his detective, Churchill also became confused and disorientated soon after the operation, ¹⁰ and the confusion was still present on 5 July when Dr Evan Bedford examined Churchill (see below). When Churchill was being lifted out of bed to be X-rayed, he proclaimed to his doctors: ‘I am a member of Parliament. I refuse to allow any more of it’. They asked for Murray's help. On seeing Murray, Churchill said,

Murray, my dear Murray, I'm a free man. Why are they pushing me about like this? I have never seen anything like it. Look, Murray, I'll leave here before dinner tonight. All we've got to do is get out of here and across the park. I never saw anything like it. ¹⁰

Murray responded,

They do know what they are doing Sir Winston. They are like everybody else in the streets outside. They want to get you on your feet again. One thing's quite certain – if they say you have to stay, you can't get up and walk out. ¹⁰

Later, as Murray helped Newman to lift Churchill back into bed, Murray told Churchill to put his arms, around their necks and pull yourself up as we lift you. Churchill said to Murray, ‘I never imagined you would become associated with this atrocious manhandling, Murray’. ¹⁰

The fact that it was difficult to persuade Churchill to take the medicines prescribed by his doctors has been recorded both by Howells ⁷ and Keefe. ⁹ On 4 July, Churchill got up for luncheon. ²⁶ He sat beside his bed and ate from a table. Lady Churchill told reporters, ‘He is alright and seems quite cheerful’. ²⁶

Newspapers were delivered each day, but Keefe suggested that Montague Browne had already pared them down before Churchill saw them. ⁹ Keefe has written that ‘I pulled up a high stool to help him turn the pages. He started with the Daily Express article, with the caption “He comes under watchful eye of nurse Gillian ‘Sunny’ Keefe, born 1939”’. ⁹ Churchill stabbed the paper with his index finger and said, ‘Is that you? Huh – mere baby!’ ⁹ Keefe replied, ‘Maybe – but I know how to look after you’, which produced a chuckle and a twinkle. ⁹

He did have the sweetest smile – so good to see after the miserable first two days of post-operation depression when, with bottom lip pursed, he had complained, ‘I want to go home’. He looked so sad and vulnerable; who wouldn't, in their late eighties, with a leg in plaster, flown from France, now in discomfort and in hospital? Here, I have to admit, I gave him a hug. ⁹

Churchill had a light breakfast and then read the newspapers on 5 July. A bulletin issued by the Middlesex Hospital stated, ‘Sir Winston is comfortable and has had a good night. There has been some irregularity of the pulse’. ²⁷ In fact, the RMO had found Churchill's pulse to be irregular and concluded that he was in atrial fibrillation, ² and Moran asked Evan Bedford to review him which he did on 5 July; he had last assessed Churchill in Carthage in December 1943. ²⁸ Evan Bedford recorded that Churchill ‘was confused and disorientated and was taking digitalis in case of a recurrence of atrial fibrillation. However, the electrocardiogram showed partial heart-block so that digitalis was stopped’ (The ECG showed sinus rhythm, not atrial fibrillation). Lady Churchill told reporters on 5 July, ‘Sir Winston is resting well and is very peaceful. He is very quiet today and is looking happy’. ²⁷ A bulletin issued on 6 July stated that a repeat X-ray was satisfactory and Churchill's pulse was more regular. ²⁹

On 7 July, Seddon recorded that there was an ‘obvious femoral venous thrombosis’ with swelling and tenderness of the thigh and leg. ² Bedford was asked to attend and advise on anticoagulant therapy. Churchill was treated first with heparin then phenindione. The bulletin on 7 July revealed that ‘there are early signs of phlebitis in his left leg, and the appropriate steps have been taken to deal with this condition’. The bulletin on the 8 July signed by Moran, Seddon, Newman and Evan Bedford stated that there had been no extension of the phlebitis, ³⁰ though the bulletin issued on 9 July stated that Churchill's left leg was more swollen. ³¹

On 10 July, the bulletin stated, ‘There has been no extension of the thrombosis, and the left leg is less swollen’. Churchill read the newspapers and smoked a cigar. Mary Soames, Churchill's daughter, told reporters, ‘ He is extremely robust. Talking to him he seems in splendid form. We thought he looked remarkably well. He was about to have his supper’. ³²

Keefe has recorded that

cigars were the bane of my life. Sir Winston would take two or three puffs, then rest his hand over the ashtray and let the cigar smoulder. The free fingertips would lie in the ash. Lady Churchill had said that she did not want him to drop ash on his silk vests as it made holes. She also asked me to make sure he did not have ash under his fingernails at visiting time. ⁹

First thing in the morning, I would put the waste basket outside the door, and the ‘vultures’ descended for the cigar butts. ⁹

On 11 July, Churchill's son, Randolph, went to the Middlesex Hospital to see his father. He told reporters that his father was ‘sitting up in bed, smoking a cigar, sipping a glass of brandy, and wiggling his toes’. ³³ Randolph Churchill also recorded his impressions later: ‘He was, considering everything, looking well; he was sweetly affectionate, absent-minded and bloody-minded’. ⁴

On 11 July, Churchill's respiratory rate increased to 36/min, and his pulse rose to 108/min, and on 12 July, many added sounds were heard in the chest in keeping with a respiratory infection. ² Tetracycline was commenced. ² The bulletin issued on 12 July stated: ‘Since yesterday, Sir Winston Churchill has had a slight rise in temperature, due to a bronchial infection. There has been some decrease in the swelling of the leg’. ³⁴ The bulletin on 13 July stated: ‘Sir Winston Churchill had a comfortable night. His temperature is normal, and he is coughing less’. ³⁵ A fortnight after Churchill's operation he was well enough to have several of the stitches removed from his leg. ⁷ Lady Churchill told reporters on 13 July that her husband's stitches had been removed that day. ³⁵

On 14 July, Churchill summoned Murray but then could not remember for what he wanted him. ‘Never mind Sir Winston, I'll come back when you have remembered, and I shall take some time off when you're out of hospital’. ‘I'll never come out of hospital’, said Churchill. ¹⁰ Murray responded, ‘Don't be silly you're the only one who thinks that. Everyone else thinks you will be up very soon’. ‘Out of bed perhaps, but not out of hospital’. ¹⁰ On 15 July, Moran reported to journalists that Churchill ‘is the same as yesterday. All is well’. ³⁶

The bulletin issued on 16 July stated that Churchill was making satisfactory progress and had been sitting in a chair. By 17 July, the press was informed that Churchill was able to walk unaided and move across the room to a chair on the other side. ³⁷ Howells has written that

a chair was placed across the room from his bed and gingerly, with a physiotherapist at his side, he walked over to it. The next day he walked 30 yards in the hospital corridor. It was a great credit not only to the doctors and nurses but also to Churchill himself. Once more he had overcome a severe disability by his sheer determination. ⁷

Keefe recalls that Churchill hated physiotherapy and was not very communicative with the physiotherapist. When I encouraged him to do a simple straight-leg-raising exercise, he stared me out. ‘I threatened to tickle his foot. To my delight, he suddenly chuckled and raised his leg. I am not sure who was having who on’. ⁹

The hospital carpenter arrived to fix the door window blind. ⁹ As the carpenter left, Churchill proffered his right hand, saying, ‘Thank you, my man’. ⁹ The carpenter shook hands and said, ‘I was at El Alamein with you, sir’. Churchill became enlivened and they had a brief chat. ⁹ The carpenter's eyes welled up and he left fumbling for his handkerchief. ‘Me too’, recorded Keefe. ⁹

One day, Keefe recalls that a small bottle of Pol Roger champagne arrived.

I had never opened a bottle of champagne and twisted the wire the wrong way. I looked up, straight into the mirror above the washbasin, and saw him watching me with much amusement. I smiled back and was treated to one of those lovely smiles. ⁹

On 20 July, Churchill had two non-family visitors. The first was former President Eisenhower, the second, the Prime Minister. Although on three occasions Macmillan declined to say whether he had discussed the Government changes with Churchill, ³⁸ Macmillan noted in his diary that, ‘He has certainly made a wonderful recovery. He was sitting up, reading a novel of CS Forester. He seemed very cheerful and quite talkative. He strongly approved the reconstruction of the government’. ⁴ The bulletin issued on 20 July stated: ‘Sir Winston Churchill is able to spend a few hours each day sitting at his bedside and he has taken a few steps, with assistance, in his room’. ³⁸

On 25 July, Lord Avon (Anthony Eden, Prime Minister 1955–1957) visited Churchill and told journalists, ‘Sir Winston looked far better than I dared hope. He was very cheerful and very talkative’. ³⁹ Moran, Seddon and Newman visited Lady Churchill at Hyde Park Gate ‘about several matters’, ⁴⁰ including arrangements for Churchill's discharge from hospital.

Churchill was ‘subdued almost apathetic’ on 30 July. ‘Slight temperature rise this morning’ (98.8 °F; 37.1 ℃). ‘Conjunctiva yellow and skin of abdomen lemony’. ² Urine – bile pigment present. Subsequent urine and blood tests revealed: bile and urobilinogen in the urine and raised SGOT (ALT) 240 u/L and SGPT (AST) 456 u/L enzyme activities. ² ‘Intrahepatic rather than obstructive jaundice. Dr Walter Somerville [Consultant Cardiologist at the Middlesex Hospital] consulted. Unlikely to be phenindione jaundice in light of small doses given but possible’. ² Somerville recommended that phenindione should be tailed off more rapidly. The jaundice had faded by 3 August. ²

Reports that Churchill had become jaundiced began to circulate on 2 August. ⁴¹ The Deputy Superintendent of the Middlesex Hospital, Mr GK Buckley, issued a statement: ‘From some newspaper reports it might be inferred that Sir Winston has had an attack of jaundice of the same variety as in the past. This is not so, and he has not had any such attack’. ⁴¹ Moran said, ‘Sir Winston…has seen visitors every day this week and there have been no grounds for concern at any time’. ⁴¹ Churchill had developed jaundice in 1958 probably due to gall stones. ⁴²

Churchill sent Seddon a telegram on 1 August, ‘I am so sorry to hear that you are unwell and do hope you will soon be fully recovered’. ⁴³ Seddon responded on 2 August,

Thank you for your very kind message. It is no more than a trifling upset. I think I should be back to full activity by the time you receive this note and I am looking forward to paying you a visit after lunch on Sunday [5 August]. I shall be particularly interested to learn if you are finding yourself steadier and stronger on your feet…I shall be able to come one evening next week-quite apart from official visits-at about the time when the coffee is brought into your room (see below). You make me so welcome.⁴⁴

Seddon recorded that the swelling from the femoral vein thrombosis had subsided by 16 August. ²

Sister Keefe recalls that when the time came to say goodbye to Churchill, he was sitting in a low armchair after lunch. I sat on a footstool on the floor beside him, to be at his level so that he could hear better. He stroked my cheek and said, ‘My pet lamb’. He then held my hand and, with complete eye-to-eye contact, said, ‘Thank you’. It was a beautiful, rewarding moment for me, never to be forgotten. ⁹

21 August 1962: home again

Churchill was discharged from Hospital after 54 days on 21 August. With a broad smile, a V-sign and a cigar in his hand, Churchill was carried in a chair by four attendants to a waiting ambulance. ⁴⁵ Hundreds of people filled the streets outside and nearby office windows were filled with waving workers. ⁴⁵ For his return home, Churchill was immaculately turned out. He wore his grey Homburg, initials WSC on the silver lining, his gold cufflinks in grey with the family crest on one side and his monogram on the other, a cream poplin collar attached shirt and a medium grey Prince of Wales check suit with knife-edge creases in the trousers. He wore a blue polka dot tie and across his six-button waistcoat hung his heavy gold watch chain. ⁷

Churchill arrived home in time for luncheon and celebrated his return home by calling all the staff into his bedroom for a glass of champagne. ⁸ The house at Hyde Park Gate was now altered so that Churchill did not have to use the stairs, and a bedroom and bathroom had been created on the ground floor of number 27. In Number 28, a lift was installed from the ground floor to the dining room on the lower ground floor, which also enabled Churchill to have access to the garden in which he loved to sit, according to Mary Soames. ³

Churchill–Seddon relationship

During his convalescence, Churchill and Seddon developed a more personal relationship than the one they had in November 1960, when Churchill was treated for a fracture of the fifth thoracic vertebra. Churchill told him that he found the evenings burdensome and invited Seddon join him to keep him company. Seddon explained that he was very busy but would attend when he could and that he would have his dinner beforehand and arrive for coffee.

Seddon has written:

When I arrived the coffee, brandy and cigars appeared. Sir Winston poured the coffee himself and always asked whether I preferred white or brown sugar. Then the brandy. Incidentally (I had no idea what he was like in his younger days) I have never met anyone who could make a modest dose of cognac last so long. The big ceremonial was choosing the cigar, about four boxes were placed on his bed tray. Each was opened and he pawed through the cigars to find one that was exactly right; he sniffed them, he rolled them between his fingers and listened to them. What good that did defeated me because he was deafer than me. I think I smoked these great cigars on three evenings. Then I gave up: there were just too big, and I asked if I might light a pipe instead. He agreed but added – about the cigars – you're still young: it's simply a matter of experience. Sometimes we talked. He waxed enthusiastic about Marrakesh and painting there. I said I had been once, and even done a little painting. On several evenings the Rank Organisation sent a man in with a projector and a film that they thought might appeal to him. Maybe I was in on two film sessions but can remember only one: Sink the Bismarck. I think I watched the Grand Old Warrior as much as the movie. He never took his eyes off it, and they lit up. He sat upright and his usually pale face flushed. His cigar went out: he just held it: his mouth opened in rapt attention. Winston was fighting the battle over again. ²

Churchill wrote to Seddon on 17 September:

I think you know how grateful I am for all your devotion and skill, which has enabled me to regain my health. I will not therefore enlarge on the theme beyond saying that I shall always remember what you have done for me. I hope you will accept these momentos of our association. ⁴⁶

Seddon could not respond to Churchill's letter until 12 October (though his wife did immediately) as he was in East Africa:

…You thank me most generously. May I, in reply, recall the words of a sixteenth century surgeon, Amboise Paré, ‘Je le pansai, Dieu le guérit [I bandaged him and God healed him]. What a delight it is to possess such a superb piece of silver [antique silver swing-handled basket, 1797 ⁴⁷ ], with an inscription perfect in its simplicity [Herbert Seddon. With gratitude. Winston S Churchill ⁴⁷ ]…How kind of to add a box of cigars [50]; I have not yet finished my first supply! In thanking you for these momentos may I also say how grateful I am to Lady Churchill for her patience and understanding and to you, Sir Winston, for your kindness to Philip Newman and me-your faithful servants-which made our anxiety easier to bear. ⁴⁸

On the occasion of Churchill's 88th birthday (30 November 1962), Newman and Seddon sent him a telegram, ‘Best wishes from two surgeons who hope in the words of the 51st Psalm that the bones which thou hast broken may rejoice’. Churchill replied: ‘I am grateful to you for your telegram and thanks to you both Psalm 73 verse 2 [But as for me, my feet were almost gone; my steps had well nigh slipped] no longer applies’.

Churchill's principal doctors in England

Dr Davis Evan Bedford CBE (1898–1978)

Bedford entered the Middlesex Hospital in 1916 but interrupted his studies in 1918 to serve as a surgeon sub-lieutenant, RNVR on destroyers. Bedford qualified at the Middlesex Hospital in 1921. ⁴⁹ Bedford specialised in cardiology first in France, then at the London Hospital (Sir John Parkinson) and was appointed to the consultant staff at the Middlesex Hospital in 1926 at the age of 28. ⁴⁹ Bedford's career was interrupted between 1939 and 1945, when he served with the RAMC as a Brigadier in North Africa, when he was called upon to treat Churchill in Carthage. ²⁸ He was President of the British Cardiac Society and of the European Society of Cardiology. He was the first Editor of the British Heart Journal. In 1968, he was the Harveian Orator of the Royal College of Physicians. He was appointed CBE in 1963.

Dr DHP Cope (1922–2015)

On leaving Epsom College in 1940, Cope was awarded the Freer Lucas entrance scholarship to the Middlesex Hospital, where he read Medicine as an undergraduate. ⁵⁰ He qualified in January 1945, and from September 1945 to April 1948, he worked as General Duty Orderly in the Royal Army Medical Corps, where he discovered his interest in, and aptitude for, anaesthetics. He was released from active military duty in May 1948 and began his training in earnest, obtaining a position as junior anaesthetist at the Middlesex Hospital. In 1951, he was appointed Senior Registrar and then in 1954 Consultant Anaesthetist at the Middlesex.

Dr OP Dinnick (1917–1995)

Dinnick qualified from the Middlesex Hospital in 1939. During the ‘blitz’ he became the senior of only two resident anaesthetists. He later served as a specialist anaesthetist in the Royal Air Force in North Africa and Italy.^51,52 At the end of the war, he was a Squadron Leader and returned to be appointed to the Consultant staff of the Middlesex Hospital. Dinnick became Senior Anaesthetist at the early age of 42 in 1959, and for most of the next 23 years ran what was a very happy and successful anaesthetic department. He served as Vice President, Association of Anaesthetists, and was President of the Anaesthetic Section of the Royal Society of Medicine.

Lord Moran MC (1882–1977)

Charles Wilson 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. ⁵³ He treated Churchill for chest pain in December 1941 in Washington, ⁵⁴ for pneumonia in London in February 1943, ⁵⁵ for pneumonia and atrial fibrillation in Carthage in December 1943, ²⁸ for pneumonia in London in August 1944⁵⁵ and for pneumonia, atrial fibrillation and jaundice in 1958. ⁴² Moran also treated Churchill in 1949 when he suffered his first stroke ⁵⁶ and was primarily responsible for managing the further episodes of cerebrovascular disease in 1950–1952, ⁵⁷ as well as his second stroke in 1953⁵⁸ and Churchill's recovery from it, ⁵⁹ the cerebellar infarction in June 1955⁶⁰ and the left hemisphere stroke in 1956. ⁶¹

Wilson was knighted in 1938, created Baron Moran of Manton in the County of Wiltshire in 1943 and was appointed Treasurer (1938–1941) and then President of the Royal College of Physicians of London (1941–1950). ⁵³

Mr Philip Newman CBE DSO MC (1911–1995)

Newman qualified at the Middlesex Hospital in 1934. ⁶² While still a registrar, he joined the supplementary reserve of officers and, as a result, was posted to the 12th Casualty Clearing Station which was sent to France in 1940. In May 1940, the unit was at Béthune. Eventually the doctors were compelled to draw lots to determine who would be evacuated and who would stay with the prisoners. Newman drew the short straw and was taken prisoner. He was awarded the DSO for services at the evacuation of Dunkirk and after his escape to England he received the MC. After the war, Newman was appointed consultant orthopaedic surgeon at the Middlesex Hospital and the Royal National Orthopaedic Hospital. He was appointed a Hunterian Professor of the Royal College of Surgeons in 1954. In 1976, he was elected President of the British Orthopaedic Association. In 1976, he was appointed CBE.

Professor Sir Herbert Seddon CMG (1903–1977)

Seddon graduated in 1928 from St Bartholomew's Hospital, London with honours and the University Gold Medal, passing his Final Fellowship Examination in the same year. ⁶³ In 1930, he was appointed instructor in surgery to the University of Michigan at Ann Arbor. Seddon returned to the UK to take up appointment as resident surgeon at the Royal National Orthopaedic Hospital, Stanmore. There he spent eight pioneering years, but in 1939 he was appointed Nuffield Professor of Orthopaedic Surgery at Oxford. ⁶³ There he undertook his work on peripheral nerve injuries which came to be accepted worldwide. The Institute of Orthopaedics in London had been created in 1946; two years later, Seddon became Director of Studies and subsequently the first Professor of Orthopaedics in the University of London. ⁶³ He became a member of the Medical Research Council for four years and was a member of the Advisory Medical Council of the Colonial Office, leading to extensive tours of Africa for which he was appointed CMG in 1951. ⁶³ He was President of the British Orthopaedic Association. He received the accolade of Knight Bachelor in 1964.

Seddon had treated Churchill for a fracture of the fifth thoracic vertebra in November 1960, following which Churchill wrote to Seddon:

…Please allow me to express to you my gratitude for all your skill and care during my illness, and my warm thanks for the graceful terms in which you phrase your letter. It was indeed fortunate for me that I should have been attended by you and I am well aware of the trouble you took… ⁶⁴

Churchill's doctor in France

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. ⁶⁵ Gilbert ⁶⁶ 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 lived at Villa Sylvie, Cap Fleuri, Cap d'Ail, Monte Carlo. ⁶⁵ Gilbert states that he practised medicine in Monte Carlo, with the permission of the French authorities on condition that he treated only British patients. ⁶⁶ Roberts continued to practice in Monaco at Le Victoria, and as Physician at Princess Grace Hospital until the 1970s when he returned to England. ⁶⁵ He died on 28 July 1977 (six months after the death of Lord Moran) at the Queens Hospital Cirencester of bronchopneumonia, Parkinsonism and cerebrovascular disease. ⁶⁵

His first professional contact with Churchill was in 1956 and he looked after Churchill whenever he stayed on the Riviera and was primarily responsible for Churchill's care when he developed pneumonia, pleurisy and jaundice. ⁴² Montague Browne described Roberts as ‘conscientious and prompt’. ⁶⁷ Mary Soames wrote: ‘Both WSC and CSC liked him very much’. ⁶⁸ Early in their relationship, Churchill expressed gratitude to Roberts by presenting him with First Editions of the History of the English Speaking Peoples: Volumes I and II at Christmas 1956; Volume III and Volume IV in March 1958.

Discussion

At the age of 87, Churchill fractured the neck of his left femur, a very serious injury at this age, then as now. Apart from his great age, his general health was not good and in particular, he was known to have extensive cerebrovascular disease by this time.^{56–58,60,61} In addition, there had been previous episodes of pneumonia^28,42,55 and atrial fibrillation,^28,42 and his steady, longstanding alcohol consumption may also have been relevant. Despite these adverse medical factors, his recovery from the femoral fracture was complicated only by postoperative confusion, transient jaundice and a deep vein thrombosis.

It is not known what drug or drugs Churchill was given by injection prior to the application of the plaster cast to the left leg in France, whether this was simply opioid analgesia or whether anaesthetic drugs were given in addition. Montague Browne records a rational conversation with Churchill following this procedure, whereas Howells records a seemingly irrational outburst that could be construed as either frustrated anger at what had happened or a transient confusional state.

However, following the operative treatment at the Middlesex Hospital on 29 June 1962, there clearly was a period of confusion, and this seems to have coincided with the development of pneumonia. Churchill's recorded resistance to comply with medication almost certainly had a different basis. Churchill, used to being in complete control of events, was immobile, vulnerable and utterly dependent on his carers. He would not be unique in lashing out verbally under these circumstances.

The cause of Churchill's jaundice was probably phenindione treatment, which had been started on 7 July for the deep vein thrombosis. He was noted to be jaundiced on 30 July. It resolved after withdrawal of phenindione treatment, which is known to induce jaundice and is mainly cholestatic in type, although liver cell damage may also occur. ⁶⁹ Phenindione-induced jaundice often follows the onset of a rash and pyrexia, though typically not until the fifth week of treatment, ⁷⁰ and eosinophilia is a common association. ⁷¹ Although Churchill's jaundice developed earlier than five weeks, there does not appear to have been an alternative cause for the jaundice. Although Type I (mild) halothane-induced hepatotoxicity is marked by mild transient increases in serum transaminase activities, it is not characterised by jaundice and usually occurs 1–2 weeks after halothane exposure.

Churchill's postoperative stay in hospital was prolonged, but he weathered yet another threatening illness with his characteristic dogged determination, and with his prodigious cigar-smoking habit undiminished, perhaps reinforced by the gift of cigars from the Press amassed outside the Middlesex Hospital, a well-wishing gesture surely unique in the relationship of a politician and the Press!