Stalin

PATIENT NUMBER 1

The summoning of the doctors to the near dacha on the morning of 2 March 1953.

Beria, Khrushchev, Bulganin, and Malenkov returned to their homes, leaving Stalin on the couch without medical attention. Perhaps out of fear, or perhaps out of unspoken ambivalence toward his recovery, Stalin’s comrades rejected the idea that they were facing a medical emergency. After Malenkov and Beria checked on the vozhd and found him sleeping, they proceeded to dismiss what the bodyguards had told them about his symptoms. Had he really had some sort of fit? The bodyguards were not doctors. Their imaginations could have been playing tricks on them. His colleagues probably also remembered that Stalin had recently accused his own doctors of being murderers. Who would take responsibility for calling a doctor (or summoning a murderer, as the vozhd might see it) unless he were absolutely sure one was needed? A simple need for emergency medical care was transformed into a multidimensional political problem.

Stalin’s bodyguards spent the remainder of the night in a state of anxiety. No doubt worried that they could be held accountable if Stalin died, they again asked for guidance from above and reported that things did not seem right with the boss. This time the four comrades decided to send a team of doctors to the dacha. Before doing so, however, they convened the Bureau of the Central Committee Presidium¹ so that the summoning of medical luminaries would look like a collective decision by the party leadership. Should Stalin recover, his anger would fall on everyone at once. On the morning of 2 March the doctors arrived at Stalin’s bedside.

The renowned Soviet cardiologist Aleksandr Miasnikov, one of the medical experts summoned to attend Stalin, gives a detailed description of the visit in his memoirs. “The diagnosis,” he wrote, “was clear to us, thank God: hemorrhage in the left cerebral hemisphere of the brain caused by hypertonia and atherosclerosis.”² The doctors gave Stalin generous doses of various stimulants but without any real hope of preventing death. From a medical perspective, his condition was no mystery. An autopsy confirmed the initial diagnosis, revealing a large cerebral hemorrhage and severe damage to the cerebral arteries due to atherosclerosis.³ Stalin had been a sickly old man. He would have turned seventy-five later that year.

In totalitarian regimes, too much depends on the personality of the dictator. From the time he came to power, Stalin’s health was a topic of worldwide interest. During his lifetime there was periodic speculation in the Western press that he was ill or even near death. People in the Soviet Union whispered similar rumors. Scholars and commentators looked to Stalin’s physical and mental health as possible keys to understanding his personality and the brutality of his dictatorship. For a long time speculation surrounding Stalin’s health was based on unfounded assumptions. Only recently have we gained access to Stalin’s surviving medical records and testimony by the doctors who monitored his health and examined him after his death.

The only one of the Jughashvilis’ three children to live to adulthood, the future dictator suffered a variety of ills growing up. At an early age, Ioseb came down with smallpox, which left his face permanently pockmarked. He also had a bout of malaria.⁴ Then, through some sort of accident, the details of which have never been clear (some say he was hit by a horse-drawn carriage), he severely injured his left arm. The injury caused his arm to atrophy, giving him problems for the rest of his life. In 1898 Ioseb wrote to the rector of the Tiflis Theological Seminary asking to be excused from a reexamination “due to a disease of the chest that has long plagued me and that grew more severe during examinations.”⁵ He sought to be released from police custody in October and November 1902 because of his “predisposition toward pulmonary consumption” and worsening cough.⁶ Apparently his juvenile tuberculosis eventually abated, and he did not show signs of the disease later in life.

As a professional revolutionary, Stalin had to endure many hardships: prison, exile, and an unsettled existence even in times of freedom. During one term of exile he became ill with typhus.⁷ His most difficult trial was his final exile in Turukhansky Krai, which lasted three years. He had difficulty adapting to the harsh climate, austere living conditions, isolation from “the world at large,” and forced idleness, and in letters to friends he complained of a “suspicious cough” brought on by “intensifying cold (37 below)” and a “general state of ill health.”⁸ Overall, however, the tsarist government was immeasurably kinder to convicts than the Stalinist dictatorship. Had young Stalin had to endure so many imprisonments and exiles in the sort of Gulag system he went on to create, he most likely would not have survived.

The revolution and Civil War not only put millions in their graves, but also deeply affected the Bolshevik party and undermined the health of its leaders. In March 1921 Stalin underwent an appendectomy.⁹ On 23 April 1921, out of concern for their health, the Politburo voted to grant Stalin, Kamenev, Rykov, and Trotsky extended vacations.¹⁰ In late May, Stalin left for the North Caucasus and did not return to Moscow until 8 August, almost two and a half months later. In 1922 he skipped his vacation, but in July the Politburo compelled him to spend three days a week out of town.¹¹ Once the Civil War ended, spending time in the fresh air of Moscow’s leafy suburban dacha communities became an established lifestyle for the top Bolshevik leadership. Stalin and his family commandeered the country home of a former petroleum industrialist. Later, after the death of his wife, the vozhd built himself a new dacha, more convenient to Moscow. This famous country home (the “near” dacha in Volynskoe) was Stalin’s main residence for nearly two decades and will forever be associated with him. It was here that he died.

At the dacha, Stalin would spend time with his immediate family and other relatives or get together with his comrades. In addition to the festive dinners with lots of alcohol (described above), Stalin’s dacha lifestyle also included games, such as billiards or gorodki (a Russian game similar to skittles), although the dictator himself was not a big lover of physical activity. “He preferred stretching out on a deckchair with a book and his documents or the newspapers. And he could sit at the table with his guests by the hour,” his daughter Svetlana recalled.¹² This penchant for immobility only increased with age.

Another significant part of Stalin’s life were his vacations in resort areas of southern Russia. He spent time in the south every year from 1923 to 1936 and from 1945 to 1951.¹³ These trips were working vacations. A constant stream of documents was forwarded to him, and he kept up an active correspondence with his comrades back in Moscow, a practice that generated invaluable records for historians. But there was also time for rest and relaxation. While in the south Stalin treated his numerous diseases: rheumatoid arthritis, bouts of tonsillitis, long-lasting intestinal disturbances, and neurasthenia.¹⁴ His ailments were also eased by therapeutic baths. “I am getting better. The Matsesta waters (near Sochi) are good for curing sclerosis, reviving the nerves, dilating the heart, and curing sciatica, gout, and rheumatism,” he reported to Molotov on 1 August 1925.¹⁵

But Stalin was not a conscientious patient. His chronic ailments were exacerbated by his lifestyle and bad habits: smoking, drinking, rich foods, and overwork. Like most people, Stalin alternated between taking care of his body and inflicting damage. In May 1926 he left for a vacation in the Caucasus. After a brief stop in Sochi he set out with Mikoyan to travel through Georgia, where he visited his native Gori before going to stay with Ordzhonikidze in Tiflis. Letters from the head of Stalin’s Sochi-based security team, M. Gorbachev, suggest that this was a boisterous trip. While “under the influence,” as Gorbachev put it, on a whim, Stalin suddenly summoned him from Sochi to Tiflis but then forgot he had done so. When Gorbachev showed up, Stalin was surprised to see him. When it became clear what had happened, everyone “had a good laugh.” Gorbachev was forced to hurry back to Sochi, covering the vast distance at breakneck speed.¹⁶ Continuing his spree, Stalin spent a long time driving around the Caucasus and wound up returning to Sochi in bad shape. “I returned to Sochi today, 15 June,” he reported to Molotov and Bukharin. “In Tiflis I came down with a stomachache (I got food poisoning from some fish) and am now having a hard time recovering.”¹⁷ Gorbachev wrote to Stalin’s assistant, Ivan Tovstukha, “Overall, the boss wound up paying quite a price for this trip across the Caucasus in terms of his health. Mikoyan and Sergo [Ordzhonikidze] turned him topsy-turvy.”¹⁸ Stalin called for a doctor, went on a diet, and began to take the waters on a regular basis.¹⁹ The doctor who treated him in Sochi, I. A. Valedinsky, recalled that his patient complained of pain in his arm and leg muscles. When his doctors forbade him to drink, Stalin asked, “But what about cognac?” Valedinsky replied that “on Saturday you can let loose, on Sunday you should rest, and on Monday you can go to work with a clear head.” “Stalin liked this response, and the next time he arranged a ‘subbotnik’ [a word usually used for mandatory ‘volunteer’ work on Saturdays], it was very memorable for me,” Valedinsky wrote, although he did not explain what made this particular gathering so unforgettable.²⁰

References to his poor health are scattered throughout Stalin’s later correspondence as well. While on vacation in July 1927, he wrote to Molotov: “I’m sick and lying in bed so I’ll be brief.”²¹ According to Valedinsky, that year he also complained of pain in his arm and leg muscles. Therapeutic baths were followed by the usual subbotnik. Stalin invited his doctors to dine with him “and was so generous with the cognac,” Valedinsky wrote afterward, “that I did not make it home until the following day, on Sunday.”²² In 1928, before taking a curative bath in Sochi, Stalin again complained of pain in his arms and legs. The rheumatoid arthritis in his left arm was progressing.²³ During a vacation in August 1929 Stalin wrote to Molotov that “I am beginning to recuperate in Sochi after my illness in Nalchik.”²⁴ In 1930, while undergoing treatment in Sochi, he fell ill with tonsillitis. His teeth also hurt. In September 1930 he wrote to his wife that the dentist had “sharpened” eight of his teeth in one go, so he “was not feeling very well.”²⁵ In 1931 he again took therapeutic baths. “I spent about 10 days in Tsqaltubo. I took 20 baths. The water there was marvelous, truly valuable,” he wrote to Yenukidze.²⁶ That September he wrote to his wife that he was vacationing in Sochi with Kirov. “I went one time (just once!) to the seaside. I went bathing. It was very good! I think I’ll go again.”²⁷ Apparently he used the Russian word for “bathing” because he could not swim.

The vacation Stalin took in 1932 was one of his longest. The log of visitors to his Kremlin office shows that he did not receive anyone there between 29 May and 27 August—almost three months. The apparent reason for such a long break was poor health. The following spring the foreign press was still speculating that Stalin was seriously ill. On 3 April, Pravda took the unprecedented step of publishing a response by Stalin to a query by the Associated Press: “This is not the first time that false rumors that I am ill have circulated in the bourgeois press. Obviously, there are people in whose interest it is that I should fall seriously ill and for a long time, if not worse. Perhaps it is not very tactful of me, but unfortunately I have no information to gratify these gentlemen. Sad though it may be, the fact is that I am in perfect health.”²⁸ Behind this characteristically mocking response was genuine irritation. Stalin’s symptoms were serious, and rest and relaxation in the beneficial climate of southern Russia apparently did not alleviate them. “It seems I won’t be getting better anytime soon,” Stalin wrote to Kaganovich from the south in June 1932. “A general weakness and real sense of fatigue are only now becoming evident. Just when I think I’m beginning to get better, it turns out that I’ve got a long way to go. I’m not having rheumatic symptoms (they disappeared somewhere), but the overall weakness isn’t going away.”²⁹ Soon, however, he felt well enough to make a 230-mile trip across the Black Sea by motor boat.³⁰

Regular trips to the south inspired Stalin to build new vacation homes there. These construction projects began in 1930 and continued for the rest of his life. “We’ve built a marvelous little house here,” he wrote of his new dacha outside Sochi in August 1933. A month later he wrote of another residence: “Today I visited the new dacha near Gagry. It’s turned out (they just finished building it) to be a splendid dacha.”³¹

In 1933 Stalin was away from his Kremlin office from 17 August to 4 November. On 18 August he left Moscow to travel south with Voroshilov. The trip—by train, boat, and automobile—took seven days, during which they visited several regions of the country. Stalin spent the remainder of his vacation traveling (including by sea), entertaining guests, and, inevitably, working. This vacation was apparently among the more enjoyable. The situation in the country had somewhat stabilized after the devastating famine, putting the Soviet leadership in a good mood. Moreover, Stalin enjoyed relatively good health. “Koba felt great the entire time,” Voroshilov wrote to Yenukidze. His only health problem was some tooth pain.³²

Stalin’s vacation the following year was less successful. In 1934 he caught influenza and returned to Moscow having lost weight.³³ Kirov, who accompanied Stalin that summer, also did not enjoy himself. “As fate would have it, I wound up in Sochi,” Kirov wrote, “which I’m not happy about—the heat here isn’t tropical; it’s hellish.… I really regret that I came to Sochi.”³⁴ Things did not go well in 1935 either: Stalin again caught influenza and injured his finger when the head of his security team accidentally slammed a car door on it. Stopping in Tiflis toward the end of this vacation to visit his mother, he came down with a stomach ailment.³⁵ In 1936, Stalin’s letters to his comrades-in-arms back in Moscow during August through October are brief, harsh, and often ill humored. They contain no personal information, just orders. They are largely devoted to the topic of “enemies of the people,” especially arrangements for the first Moscow show trial against Zinoviev and Kamenev.

Nineteen thirty-seven had a gloomy start both for the country, which was succumbing to another round of repression, and for Stalin, who began the year with a bout of tonsillitis. (By 5 January he had sufficiently recovered to enjoy dinner with his comrades and doctors, followed by dancing to phonograph records.)³⁶ Despite his continued poor health, for the first time in many years he did not leave Moscow on vacation. The decision to stay was undoubtedly due to his intimate involvement in the purging of Soviet society. He also stayed in Moscow the following few summers. After the winding down of the Great Terror, the impending war prevented him from relaxing down south. In 1939, for example, he spent August embroiled in difficult negotiations with Western powers and then the Nazis, resulting in the pact with Hitler. He had recently turned sixty, and his health had not improved. In records dated February 1940, Valedinsky mentions another episode of tonsillitis and a bad cold.³⁷

The outbreak of war in the summer of 1941 pushed the already hardworking leader to his limits. Unlike many Soviet citizens, of course, he was not going hungry or enduring long days of backbreaking labor, but the additional workload and responsibilities put a greater strain on his health. In September 1944 discussions with the United States ambassador to Moscow, Averell Harriman (who was attempting to arrange for the Soviet leader to meet with Roosevelt and Churchill), Stalin explained that he would not be able to leave the country because of “increasingly frequent illnesses.” According to one account of these talks, “In the past Com. Stalin would have the flu for one or two days, but now it was lasting for one and a half or two weeks. He was showing his age.”³⁸ In his categorical refusal to travel by plane, Stalin may have been overdramatizing his health problems, but not by much. A number of memoirs describe Stalin’s frail health during the war years. Whenever the situation at the front permitted it, the dictator retreated to his dacha and worked from there.

In October 1945, shortly after the surrender of Japan, Stalin took his first southern vacation in several years.³⁹ Toward the end of his life these trips were shifted to later in the year, usually commencing in August or September and ending in December. Apparently he preferred to enjoy the peak of summer at his dacha outside Moscow and to head south when the weather up north turned cold. His vacations also grew longer. In 1946–1949 they extended to three or three and a half months, and in 1950 and 1951 he spent four and a half months out of town.⁴⁰ While at his southern residences, Stalin engaged in more or less the same activities as in Moscow. He spent time working on the day’s mail and writing to his comrades. He also received visitors, although fewer than in Moscow. As in Moscow, however, he enjoyed presiding over festive gatherings at the dinner table and playing billiards. But some activities were specific to his vacation lifestyle. During his visits to Russia’s resort towns, he took therapeutic baths, went for walks, and traveled. In 1947 he expressed a desire to travel by car from Moscow to Crimea, although the poor quality of the roads allowed him to get only as far as Kursk, where he boarded a train. Long car trips were evidently bad for his rheumatism. A number of memoirs report that he nevertheless preferred the less comfortable jump seats to the cushioned back seat.⁴¹ He seldom stayed in one place very long when visiting the south, moving among his continuously growing collection of dachas.⁴² Sometimes he would invite his daughter and son to join him, occasioning a sort of family reunion that, for a number of reasons, was not possible in Moscow.

After the war, these visits to the south alternated with long periods when Stalin barely left his Moscow dacha. Visits to his Kremlin office became increasingly rare, primarily due to his deteriorating health. He continued to suffer from stomach pain and intestinal disturbances, accompanied by fever, throat problems, colds, and influenza. His atherosclerosis was progressing.⁴³ Despite scattered attempts to do so, he was by now simply incapable of changing his sedentary lifestyle. The copious fare served at his frequent late-night dinner gatherings was surely not good for him. According to Milovan Djilas, who visited Stalin’s dacha several times in the 1940s, “The selection of food and drink was huge, with an emphasis on meat dishes and hard liquor.”⁴⁴ The leader of the Hungarian Communist Party, Matyas Rakosi, recalled the following:

The atmosphere at these dinners was free and easy; people told jokes—often even dirty ones—to the raucous laughter of everyone present. Once they tried to get me drunk, but wine doesn’t affect me, which earned me recognition and a bit of surprise from those in attendance. Our last dinner together was in the fall of 1952. When Stalin left the room at three in the morning, I commented to the Politburo members, “Stalin is already 73; aren’t such dinners, stretching so late into the night, bad for him?” His comrades assured me that Stalin knew his limits.⁴⁵

Stalin brought up his age and the importance of cultivating a new generation of leaders with increasing frequency.⁴⁶ Deep down, however, he must have hoped for the best. In November 1949, when the Albanian leader Enver Hoxha expressed the wish that Stalin would live to one hundred, the Soviet leader joked: “That’s not enough. Back home in Georgia we have old people still alive at 145.”⁴⁷ As Stalin’s daughter Svetlana attested, “In later years he wanted to continue in good health and live longer.”⁴⁸

In 1952, Stalin did not travel south. Even though he remained in Moscow, he visited his Kremlin office only fifty times, an average of less than once a week. On 21 December 1952, for his seventy-third birthday, his daughter Svetlana made her final visit to her father’s dacha. “I was worried at how badly he looked,” she recalled. “He must have felt his illness coming on. Maybe he was aware of some hypertension, for he’d suddenly given up smoking and was very pleased with himself.… He’d been smoking for fifty or sixty years.”⁴⁹ By this time his atherosclerosis was well advanced. The autopsy performed two and a half months later showed that damage to the arteries had greatly impeded blood flow to the brain.⁵⁰

To what extent was Stalin’s death hastened by a lack of professional care? It is widely believed that he did not see any doctors during the final months of his life due to arrests at government hospitals in connection with the Doctors’ Plot (see chapter 6 below). Svetlana Allilueva writes:

He was probably aware of an increase in his blood pressure, but he hadn’t any doctor to take care of him. Vinogradov [a renowned doctor who had treated Stalin], the only one he trusted, had been arrested and he wouldn’t let any other doctor near him.

Somewhere or other he got hold of some quack remedies, and he’d take some pills or pour a few drops of iodine into a glass of water. Moreover, he himself did a thing no doctor would ever have allowed: Two months after I last saw him and just twenty-four hours before his stroke he went to the bathhouse near the dacha and took a steam bath, as he’d been accustomed to doing ever since Siberia.⁵¹

Allilueva’s testimony has to be taken with a grain of salt. She rarely saw her father and knew little about his life. Her reminiscences offer a subjective view of events. No archival documents have been found to clarify whether Stalin was under the care of doctors during the final months of his life. Nothing has been written about the quality of his health care at that time. Perhaps no treatment in the world would have helped.

We are equally in the dark about another complex question: the effect Stalin’s ailments had on his decisions and actions. Without solid evidence, speculation on this subject remains just that. What we do know is that Miasnikov, one of the doctors summoned to his deathbed, believed that the extensive damage to Stalin’s cerebral arteries uncovered during his post mortem must have affected his character and behavior:

I believe that Stalin’s cruelty and suspiciousness, his fear of enemies and loss of the ability to assess people and events, his extreme obstinacy—all this was the result, to a certain extent, of atherosclerosis of the arteries in his brain (or rather, atherosclerosis exacerbated these traits). Basically, the state was being governed by a sick man.… Sclerosis of the blood vessels in the brain developed slowly, over the course of many years. Areas of cerebral softening that had originated much earlier were discovered in Stalin.⁵²

These observations by a distinguished doctor are entirely consistent with the testimony of Stalin’s associates. Even the most devoted among them, Vyacheslav Molotov, admitted, “In my opinion, Stalin was not quite in possession of his faculties during his final years.”⁵³ A historian, as well, would have no trouble coming up with “oddities” and inappropriate responses in Stalin’s political behavior. But historians are not doctors. While keeping their subjects’ possible ailments in mind, they try not to dwell on them.