Il labirinto

Di cosa morì il padre di Winston Churchill?

he decade of the 1880s "saw the meteoric rise and catastrophic fall of the brilliant Lord Randolph Churchill."1 An intense personality of shining wit and piercing sarcasm propelled him to great political heights, but before he reached the pinnacle, his career was instantaneously extinguished when he resigned as Chancellor of the Exchequer. Then the spark of life itself was snuffed out. His death at age 45, reportedly from syphilis, cast a pall over his early fame. Now that pall may be lifted. Lord Randolph Churchill's main symptoms are much more consistent with a less titillating but far more logical diagnosis.

Randolph Henry Spencer-Churchill, younger son of the 7th Duke of Marlborough, was born 13 February 1849. Like other young men of his time, he joined in the merry life of the Marlborough House set, where the tone was set by his friend the Prince of Wales.2 In 1874 at age 25, he married Jennie, the beautiful second daughter of Leonard and Clara Jerome of New York. He was elected a Member of Parliament for Woodstock and embarked upon a tumultuous political career.

Not all of Randolph's time was spent in the House of Commons. He took to the turf and traveled widely: as far afield as South Africa, from whence he returned in January 1892, sporting a beard. The next year he visited Russia and Germany to relax at spas with Jennie. Against their doctors' advice, Lord and Lady Randolph made a world tour in 1894 which was cut short by his rapidly deteriorating health. He returned to England in late 1894, "as weak and helpless in mind and body as a little child," according to his son and biographer.

Even as a young man, Randolph's health had been unreliable. He was a heavy smoker, sufficiently so to "burn his tongue," and friends and physicians advised him to quit smoking and moderate his drinking. He was a very hard worker, with a frenetic energy that Winston described as "of a temper that gallops till it falls."4 Periods of intense activity led to exhaustion, followed by periods of profound fatigue and melancholia.

Lord Randolph was seriously ill in 1890, with palpitations associated with exhaustion. His family physician, Dr. Robson Roose, prescribed belladonna, laudanum and digitalis. The following year, he experienced an episode of severe confusion, which suggests acute high blood pressure. Earlier, in 1882, he had had an extended illness which Lady Randolph's diary refers to as tiredness and fevers. Later, in mid-1893, Dr. Roose told Jennie, who was distraught over her husband's illness, that Randolph's heart condition had, nonetheless, been cured. But around this time, Randolph began to have speaking difficulties which were associated with hearing and balance problems.

Over the next two years until his death in 1895, Lord Randolph complained of dizziness, palpitations, and intermittent numbness in his hands and feet. His speech became more slurred, and during one of his last parliamentary speeches, he hesitated on the text. His friend Lord Rosebery later recorded that "he was the chief mourner at his own protracted funeral, a public pageant of gloomy years."5 He eventually became quick-tempered and combative. Finally, he died in a coma, with pneumonia and, probably, kidney failure.

His biographers, including his son Winston, were divided on the nature of Lord Randolph's medical problems and the cause of his death. They have generally attributed his deterioration and death to syphilis (Winston in conversation though not in print) and its late effects. Some have suggested other neurological conditions, such as epilepsy, multiple sclerosis, amyotrophic lateral sclerosis (Lou Gehrig's disease), chronic alcoholism or a brain tumor.

The dramatic deterioration in his health and the various descriptions of his behavior in his last three years might support a diagnosis of dementia paralytica in late or tertiary syphilis, which affects the brain and appears ten to twenty years after the primary infection. This would likely have affected Jennie and their two sons, Winston and Jack. But if a diagnosis of advanced syphilis is to be accepted, there must have been an initial infection.

There has been considerable speculation about when Randolph might have become"infected." The most notorious account is by journalist Frank Harris in his 1924 autobiography, My Life and Loves, who recounts a story told by Louis Jennings, Randolph's friend and political colleague, who had published Randolph's 1880-1888 speeches. After a drunken party, Jennings said, fellow students put Randolph with an "old hag." The next morning he woke, discovered his situation, threw money at the woman and fled. He was immediately treated by a local doctor with disinfectant. Eventually, "a little, round, very red pimple appeared...on his peccant member." (This is not the description of a primary syphilis chancre, but of herpes.) A doctor supposedly treated him with mercury and warned him off alcohol.

Jennings's story is questionable for several reasons. First, the chance of contracting syphilis in one sexual encounter is less than one percent. Also, Jennings, who was dead when Harris recounted the story, had an axe to grind: he had angrily deserted his friend when Randolph attacked the Tory party and several of its members in 1893. Jennings's account as reported by Harris has never been corroborated. By 1924, Harris himself had fallen out with Winston Churchill, for whom he had been a literary agent. Harris seems to have had a preoccupation with syphilis, having made the same assertions concerning Oscar Wilde, which were incorrect, and Guy de Maupassant.

Dr. Claude Quetel sheds further light on Harris: "He with whom became friendly in 1880, and who also had a one-track mind, tells of Maupassant's sexual vigor and boasting; the strange thing is that he was prouder of his amorous exploits than of the stories he had written."8 Lord Randolph's nephew, Shane Leslie, and Shane's daughter Anita, both concluded that Harris's "old hag" story was incredible, and offered their own scenarios. Shane Leslie alleged that Randolph was infected by a chamber maid at Blenheim Palace around the time of Winston's birth.9 He also asserts that Winston's brother Jack was not fathered by Randolph, but by John Strange, later Lord Roden, who at that time was the same age as Jennie's father-in-law, the Duke. There is no substantiation for this and pictures of Winston and Jack together belie the suggestion.

Anita Leslie theorizes that Randolph had a French mistress who had syphilis.11 She infers this from complaints by Jennie to the Duchess of Marlborough about Randolph's coldness toward her in 1886. But correspondence between Jennie and Randolph at that time begins "Dearest," possibly indicative of a sudden reconciliation. Was this the year Randolph first became aware of a deterioration in his health? While it would be another five years before the appearance of severe symptoms, did his physician Dr. Roose now suspect that late syphilis was a real possibility, and suggest he abstain from physical intimacy with Jennie?

The spirochete responsible for syphilis was not to be discovered until 1905 and the definitive blood test was not available until a couple of years later. Since the initial and secondary manifestations of syphilis are highly contagious, Dr. Roose would have been mindful of the current medical practice, requiring him to determine if Jennie and the two boys were infected. A contemporary medical text states: "When the patient is a married man the health of his wife and children will form a guide in enabling us to arrive at a correct diagnosis."12 Roose would also have inquired into any history of secondary syphilitic features such as a rash over much of the body. There is no record of any such problems.

There is no indication that Lady Randolph or her sons were infected with syphilis. If it is accepted, as reported, that both boys were born prematurely, this was more likely to have been due to a weak opening to the womb than to the disease. If the boys were not born prematurely, that would cast even greater doubt on a diagnosis of syphilis. Neither son was born with the infections that resemble secondary syphilis, nor did they have late hereditary syphilis, commonest between the ages of 7 and 15, manifested by deafness, partial blindness and/or notched teeth.

There is likewise no evidence that Jennie's subsequent husbands, or the many lovers she is alleged to have had, ever contracted syphilis. Although unlikely, this might have included the Prince of Wales, who wrote her after Lord Randolph's death: "My dear Lady Randolph, the sad news reached me this morning that all is over...& I felt that for his and your sakes it was best so...There was a cloud in our friendship but I am glad to think that it is long been forgotten by both of us."

In the late 19th century, there was a clear predisposition toward syphilis in clinical diagnosis. In 1889, Dr. William Gowers, a well-respected neurologist, emphasized this overdiagnosis of neurologic syphilis when he delivered the Lettsomian Lecture to the Medical Society of London. He chose as his topic "Syphilis and the Nervous System."

In mid-1893, Dr. Roose conferred with Dr. Gowers's colleague, Dr. Thomas Buzzard. By then, Lord Randolph was experiencing intermittent problems with speech, concentration, depression and more frequent outbursts of violent temper. Dr. Buzzard was an expert in managing neurosyphilis, or late syphilis of the brain. It was his opinion that 95 percent of his patients had the disease.

Dr. Roose's and Buzzard's preoccupation with dementia paralytica, sometimes referred to as "general paralysis" of the insane, as an explanation for Randolph's illness is understandable. There was then no definitive blood test, no effective treatment, no sophisticated neurological testing, and no imaging techniques, such as CAT scans and MRIs. Untreated syphilis, particularly dementia paralytica, manifests itself in many ways, and may be confused with other diseases without careful diagnosis.

The 19th century preoccupation with syphilis was noted again later by Dr. F. M. R. Walshe, a mid-20th century neurologist, who said: "The belief that syphilis is the commonest single cause of organic nervous disease dies hard. It is a legacy from the text books of the end of the last century, in virtue of which syphilis of the nervous system occupies the place of honor, as though 'by merit raised to that bad eminence,' in most accounts of disease of the nervous system."

It seems likely that Lord Randolph had been convinced by his doctors that he had a severe degenerative neurological condition, possibly syphilis, as early as 1886. But this is not clear because Dr. Roose uses the term "general paralysis" to refer to a condition caused by the disease, and to a condition caused by "exhaustion." He once commented, "Chronic inflammation of the brain attacks persons of exhausted habits, brought on by excesses and irregular living. The patient has frequent headaches and gradual loss of health, and then gets a perversion of most of the senses, as of sight, taste, smell,etc., and in fact, all the symptoms of the incipient mania. The only treatment is to try and combat the various morbid symptoms as they arise and improve the general health in every way; but, in two or three years, general paralysis is almost sure to occur." Here the term "general paralysis" is clearly associated with exhaustion--not syphilis.

Lady Randolph Churchill may have been apprised of her husband's condition during a secret visit to his doctors in 1892, which provoked a fearful row. Winston may have learned from the doctors about the seriousness of his father's illness in 1894. He wrote a distraught letter to his mother while her parents were on their world tour. But it is not certain whether he understood Randolph's illness to be syphilis.

At the end, it was evident that Drs. Roose and Buzzard were convinced that Randolph had "general paralysis," which many people have taken to be a code word for syphilis of the brain. Dr. Buzzard, in response to an inquiry from the Prince of Wales' physician, explained in December 1894 that "Lord Randolph is affected with General Paralysis the early symptoms of which in the form of tremor of the tongue and slurring articulation of words were evident to me at an interview two years ago. In Lord R's case the physical signs--tremor, faulty articulation, successive loss of power in various parts of the frame have been much more marked than the mental ones which have hitherto been of comparatively slight character, grandiose ideas however, not being absent at time & on some occasions violent of manner."

Are there diagnoses other than syphilis that explain the reported changes in Randolph's personality, the problems with speech, and the evidence of neurological and other deterioration? Could the changes simply have been the evidence of "exhaustion," as may have been Dr. Roose's notion? "At the present day 'want of tone' is the characteristic feature of disorders in general and in none is it more obvious than in those which peculiarly affect official and professional men working at high pressure. Excessive smoking, too much alcohol, tea, and coffee, often resorted to by overworked persons, are frequent causes of sleeplessness," wrote Dr. Roose two years after his famous patient's s death.21 Lord Randolph's personality appears to have been intense, and one psychiatrist has concluded that he was a manic depressive. Brilliant in many ways, Lord Randolph was also brisk and impatient. Much of his behavior during his last five years seems to be no more than an accentuation of his prior personality.

Lord Rosebery described Lord Randolph in comparable terms: "His wit, his sarcasm, his piercing personalities, his elaborate irony, and his effective delivery, gave astonishing popularity to his speeches. His slim, boyish figure, his mustache which had an emotion of its own, his round protruding eyes, gave a compound interest to his speeches and his conversation."

Another friend, George Smalley, commented, "Lord Randolph had...an imperious temper, an intellectual disdain of natures from which intellects had been omitted, moods of black despair late in life, but all through life acted to win his battles without much thought of the cost--all these he had, and no one of them nor all of them broke or impaired the spell laid upon those about him." And A.L. Rowse, the Churchill historian and biographer, asserted, "Though a very quick and piercing judge of a situation, Lord Randolph Churchill's judgment was not really reliable. He was self-willed and impulsive, above all impatient. If he had only had patience all the rest would have come into line. But he had the defect of an artistic temperament, what we in our day of psychological jargon diagnose as the manic depressive alternation--tremendous high spirits and racing energy on the upward bound, depression and discouragement on the down."

It is necessary to say, however, that Lord Randolph's uncontrollable rages were an embarrassment to him. In 1892, Winston inadvertently annoyed his father by firing a shotgun under his window; his father lost his temper, then quickly made amends. "Understanding that I was distressed," Winston wrote, "he took occasion to reassure me."There were other similar incidents, for which Lord Randolph was immediately apologetic.

Lord Randolph had always had a slight speech impediment, and as a youngster he had had hearing problems, so it is difficult to single out problems with his speech, once thought to be a clear and common symptom of syphilis in its late stage affecting the brain. In the same sense, the muddled thoughts, memory lapses and profound confusion, all features of syphilis's paralytica dementia, were absent from Randolph's writings until the end of 1894. He wrote more lengthily, and his script became shaky, but it was never unintelligible. Until the last, when he was in a coma, his thoughts expressed in writing were rational; they include a cogent letter to Winston while on the world tour in August 1894.

In a letter to his mother on 8 October 1894, Lord Randolph describes how he cured the numbness in his hands and feet by putting them in hot water.28 If he had been suffering from dementia, he would not have been able to write such a cohesive letter. A likely explanation for the longstanding problem with his circulation is his chain-smoking. Spasms in the arteries reduce circulation which causes numbness and pain due to lack of oxygen in the tissues.

His speech problems caused Randolph great frustration. "I know what I want to say but damn it, I can't say it," he told his friend Wilfrid Blunt in May 1894.29 At several times he expressed similar anxiety over the difficulty of articulating his words. These fugue states, or "psychic seizures" are strongly suggestive of a variety of epilepsy found in the deep parts of the brain, close to the speech area. The progressive march of the disease process strongly suggests an expanding lesion or mass.

Consistent with his right handedness is the possibility that Lord Randolph developed a left side brain tumor, for which no surgery was available. This would also be consistent with the circulation problems in his hands, which in turn would be related to his intermittent heart failure and arterial spasms from nicotine in cigarettes. Even Dr. Buzzard might have agreed when he said "...intense pain in the head, when it is coupled with amaurosis (or prostration) is very suggestive of the presence of an intra-cranial tumor...If instead of atrophy of the discs we had found optic neuritis, this condition, when taken in connection with the intense severity of the pain in the head, would have gone far towards enabling us to pronounce a somewhat confident diagnosis of intra-cranial tumor."

If Dr. Buzzard had been convinced that Lord Randolph Churchill had advanced syphilis, he would certainly have treated him with mercury and with potassium iodide, which he strongly espoused for all neurosyphilitic patients.31 But Buzzard makes no mention of such treatments in any of his papers during Randolph's illness--and, had Randolph taken these two, their toxic effects would have been evident.

Indeed, the only medications Lord Randolph received that can be documented were for pain (laudanum) and heart failure (belladonna and digitalis). Dr. Buzzard's reference to "general paralysis" in Randolph's case is not diagnostic of syphilis, although it suggests this was his eventual conclusion. While syphilis may have been a reasonable diagnosis in the absence of modern techniques, the patient's temperament, combined with his main symptom of speech and articulation problems and absence of dementia, is more consistent with a tumor deep in the left side of his brain. It is not possible to be certain; but it is more likely to be the proper diagnosis.

His father's illness impressed Winston Churchill with a strong sense of impending mortality. He frequently remarked that he needed to accomplish his goals before his forties, and his resultant activity caused observers to refer to him as a "young man in a hurry." Presumably he was happily surprised at his longevity, but he long accepted the common rumors about his father's death. Late in life he told his private secretary, "you know my father died of locomotion ataxia, the child of syphilis."

When did Churchill pick up this story? The likely time seems to be 1924, when Frank Harris's book was published, precisely when Winston had left the Liberal Party and reverted to the Conservatives. The Tories were incensed and attempted to blacken his name, calling him a drunkard and saying that he was infected with syphilis. This same year, his 11-year-old nephew was confronted by a classmate at Summer Field Prep School, Oxford, who charged, "My daddy says all you Churchills have revolting diseases and are quite mad.

Winston survived the Tory attacks and became Chancellor of the Exchequer, the greatest cabinet position his father had held. Now, his father's reputation can also be vindicated.