Paratyphoid blamed on Ulster: a nursing odyssey.

SUMMARY: The aim of the Modicum mission from the United States was to determine the fate of the Western World, the Second Front and the Manhattan Project plans for development of atomic weapons. The Modicum mission was appointed in March 1942 by Franklin Delano Roosevelt as President and Commander-in-Chief of the US forces. The journey via the Anglican Cathedral in Bermuda, to Gander, to London, to Ulster was eventful. There was a clay-pigeon shooting contest in Gander. Generals Marshall, Eisenhower, Clark and Averell Harriman were outshot by their pilot. In Ulster, an escorting US sergeant killed a Londonderry bus driver with three shots. At a house party requested by King George VI and General Marshall, at Ashbrook, Ardmore, near Londonderry, it is alleged Averell Harriman was poisoned with Salmonella schottmülleri. He was delirious and 'gravely ill' for three weeks at 3 Grosvenor Square next to the American Embassy. He subsequently married his "other nurse", Pamela. Ambassador Pamela Churchill Harriman, a long-time ardent supporter of the Clintons, died in February 1997 following a stroke.

INTRODUCTION

In order to try to determine the origin of the paratyphoid B, enteric fever infection of W Averell Harriman, Franklin Delano Roosevelt's expediter, we need to follow itineraries. Harriman writes in his autobiography that Hopkins and himself “were billeted at the country house of a retired army officer who lived in elegant discomfort not many miles from Balyrena [sic], the base General Marshall was visiting”. “Harriman,” he writes of himself, “was forced to spend three weeks in bed”, “gravely ill”, “feverish and at times delirious, with what doctors believed to be a form of paratyphoid, probably traceable to drinking water from the Irishman's old well”1. “The incubation period of enteric fever (typhoid and paratyphoid) is typically eight to fourteen days, sometimes twenty-three”2. Christie cites incubation of twenty-one to twenty-three days, but four to five days may suffice when S paratyphoid B is the infecting agent, and the vehicle a highly favourable one, such as milk or cream3. Acute onset of symptoms is common2. The course of paratyphoid B infection may be identical to typhoid, producing a clinically indistinguishable enteric fever. The incubation period of enteric fever due to water-borne contamination is almost invariably longer than infection from other sources2,3. The pathology of enteric fever due to paratyphoid B is well described by Gadeholt and Madsen who report on 1,324 cases occurring in Norway between 1912 and 1961. Thirty-four of these patients with paratyphoid B died. All but eight of the surveyed 2,647 cases of typhoid and paratyphoid B were autopsied4.

WAR-TIME JOURNEYS

On the 20th March 1942, Averell Harriman checked out of the Dorchester Hotel in London and flew with Lord Beaverbrook to Bermuda. From there, Beaverbrook flew to Miami and Harriman to Washington, DC5. A fortnight later General George C Marshall and Harry Hopkins and part of the Modicum mission left Baltimore early on the 4th April 1942 in a Pan-Am Clipper for Bermuda, having been given aliases in Washington6. In Bermuda the opposite approach to the secrecy was taken. The next day in the cathedral, Marshall read the second lesson at Easter Matins, Revelation 1:4-18*, ending “have the keys of hell and of death”7–11. According to Mrs. Marshall's account, her husband read “Philadelphia” with particular emphasis, leading one Philadelphian worshipper to enthusiastically express her pride in her native city8. Marshall and Hopkins were wished God-speed direct to London, but they flew non-stop to Gander, Newfoundland to join the rest of the Modicum group. At Gander were Dwight D Eisenhower, Mark Clark and Averell Harriman. The combined party was then put on a Boeing 307 Stratoliner piloted by Otis Bryan12. The Stratoliner had to return to Gander, Newfoundland, because of atrocious weather conditions over Greenland. Pilot Bryan won a “high brass Gander skeet (clay-pigeon) shoot out (24 of 25)”. Marshall was an excellent and experienced quail hunter13, but was outshot. Bryan then flew them on to Prestwick; thence to London12. Upon their arrival, Winston Churchill told Marshall he knew of his Easter lectern performance8.

BOEING 307 STRATOLINER ACROSS THE ATLANTIC

A total of only ten Stratoliners were ever built, all by Boeing. Three were for Pan Am, five for TWA and a ninth for Howard Hughes. The tenth, the prototype, had crashed, but TWA put the Stratoliner into service on July 8, 1940: the first fully-pressurised aircraft to enter aviation service. With 33 passengers and five crew, a 12-foot wide cabin and overnight berths, it could fly 20,000 feet higher than all other airliners. A galley-kitchen was provided, staffed by two registered nurses12.

The Stratoliner's deployment for the Marshall, Hopkins, Harriman trip to London and then Ulster had national and international implications for the United States. The US War Department of which Marshall was effectively professional head, wanted control of all the Stratoliners and many other civilian airliners and helicopters: this they achieved on May 7, 194214 by Franklin D Roosevelt's presidential memorandum to the Secretary of War and the Chief of Staff15. Undoubtedly the US military realised that the flight across the Atlantic at 14–20,000 feet would be manifest to the Axis and would impress US allies.

LONDON, APRIL 1–15, 1942

On the 3rd April 1942, FDR had written “Dear Winston, Best of luck. Make Harry (Hopkins) go to bed early, and let him obey Dr. Fulton, US Navy, whom I am sending with him as super-nurse with full authority”16. Hopkins was a long-term live-in White House advisor to the Roosevelts. In 1939 he had undergone surgery for cancer of the stomach17.

From the 9th to the 16th of April, the US Delegation, having arrived on the 8th, had long formal meetings in Whitehall with Winston Churchill and the British Chiefs of Staff. General Hastings “Pug” Ismay took the minutes18. Having been ill and in pain after his arrival, Hopkins on April 15, 1942 addressed Westminster MP's. He suggested, records Harold Nicolson, “That we should be mad to get rid of Winston”. “Somebody asks him whether America can advise us on the sort of propaganda we ought to conduct”. Hopkins replied, “We are the worst propagandists in the world and you are the next worst. Why not consult someone better?”19 Averell Harriman was present. Marshall had asked King George VI at luncheon earlier that day if, because of Hopkins' delicate health, while in Ulster they could stay in a private home20.

Averell Harriman, meanwhile, had moved into 3 Grosvenor Square, London, with his daughter Kathleen. Aged twenty-four, she had been educated at Foxcroft, a fashionable girls' boarding school, and Bennington College, Vermont. Number 3 was adjacent to the American Embassy on the square's south side. The bottom two floors contained embassy offices. The Harrimans, father and daughter, were joined by Pamela Churchill, the wife of Randolph who had just left London to join the Special Air Service (SAS). Harriman, Pamela and Kathleen all had separate rooms and could order food from the American Embassy21.

Six hours earlier than the US Army itinerary, for 17th April 1942, Marshall, Harriman and Hopkins flew to Limavady, near Londonderry, to inspect newly-deployed US troops22. They were met at the airport by their designated host, Major Douglas Beresford Ash DSO, DL, who had been a Royal Fusilier Captain at the Somme. He survived that blood-bath of Ulster manhood to become squire of the family estate, Ashbrook21. Pamela continued as Winston's sometime hostess. He appreciated his daughter-in-law, saying “Aren't I lucky to have such a pretty daughter-in-law?”23

The Washington Post of 19th April 1942 states, “Hurrying about in an American staff car guarded by machine-gunners and riflemen of the United States Scout Corps, General Marshall and the others were busy.” Marshall visited the US Field Hospital of 250 beds outside Londonderry and spoke to “at least one patient in each ward - Americans and British alike”24. On their way to Ashbrook from Limavady on April 17th, near Ballykelly, a bus driver was shot dead. US Sergeant WV Clipsham fired the three shots. At his court-martial for manslaughter Clipsham was acquitted, partly on the grounds that the bus driver had deliberately delayed Marshall, Hopkins and Harriman by driving in the middle of the road25.

A VISIT TO ASHBROOK

Marshall, Harriman and Hopkins arrived at Ashbrook, Ardmore, before lunch on 17th April 1942 to be received by their host and hostess, Major Douglas and Lady Helena Beresford Ash26. According to Harriman, Hopkins developed “An immediate aversion for the place, resenting not only the lack of creature comforts but also his host”1. Ashbrook was no White House and Fusilier Ash was less captivating than Hopkins' longtime host President Roosevelt. Marshall, on the other hand, was charming. John Beresford Ash, the son, has said “When I was being bathed, General Marshall thought I was a little girl.” General Marshall atoned by letter and a “box of candy” for the little “tow-haired gentleman.” John Beresford Ash ate the chocolates and the letter still exists26.

Dinner on the 17th of April was not an entire success. Marshall ate a disproportionate share of the main course - thin slices of liverwurst, slivers of carrots on a few lettuce leaves and strips of bread. There was a small dessert. Hopkins and Harriman “suffered the pangs of hunger all that evening”. Early the next morning Hopkins wrote a note to Marshall suggesting porridge, pork and beans for breakfast. Marshall from his bed wrote on a blank radiogram in pencil, “the Chief of Staff …feels compelled to observe that the hour hardly justifies Mr. Hopkins in disturbing the rest of so high a military official. The Chief of Staff suggests that instead of a crude meal of pork and beans, Mr Hopkins would be better off, with a small circle of liverwurst, the ragged edge of a piece of lettuce and the false hopes of more to come”27. On their leaving the next day, 18th April, the escorting convoy was held up while Marshall, Hopkins and Harriman inspected the rhododendrons, on which Harriman was an expert. “The war can wait,” said Marshall26. Rhododendrons covered many of Harriman's 40,000 acres of Arden, New York. Arden also had thirty-odd bedrooms and its food was of “genuine mediocrity or worse”28.

According to the proposed itinerary,22 luncheon on the 18th of April was provided for the Modicum party at the headquarters of Major General Russell P Hartle, commander of both US Army Northern Ireland and V Corps. Since late March of 1942 his mess had served mainly American rations29, Averell Harriman, Hopkins and Marshall flew from Limavady to the RAF station at West Freugh. Thence by ground to Portpatrick, from where Hopkins and Marshall flew by Pan Am Clipper Flying Boat to Washington, DC, arriving in time for dinner the next day, 19th April 194222,27. From the Portpatrick Hotel Harriman arrived on the 19th April 1942 at 3 Grosvenor Square, thence to report to Winston S Churchill.

ILLNESS

On the 21st April, Averell Harriman became violently ill. High pyrexia was accompanied by delirium. He was cooled, fed and nursed by his daughter Kathleen and friend Pamela Churchill21. The patient and nurses were friendly with Lord Beaverbrook, who summoned Dr Daniel Thomas Davies - later knighted30,31. Davies, University of Wales and the Middlesex, FRCP 1932, had been Assistant Chemical Pathologist at the Middlesex30. Davies used a Widal test and microscopy to diagnose Paratyphoid B due to Salmonella schottmülleri31–33. Dr Davies' narcotic prescription for Averell was delivered to nurse Pamela on the 25th of April (Fig 1)34. Dr Davies then prescribed eighteen days worth of strict ‘modified ulcer diet’35 based on the Osler textbook as revised by HA Christian36. Next day, 26th April, at 2:00 pm, Eastern Daylight Time, Davies telephoned the Harriman family physician, Dr Alvan L Barach, of 929 Park Avenue, New York City. Davies reported on his consultation with Viscount Dawson of Penn about Averell Harriman36. The following day, the 27th, daughter Kathleen wired Lord Beaverbrook, now translocated from Miami to the Waldorf-Astoria in Manhattan, “Averell picked up a bug in North Ireland hob nobbing with the indigent aristocrats. Character obscure but has caused high fever…Explain to Marie (her step-mother). Pam joins with love”37.

Fig 1a

Davies followed the therapeutic regimen specified by Osler and Christian2. This prescription for codeine is the only prescription in the Harriman archives written during April and May 1942.

A vomit-bowl had to be sent to Mrs Randolph Churchill by Special Messenger.

Two days later, Pam's mother-in-law wrote in her own hand from 10, Downing Street, Whitehall: Dr. Davies brought in three American Red-Cross nurses, but Pamela Churchill stayed on as “the other nurse”- Averell Harriman's oft-repeated description of her war-time service to him21 (Fig 2).

Fig. 2

William Averell Harriman by Gardner Cox, oil on canvas, 1975, National Portrait Gallery, Smithsonian Institution.

April the 29th 1942

My dear Averill [sic],

Winston and I are grieved that you are ill.

Please please be very patient and lie very still. Winston had paratyphoid. It is a horrid and tedious illness, but when at last it is over one truly is absolutely well again. In fact the very capable Austrian doctor who looked after Winston (who fell ill at Salzburg) told me that after paratyphoid one has a completely new inside to one's stomach like a new born baby. In fact one is rejuvenated!

I'm afraid when the temperature goes down one becomes terribly hungry and of course one can't eat anything solid. Winston was very naughty and ate roast mutton too soon and had a relapse. We both send you our love and thoughts and wishes.

Yours ever,

Clementine S Churchill

We all feel you have contracted this illness in the service of both our countries38.

Daniel Davies, after his chemical pathology role at the Middlesex, had at the age of thirty been appointed as a physician to the Royal Free. His service as Physician to the Royal Household culminated in his Appointment as Physician to King George VI and later to the Queen. A more exacting patient of his was Beaverbrook. Davies, having made the diagnosis of paratyphoid B in Averell Harriman, would obviously realise the importance of suggesting a source of infection that did not betray inter-allied war planning or transportation secrets. Whether or not Ashbrook was the source, it was a convenient attribution. News of all this never reached the British 31st General Hospital or the advance body of the US 5th General Hospital at Musgrave Park,39 who by late March 1942 were, like the other US forces in Ulster, supplied with food and water tested and approved by the US military29.

THE NURSING OF HARRIMAN

The nurses wore rubber aprons. These were washed frequently with bichloride of mercury solution. After handwashing, the nurses soaked their hands thoroughly in 1:1,000 bichloride solution before and after each contact with Averell Harriman, and before they ate40. Pamela Churchill was vaccinated against paratyphoid B, and the other caregivers had already been vaccinated40.

The Davies modified Christian-Osler regimen included food obtained by the US Army and Navy as well as “beef bouillon made nearby by the chef at Claridges”41. “Delirious with fever and chills he required constant care”21 which Pamela and Kathleen provided.

ORIGIN OF PARATYPHOID

“The portal of entry of the paratyphoid bacillus is through the intestinal lymphatics and during the incubation period they multiply in the liver, spleen and mesenteric lymph glands”42. In Sir William Savage's 40 different series reported in 194243, water was rarely a vehicle of infection: four-fifths of the cases were due to infected food. Half of the time the infected food was cream or cream cakes.

Bedell Smith writes that Averell Harriman “while on a trip to Northern Ireland with Harry Hopkins and General Marshall… contracted paratyphoid from drinking contaminated water”21. No one else at Ashbrook reported contracting paratyphoid in 1942. When or where, then, did Harriman contract the disease? In the previous twenty-three days he had been in the United States, on the Stratoliner with its two sojourns in Gander, Newfoundland, London and then Ashbrook. There were no reported cases in Washington, DC44, or London45 at that time, so that makes cream and cakes at Gander or cheese from the galley of the Stratoliner suspect.

Gander would, in 1942, get cheese from Quebec. The Province of Quebec was experiencing enteric fever outbreaks traced eventually to its cheeses46. Harriman was present at Hopkins' talk to the Westminster MPs, but no one else was recorded as having been sickened at either the House of Commons, the US Embassy or the Dorchester Hotel. The New York Times reported that Harriman had had influenza47, most likely as instructed by the US Embassy. Paratyphoid B was extremely uncommon in Ulster in 1942, and almost nonexistent in March and April 1942 (Table I). The Medical Department, US Army, reported for 1942 only one admission to hospital for paratyphoid in its entire European theatre of operations48 and a total of forty-one admissions to hospital for paratyphoid world-wide for that year49. Newfoundland was administratively a part of Great Britain from 1934 to 1949 and we are unable to locate data on its incidence of enteric fever in 1942. The source of Harriman's enteric fever will probably never be conclusively ascertained, but it is extremely unlikely that it was Ashbrook water. The incubation period was too short.

Table I

The Reported Incidence of Enteric Fever (Paratyphoid and Typhoid) in different areas of Averell Harriman's travels, Spring 1942

REPORTED CASES
Week ending	London District, Typhoid	London District, Paratyphoid	Ulster, Typhoid	Ulster, Paratyphoid	Washington DC*	New York City*
28/02/42	2	0	2†	–	0	2
07/03/42	1	1	0	NR‡	1	3
14/03/42	3	0	3	0	0	3
21/03/42	0	1	1	NR	0	1
28/03/42	0	0	2	NR	0	2
04/04/42	1	0	0	NR	1	1
11/04/42	0	0	2	NR	0	6
18/04/42	1	1	0	NR	0	4
25/04/42	0	0	0	0	0	4
02/05/42	3	1	0	0	1	5
09/05/42	3	0	1	0	0	2
16/05/42	2	0	1	NR	0	2
23/05/42	0	NR	1	NR	0	2
30/05/42	1	0	0	NR	0	3

Reported incident cases typhoid and paratyphoid combined

Includes paratyphoid-a and -b

NR = No return available for that period

TYPHOID VACCINATION POLICY

All US Army and AAF (US Airforce) personnel were vaccinated with typhoid, paratyphoid A and B bacilli heated to a temperature of 53-55°C. The US vaccine contained 1,000 million typhoid bacilli and 250 million Salmonella paratyphi (a) and the same number of Salmonella schottmülleri in each cc. Doses were 0.5cc followed by 1cc administered subcutaneously approximately a week and then a fortnight later. Complication rates were about twenty percent50. Since Hopkins was under naval medical supervision, he had presumably been similarly inoculated against paratyphoid. The efficacy of enteric fever vaccination is complex and still presents a challenge to world health policy51.

THE HARRIMANS

Patient Harriman's father, Edward Henry, was described as “a malefactor of great wealth” and an “enemy of the republic” by President Theodore Roosevelt. Edward H Harriman's wife Mary was a New York banker's daughter of impeccable probity. Their first-born son Harry died of diphtheria. William Averell, the next son, was born in November 1891. Averell's upbringing was arduous: work, then strenuous sport, then more work52. Groton, a spartan but leading private boarding school, was followed by Yale, where Harriman was elected to the semi-secret, but prestigious club, Skull and Bones53. In 1909 Edward H Harriman died, leaving a fortune equal to £500,000,000 in today's money and instructions to sons Averell and Roland to increase that capital. Steamships, Soviet manganese mines and an airline were not lucrative but Averell became chairman of Union Pacific and ordered complete modernization of its railroad system, which was most successful; he fussed like “a professional housekeeper”54.

Harriman scored the final winning goal for the United States in the 1928 Pan-American Championship Polo Series. The United States won two out of three games against Argentina before a combined final series attendance of 85,000 spectators55. His first wife Kitty contracted tuberculosis. They were divorced in 1929 after Harriman had become attracted to Marie Norton Whitney, the wife of Cornelius Vanderbilt “Sonny” Whitney. Averell and Marie were to remain married from 1929 until Marie's death in 1970 (Fig 3).

Fig 3

Averell Harriman (right) and Harvard University President Nathan M Pusey escorting Mrs. Jacqueline Kennedy to dinner at the meeting inaugurating the Institute of Politics at the John F Kennedy School of Government, Harvard University, 17th October 1966. Associated Press wirephoto from the New York World Telegram and Sun Newspaper Photograph Collection, in the Library of Congress.

Averell Harriman married ‘the other nurse’ the Hon. Pamela Digby Churchill Hayward, on Monday 27th September 1971 at Our Lady's Chapel at St. Thomas More Roman Catholic Church on East 89th Street, New York City. Marie Harriman had died in September 1970 and Leland Hayward on 18th March 1971. Hayward's producers' rights to South Pacific, Mister Roberts and Sound of Music continued. Ex-Governor (of New York State) Averell appeared happily married until his death on 27th July 198656 (Fig 4).

Fig 4

General Secretary of the Communist Party of the Soviet Union Yuri Andropov (right) greets Mr and Mrs Harriman on the 2nd June 1983 in the Kremlin. Photograph by Vladimir Musaelyan for Tass, copyright 1983, Sovfoto. From print in the W Averell Harriman Papers in the US Library of Congress, container 895.

Aged sixty-six, Pamela Harriman was in late 1986 worth approximately $115 million57. Pam-PAC (Pamela's Political Action Committee) was a leading funder of Democratic candidates. On the 18th October 1991, Pamela donated $1,000 to Bill Clinton. In April 1992 she invited him to dinner at her N Street Washington, DC house. By July, she was fully involved in his campaign as co-chairperson. Pamela acknowledged that Hillary Rodham Clinton “has analytical capability and intellectual self-confidence - Hillary is not irritated or put off by stylistic differences”58. Pamela gave a cocktail reception and dinner for the Clintons on the 12th September 1992 at her Willow Oaks, Virginia, farm, which raised over two million dollars59.

On the 4th May 1993, Pamela undertook her Senate Confirmation Hearings to become the 64th U.S. Ambassador to France60. All went smoothly, except Senator Helms exhibited some confusion. Pamela's membership in the Monet society, he opined, was support for Jean Monnet.

“Senator, it is the painter. His home is in France. It is called Giverny”. “Are you prepared to supplement with personal funds?” Helms asked. “Yes, Senator, whatever is necessary.” “It will be necessary,” said Helms61. Ambassador Harriman complied but only up to a point (Fig 5). All did not go well financially. A senior legal adviser and former US Secretary of Defense, Clark Clifford, was disbarred because of his involvement in the Bank of Credit and Commerce International (BCCI) financial scandal, and her chief financial officer, inherited from Averell, was fired for investing millions of Harriman dollars unwisely and without due authorization62.

Fig 5

“Portrait, oil on canvas, 1996, of the 64th US Ambassador to France, following Benjamin Franklin, 1996, by Anthony Palliser (1949-). The Honorable Pamela Digby Churchill Hayward Harriman was confirmed by the Senate in May 1993 and died in office on February 5, 1997. This photographic reproduction was provided courtesy of the Embassy of the United States of America in Paris, solely for use in association with this Medical History.”

The Trustees of Averell Harriman's daughters and grandchildren filed suit against Pamela on 15th September 1994. In a lengthy 100-plus page complaint, they accused Pamela of being a “faithless fiduciary”. This Manhattan Federal Court action was supplemented by requesting the commissioner of accounts in Loudoun County Court, Virginia to remove Pamela as executor of Averell's estates and as trustee of three trusts established in his will62. In June 1995, Averell's offspring filed another suit against Pamela for rejecting a settlement agreed by attorneys. Pamela no longer spoke to Kathleen. In October 1995, Pamela sued her former advisers, including Clark Clifford and Brown, Brothers Harriman & Co. Just after Christmas 1995, the Harriman heirs and Pamela shook hands and discussed the Republican-induced US Federal Government shutdown. They then settled their legal suits that day – 29th December 1995. On the 6th January 1996, Mary Harriman Fisk dropped dead of a heart attack. Pamela, now back in Paris, sent Kathleen a gracious note of condolence on the death of her sister. The next day, Sunday 7th January 1996, a member of Ambassador Harriman's staff phoned the Hedley-Whytes' Paris hotel room to say that the Tuesday 9th of January Embassy dinner party to which they had been invited in connection with trade and standards negotiations had been cancelled due to the Congressional action. John Hedley-Whyte had previously chaired a meeting on medical equipment standardisation and the US acceptance of CE (Conformité Européene) markings63 in the US Embassy on the Champs Elysées. Ambassador Harriman was, like her late husband Averell, an expediter, for the President of the US. William Jefferson Clinton had a few months earlier, in 1995, signed a treaty with European Union President Jacques Santer64.

Ambassador Harriman, the ‘other nurse’, died on the 5th February 1997, following a stroke suffered the previous day while at the Ritz Hotel, Place Vendôme, where she had been swimming65. She was posthumously awarded France's Grand Cross of the Legion of Honour by President Jacques Chirac66. President Clinton delivered the eulogy during her memorial service at Washington's National Cathedral, before her burial at the Harriman family estate in Arden, New York67.

POSTSCRIPT

If anyone has evidence that Ashbrook was or was not the source of Harriman's serious paratyphoid infection they should clarify the unproven, indeed unlikely aspersion that currently exists. On the positive side, all present at Ashbrook for the regally requested house-party agreed that the wine stored in a “large, brass-bound mahogany bucket”27 was excellent.