What Killed Jane Austen?: And Other Medical Mysteries

by George Biro

  On 29 October the ear developed an abscess. It was then his doctor lent credence to the syphilis story, by recording it as: ‘a tertiary symptom of the infection he contracted when twenty’.

  Morphine and chloral hydrate had no effect on the pain. On 27 November he became delirious and meningitis manifested itself. Neither ice packs to the head nor mustard plaster to the feet had any effect, and on 30 November 1900 Oscar Wilde died.

  It is incredible to think it is only 100 years or so since a bunkered morality could cause such mental and physical suffering in trying to sanitise the actions and works of this towering genius.

  (JL)

  The death of V.I. Lenin

  Among the side issues of the upheavals in Russia in the fairly recent past was the macabre rumour that the body of Vladimir Il’yich Ulyanov, better known as Lenin, was removed from its splendid glass-enclosed sarcophagus in the Kremlin wall and deposited elsewhere. Before he disappears completely from our consciousness, as well as our vision, let’s just take a look at the drawn-out death and ghoulish preservation of the old revolutionary.

  Ulyanov was born in 1870, the third of six children, one of whom, his eldest brother, was hanged for conspiracy in 1887. He adopted the pseudonym Lenin in 1901 during his clandestine party work after exile in Siberia. One grandfather was a physician and the other a serf, and he himself was regarded as a very bright student of Greek and Latin. But the fire he felt in his belly could not be fuelled by the classics, only by revolution, so he turned to politics.

  His subsequent public life is well recorded; what we want to know are the medical aspects.

  During the greater part of his life he was physically strong. This robust nature held him in good stead in August 1918 when, after an assassin fired two bullets into him, he made a speedy recovery, even though both missiles remained in the body. But early in 1922 at the young age of 52 Lenin became seriously ill with headaches, and in April his doctors thought it prudent to remove some of the ironmongery. He recovered, but in May had a stroke which left him partially paralysed and unable to speak. By dint of will power and a sterling constitution, the following month he recovered enough to throw himself into the formation of the nascent USSR.

  In December he had another stoke with paralysis, and then on 10 March 1923 yet another cerebral haemorrhage which deprived him of his speech. It never returned, and he was in this hapless and, for him, surely most frustrating state until he died in the city of Gorki on 21 January 1924.

  It was then there occurred an exacting post-mortem examination which in the end became a pathological tour de force, followed by preservation.

  The autopsy was done by one man, Professor A.I. Abrikosov, but he had no less than eight top-flight pathologists and clinicians standing by, ready to purse their lips and suck their teeth at the slightest hint of hesitancy. Not only that, the Minister of Health himself was present, presumably to make sure the rites were enacted in an ideologically sound way. As reported in Izvestiya of 25 January 1924, it took three hours ten minutes to complete.

  Externally, two old bullet scars were apparent, one in the left arm and the other over the right clavicle where the missile had been removed. The remaining bullet was found in the muscle covering the shoulder joint. The surface of the left hemisphere of the brain was depressed, and when cut open found to be extensively collapsed. Beneath the collapsed area were areas of yellow softening involving both white and grey matter, and cavities containing cloudy fluid. There were marked arteriosclerotic changes in the main arteries at the base of the brain. These arteries were considerably narrowed, as were their tributaries and the carotid arteries (the principal arteries on each side of the neck). In fact the left internal carotid was completely blocked. There was fresh blood in the mid-brain.

  There were a few adhesions in the lungs and a healed scar in the left apex (the upper extremity of the lung, behind the first rib). The coronary arteries were narrowed, and fatty deposits were present in the aorta.

  The cause of death was put as due to haemorrhage over the corpora quadrigemina area of the brain, and it was stressed that the post-mortem showed that most of the very severe brain damage must have been present for some time before death (a point perhaps lost on later generations).

  It was decided to have the body lie in state. To this end it was soaked in the usual solution of formalin, glycerin, potassium iodide, alcohol and zinc chloride to preserve it for a matter of weeks only.

  In six weeks some 100,000 people filed past, and there were many requests from outlying areas to hang on until they got there. Signs of deterioration with autolysis (cell and tissue degeneration) and skin desiccation began to set in, yet still the faithful filed reverentially past. It then dawned upon officials that the population of the USSR being what it was, this could go on until something pretty unpleasant was the only thing left. So they decided to embalm the body properly and display it in a specially built mausoleum in Red Square.

  It was then that the embalmers received what they surely would consider the call of a lifetime, and the anatomy professor at Kharkov University was given the awesome task. Bit by bit every part of the body, including bones, was hydrated, depigmented with acids, peroxides and aldehydes, and then embalmed. Work proceeded day and night for four months, and the body was finally inspected by the appropriate committee on 26 July. It was declared to be sweet and, well, lifelike.

  The Soviet Government wisely decided to publish the autopsy data at the time; political mileage might otherwise have been made out of it.

  One bit was missing, however—the brain. It was hoped that its study by the renowned German neuropathologist Oskar Vogt would throw light on the alleged genius of its owner. In return for the honour, the Germans undertook to train Soviet scientists in their methods. A special institute was later built in Moscow, from which the Russians operated.

  For three years the brain was scrutinised and picked over, until at last Vogt concluded that the pyramidal cells in Layer III of many cerebral areas were unduly numerous and large. At the time this was thought to have a mental association and was in tune with Lenin’s intellect. More work was deemed necessary to compare the brain with those of other deceased intellectual giants, of which it seems they had 13 in stock. In addition, specimens from different ethnic groups were called for, as well as from some animals and children. A special questionnaire on Lenin’s personality was devised, which was to be filled in by those who had known him.

  And then, nothing; no articles, no huzzas, no Red Stars. The project was quietly, and probably mercifully, dropped. (After the Second World War the laboratory was found to be in ruins and containers with specimen brains and slides scattered over the floor. Nowhere was there any trace of Lenin’s name.)

  Vogt’s study did not throw much more light on the alleged genius of the subject. There is no doubt about Vogt’s diagnosis, but his ideas about the size of cells being of significance or that racial peculiarities affect intelligence were a bit outdated even then.

  At least the team of embalmers did a good job. The old chief only needed to be dusted every now and again to maintain his pristine appearance which he held for over 67 years.

  Where is Lenin’s body now? Apparently it is still in the mausoleum in its original spot. The mausoleum was closed after the uprising of 1993 and the body disappeared from view for some time, but the building has been reopened on a very restricted timetable while the authorities ponder the sensitive issue of the final resting place of the old leader.

  The Moscow Brain Institute, the child of the project, still stands as one of the leading neurological centres of the world. Perhaps they should bury Vladimir Il’yich Ulyanov there.

  (JL)

  Was Winston Churchill fit to rule?

  It was [Churchill’s] exhaustion of mind and body that accounts for much that is otherwise inexplicable in the last year of the war—for instance the deterioration in his relations with Roosevelt (Lord Moran)

  Can we understand what drove a man as
great as Winston Churchill (1874–1965)? Was it his parents’ constant rejection of young Winston that made him strive so hard? At 18, he wrote to his mother: ‘I can never do anything right. I suppose I shall go on being treated as “that boy” until I am 50 years old.’ Or was it his belief that, like his father, he would die at the age of 46? What better goad to overachieve?

  These were not his only burdens. Churchill was also unlucky in his choice of ancestors: five of the previous seven Dukes of Marlborough had had severe recurrent depression. Churchill himself called his recurrent moods of depression ‘black dog’.

  In 1915, at the time of Churchill’s Dardanelles fiasco, his close friend, Lord Beaverbrook, wrote: ‘What a creature of strange moods he is—always at the top of the wheel of confidence or at the bottom of an intense depression.’ All this is very strong evidence that Churchill had what psychiatrists now call bipolar mood disorder (formerly known as manic-depressive disorder).

  Even as a young man, Churchill was a health faddist, self medicator and lover of quack remedies. He used inhalations before speaking in public, and travelled with cylinders of oxygen.

  When Britain declared war on Germany in September 1939, Churchill emerged from 10 years of political exile to become First Lord of the Admiralty.

  In May 1940, after Germany invaded France, Belgium and Holland, Churchill succeeded Chamberlain as Prime Minister. He looked like Britain’s only hope. Hitler had made (temporary) peace with Stalin and now controlled Europe; the United States still remained neutral.

  But Churchill was now 65, and there were many concerns about his health. So in November 1940, Sir Charles Wilson (later Lord Moran) became Churchill’s personal doctor.

  This doctor-patient relationship continued, though not smoothly, until Churchill’s death 25 years later.

  In December 1941, at the White House, Churchill got chest pain. He said it was muscular but he was frightened; Moran thought it came from the heart. Luckily, it did not recur.

  From early 1943, Churchill had several attacks of pneumonia. After meeting Roosevelt and Stalin at the Teheran Conference, he had pneumonia with heart problems.

  Alanbrooke, Chief of the imperial General Staff, complained in March 1944: ‘He seems quite incapable of concentrating for a few minutes on end, and keeps wandering continuously.’

  At the Potsdam Conference, Churchill was too tired to read his briefing papers, and had to be carried in a chair.

  The Labour landslide of July 1945 unexpectedly dumped the Conservatives. Churchill was depressed for months, but unfortunately stayed on as Leader of the Opposition.

  A month later, after a long game of gin rummy, he had weakness of the right hand, but he recovered. Lord Beaverbrook made officials announce that it was ‘a chill’. A Cabinet Office Under-Secretary, Sir George Mallaby, described Churchill at this time as rambling and lacking comprehension.

  In October 1951 he narrowly won an election, and returned to Downing Street; he was now 76. Moran wrote: ‘The old capacity for work had gone, and with it much of his self-confidence … Everything had become an effort.’

  For his fatigue, Churchill vainly consulted the osteopath Stephen Ward (who later led to the fall of a Conservative Government).

  In early 1952, Churchill had a more serious stroke affecting his speech. By now, he insisted on even the most complex issues being condensed into one paragraph before he would consider them. Moreover, the Prime Minister often could not even follow a discussion.

  Moran wrote: ‘ … he was not doing his work. He did not want to be bothered by anything; he was living in the past …’

  But not once did Moran encourage Churchill to resign. Just the opposite:

  Winston … once asked me whether he ought to have retired earlier … I was, I think, alone in urging him to hang on, though I knew that he was hardly up to his job for at least a year before he resigned office. His family and friends pressed him to retire; they feared that he might do something which would injure his reputation. I held that this was none of my business. I knew that he would feel that life was over when he resigned … It was my job as his doctor to postpone that day as long as I could.

  In 1953, after an official dinner, Churchill had another stroke. This one affected his left side: he could neither speak nor leave the table. Again, officials hushed it up.

  The neurologist Sir Russell Brain doubted whether Churchill would live another year, and agreed with Moran’s view that immediate retirement might hasten death. A cardiologist was emphatic that Churchill could not act as Prime Minister.

  But somehow, the wilful, wily old man defied such opinions, and carried on the pretence: instead of dealing with matters of state, Churchill read novels and played cards.

  He himself once conceded that a prime minister could get to be past it, and should be removed, as Adam Sykes and Ian Sproat record in The Wit of Sir Winston: ‘The office of Prime Minister is unique. If he trips he must be sustained; if he makes mistakes, they must be covered; if he sleeps he must not be wantonly disturbed; if he is no good he must be pole-axed.’

  But there was no one strong enough to pole-axe Churchill.

  In late 1954, he had to apologise after misleading the Commons (and jeopardising the government’s foreign policy) about a telegram he claimed to have sent to Field-Marshal Montgomery during the war.

  There was no such telegram; by now even the Conservatives had had enough. But it was April 1955 before the Prime Minister finally stepped down.

  By then, he was spending most of his days in bed; his last years must have distressed those who had known him in better days. In January 1965, aged 90, Churchill died.

  Details of Churchill’s poor health did not reach the public until 1966, when Moran published his book Winston Churchill: The Struggle For Survival. Uproar! Churchill’s family and many colleagues were indignant that Moran had revealed personal medical details.

  But there is another issue, more important than that of confidentiality. Despite repeated evidence of Churchill’s serious ill-health during the war, he did not resign as prime minister until 10 years after the war ended.

  As Churchill’s personal doctor, should not Moran have balanced his duty to his patient against the interests of his country? Could he have induced Churchill to step down earlier? Could anyone else have done so?

  If we make pilots and bus drivers pass medical examinations, why don’t we do the same for politicians?

  (GB)

  Josef Stalin and the doctors

  Josef Vissarionovich Djugashvili was born in Georgia, Russia, in 1879. If he had retained that name he may well have lived and died a peasant. But he didn’t, for in 1912, when he was invited by Lenin to join the Central Committee of the Bolshevik Party, he changed it to the Russian for ‘man of steel’—Josef Stalin. It suited him well. Stalin was born into abject poverty, the son of a drunken, abusive father. As a child he endured a severe attack of smallpox which left his face permanently scarred. It was so disfigured that when he came to power, thousands of photographs had to be doctored to disguise the lesions.

  At the age of 10 his left arm was injured, possibly as a result of being thrashed by his father. Osteomyelitis (inflammation of the bone) followed, and poor treatment led to a ‘Volkmann’s contracture’ where the hand would not open fully and muscle control was lost. There also a permanent shortening of his left arm by about 7.5 centimetres. He often wore a glove, allegedly for rheumatism, but probably to conceal the defect in his hand. At times he also wore a brace on the arm, as can be seen in some unguarded photographed moments.

  Despite these defects, Stalin was physically very strong as illustrated by the story that late in life he swung the beefy Marshall Tito off his feet in a bear hug.

  But his violent upbringing had its effect, for as the years rolled by Stalin grew mentally unstable and more and more paranoid. He had thousands shot on the suspicion of plotting against him; his motorcade comprised five identical cars which changed position continually to confuse would-b
e assassins. In his apartment there were four rooms fitted out as bedrooms; not before retiring did he choose the one in which to sleep.

  After the Second World War Stalin chose (or was forced into) partial retirement due to his high blood pressure, whereupon he became even more suspicious, calculating and irritable. Locks and bolts increased in number, and he had members of the Politburo eat with him every night so he knew where they were. All his food had to be tasted—and often had to be doubly tested—by his cronies.

  By 1952 he was dosing himself with a variety of pills and iodine drops for unspecified symptoms. Though he had a physician, Stalin considered it far too dangerous to let him near.

  And then out of the blue on 13 January 1953 the newspaper Pravda proclaimed that Stalin had uncovered a sinister medical conspiracy. It seems the dictator had received a letter from a Dr Lydia Timashuk in which she claimed Comrade Andrei Zhdanov and other Soviet luminaries had been poisoned by his (Stalin’s) doctors. Zhdanov had been the party chief in Leningrad and freely canvassed as Stalin’s successor.

  But Georgy Malenkov, a prominent Communist Party official, also coveted the top post. In 1946 he had lost his job in the Party Secretariat following criticism by Zhdanov of his management of the dismantling of German industrial equipment and its transportation to the Soviet Union. So Zhdanov’s death in 1948 was suspiciously providential as far as Malenkov was concerned. And indeed after Stalin’s death he did become prime minister for a couple of years.

  Following his old philosophy that ‘if a report is 10 per cent true we should regard the entire report as fact’, Stalin believed Timashuk’s letter. Zhdanov had, of course, been treated by trusted Kremlin doctors who were well-known and respected in the medical as well as the political world.