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