Wednesday, April 12, 2017

A third dose of pneumonia

It is just ten days since the P.M. landed at Northholt with a temperature of 103; for some days after that he was chesty, and the X-rays revealed a shadow at the base of the lung, a third dose, though a very mild one, of pneumonia. There had been some doubt whether he would be fit to set off on another trip so soon. I decided at the last moment to ask Lionel Whitby and a nurse to come with us. Winston has got it into his head that a pathologist is an essential part of the team to deal with an attack of pneumonia, and I thought it would comfort him to have one on board.’ This is from the so-called diary of Charles McMoran Wilson who died 40 years ago today. He was Winston Churchill’s personal doctor through the Second World War, often travelling with him on trips abroad. Soon after Churchill’s death, Moran published his diary extracts concerning the great leader, but it caused huge controversy, not only because its revelations were considered to be in breach of many confidences and ethical considerations, but because the ‘diary’ was little more than a construction written in retrospect.

Wilson was born in 1882, in Skipton, Yorkshire, the third child of a doctor and his wife. He was schooled at Pocklington Grammar School; and he studied medicine at St Mary’s Hospital Medical School 
(now Imperial), London. While training as a registrar, he took 18 months out to travel in Egypt and Italy, but he returned to complete his studies. He won the gold medal in the London MD exams in 1913, and the same year achieved membership of the Royal College of Physicians. During the First World War, he enlisted in the Royal Army Medical Corps, becoming medical officer to the 1st Battalion of the Royal Fusiliers from 1914 to 1917. He was then in charge of medical facilities at the British hospital in Boulogne from 1917 to 1918. He won the Military Cross in the battle of the Somme (1916) and the Italian silver medal for valour (1917), and was twice mentioned in dispatches.

After the war, Wilson was appointed as physician to outpatients at St Mary’s. In July 1919, he married Dorothy Dufton, and they had two sons. From 1920 to 1945, he served as Dean of St Mary’s, but also maintained a private Harley Street practice. He studied the effects of war on the resilience of soldiers publishing a series of lectures - The Mind in War - in the 1930s. He was knighted in 1938 and became Baron Moran in 1943, thereafter making many speeches in Parliament on the NHS. He was also a member of the Spens Committee, which devised the merit awards system for consultants. In 1941, he was elected president of the Royal College of Physicians every year until he stepped down in 1950.

Most famously, Wilson was Winston Churchill’s private doctor, from two weeks after he had become Prime Minister, accompanying him on most of his travels through the war, and recommending specialist medical help whenever needed. After the war, and until 1961, he chaired the government standing committee which determined which consultants should receive increments in their salaries. He died on 12 April 1977. Further information can be found at Wikipedia, the Royal College of Physicians, or the Oxford Dictionary of National Biography (although log-in required).

Moran was not a committed diarist, though he did keep notebooks intermittently. Some of these are held by the Wellcome Library, London. In particular, the Library notes that it has photocopies of his World War I army notebooks (the originals remain with the family). It also has: ‘A closely written loose-leaf manuscript book, which overflowed into collections of separate pages, covering the years 1940 to 1947. Judging by the varied use of past, present and future tenses and references under some dates to events that had not yet happened this volume must have been a fair copy of some earlier writing. There are further manuscript books, mixture of notes, diary and medical details continuing to 1955 and many pieces of paper, often backs of envelopes, with vignettes of a few lines elaborating particular ideas; some of these jottings, more or less modified, found a place in the book.’

In 1966, soon after the death of Winston Churchill, Constable published Moran’s book Churchill: The Struggle for Survival (1940-1945). It was presented as a day-by-day diary kept by Moran, as reflected in the book’s American title Churchill: Taken From the Diaries of Lord Moran. Some forty years later, the text was abridged and revised, and retitled Churchill at War: 1940-45 (Robinson, 2002). The Publisher’s blurb states: ‘This new edition of extracts from the extremely candid diaries of Churchill’s doctor Lord Moran, his devoted friend and confidant, contains material not previously revealed. It sheds a new light on how the great man faced up to and absorbed the strain of events during the war years, the tremendous burden of his responsibilities, and his extraordinary resolution. Moran’s keen observation, sensitivity, truth and insight, are brought to bear on Churchill’s conduct and personality. We hear of the weaknesses as well as the strengths: his rages, his jokes and salty comments, his occasional foolishness, his rare cattiness (of Attlee: ‘He has a great deal to be modest about’) and endearing playfulness, are all captured. Moran was not just an acute observer of his most famous patient. At Churchill’s side, he was able to record remarkable details of other world figures, and the historic events in which Churchill played so momentous a part.’

The original publication produced a storm of protest, not only from Churchill’s family but from other medical professionals, quoted by Moran, who considered Moran’s revelations had breached their confidences and crossed an ethical line. In the 2002 edition, Moran’s son, John, goes to some lengths to counter some of the criticisms levelled at his father. However, he fully accepts that his father did not keep a diary ‘except for very short periods’, and quotes Richard Lovell in his biography Churchill’s Doctor: A Biography of Lord Moran (Royal Society of Medicine, 1992).

Lovell says: ‘‘In his two books . . . Lord Moran alluded to his diary But he indicated in the prefaces to both books that he did not keep a diary in the ordinary sense of the word. In the First World War he scribbled in army notebooks, on the backs of orders and odd sheets of paper and in his Churchill years on the backs of envelopes and other scraps of paper. The scribblings in the army notebooks, and the elaboration of his thoughts in other notebooks, formed the basis for The Anatomy of Courage. In his Churchill years, the earliest orderings of his thoughts from his jottings (some of which, often barely legible, were also scattered through the family papers) appeared in diary form in closely written loose-leaf manuscript books, which overflowed into collections of separate pages. Judging by varied use of past, present and future tenses, and references under some dates to events that had not yet happened, these manuscript books cannot be regarded literally as a diary. Finally, in regard to the notion of a diary, the closest diary-like records from the Second World War onwards were unquestionably the letters written by Lord Moran to his family, many of which they kept.’

Thus, the diary format in the original 1966 book and its re-edition is a deception - little more than a construction in retrospect. John H. Mather, writing for the International Churchill Society, has taken a close look at the 2002 edition in order to answer his own question ‘What can be said now about the accuracy, veracity and comprehensiveness of Moran’s “diary”?’

Mather concludes: ‘Notwithstanding the discrepancies in the diary, and with the benefit of forty years of hindsight, we may conclude that Moran was the first physician significantly to reveal important information about a world figure that no one else would have been able to record. When under attack, and in his own defense, he commented to The Times: “It is not possible to follow the last twenty-five years of Sir Winston’s life without a knowledge of his medical background . . . It was exhaustion of mind and body that accounted for much that is otherwise inexplicable. Only a doctor can give the facts accurately.” Moran’s revelations of Churchill’s physical and mental health was a first, but subsequent biographers have not been squeamish about covering similar ground. This is a big plus for medical historians. Commenting on Moran as a diarist, an academician observed in 1969: “The topical question of whether a patient’s confidence has been outraged by his physician’s account of him both in his strength and in his weakness will no longer agitate the reader.” ’

Finally, here are some extracts from Moran’s ‘diary’ (taken from the 2002 edition).

28 July 1942
‘I was summoned this morning to No. 10 Downing Street, where I heard that we should soon be on the move. The P.M. has decided to fly to Cairo. From Gibraltar he will fly south to Takoradi on the Gold Coast, and so across Central Africa to Cairo. It means about five days in the air, landing at places where malaria and yellow fever are rife. The P.M. wanted my advice about inoculations. I did not like the plan and gave my reasons.

As I was leaving I met John Anderson. He said that certain members of the Cabinet were concerned about the Prime Minister’s travels and the dangers he was running in flying over hostile territory in an unarmed bomber. He and Cripps had arranged to see the P.M. this afternoon, and, as health might come up, he would like me to be there.

At the appointed hour I joined them in the Cabinet Room I was most concerned with the actual risk of the protective measures against yellow fever. While we were discussing these problems, the door opened and the Prime Minister hurried in, beaming at us disarmingly - always a sign that he is up to mischief. He began to unfold a large map, spreading it on the table.

“Vanderkloot says it is quite unnecessary to fly so far south. He has explained to me that we can fly in one hop to Cairo. Come here and look.”

Sir John knelt on a chair to get nearer the map, while Cripps leant over his shoulder. The P.M., with a pencil, traced the route from Gibraltar across Spanish Morocco till he struck the Nile, where his pencil turned sharply to the north.

“This changes the whole picture,” the P.M. added confidently. I ventured to ask who Vanderkloot was. It appeared that he had just cross the Atlantic in a bomber, and it is in this machine that we are to fly to Cairo. I wondered why it was left to an American pilot to find a safe route to Cairo, but that did not seem a profitable line of speculation.

“You see. Charles, we need not bother about inoculations.”

Anderson and Cripps pored over the map like excited schoolboys, and the party broke up without a word of warning or remonstrance about the risks the P.M was taking in flying over hostile territory in an unarmed bomber by daylight. The P.M. gets his own way with everyone with hardly a murmur.’

1 August 1942
‘Called at No. 10 to see if anything was wanted. The P.M. seemed abstracted. “There’s something very wrong there,” he muttered half to himself. “I must clear things up.” For a long time he has been worried by the reverses in the desert, and when he told me that he had asked Smuts to join him in Cairo, I knew he meant to bring things to a head. As I was leaving, he put down a telegram the secretary had just brought in.

“We may go to see Stalin. He won’t like what I have to say to him. I’m not looking forward to it.” The P.M. is turning over in his head how he can break the news to Stalin. He has to tell him that there will not be a Second Front in France this year.’

11 August 1943
‘I wish sometimes that one member of this singular family would behave like an ordinary human being. Clemmie is the culprit this time; she is being difficult - over nothing. The P.M. was in tremendous form last night. In a few hours he would be leaving Quebec for Hyde Park to spend some days as the President’s guest; then, as he grunted with great satisfaction, things would really get moving. I was therefore surprised to find him this morning in poor spirits. It appears that Clemmie was to have gone with him; but she changed her plans at the last moment; she was not sleeping well, she said. The truth is she does not like the President; once she confided to me that she does not like any great man except Winston. Winston tried to argue with her; it was not very polite to the President, he said. But Clemmie can be as difficult and obstinate as the great man himself. Besides he has ‘talked at’ her so often she has become resistant and doesn’t mind being ‘shouted down’.’

11 December 1943
‘Our luck is out. Soon after daybreak we came down near Tunis. A cold wind blew across the deserted aerodrome, there was no one about, no car, nothing. The P.M. got wearily out of the hot aircraft, looked around blankly and then, in spite of our protests, he sat down on a box, took off his hat and gloomily surveyed the sandy ground. The wind blew a wisp of hair this way and that, his face shone with perspiration. I pressed him to get back into the Skymaster; he only scowled. I went off to find out what had gone wrong, and learned that the airfield where we were expected was fifteen miles from this spot. There was nothing for it but to reembark. As the P.M. walked very slowly to the aircraft there was a grey look on his face that I did not like, and when he came at last to this house he collapsed wearily into the first chair. All day he has done nothing; he does not seem to have the energy even to read the usual telegrams. I feel much disturbed.

I went to bed early and woke to find the P.M. in his dressing-gown standing at the foot of my bed. “I’ve got a pain in my throat, here.” He put his finger just above his collar bone. I rubbed my eyes and got up. “It’s pretty bad. Do you think it’s anything? What can it be due to?” he demanded in one breath. I reassured him, and indeed I am not unduly perturbed. For a man with his strong constitution he never seems to be long without some minor ailment. Probably in the morning I shall hear no more of this pain.’

25 December 1943
‘To Early Service with Mrs Churchill. It was held in a barn with a few officers and men of the Coldstream Guards as communicants. During the service a dove flew in and perched on a rafter. The men said it meant that there would soon be peace.

An officer asked me, a little wistfully, how long the war would last. They are out of it all for a week or two guarding the Prime Minister, but they must know that when they go back the odds are against them; that it is just a matter of time. These highly civilized young men, who are so meticulous in the discharge of their duty, feel the utter beastliness of war, though they never speak of it. They have been brought up by their fathers to think that there is no sense in war, that it brings the solution of nothing.’

8 September 1944
‘It is just ten days since the P.M. landed at Northholt with a temperature of 103; for some days after that he was chesty, and the X-rays revealed a shadow at the base of the lung, a third dose, though a very mild one, of pneumonia. There had been some doubt whether he would be fit to set off on another trip so soon. I decided at the last moment to ask Lionel Whitby and a nurse to come with us. Winston has got it into his head that a pathologist is an essential part of the team to deal with an attack of pneumonia, and I thought it would comfort him to have one on board.

It was a happy thought. This morning when the P.M.’s temperature went up again he became thoroughly rattled and bad-tempered, until Whitby restored morale by finding that he had a normal blood count. The trouble is that Winston always has pneumonia at the back of his mind. Now the temperature has subsided and he is quite himself again.’

15 October 1944
‘After breakfast I called on the P.M. and found that he had diarrhoea. He was, however, in good spirits, and very hopeful about the way things are going. This afternoon his temperature went up to 101. He is quite certain now that he is beginning another attack of pneumonia.

“I am in your clutches once more, my friend. What about getting Bedford? I wouldn’t wait. The Cabinet will be getting fussed. Clemmie would like to come out, I am sure.”

He buried his head in his hands and moaned. Then Sawyers did something wrong and the P.M. flew at him. I fancy that his temperature is associated with the diarrhoea, but he won’t accept this, because the diarrhoea stopped at noon, and now, seven hours later, the temperature is still up. Nothing is gained in such circumstances by arguing. If, on our journeys, I were to send for specialists and nurses every time the P.M. runs a temperature we might as well add them to our travelling establishment. However, I sent a message to Cairo asking Pulvertaft and Scadding and two nurses to stand by; it would take them twelve hours to get here. Time enough tomorrow to send a telegram to Clemmie.’

30 January 1945
‘I turned in soon after we were in the air to get some sleep, as we were to land at Malta between four and five in the morning; an hour later Sawyers pulled my curtain back and said that the P.M. had a temperature - a good beginning to a winter journey of three thousand miles. The P.M. blames my sulphaguanadine tablets, which he has been taking during the day. As they are not absorbed from the gut, they could not be responsible, but the P.M. has views on everything, and his views on medicine are not wanting in assurance.

He was restless, and I soon gave up any attempt to sleep. He asked me if I would like to send for Whitby, the pathologist, and what about Clemmie? - the Moscow performance over again. He has developed a bad habit of running a temperature on these journeys.

It is not the flesh only that is weaker. Martin tells me that his work has deteriorated a lot in the last few months; and that he has become very wordy, irritating his colleagues in the Cabinet by his verbosity. One subject will get in his mind to the exclusion of all others - Greece, for example.

Winston stayed in bed in the plane till noon, when he was taken to H.M.S. Orion. He rested until the evening, when Harriman came to dinner. Only this morning he was in the doldrums when, turning his face to the wall, he had called for Clemmie. Surely this bout of fever should put sense into his head. But Winston is a gambler, and gamblers do not count the coins in their pockets. He will not give a thought to nursing his waning powers. And now, when it was nearly midnight, he demanded cards and began to play bezique with Harriman. Damn the fellow, will he never give himself a chance?’

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