Winston Churchill's Illnesses, 1886-1965

Winston Churchill's Illnesses, 1886-1965 by Allister Vale and John Scadding

The cover of this definitive and fascinating book immediately draws the reader to one of the iconic photographs taken by Yousuf Karsh in Ottawa in 1941. At that time, Churchill had just reached the age of 67 and in the two years previously had steered Britain through the Dunkirk evacuations, the Battle of Britain and the Blitz. Despite this, the subject looks remarkably at ease. His BMI might be on the generous side but the cigar is surprisingly absent and perhaps we could be deceived by this apparent picture of glowing health.

In the early chapters we learn that by the time that photograph was taken, Churchill had already encountered the medical profession on seven occasions and that five of these presentations were potentially life threatening. These episodes and his subsequent illnesses are dealt with chronologically chapter by chapter. Each with an extremely useful section on “medical aspects” which carry further explanatory detail of the earlier text. The whole narrative is skilfully interwoven between landmarks of Churchill’s political career, the ongoing war campaigns and the inevitable travel, whether for work, pleasure or convalescence. Vale and Scadding have clearly ensured accuracy in minute detail by triangulating references wherever possible: from Sir Winston himself, the Churchill Archives, family members, political colleagues, his secretaries, medical specialists and those who nursed him. The subtle, and sometimes not so subtle, differences between these accounts are both revealing and intriguing. In the extensive annotations, the book includes many other reference sources, consisting of newspapers and literary works on Churchill which number over 1000. The authors have also provided a select bibliography and it is clear that this degree of painstaking research has an almost forensic quality.

We learn that in Churchill’s earlier years, the cornerstones of a healthy lifestyle included the avoidance of chills, quality sleep and convalescence in a warm climate with the undoubted benefits of sea bathing. The authors emphasise that at that time there was little of proven efficacy in the therapeutic armamentarium. The advent of potentially toxic antibiotics and antimalarials demanded a more scientific approach to the risk/ benefit ratio of treatment with the sulfa drugs and mepacrine. It transpires that Churchill, in common with other prominent patients, would not hesitate to quiz his doctors on the evidence base of any new therapies on offer! From the medical perspective, the authors meticulously document the traditional clinical approach of Churchill’s specialists, who were obliged to rely on thorough clinical examination and interpretation of the clinical findings. Monitoring the clinical progress of pneumonia in the pre-antibiotic era, whether at home or abroad, was dependent on the constant presence of either the physician or nurse and often both. The logistical challenges in obtaining a portable chest Xray in North Africa in 1943 are vividly described.

The illustrations include the carefully charted observation records of an often feisty and at times uncooperative patient. Fluid balance charts include champagne, brandy and whisky with soda. There is also a graphic reminder that even the Prime Minister’s domiciliary ECG was not immune to interference from sources of alternating current! The reader learns of advances in haematology, analgesia, anaesthesia and preferred options for night sedation. Churchill’s supervising physicians and surgeons were often in the public eye and their personalities and opinions are nicely summarised. In an era before ultrasound scanning and neurological imaging, their diagnostic and prognostic uncertainties around Churchill’s later recurrent strokes are well described. In the final chapters, one appreciates how Churchill faced ill-health with the same “courage, resilience and determination” that he had exhibited in all other aspects of his life.

What of Karsh’s photograph and that picture of apparent glowing health? In the words of the song: “You can't judge a book by the cover” (1). The book is a literary tour de force and whether the reader is medically qualified or not, it is a compelling read.

Reference:

1. Diddley, B. 1962. “You Can't Judge a Book by the Cover”. Lyrics: Willie Dixon. Chicago: Checker Records.

                                                                                                                                                              
 Dr Neil Dewhurst