The week before last,at a so-called clinicopathological conference,a mainstay of medical schools in which a mysterious medical case is presented to an audience of doctors and medical students,the patient under discussion was long deadhe was,in fact,Vladimir Ilyich Lenin,who died of a massive stroke at 6:50 p.m. on Jan. 21,1924,a few months before his 54th birthday. The questions posed to the conference speakers: Why did he have a fatal stroke at such a young age? Was there something more to his death than history has acknowledged?
At the University of Maryland,a clinicopathological conference focused on historical figures has been an annual event for the past 19 years; attending doctors have reviewed the case records of Florence Nightingale,Alexander the Great,Mozart,Beethoven and Edgar Allan Poe. Last Friday,two experts were called upon to solve the mystery of Lenins death: Dr Harry Vinters,professor of neurology and neuropathology at the University of California,Los Angeles,and Lev Lurie,a Russian historian in St. Petersburg.
Vinters began by telling the audience some details of Lenins medical and family history. As a baby,Lenin had a head so large that he often fell over. As an adult,Lenin suffered diseases that were common at the time: typhoid,toothaches,influenza and a painful skin infection called erysipelas. He was under intense stress,which led to insomnia,migraines and abdominal pain. At 38,he was shot twice in an assassination attempt. One bullet lodged in his collarbone after puncturing his lung. Another got caught in the base of his neck. Both bullets remained in place for the rest of his life. Lenins father died early,too,at 54. The cause of death was said to be cerebral haemorrhage,but Lenins father had an illness at the time of his death that may have been typhoid fever. Most of Lenins seven brothers and sisters died young,two in infancy. A brother was executed at age 21 for plotting to assassinate Czar Alexander III,and another brother died of typhoid at 19. Of the three who survived past young adulthood,a sister died of a stroke at age 71,another sister died of a heart attack at 59,and a brother died at age 69 of stenocardia,an archaic medical term whose meaning is no longer clear.
In the two years before he died,Lenin had three debilitating strokes. Syphilis was suspected,but a test was said to have been negative. Then,in his last hours and days of his life,Lenin experienced severe seizures. An autopsy revealed a near total obstruction of the arteries leading to the brain,some of which were narrowed to tiny slits. But Lenin did not have some of the traditional risk factors for strokes. He did not have untreated high blood pressurehad that been his problem,the left side of his heart would have been enlarged. He did not smoke and would not tolerate smoking in his presence. He drank only occasionally and exercised regularly. He did not have symptoms of a brain infection,nor did he have a brain tumour. So what brought on the stroke that killed Lenin?
The clues lie in Lenins family history,Vinters said. The three siblings who survived beyond their 20s had evidence of cardiovascular disease,and Lenins father died of a disease that was described as being very much like Lenins. Vinters said Lenin might have inherited a tendency to develop extremely high cholesterol,causing the severe blockage of his blood vessels that led to his stroke. Compounding that was the stress Lenin experienced,which can precipitate a stroke in someone whose blood vessels are already blocked.But Lenins seizures in the hours and days before he died are a puzzle,and perhaps historically significant. Severe seizures,Vinters said are quite unusual in a stroke patient. But,he added,almost any poison can cause seizures.
Lurie concurred,telling the conference that poison was in his opinion the most likely immediate cause of Lenins death. The most likely perpetrator? Stalin,who saw Lenin as his main obstacle to taking over the Soviet Union and wanted to get rid of him. In 1921 Lenin started complaining he was ill. From then until his death in 1924,Lenin began to feel worse and worse, Lurie said. He complained he couldnt sleep and had terrible headaches. He could not write,he did not want to work, Lurie said. But he was planning a political attack on Stalin,Lurie said. And Stalin,well aware of Lenins intentions,sent a top-secret note to the Politburo in 1923 claiming that Lenin himself asked to be put out of his misery. Stalin added that he just could not do it: I do not have the strength to carry out Ilyichs request and I have to decline this mission,however humane and necessary it might be.
Lurie said Stalin might have poisoned Lenin despite this assurance,as Stalin was absolutely ruthless. Vinters believes that sky-high cholesterol leading to a stroke was the main cause of Lenins death. But he said there is one other puzzling aspect of the story. Although toxicology studies were done on others in Russia,there was an order that no toxicology be done on Lenins tissues. So the mystery remains.