A conversation with Dr. Adam Bogart about the Bolsheviks and Lenin's and Stalin’s illnesses

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Monday, November 21, 2016

November 12, 2016, Hi Miguel, Food for thought [“Vladimir Mikhailovich Bekhterev (1857–1927): Strange Circumstances Surrounding the Death of the Great Russian Neurologist” by Kesselring J] … It seems either Stalin or some of his colleagues consulted a neurologist about his withered arm in 1927, and the neurologist made a dx. of syringomyelia. [But] it is usually attributed by historians to either beatings by his father or childhood infection of some sort. But as you say, historians cannot be doctors [or medical scientists!].

Stalin and LeninIt could be Stalin actually wanted to find out if anything could be done for the arm, because he was so embarrassed by it. We know a few of his toes were webbed on one foot, and he was so embarrassed about that, he always wore boots even when swimming!

Unfortunately, the neurologist was somewhat ignorant of the conditions of the USSR in this era, and added a short psychiatric note as well. Looks like we have another case of poisoning by Stalin, not of him… In the meantime I will be searching for Lenin's autopsy report. Best regards, — Adam

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November 12, 2016, Hi Adam, I first learned on the Bekhterev-Stalin affair after reading the book, Great Men with Sick Brains by the neurosurgeon Bengt Ljunggren shortly after it was published by The American Association of Neurological Surgeons about 1990. Dr. Bekhterev was also Lenin’s neurologist, and although apolitical, he provided propaganda “services" to the Russian revolutionaries by pledging allegiance to the new regime. According to this book, rumors circulated that Bekhterev had also diagnosed Stalin with “grave paranoia” — a lethal mistake for the great doctor.
 
In any case Stalin also had Bekhterev’s son Pietr shot because the son suspected that Bekhterev was poisoned by order of Stalin. Prof. V.N. Vinogradov (1882-1964), who I mentioned in my opening article on Stalin’s death was more fortunate. As Stalin's doctor and physician in the Kremlin, he told Stalin he needed to slow down, which Stalin construed indiscreet or malicious, and Vinogradov was arrested and pulled into the concocted Doctor’s Plot, the dyelo vrachey.

Unlike Bekhterev who was dealt by Stalin immediately, Prof. Vinogradov was saved by Stalin’s sudden death. 

November 23 (addition) As to historians not capable of being physicians, I was explaining Dr. Plinio Prioreschi's statement, "Medicine being a very esoteric field cannot easily be mastered by nonphysicians." Prioreschi added, “the asymmetry (in esoterism) between science and the humanities… allows the physicist to be a poet but forbids a poet to be a physicist.” He truism was affirmed in the case of Stalin's medical death as I explained elsewhere. — MAF

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Interesting, Miguel. I did not know about the son. I see he does not make the dx. of syringomyelia explicitly, and I am not sure I agree if he did think that. I don't see any spasticity when Stalin walks, but I need to take another look at a film clip and watch more closely.

It's interesting that Hitler did not mind doctors speaking frankly to him on what the problem was and what he should do. Then, concerning the Jewish doctor's plot, it is also interesting that Stalin was not anti-Semitic by policy as was Hitler, so although he made many crude remarks about Jews, I have always concluded that by 1948 he was already showing signs of organic disease. 

In 1927, Stalin did not have the absolute power over the USSR that he would by 1929. I don't even think Trotsky was booted out yet, though powerless. So, I wonder if that made a difference in how he had to deal with Bekhterev. Best, Adam

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Hi Adam, Stalin was in a power struggle with Trotsky in 1924. He successfully tricked and was allied to Zinoviev and Kamenev (forming the “Triumvirate”) against Trotsky. After Trotsky was defeated politically, Stalin, at the Party Congress, December 1925, remained allied to Bukharin but turned against his former allies whom he detested, Zinoviev and Kamevev. He declawed them by 1926 and had expelled Trotsky from the Party by 1927. Bukharin was easily outmaneuvered and allowed to remain as head of the “right wing” of the Party (as supporter of the New Economic Policy of Lenin [NEP], some liberalization, etc.) nominally until 1929, at which time he too was expelled from the Politburo. Stalin basically had near absolute power by 1927. The token opposition was terrified by then. By 1929 he had absolute power and basically no serious opposition. The old hard Bolsheviks had been tamed to submission; they would all be eliminated later!

Stalin was inclined to anti-semitism as shown by his late anti-cosmopolitanism campaign, but recognizing the number of prominent Jews in the Party, his indispensable Jewish associates, and Jewish wives in the leadership, he tolerated them until the 1940s. Beria was the great sponsor of the Jews, again because he and Stalin could use them in a variety of projects because of their shown resourcefulness, devotion to the cause, and loyalty to the Party.
 
I have reviewed Stalin’s major biographies as well as one of Beria and Ezhov, (NKVD heads) at haciendapub.com. I strongly recommend the two books on Stalin by Simon Sebag Montefiore, one of them, Young Stalin, I reviewed as well. Montefiore’s two books are cliffhanger tomes, perhaps the best biographies with a lot of personal stuff found nowhere else. You can easily search them at haciendapub.com. Thanks for Lenin’s post mortem! Miguel

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Hi Miguel, That's all true, but in 1927 he [Stalin] could not simply have anyone arrested and shot with or without trial, unless there was some reasonable pretext. Especially a man as well recognized and respected as Bekhterev. Zinoviev and Kamenev were a cinch to tackle, because they were one of the original old Bolsheviks who found it amusing to place Stalin in the position of General Secretary, having no idea what kind of power that position really granted him. They were intellectuals, and as such, were too stupid to know just what kind of evil genius they were dealing with. It was always the same old story with all of them. Of course, it was Trotsky whom he tricked into not revealing the contents of Lenin's last testament, which would have had them remove him from power forever. Note that all three of them were Jews (I think Kamenev may have been half Russian Orthodox), but this had absolutely nothing to do with Stalin's hatred of them.
 
He surely did tolerate anyone who was useful to him, but Lazar Kaganovich was a friend, and that is probably because he was as almost as cruel and brutal as Stalin was, but he never gave any indication that he wanted to grab more power than Stalin allowed him. Stalin essentially gave Kaganovich and Nikita Khrushchev unlimited power to mastermind the Holodomor in Ukraine, where they both came from. But I am told by Ukrainian physicians and physicists I know that in modern day Ukraine, most of the blame for that is placed on Kaganovich alone, so I have to assume it is because he was Jewish.
 
Yes, I always thought Beria was no lover of Jews, but he was much more practical with how he handled them. That leads me to a perplexing aspect of Lenin. He was clearly philosemitic, and would not tolerate anti-Semitism because he truly believed Jews made the best communists.  Yet, we know now that Lenin placed a few Jews in high positions to make it look like the majority of Jews were in charge of the Communist Party, and he knew that they could be used as scapegoats that way, which they still are to this day. When you examine the Communist Party roles for 1920, you find 10% Jews and 90% Russians, but that is the opposite of the common perception, which is exactly what Lenin wanted.
 
I am glad to have found a copy of the autopsy report for you. Let me know your thoughts. There is no indication of syphilitic cerebrovascular disease, and even the aorta shows changes consistent with atherosclerosis, not syphilitic aortitis. Many people will still insist upon it, but I just don't buy it. Best, Adam

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November 13, 2016, Hi Adam, The Jewish contribution to the Bolsheviks, not surprisingly, was in the relatively more educated leadership and their wives. It was less so in the illiterate Russian proletariat in the rank and file.

Actually Beria employed many Jews in high positions even while Stalin was already imprisoning them or having many Jewish communists shot after returning from the Spanish Civil War. Beria pulled them out of jail and employed them. This is testified by both Sudoplatov and Aleksandr Orlov.
 
As far as Lenin's autopsy, this is what I think. True, the gross autopsy findings are less consistent with neurosyphilis than with atherosclerotic cerebrovascular disease. Nevertheless meningovascular syphilis can also result in endarteritis with obliteration of arterial lumens, arterial thrombosis, and ischemic necrosis of the brain parenchyma. No doubt occlusion of the left ICA accounted for his right hemiparesis and Wernicke’s aphasia observed clinically with the necrosis of the cerebral parenchyma in the left hemisphere seen pathologically. The hemorrhage in the quadrigeminal plate caused his death but again this could have resulted from inflammatory vascular changes of syphilis or atherosclerosis. No mention was made of gummas, but without microscopic sections around the involved blood vessels and brain parenchyma I don’t know if we can rule out neurosyphilis completely yet. Miguel

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Yes, that is true. I believe Molotov's wife was Jewish, as was Yezhov's, and I could look up a number of others that prove you right. It is untrue that Stalin married "Rosa Kaganovich" as his third wife, but I do think he had affairs with Jewish women, however. When it came to relieving his enormous sexual appetite, he did not discriminate.
 
The illiterate Russian proletariat in the rank and file were who Stalin enlisted through his role as General Secretary because they did what they were told and had no idea what the bigger picture was all about, but why did Lenin appoint Yakov Mikhailovich Yurovsky (a Jew) to head the team who assassinated the Czar and his family? He did not do an especially good job of it, and people to this day remember only him, not that the rest were Russian Orthodox.
 
I will read these articles you have linked me to as soon as I get a chance. Thank you for the material. I always appreciate more information on this subject.
 
No, I can't agree with you that the hemorrhage in the region of the corpora quadrigemina was the immediate cause of death, given he [Lenin] died during status epilepticus the evening before. As you have pointed out, we need to have the clinical information along with the autopsy, and in Lenin's case it is well documented. But, we do know the brain sections are still extant in the Russian archives and they will not release any of them to the Americans for examination, which makes no sense to me at this point. If there are questions about the histology, they would be trivial to answer even now. Best regards, Adam  

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Adam, Actually although not abstinent to either, Stalin was relatively temperate as to both alcoholic drinks and women. In this regard, the best and most captivating biographies on Stalin’s personal life, remain Simon Sebag Montefiore’s Young Stalin and The Court of the Red Tsar (2003), which I strongly recommend.

We need more information. That is why you need to research and write the paper with whatever material we can get. Yes status epilepticus is one of the conditions that was reported clinically, but autopsy-wise, the little hemorrhage in the region of the corpora quadrigemina is all we can pinpoint pathologically. Psychotic behavior and delirium were also reported. There was no evidence of transtentorial herniation with swelling and edema secondary to acute infarction or hemorrhage anywhere else. Convince me with a good paper about your thesis. Cheers, Miguel

Adam Bogard, Phd, is a Behavioral Neuroscientist at the Sanders Brown Center for Aging University of Kentucky, Lexington, KY. Behavioral Neuroscience Kent State University Kent, OH. Post doctoral fellow at the Albert Einstein College of Medicine, Gruss Magnetic Resonance Research Center Bronx, NY. MS Immunology conjointly Adelphi University/Mount Sinai Medical Center New York City, NY.

Miguel A. Faria, MD, is an Associate Editor in Chief and World Affairs Editor of Surgical Neurology International (SNI). He is a retired Clinical Professor of Surgery (Neurosurgery) and Adjunct Professor of Medical History, Mercer University School of Medicine. Former member of the Injury Research Grant Review Committee of the Centers for Disease Control and Prevention (CDC; 2002-05). Realclearhistory contributor (2012-present). He is President of Haciendapublishing.com

This article may be cited as: Faria MA. A conversation with Dr. Adam Bogart about the Bolsheviks and Lenin's and Stalin’s illnesses. HaciendaPublishing.com, November 21, 2016. Available from: http://www.haciendapublishing.com/articles/conversation-dr-adam-bogart-about-bolsheviks-and-lenins-and-stalin%E2%80%99s-illnesses

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Wood revisited once.

We could discuss Wood and Gershwin for a long time because there is so much to say about them, but there is the work on early Russian and American neurosurgery as well as the Lenin paper to think about now as higher priorities.

I did want to add that Wood is of especial interest because he was a celebrity type of political figure in those days, and everybody knew of him. Contrariwise, Cushing in 1910 was only known to his colleagues and the patients who he had operated on.

The subsequent reporting in the newspapers of the 1910 operation not only made Cushing a household name, but it made Americans aware of the infant specialty of "surgical neurology", as before this people were used to the notion of operations on the brain being performed by a general surgeon sometimes with a neurologist in the operating room directing him.

Cushing's dictum that a neurological surgeon should concentrate on neurological cases only (but maintain or exceed the technical proficiency of a good general surgeon), and his insistence that the neurological surgeon should also be a good neurologist was a departure from the accepted practice of brain surgery at the time. Part of this was due to his work from 1900-1910 to lower the tremendous mortality in cerebral operations when the intracranial pressure was increased. Patients knew of these statistics and were so terrified to have a tumor removed that they would rather die with it untouched. As late as 1893, Allen Starr advised the surgeon to simply shave off any portion of the brain that herniated when the dura was opened. As a result of this type of practice, surgeons could simply not make a living if they took on only neurological cases.
ARB

PS Funny enough, in December 1910, Sir Bernard Spilsbury was making a name for himself as the first "celebrity pathologist" by working for the Crown during the trial of Dr. Hawley Harvey Crippen.

Gershwin and Wood

Hi Miguel,
Briefly for now, because you raise some issues always in and out of my consciousnesses. Maybe I wish they weren't!

Especially Gershwin. I thought he never regained consciousness after surgery and spiked a high fever, so the surgeon must have accidentally disturbed the medulla. It is generally considered he was hopeless anyway, since the diagnosis was glioblastoma. I think it was temporal, which would account for his smells of burning rubber and bouts of strange behavior. However, the abnormal behavior preceded operation by many years (how long not known until recently), leading some to suggest recently it couldn't have been that malignant. I believe reexamination of the slides has confirmed this but I would have to check. If not for the highly Freudian stance psychiatry took in that era, an earlier diagnosis might have saved him. As it was a temporal lesion, Gershwin is considered to have suffered from the "Uncinate fits" of Huglings Jackson. You see more here:

http://www.scielo.br/pdf/anp/v60n2B/10223.pdf

Yes, Wood's case is very interesting and the brain is still viewable at Yale. I would like to see it. First operation, 1910. Easily localized without x-ray, but Cushing replaced the bone flap which was hyperostosed by the tumor, so local recurrence was inevitable. I don't think the meningioma was malignant. I don't remember why he died after the 1927 operation. Was it excessive blood loss, because the meningiomas are as a rule, vascular? It would be very ironic, because if so, in 1910 the operation went fine, and they did even not have these two things:

1911- Cushing introduces his silver clips to stem bleeding from small cerebral vessels.

1925- Working with his biophysicist Dr. William Bovie, he introduces the electrocautery.

Cushing also did not coin the term "meningioma" until 1922, as before that they were known as "Dural Endotheliomas."

Cushing was an extremely nasty person, but never to his patients. That is why when he lost one of his closest friends in the operating room, he never totally got over it. It broke him. --- ARB

A legacy of great men destroyed by sick totalitarian brains!

Hi Miguel,

I am aware of the great works in general medicine and biology in the late Tsarist era, and we know the so called "progressive" label now refers to people that are anything but. You will find the American liberal, while not a lover of Stalin, will at least unconsciously practice his techniques.

Yes, and Harvey Cushing died in 1939 of heart failure, with the famous meningioma or colloid cyst found around the third ventricle (no consensus on that one). Cigarettes? Loyal Davis, as one of his residents, thought he would be treated
more kindly if he bought Cushing a pack of his favorite brand. No, Cushing just snatched them out of his hands and said nothing.

I would say Walter Dandy might have been able to do it, but I like to remind people it is not completely correct to say he was the first to observe what air might do when it is in the ventricles. I wouldn't bet my life on it, but I think
he read this paper. The x-rays are not published here, but I have them from elsewhere.

Pavlov may have been, but he trained as a general surgeon. He couldn't study behavior if he couldn't operate on those dogs. Application of the x-ray as early as 1896 with bread soaked in Bismuth Sub-nitrate for contrast in cats by Walter Cannon confirmed some of his observations. Thank you for your best wishes! Best Regards, Adam
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Hi Adam,

Before the 1917 Revolution, Russia was quite advanced culturally in art, philosophy, literature, and in the pursuit of science & medicine. Consider the great Russian novelists, such as Chekhov, Turgenev, Tolstoi, and Dostoyevski; artists and composers, such as Vladimir Mayakovsky and Pyotr Tchaikovsky; neurophysiologists and other scientists, such as Ivan Pavlov (Nobel Prize 1904) and Dmitri Mendeleev, etc. Alexandr Solzhenitsyn, a physicist, discusses this in his masterpiece, November, 1916, a part of his brilliant work, the Red Wheel series. He adds financiers and, most importantly, for the advancement of Russia at the turn of the century, engineers.

The USSR under Lenin advanced in the police state tactic and under Stalin advanced in heavy industry and bellicosity and also repressive tactics, but sank in the arts and science. Lysenko was king!

http://www.haciendapublishing.com/medicalsentinel/perversion-science-and...

Neurology and neurosurgical text books from the early twentieth century would give an idea of the status of neurology and surgery and would have cited not only Pavlov but also Vladimir Mikhailovich Bekhterev (1857–1927), Prof. V.N. Vinogradov (1882-1964), and Nikolay N. Burdenko (1876-1946), the father of Soviet Neurosurgery. Burdenko had predeceased Stalin, so he could not have operated. Surgery could have been done in Stalin but with little chance of a positive result. Even if he had survived, he would have been left with a severe right hemiplegia and aphasia. Walter Dandy, in my opinion, would have been his best bet, but the American giant had died of a heart attack the same year as Burdenko (1946) and would not have been available.

But even if Stalin's surgery could have been done, don't forget the problem was not with the technical difficulties of the operation, which would have been routine, but the need of the Soviet physicians to bring down his blood pressure, and to stop the bleeding diathesis from the rat poison (i.e., Vit. K blocker derivative) that cause the hemorrhage to begin with. Incidentally, you mentioned Harvey Cushing, who had died in 1939, but the best technical surgeon at the time, especially for heroic neurosurgery, without a doubt, would have been Walter Dandy, but any competent surgery would have sufficed. When George Gershwin became acutely ill in Los Angeles with a brain tumor in 1937, Cushing in retirement, recommended Walter Dandy to operate but the neurosurgeon was in a yatch fishing in the Chesapeake Base with the governor of Maryland. The coast guard and private planes were sent to bring him back to the West coast. Gershwin was operated At Mount Sinai in LA and died there before Dandy could reach him. Harvey Cushing did operate on a meningioma afflicting Leonard Wood, the former American military governor of Cuba, but the Major-General, then the Governor-General of the Philippines died at a second operation by Cushing when the meningioma recurred two decades later in 1927.

You could insert the link to that paper by Wilder Penfield in a relevant and related comment by you on the subject, if you decide to do so. I mentioned Pavlov in the context of B.F. Skinner. Both men were behaviorists:
http://www.haciendapublishing.com/articles/critique-psychologist-b-f-ski...

Sincerely, MAF
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Hi Miguel,

Concerning Lysenko, he was Ukrainian, and Stalin was no friend of them. BUT, he came from a very poor family and treaded his way up to fame through hard work, even if misapplied. This is as opposed to Trotsky et al, who came from a well to do family to begin with. Stalin liked Lysenko, because he put hard work into what he did, and did not leech off family money. Or so he thought. True enough, that Stalin didn't. His family had none. Except Stalin had to ignore how rich Lenin's family was. Also that he was highly educated and a lawyer. Though, I sometimes wonder with Stalin's genius for acting, if he really hated Ulyanov.

it is not easy to find descriptions of Russian neurosurgery in the late Tsarist era. Problem is that the Russian sites on this are heavily propagandized. I can see they are lying about the accomplishments of many of the surgeons. However, I could be selective and post what I think might be true.

Well, it is possible Stalin was free of bleeding diathesis if we take the position we can't be sure of the poisoning. You could give me your opinion as you know better, but I would have recommended the old two stage procedure of the early 1900's. Subtemporal decompression under local anesthetic, and wait until the patient stabilizes...blood pressure would lower if part of it was due to increased intracranial pressure. Then you could re-operate and attempt to remove the lesion under a general anesthetic - chloroform in those days, because the coughing with ether raised the intracranial pressure. Maybe you think this wouldn't apply, but if it did, then you wouldn't need Dandy. Also, they would needle the brain during a decompression to see if the resistance changed and suppose that might be the lesion. Maybe you still do - I don't know. But we have more than skull x-rays now.

If the patient had been comatose, they could and did decompress with no anesthetic. Even now, I'm pretty sure in something like severe gunshot wound to the head, you don't need to use it in all cases. This is not to say that a
neurosurgeon will find all 10% of gunshots to the head that reach him alive operable. I don't have to tell you! Best Regards, Adam
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MAF, Yes Stalin was poisoned; alternative theories, conjectures, yes; but no one has been able to dispute the evidence and my conclusions, when considering the clinical and autopsy findings in the context of the political times and the behavior of his inner circle. Not even the German historian at the Kremlin has disputed or even answered my queries to him on the subject:

http://www.haciendapublishing.com/articles/death-stalin-%E2%80%94-was-it...

Stalin's outcome with Beria as his keeper!

I certainly did not mean to say I didn't accept your conclusion of poisoning, but I did want to make sure we agreed it can never be positively proven. However, since doctors at the time he was dying did not know he was poisoned, they would likely not have tried to treat a bleeding diathesis before surgery.

Let's say he wasn't poisoned (or even if he was). If surgery to evacuate the hematoma was successful, how is you make the statement that hemiplegia and aphasia would be permanent?

I'm not saying a person like you who studied and practiced neurosurgery for so long does not have opinions that are likely much more based on facts and experience than mine, but you read Lenin's autopsy report and saw for yourself why the left Sylvian artery occlusion had to be the cause of some of his symptoms. I cannot make any kind of statement regarding localization or prognosis from the brevity of writing that is Stalin's autopsy report.

If you are correct, however, it would be amusing to think that he would have then have been in Lenin's position under Beria's charge, and Beria would have likely done every same thing to him as he did to Lenin when Lenin first became ill. Perhaps even worse, as Stalin was motivated by a grab for power, while Beria would have to had his need for sadism thrown in. Stalin could control that if it was not essential to what he needed. Beria was a base animal who couldn't help it. --- ARB

Dr. Faria replies: We must assume it was a large hemorrhage in the left hemisphere, and he died of rostro-caudal deterioration with transtentorial herniation, as discussed in the clinical course of my paper, and such an expansive hematoma in the critical area at the crossroad of the speech and motor areas at Stalin's age, would have caused extensive primary neural and axonal damage, and from my experience, which is quite extensive with treatment of intracerebral hematomas — from aneurysmal, hypertensive, and bleeding diathesis (waiting until the clotting disorder is corrected) at Emory hospital, and for traumatic (blunt, penetrating, and GSW) hematomas at Grady hospital in Atlanta — I can assure of the most likely two outcomes!

And yes, ironies or ironies, Stalin would have been in the same boat as Lenin with Beria as his gatekeeper! ---MAF

I believe it!

Yes, I needed your opinion, and that is probably exactly what happened, so it was hopeless even if he survived. In such condition, even if Beria did not hold him in a dungeon, there could be no possibility of him ever returning to his role as head of state.

Still, you would operate knowing the most likely outcome, and what I have wondered before is why they didn't attempt something more radical, since they had nothing to lose. I assume part of it was politically based, but it is difficult to find hard evidence of that. Although, likely fright of Beria no matter what they did is easy to guess at.--- ARB
PS. As regards aneurysms, it is funny that they were one of the only neurosurgical conditions Cushing would never touch.

Another famous Soviet brain I saw....

In this same hospital (Roosevelt/St. Luke's in NYC) I also viewed the brain of George Balanchine. He was born in Tsarist Georgia as Giorgi Melitonovitch Balanchivadze in 1904. We now know he died of Creutzfeldt–Jakob disease, but in 1978 when his symptoms first commenced, CT was not of high enough resolution to make the diagnosis, even with the clinical information. In fact, it was not until his autopsy in 1983 that the diagnosis was actually made. From what I understand, the autopsy suite was packed, because everyone wanted to know what he had.

While on tour in Germany in 1924, he defected. I don't know who exactly was running the USSR at this time besides Stalin. I suppose it was more than just Kamenev and Zinoviev, but I am sure whoever had any power just after Lenin's death must have been completely furious!

As for his brain, grossly it showed nothing special but the usual atrophy seen in the cerebellar-pontine angle and brainstem characteristic of the disorder.

You, Miguel, love medical history (as do I), and Roosevelt Hospital is absolutely full of it. In 1995, the skeleton of its original benefactor was found inside one of its walls during remodeling. Not a total surprise, as that is what he requested in his will if he gave the hospital the starting money.
ADAM

Hatred of Intellectuals

I've been busy myself lately, Miguel, so I am sorry I did not see this response until yesterday. I realize we may have moved on from this topic somewhat, and now you and Dr. Ausman know I am planning to formally start writing the paper on V.I. Lenin's final illness next month.

I'm sorry, but this topic to me is one that hits so close to home. It may be why I can see in myself a bit of begrudging admiration for Stalin. Not at all in his lust for blood, but in the way that he was so intelligent and yet was mocked so smugly by "academia" who had no idea what kind of man they were so casually dismissing.

Yes, you know this is the internet on a public forum, but I will say this anyway because I feel so strongly about it. To me, it is so much like the smugness of the American left here who thinks we on the right are a bunch of uneducated and ignorant "fascists" who live in "trailer parks" and want to remove the vote from women and bring back slavery.

We did not react to this complete nonsense with the terror of a Stalin, but I do believe we voted in Mr. Trump because we were sick and tired of being the true intelligent force in this country, yet treated like a bunch of fools by the ignorant people on the left, who are the real danger to our country. They do not even know what the electoral college is, or how it works! We are the ignorant ones?!?

Most of us here have advanced degrees, but unlike those on the left do not consider them some badge that gives us the right to spit on others. However, having such degrees usually means we have come into very close contact with the type of leftist that dominates academia, and in my case, I find them so repellent that they (in large measure) are the ones who made up my mind as to the leaning of my current politics. They are anything but open minded and tolerant, and quite frankly, I find many of them to be prejudiced, racist, and just miserable, hateful, and hypocritical human beings.

That doesn't mean I can't get along with them in a working relationship, but it does mean I can't imagine how I could vote for the same people they do!

BTW, I had a neurosurgical question for you, if you don't mind it being out of place here. I just don't want to forget asking you again. In the article I sent you privately written by Victor Horsley in December 1910, he claims to have observed a sizable reduction in the volume of gliomas merely following a subtemporal decompression. I find that fascinating if it is true. He did not at all touch the tumor. I am thinking. With a malignant tumor expanding in the skull, the brain is increasingly compressed, and a decompression operation would naturally restore much of the normal size and position of its structures (i.e. ventricles, nuclei, white matter ,etc.). But what of the tumor? It too, must be compressed in a similar manner as the brain, so a decompression should rapidly expand the tumor as well, should it not?

Could such rapid expansion of a glioma damage its naturally more friable blood supply and infarct much of it? I am just guessing here, and I apologize again for putting this question out of place, but it has been off and on my mind and I have kept forgetting to ask you.

There is some relation of this paper to Lenin's illness, so perhaps we could consider the question not totally off base in this section? Best Regards, Adam

Glioma regression

Dr Faria replies: Good comments, Adam. Regarding the loaded neurosurgical questions. Let me simply say that the decompression helps the normal brain generally in part for the reasons you stated, but it has no physiologic effect in the tumor remaining that we can detect either radiographically or clinically. What Victor Horsley stated to the German Society of Neurologists in Berlin in 1919 and published in the paper you mentioned was:

Indeed, it was owing to a patient deciding before an operation that no procedure involving an increase of his hemiparesis should be carried out, that I made the first observation that a simple decompression operation could cause arrest and complete degeneration of a glioma. Though the same result has been observed since in other cases, they are so few that it is impossible to draw any conclusions as to the factors which combine to render such a fortunate result possible.

Perhaps, Horsley meant by simple decompression a partial removal of a tumor. I taken he meant removal of swollen cerebral tissue in a "silent" area of the brain, leaving the dura opened or grafted, and/or bony removal (craniectomy or leaving the bone flap out).

First, Decompression certainly allows more room for the normal brain to function with improvement in symptoms, as discussed by Horsley, and this truism still holds today. But, the specific claim made by Horsley about glioma regression by simple decompression, presumably by removing bone and possibly normal or swollen cerebral tissue, unfortunately has not been substantiated. Second, partial removal of glioma gives temporary relief. Third, Gliomas, particularly astrocytomas, have been known to spontaneously regress (in rare situations); more commonly they have been noted clinically to have become dormant with or without surgery for years. Fourth, at the time of Horsley, without the benefits of CT scars or MRIs technology, arrest in the growth of brain tumors following decompression and partial removal of the tumor could have caused improvement in the clinical condition of the patient. Fifth, postoperative radiation frequently causes further regression of tumors. In all such cases, the radiographic findings of improvement based on the techniques of the time — namely ventriculography or pneumoencephalography — and the accompanying clinical stabilization, could have been easily ascribed incorrectly as “cures” (Horsley's "degeneration of a glioma") in slow growing or dormant gliomas such as astrocytomas or oligodendrogliomas without residual mass effect.

Decompression continued

I think you are right about Horsley. He did not have CT or MRI to follow the growth or decrease in the volume of the tumor. He had the skull x-ray, but we know even the most vicious tumors usually present as normal that way. I'm not talking about shift of physiological calcification, because that might not be an accurate method of measuring the volume of tumor. He died in 1915, three years before the introduction of air studies.

I believe some of the lower grade gliomas can be cured, but we don't know what kind of gliomas he was referring to, because it took until about 1926 for Cushing to introduce the present grading system. I tended to side with you, even before you wrote that, but I wanted your opinion anyway. He likely saw improvement after decompression because of relief of intracranial hypertension, but how would he differentiate that from shrinkage of the glioma? I am sure he had autopsies done on such patients, but without imaging, how would he know what they looked like before he operated?

One thing might give us a tip. He, (along with early many neurosurgeons from the 1890's to 1920's) occasionally referred to patients diagnosed with "glio-sarcoma." I'm not the expert here, but I know that these tumors are fairly rare and even worse than any glioma.

I saw when I was very young a formalin filled jar with Ethel Merman's brain in it. She died about 10 months or so after surgery for glio-sarcoma. I thought about that brain later, and I realized that these early neurosurgeons were referring to a glioblastoma, and the error was in their terminology. There simply couldn't be that many glio-sarcoma cases as you would think there were if you believed what neuropathologists said in that era. So, I wasn't try to load the question. I was thinking maybe we overlooked something really promising from the old literature. Shrinking a high grade glioma just by decompression might offer some interesting possibilities in combination with other treatments. However, I knew you were right. It is just too easy.
ADAM

Bukharin & Stalin

Stalin and Bukharin actually had been very good friends. Not that it mattered in the end, as we know all too well. But Stalin had another good reason to share leadership (or at least make it appear so) of the USSR with Bukharin after he dissolved the triumvirate he shared with Kamenev and Zinoviev.

In 1926, Stalin does not as of yet have any particular economic plan of his own. Bukharin, as the well known and charming party intellectual truly is brimming with ideas, not just a few of which will (and do) improve the lot of the common peasant.

So, it is safe to say that Stalin goes along with Bukharin's ideas for a while (with correction, because he does not want to reveal how truly ignorant of Marxist economic philosophy he really is), but that is more or less all, because the reality of power now is that it is almost fully concentrated in the party apparatus, and Bukharin is not in it.

I have summarized some of this from an excellent PBS documentary made in 1990 on Stalin, and it explains why placing Stalin in the seemingly unimportant position of General Secretary in the early 1920's gave him an understanding of the power contained in the party apparatus, while the other old Bolsheviks had no comprehension of this, preferring instead to work in the "government."

Stalin's extensive theological education is generally considered to be the reason why he had such difficulty grasping the abstract concepts of Marxist philosophy. I don't know how true this is, but Dmitri Volkogonov gives an excellent account of the tragedy that befell the unknowing Jan Sten of the Institute of Red Professors when Stalin hired him on as a tutor in Marxist theory in 1925, clearly grooming himself to be Lenin's heir apparent.
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Reply — I really doubt Stalin had difficulty with Marxist philosophy or anything else, except languages. He simply discarded what he did not want to use and adapted whatever methods he deem appropriate — whether political philosophy or tactical repression, gulag system, famine, kangaroo trials, etc., whatever was needed at the moment to satisfy the needs of the totalitarian State that he identified as himself, and not the dogmatism of Karl Marx. ---MAF

Linguistics & Philosophy

Perhaps you say languages because he spoke Russian with a thick Georgian accent and was mocked by Tsarist teachers, party and peasantry because of this? Yet, that would not be a difficulty with languages per se. But he had hired an actor who taught him how to speak in a slow but regular cadence, which was more suited to his tone of voice and did captivate the masses in a different way than Hitler, because their basic styles of emoting were so different. At least, unlike Hitler, Stalin KNEW more than one language.

Every politico-economic system (even one so ridiculous as Marxism) has to have a philosophical underpinning, and most are quite complex. Stalin's method of thinking was so rigid in this respect that he just could not grasp the abstract concepts of party theory, because being an abstract genius in evil does not necessary translate over to being an abstract genius in political science. Though he was such a intelligent man, why do you think he harbored such a life long hatred and jealously of the party intellectuals? He himself was fairly well educated and well read, so what difference would they make to him?

Because both he and they knew he could not (and Beria was even worse) grasp the simplest elements of abstract Marxist theory.

But you say, "He simply discarded what he did not want to use and adapted whatever methods he deem appropriate — whether political philosophy or tactical repression, gulag system, famine, kangaroo trials, etc., whatever was needed at the moment to satisfy the needs of the totalitarian State that he identified as himself, and not the dogmatism of Karl Marx."

Yes, and despite what I said, you are 100% correct. In fact, he totally inverted the scheme of Marx and Lenin, as he limited himself to communism in one country, at least until after the war. Best, Adam
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Most German and Russian intellectuals of the late 19th and early 20th century, including Marx and Lenin, spoke several languages. Stalin only spoke Georgian and Russian and reportedly tried but failed to learn English. Yes, he disliked intellectuals, although he was brighter and as well-read as most; he ended up annihilating most of them anyway. His quintessential intellectual was Trotsky, whom Stalin detested following one amusing occasion. In the early days, two comrades, man and woman Bolsheviks, were making love behind a curtain. Stalin heard them "frolicking" and alerted Trotsky with a smirk of a smile. Trotsky made the mistake of rebuffing and curtly reproving Stalin for his lack of social graces. It was a great mistake, and Stalin never forgot or forgave it. From then on he judged Trotsky a fastidious prick, a prig; Trotsky thought of Stalin as crude and misjudged him as, “an outstanding mediocrity of our Party" (Montefiore) — another fatal miscalculation!--- MAF

On Trotsky, his mortal injury, and the Kronstadt rebellion!

I wanted to say that I never had any sympathy for Trotsky, because I think Stalin was content with the psychological torture Trotsky underwent when he was thrown out of the USSR forever. It only began to enter Stalin's mind to get rid of him forever when Trotsky began to viciously attack "Stalinism."

He was right to criticize it, but he criticized it for the wrong reasons. They were not so noble as he portrayed them. He was simply envious that he was not running the USSR, and butchering the same people Stalin was doing. If he would have killed a few less million, that would only be because he was just as cruel, but not as paranoid.

From s surgical standpoint I have seen evidence that the famous icepick hit his skull with the blunt end, not with the sharp pick. So it was blunt head trauma, not penetrating head trauma he sustained. That is why he survived a day or two day following the attack and operation. ---ARB

Dr. Faria replies:I agree that Trotsky was a vicious as Stalin in getting rid of political enemies and "enemies of the State," but not as paranoid; this is well documented when in March 1921 Trotsky suppressed the Kronstadt Rebellion and ordered the most capable Soviet general Mikhail Tukhachesky (later executed by Stalin as documented in this website) and the Red Army to destroy the former heroes of the Revolution, the Kronstadt sailors. This insurrection convinced Lenin of the need of the New Economic Policy (NEP). If I do remember correctly Trotsky's mortal injury was quite penetrating!---MAF

The irony of Gen. Tukhachesky's execution.

They needed Gen. Tukhachesky to fight the Germans, but yet Stalin allows Budyonny to live after voicing such stupid opinions as the need for a horse riding cavalry! In fact, I think he let him implement one.

Too bad Tukhachesky did not know Stalin liked to say "Gratitute is a sickness of dogs," especially since he meant it, and so it didn't matter how much the general tirelessly modernized the Red Army. --- ARB

MAF: An interesting aside, Adam, about Spanish gold, the elusive Alexander Orlov and his defection-deception and General Tukhachevsky is found in:
http://www.haciendapublishing.com/articles/astounding-case-soviet-defect...

If they only had time to fly in Dr. Walter Dandy!

You are right. The injury was penetrating, but I was also right. He used the blunt end of the pick, not the sharp end. Not that it matters who is right, but I knew I read that somewhere years ago.

https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/01.NEU....

Trotsky's associates wanted Dandy after the Mexicans operated, but Trotsky died before they could secure a flight for him. You might give me yours, but my opinion after reading this is that Dandy might have saved him if he had operated in the first place.

You are right about the Kronstadt rebellion, if anyone needed any proof of his ruthlessness after his performance in the civil war as Red Army Commander. Probably Stalin first became jealous of him because of his major role in beating the Whites from 1918-1920, while Stalin himself had only a minor one. His mistake in underestimating Stalin was due to the usual snobbishness of a leftist intellectual, not because he lacked perception in general.

The NEP was probably one of the most positively impacting policies Lenin had ever implemented, and given that Marx had expected revolution to occur in a more capitalistic and advanced country than Tsarist Russia, was completely in line with his philosophy.--- ARB

MAF: As for Ramon Mercader, Trotsky's assassin, he spent, I believe 20 years, in a Mexican prison refusing to reveal one iota of who he was or the conspiracy. He was released after completing his sentence and went to Cuba where he was a hero of the Cuban Revolution and the DGI but otherwise incognito as to the general public. Ramon's mother Caridad mercader was a Spanish communist and mistress of a top KGB agent, the legendary, Leonid Eitingon, the actual organizer of Trotsky assassination working under Pavel Sudoplatov and Beria. I discussed Mercader briefly in my article "Stalin, Communists, and Fatal Statistics." The whole story is in Pavel Sudoplatov and Anatoli Sudoplatov's book, Special Tasks: The Memoirs of an Unwanted Witness - A Soviet Spymaster

Ramon Mercader, Assassin, Communist Hero!

1. The article in Neurosurgery is interesting because it tells me that the wound was not mortal. They say he died of loss of blood and shock, but it is not possible to go into shock from loss of blood in the brain only, if it stays in the skull, is it? We are not talking a ruptured spleen here. It must have been herniation through the tentorium, but you can see that in 1940; you would not want to go to Mexico for any kind of surgery. One of the surgeons even admits as such that he does not believe in craniotomy to stop bleeding.

2. So did Stalin intend a quick and neat death for Trotsky? I think so. He did not punish Mercader, but I have to think the hit he put out on Trotsky was much more clean and efficient.

3. I wonder what kind of revolutionary hero the Cubans thought Mercader was? As we now know, the party Lenin started in October 1917 looked nothing like the party of December 1929, when Stalin assumed full rule and announced on the 21st that all Kulaks were to be liquidated as a class. As bad as Lenin was, Mercader would not have been a hero for him.

Than you for the interesting links. I will get to read those by the weekend. Also, Dr. Blaylock's article is wonderfully written PLUS historically correct, and I would to add a thing or two to it. --ARB



Diary of Dreams performs at the 2016 M’era Luna festival in Hildesheim, Germany. M’era Luna, “one of the biggest dark music events in Germany,” is held each year on the second weekend in August. Close to 25,000 people attend the festival annually to hear gothic, metal and industrial music performed on two large festival-style stages.