Kremlin Case History

Joseph Stalin's doctors had known for years that their patient had hardening of the arteries and high blood pressure; the signs show over a long period and are unmistakable. There was not much they could do about it, except to warn him against overexertion and overexcitement. A few recently discovered drugs such as hexamethonium (TIME, Aug. 4) and Apresoline give some patients a degree of temporary relief, but that is all.

The hemorrhage, as is usual in such cases, came without warning. It could not have mattered whether Stalin was in earnest conference, or playing cards, or asleep. An artery in his brain, no longer able to withstand the pounding of the blood coursing through it under excessive pressure, blew out like a worn bicycle tire. Blood flowed into the brain cells of the surrounding grey matter, clogged them and made them useless. Then the blood began to clot.

Stalin's right arm and leg were paralyzed, showing that the stroke was in the left side of the brain. His power of speech disappeared in the few moments before he lapsed into unconsciousness. From the moment they reached his side, the doctors knew that his plight was critical. They needed no delicate instruments to note that his breathing was highly irregular, with long pauses between rapid spells. His pulse rate shot up to 120, and this too was irregular. His blood pressure of 220 over 120 was high (though many people live for years with such readings). More disturbing to his doctors were signs that Stalin's heart was beginning to fail.

Camphor & Leeches. By their own elaborately detailed case history, the doctors did everything possible for their prophet. When his breathing became more than usually labored, they clapped an oxygen mask on him. Since he was comatose and could take no food, they fed him a glucose solution through a vein. To guard against pneumonia, they saw to it that his position in bed was changed often, and they injected penicillin. They injected caffeine to stimulate Stalin's nervous system. Following an old idea (which most U.S. doctors have abandoned), they injected camphor to boost his heart.

The doctors took frequent electrocardiograms of their patient's failing heart and directed dozens of laboratory tests. From the first, the results were disquieting, e.g., the number of white cells in the blood was mounting rapidly, suggesting inflammation in the lungs. On the third day, the electrocardiogram showed fresh damage to the heart muscle. But the sleepless Kremlin physicians fought on, meeting crisis after crisis in breathing and heart action.

Twice they used leeches to reduce the volume (and hence, they hoped, the pressure) of their patient's blood. At this, West-of-Curtain doctors raised their eyebrows: the job could have been done better and more easily by the modern method of puncturing a vein. However, the bloodsucking creatures could do no harm, and the Russian physicians may have had a nonmedical reason for their use--it would convince even the most old-fashioned Russian that nothing had been left undone that might save Stalin.

In a Sawed-Off Skull. In the end, neither antibiotics nor leeches could avail. Stalin's heart raced faster & faster, up to 150 beats a minute, in its automatic effort to compensate for the small volume of blood it could pump. (The coronary artery, supplying the heart's own muscle was diseased like the rest.) Half of Stalin's brain was already dead. When his heart stopped the rest of the brain died and with it the man.

Stalin was dead, but his doctors' work was not yet done. It was necessary to prove that they had diagnosed his illness correctly and treated it properly. A pathologist sawed off the top of the dead dictator's skull and laid bare the brain To their infinite relief, the doctors saw "a large area of hemorrhage in the grey matter of the left hemisphere of the brain." This had destroyed vital functions of the brain." The brain arteries were hardened.

The doctors went on slitting and snipping the corpse until they exposed the heart. Its lower left side was enlarged.

There were traces of many hemorrhages in the heart muscle, of others in the lining of the stomach and intestines. Hopefully the doctors proclaimed that they had been right all along and that nothing could have saved the dictator's life.

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