Winston Churchill (1874–1965),Dr Robson Roose,MD Brux,FRCPE (1848–1905) and Dr Joseph Rutter,MD Lond,MRCP (1834–1913): Treatment for pneumonia in March 1886

Introduction

Winston Churchill (Figure 1) explained why he went to school in Brighton. ¹ ‘Our family doctor, the celebrated Robson Roose (Figure 2), then practised at Brighton; and as I was now supposed to be very delicate, it was thought desirable that I should be under his constant care. I was accordingly, in 1883 [Churchill is mistaken, it was 1884^2,3], transferred to a school at Brighton kept by two ladies [Charlotte (headmistress) and Kate Thomson).' ¹ The Brighton School was based at 29 and 39 Brunswick Road, Hove (Figure 3), which Roose's son, Bertie (Figure 1) also attended. Churchill remained at the school for three years, ‘though I very nearly died from an attack of double pneumonia [in fact it was only right sided].’ ¹ OPEN IN VIEWER

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Figure 2.

Dr Robson Roose in 1900 ©W & D Downey.

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Figure 3.

Brighton School on the celebration of Queen Victoria's Golden Jubilee on 20 June 1887, ©Churchill Archives Centre, Churchill College, Cambridge (The Papers of Lord Randolph Churchill, RDCH 09 001 027).

Churchill does not mention directly the physical abuse he received previously at the hands of the Revd. Herbert William Sneyd-Kynnersley, Headmaster at St George’s School, Ascot, which was also undoubtedly a factor in his transfer to Brighton. He does state, however, that he was in a low state of health at St George's (Churchill camouflaged it as St James's School ¹ ) and after a serious illness he was transferred to the Brighton School where he benefited from the gentle surroundings and bracing air of his new school. ¹

We will review Winston's illness in March 1886 and its management by one of the most fashionable ‘society’ doctors in England at the time, Dr EC Robson Roose, with the assistance of Dr Joseph Rutter. We will examine the careers of both doctors and consider how Roose was able to rise from the position of assistant to a parish doctor (an apothecary) to an important place in the social and medical life of London and establish a large practice which was frequented by ‘exalted personages’, leaders in politics and society. ⁴

Methods

Information regarding Churchill's illness was available from few sources. Foremost were those of the family physician, Dr Roose, who wrote a series of letters to Winston's father, Lord Randolph Churchill, which are held at the Churchill Archives Centre, Churchill College, Cambridge (The Papers of Lord Randolph Churchill, RDCH), but which have been published.^2,3

Winston's illness March–April 1886

It is not known when Winston first became ill or when Roose was summoned to assess him, though his mother, Lady Randolph Churchill, was informed of Winston's illness on the 13th March; she hurried to Brighton and stayed at the Bedford Hotel.^3,5 Lord Randolph Churchill sent a telegram to her from London which stated that he would arrive in Brighton at 9.10 (probably in the evening) on the 13th March. Initially, Roose would not let the Churchills see Winston, ⁵ presumably because he was so ill.

Roose wrote to Lord Randolph on the 14th March at 10.15 p.m. stating that Winston's temperature was 104.3°F (40.2℃) and that the right lung was ‘generally involved – left lung of course feeling its extra work but, as yet, free from disease!’ ³ Winston's respiratory rate and pulse were increased. ³ Recognising the impact these observations might have on the Churchills, Roose wrote, ‘This report may appear grave yet it merely indicates the approach of the crisis [the turning point of the disease in pre-antibiotic days after which the patient either improved or deteriorated].’ ³ Roose informed Lord Randolph that he was in the room next to Winston to watch his patient during the night ‘for I am anxious.’ ³

At 6 a.m. on the morning of the 15th March, Roose wrote to Lord Randolph stating that as Winston's high temperature indicated ‘exhaustion’ he had used stimulants, by the mouth and rectum, with the result that at 2.15 a.m. the temperature had fallen to 100°F (37.8℃). ³ Roose confirmed that he would not see patients in London that day but care for Winston. ³

Roose wrote again to Lord Randolph at 1 p.m. on the 15th March stating that Winston's temperature was now 103°F (39.4℃) but that he was taking nourishment better. ³ Roose indicated that his strategy was to keep Winston's temperature under 105°F (40.6℃), and he predicted that by Wednesday 17th March Winston's fever would have subsided, and the crisis past. ³ ‘Nourishment, stimulants and close watching will save your boy’. ³ Roose informed Lord Randolph that he would remain at Winston's bedside until 3.30 pm when he would walk to the Orleans Club (a residential club at 64 King's Road, Brighton, frequented by Lord Randolph and friends) and leave a report but not be absent from Winston's bedside for more than an hour. He concluded, ‘Pardon this shaky writing. I am a little tired’. ³

Roose wrote his third letter to Lord Randolph at 11 p.m. on the 15th March which stated that Winston was holding his own, and his temperature was 103.5°F (39.7℃). ³ On the morning of 16th March Roose informed Lord Randolph that after an anxious night during which Winston was delirious, his temperature was now 101°F (38.3℃) and the left lung was still uninvolved. ³ Roose again remained in Brighton rather than attend his London practice. ³

There was better news on the 17th March. Roose wrote to Lord Randolph at 7.00 a.m. before he made his way to his London practice stating there was good news. Winston had had 6 hours sleep and was no longer delirious. His temperature had fallen to 99°F (37.2℃), his pulse was 92 beats per minute, and his respiratory rate was 28 per minute. ‘He sends you and her ladyship his love.’ ³ Roose left Dr Joseph Rutter ‘in whom I have every confidence’ ³ in charge of Winston's care after a joint consultation at 8.45 a.m. Rutter's fee was £2 2 shillings (approximately £101 in 2017) each visit. ³ The fee Roose charged is not known but is likely to have been greater.

Roose indicated to Lord Randolph that he would not return that night to Brighton as he hoped that Winston would not relapse with ‘nourishment the avoidance of chill, rest and quiet …’ ³ To reinforce this message, Roose also wrote to Lady Randolph Churchill from the station to impress upon her the absolute necessity of quiet and sleep for Winston and that Mrs Everest (Winston's nanny and chief confidant) should not be allowed in the sick room today. ‘I am so fearful of relapse knowing that we are not quite out of the wood yet.’ ³

Roose promised, however, that he would return to Brighton on the 18th March or Friday 19th March ‘as the lung will I hope begin to be clearing up and must be carefully examined’. ³ Lord Randolph informed his wife from the Carlton Club, London, that he would return to Brighton on the 19th March when Roose would examine Winston again. ³ No correspondence of this professional encounter has survived.

On the 17 April, Lord Randolph informed his wife that Winston was getting on well ‘and is attended by Dr Gordon. He cannot go out yet as the weather is raw …’ ³ Winston was delighted, however, by a locomotive steam engine his father had given him. ³

Edward Charles Robson Roose MD Brux FRCPE Hon LLD FCS (1848–1905)

Roose was born at 32 Hill Street, Mayfair, London, on 23 November 1848, and was the third son of Francis Finley Roose, solicitor, and his wife, Eliza Burn, and the grandson of Sir David Charles Roose (Sheriff of Dublin 1827). ⁶ Roose was the fifth of six children; one of his older brothers (Charles Ilderton Curran) and one sister (Emma Anne) died within the first two years of life. Hill Street was a very fashionable street in Mayfair, where Roose subsequently had his practice (number 44).

The records of the Society of Apothecaries indicate that Roose was apprenticed for three years (1864–1867) to Mr George Geere MRCSE of Brighton, an apothecary. This apprenticeship would appear not to have been a random choice for in 1862 Geere, by then a widower after the death of his first wife Ellen in 1856, had married Roose's eldest sibling Frederica Laura Maria (1840–1888). It seems possible that Roose's apprenticeship may have been ‘facilitated' by his sister. Roose attended a course of lectures at Sussex County Hospital (certified by Mr Rimmer and Mr NP Blaker) during this time. The Hospital had been recognised as a School of Practical Medicine and Surgery in 1834 by the Court of Examiners of the Royal College of Surgeons of England and by the Society of Apothecaries. ⁷

Roose entered Guy's Hospital, London in the 1867–1868 session. In addition to clinical training at Guy's and the Sussex County Hospital, he undertook three dissections in each of his first two years which were ‘very good’ (Guy’s Pupil’s Returns 1867–1868, pupil 69, G/FP10/7-10). He obtained his first medical qualification in I870 (Licentiate of the Society of Apothecaries; LSA). He became a Licentiate of the Royal College of Surgeons of Edinburgh (LRCSE) and a Licentiate of the Royal College of Physicians of Edinburgh (LRCPE) on 28 February 1871, via the Double Qualification Scheme, which was a popular method of gaining a formal qualification that said he was competent to practice as a doctor.

Roose married Edith, daughter of Henry Huggins, on 30 July 1870 in Brighton and they had five children. Henry Edward Robson (1871–1937) a stockbroker, Katharine Edith (1873–1956), Bertrand/Bertram Charles Robson (1875–1896/1900), Fitzroy Owen Jonathan (1880–1952) an electrical engineer, and Hubert Gardner Francis (1882–1929) who was a mining engineer.

In 1872 he became a Member of the Royal College of Surgeons of England (MRCS). At the time the MRCS was obtained by passing a two-stage examination. The first examination took place early in training and was an oral examination on anatomy, physiology, chemistry, botany and materia medica (therapeutics), while the second examination (known as the final examination) was in surgery and was both written and oral.

Although Venn’s Alumni Cantabrigienses ⁸ states that Roose was admitted to Trinity Hall, Cambridge as a fellow-commoner [fellow-commoners were noble or wealthy undergraduates] in 1886, a search of the admissions register and the Praelector’s Book found no trace of Roose either for 1886 (by which time he was a well-established practitioner) or at any time between 1859 and 1886. It is possible that Roose may have been granted a place at Trinity Hall, but never took it up. For the same reason the statement in the Oxford Dictionary of National Biography ⁶ that Roose entered Trinity Hall, Cambridge, but left the university without a degree, cannot be accurate. He was awarded a Doctor of Medicine degree by a university in Bruxelles in 1877; it is not known whether this involved an examination, though it is known he studied in Paris. ⁹

Roose became a Member of the Royal College of Physicians of Edinburgh (MRCPE) in 1875. At that time, election to MRCPE was by testimonials from colleagues; Dr Allen MRCPE, 35 Regency Square, Brighton (Roose lived at 44) provided a testimonial. The first Membership of the Royal College of Physicians of Edinburgh by examination was not introduced until 1881. Roose was elected to the Fellowship of the Royal College of Physicians of Edinburgh (FRCPE) in 1877. He became a Fellow of the Chemical Society in 1886. Typically, someone would be nominated for Fellowship by existing Fellows of the Chemical Society, usually by those known to them personally. Roose was awarded the LLD in 1889 by the Queen's University, Kingston, Canada. It is not known by the University on what basis this Honorary degree was awarded, though Roose was in distinguished company as the list of those receiving this honorary degree confirms. ¹⁰

Roose was for a brief time in partnership with Geere, but this was dissolved on 20 October 1871 by mutual consent. ¹¹ Roose was appointed Surgeon for District no 6 of the Brighton and Hove Provident Dispensary in 1873. ¹² Roose first practised at 32 London Road then at 44 Regency Square, Brighton, where among the aristocratic and fashionable invalids sent to that health resort to recuperate, he laid the foundation of a practice ‘which in time became very large, and included leaders in politics and society, and still more exalted personages’. ⁴ It is said that while at Brighton he was discovered by Edmund Yates (newspaper editor, journalist, novelist) who introduced him to various influential personages. ⁹

By 1885 Roose's professional position was secure and he closed his Brighton practice and thereafter practiced only at 49 Hill Street, Mayfair, London.^4,6 In his early days in London Roose had had a relatively hard struggle to succeed professionally. However, after Roose attended Mr Gladstone (Prime Minister four times) in one of his illnesses, when he (Roose) was only in his thirties, ¹³ his popularity steadily increased, and he built up a large and fashionable practice, although this was owing more to his social skills than any medical ones.^6,14 He was also the physician of Lord Randolph Churchill (Chancellor of the Exchequer), Sir Michael Hicks Beach Bt (Chancellor of the Exchequer), Joseph Chamberlain (Cabinet minister), the Marquess of Hartington (political party leader and subsequently the Duke of Devonshire), Henry Labouchère (politician, writer, publisher), Mr Ritchie (Chancellor of the Exchequer), Montagu Williams QC (Treasury counsel), Edmund Yates, and the Shah of Iran among ‘many men and women who were eminent in politics, in literature, and in the “smart” world’. ¹⁴

Roose held no hospital appointment, but in 1895 was appointed Medical Attendant at the Turkish Embassy, London. ¹⁵ He published four books,^16–19 contributed three articles to the Fortnightly Review,^20–22 one to Scientific American ²³ and one brief report to the British Medical Journal. ²⁴ None were of great academic value though his book on gout went through six editions over four years. ¹⁶ The conclusion of the British Medical Journal was that, ‘He added nothing to the sum of knowledge …’ ⁴ Yet, ‘he preached commonsense and the doctrine of healthy living … Robson Roose was one of the earlier apostles of simple diet, rest, exercise, and abundant sleep; and many an exhausted Londoner, jaded by too much work or too much pleasure, has come away from his consulting room, carrying with him a budget of judicious advice, that was worth more than much medicine.’ ¹⁴ This focus explains the topics of his publications, which included The wear and tear of London Life, ¹⁷ Waste and repair in modern life, ¹⁹ Rest and repair in London life ²⁰ and The function of clothing. ²³ An obituary published in the Salisbury Times stated that his writings found a larger following in Germany where they were regarded as standard medical works than in his own country. ¹³

The British Medical Journal ⁴ concluded that there must have been something beyond the common in a man who was able to win and retain the confidence of men so shrewd and so experienced in the world's ways. ⁴ Although Roose's position in the profession scarcely accorded with that in which he was held in the eyes of the public, ⁴ it was acknowledged that he had to a consummate degree, the art of managing patients. ⁴ Moreover, ‘his diagnosis of all cases brought to him was marvellously correct, and unlike the majority of fashionable physicians he was always ready to give it in writing’. ¹³

The Turkish Ambassador, His Excellency Rustem Pasha, who lived at 1 Bryanston Square, London W1 wrote, ‘I have the greatest opinion of Doctor Robson Roose's talents and consider him one of the best and most skillful medical men in London, he has saved my life last year and he saved also the life of my secretary … when she was given up by her medical attendant and considered past all hopes of recovery. Doctor Robson Roose is not only an eminent physician, he is also a most kind hearted man, and I know of more than one instance when, out of mere charity and kindness, he has used his skill and given his valuable time to attend cases, when he knew no remuneration was to be expected; considering how valuable his time is, this says a great deal in favour of his kind heart and sentiments of humanity.’ ²⁵

Roose was described ‘as a man of the world, with a pleasant manner, and a sense of humour, his methods did not always command the admiration of his scientific brethren; but he understood human nature, and knew how to minister to the mind as well the body, being, indeed, shrewdly convinced that the two elements are inseparably associated. He had the faculty of inspiring confidence’. ¹³ The Times concluded that ‘his great success was largely due to his ingratiating manner and his abundant tact’, ²⁶ though his colleagues acknowledged he was a man of kindly disposition who found legitimate satisfaction in the fact that he had risen from the position of assistant to a parish doctor to an important place in the social life of London. ⁴

Roose was known to be an impressive host (supported strongly by his genial and accomplished wife) and at his table might be found potentates, peers, and politicians of different parties who found his home a convenient neutral territory where they could meet without attracting public attention. ⁴ Society journalists vied with each other in singing the praise of the hospitable physician in the lay press.

In the period 1889–1892 letters were written to Lord Radnor, Treasurer of the Household, attempting to obtain a knighthood for Roose. The writers included Edward Levy-Lawson (later Lord Burnham, owner of the Daily Telegraph and a fellow member of the Orleans Club, Brighton), Joseph Chamberlain, Lord Salisbury (Prime Minister three times) and Henry Laboucherie. Others petitioning on Roose's behalf were Justin McCarthy (Member of Parliament 1879–1900), Princess Helena of Schleswig-Holstein (daughter of Queen Victoria) and Rustem Pasha (Turkish Ambassador). ²⁵ Despite these interventions, no knighthood resulted.

Later in life, Roose became a director of a coal company in Kent, which was to involve him in a lawsuit brought against the company. ⁶ Although he was acquitted of all blame, the result of the trial in 1901 caused him not only heavy financial loss but much ‘vexation of spirit’. ⁴ After his wife's death in the same year ‘the whole course of his life was greatly changed’. ²⁶ He retired to Dorman's Park, East Grinstead, retaining only consulting rooms in London. Roose died at St Ermin's Hotel, Westminster, London, on 12 February 1905, as a result of hepatic cirrhosis. ⁶ He left £7659 15s. 4d (equivalent to £877,365 in 2017).

Joseph Rutter MD Lond MRCP (1834–1913)

Joseph Rutter was born in 1834 in London and named after his paternal grandfather. He was the fourth of seven children born to John Rutter (1796–1848) and Priscilla nee Edmonds (1800–1878). The parents were members of the Society of Friends (Quakers). Joseph had two brothers and four sisters. Joseph's elder brother was Thomas Edmonds (born 1829). Joseph's elder two sisters were Caroline (born 1831) and Sarah Jane (born 1832). His younger two sisters were Priscilla (born 1835) and Ellen Elizabeth (born 1840). In 1851 Joseph lived with his widowed mother and siblings at High Street, Lindfield, Sussex.

Rutter studied medicine at University College Hospital, London, and at the AGM of the Medical Society University College in October 1858 he was elected to the committee for the ensuing year. ²⁷ He passed the first MB examination in the first division in 1858 ²⁸ and qualified MB in 1860. ²⁹ He gained the MRCS first part anatomy and physiology on 18 December 1858 ²⁸ and the final MRCS on 3 June 1861 while living in Wandsworth. ³⁰ Rutter obtained the LSA on 23 May 1861 while living at Hillingdon. ³¹ By 1860/61 he was living and working at University College Hospital London as a physician assistant.

Rutter obtained MD (Lond) in 1862 ³² and MRCP (Lond) in 1868. ³³ Candidates for the Membership of the Royal College of Physicians of London at that time were required to sit papers on medical anatomy and the principles of medicine, the practice of medicine, and the principles of public health and psychiatric medicine. Candidates were also expected to translate short extracts from Latin, Greek, French and German, so they could demonstrate that they had a sufficient level of general education and culture, and thus could maintain the dignity and honour of the College. A clinical examination and two oral examinations would follow. Candidates had to be a minimum age of 25, provide satisfactory testimonials of their character and their education, and not be engaged in trade. While the Examination was run four times a year, the numbers passing remained small, e.g. only 20 in 1880.

Rutter's abilities at an early stage in his career prompted Sir James Clark (Physician-in-Ordinary to Queen Victoria) to offer him an appointment at Court. ²⁹ Instead around 1865 Rutter settled in Brighton where he quickly gained an extensive practice. In 1870 he was appointed Physician in Ordinary to the Brighton and Hove Dispensary in the place of Dr A Hall ³⁴ and consulting physician at the Brighton and Hove Provident Dispensary. ³ The Dispensary was established to promote a spirit of independence amongst the poor; it opened in 1837. The dispensary was supported by voluntary contributions, and for one penny per week per person, and one halfpenny per child, it gave medical aid, although aid was given gratis when necessary.

Rutter was appointed assistant physician at the Sussex County Hospital in May 1873 in succession to Dr Withers Moore ¹² and in 1884 he succeeded Dr EF Fussell as physician at the Hospital. ³⁵ He retired as senior physician in 1896, and as consulting physician in 1899.

Rutter was interested in the work to aid the blind, and he played a very prominent part in the foundation (three years before his death) of the Moon Pension Fund for the ‘necessitous' blind of Sussex, in connection with the well-known institution for the blind in Queen's Road, Brighton. ²⁹

Rutter lived with his mother and younger sisters at Codrington House, 141 Western Road, Brighton (formerly the home of Admiral Sir Edward Codrington who fought at Trafalgar) and he continued living there (where he also practiced) with his sisters after his mother's death in 1878. He retired from practice in 1899 when he and his sisters moved to 11 Wilbury Gardens, Hove. He never married.

He died at Wilbury Place, Hove age 79 years on 16 December 1913 ²⁹ and left £30,655 10s 1d (in 2017 approximately £3,332,474). ³⁶ In his will he left his residence and furniture to his sister Priscilla, smaller bequests to servants, Dr Barnardo's Homes and Miss Weston's sailors homes, and two-thirds of the residue to his sisters and one third to his nephews, John H Rutter and Hubert Rutter. ³⁶

Dr Gordon

No medical practitioner with the surname Gordon resided in Brighton in the 1880s according to successive Medical Directories. Presumably, for this reason, the Companion Volume ³ suggests that Gordon was misidentified by Lord Randolph; the compilers of the Compendium believed he was referring to Dr Clement Godson, ‘a leading paediatrician’. ³ Godson was a famous obstetric physician at St Bartholomew's Hospital, London. ³⁷ Although Godson is likely to have had some expertise in the care of sick children, as many early London paediatricians began their professional life as obstetricians, there is no evidence that Godson attended sick children in London or Brighton.

Discussion

Pneumonia was a common illness in children at the time and a major cause of mortality. Data from North America indicate that between the ages of five and 14 years, pneumonia accounted for almost 10% of all childhood deaths in the late nineteenth century. ³⁸ The statement ⁵ that Winston Churchill previously suffered from a weak chest and was prone to severe bouts of asthma during his three year residence in Ireland (1877–1880) is based on the recollections of Peregrine Spencer-Churchill (son of John ‘Jack’ Spencer-Churchill, Winston's brother) and family correspondence which suggested that months of heavy rain was the cause (personal communication from Celia Lee ⁵ ). At the time, Winston's grandfather, the Duke of Marlborough, was Viceroy of Ireland and his father was Private Secretary to the Viceroy.

What of the treatment (‘I used stimulants, by the mouth and rectum’) administered by Roose? It is probable that Roose refers to alcohol when he uses the term ‘stimulants’. In a paper published in 1861 on the Use of stimulants in pneumonia, Russell ³⁹ sets out to demonstrate ‘the great value of stimulants in the treatment of pneumonia, and to advocate their fearless administration … extending my advocacy to the freest employment of brandy even in hourly doses …). Furthermore, Yeo ⁴⁰ confirms that in 1884 alcohol was widely used in the treatment of pneumonia. The author was of the opinion that if ‘cardiac exhaustion, with sleeplessness and delirium’ were observed, the ‘free use of alcoholic stimulants’ was essential. Waters ⁴¹ reported on his experience of treating pneumonia as a physician between 1861 and 1881. ‘In a large majority of cases … some alcoholic stimulant-wine or brandy, more frequently the latter-was given early in the disease, usually from the beginning of treatment, and continued throughout the attack … In the most severe cases, brandy was given every hour, or hour and a half.’

In his Croonian Lecture of 1872, Bristowe ⁴² reviewed the treatment of pneumonia. He reported that Todd (Professor RB Todd, first Dean of the Medical Department, King's College Hospital, London) and his followers treated pneumonia mainly by the administration of alcohol in large quantities. In contrast, Bristowe ⁴² claimed that he had refrained altogether from the use of alcohol, excepting during the period of convalescence, ‘without any diminution of success’. It was accepted at the time, even by those clinicians who did not routinely prescribe alcohol in the treatment of pneumonia, that if the patient was a heavy drinker alcohol must be prescribed to prevent the onset of the alcohol withdrawal syndrome. ⁴²

The decision to send Churchill to Harrow rather than Eton after his attendance at the Brighton School was because of this attack of pneumonia. It was considered that Harrow-on-the-Hill would be more bracing and less injurious to his lungs than Eton (a low-lying area) surrounded by the ‘fogs and mists of the Thames Valley’. ² Churchill subsequently enjoyed good health as a young man, with a distinguished military and then political career, up until the onset of medical problems in his seventh decade. We believe that this episode of childhood pneumonia did not have any bearing on his later episodes of pneumonia in the 1940s,^43,44 though his tobacco smoking habit may have been important. As his son wrote, ‘Winston never suffered from lack of lung power, either on the political platform or in the House of Commons.’ ²

Conclusions

Winston Churchill developed pneumonia age 11 years. He was treated in the school in Brighton he was attending with close watching, nourishment, and stimulants (probably alcohol orally and rectally) by the family physician, Dr Robson Roose, with the assistance of another physician, Dr Joseph Rutter. Roose was exemplary in his professional commitment to his young patient and assiduous in informing Lord Randolph Churchill of his son's clinical progress.