LEGACY—INSTITUTIONS AND PEOPLE
The Death of Leon Trotsky
Enrique Soto-Pérez-de-Celis, MD
Department of Internal Medicine,
Instituto Nacional de Ciencias Médicas y
Nutrición Salvador Zubirán,
México City, Mexico
Reprint requests:
Enrique Soto-Pérez-de-Celis, MD,
Camino a Santa Teresa 890 Torre XIII
Departamento 401,
Colonia Héroes de Padierna,
Delegación La Magdalena Contreras,
Ciudad de México, México.
E-mail: [email protected]
Received, October 26, 2009.
Accepted, March 5, 2010.
Copyright © 2010 by the
Congress of Neurological Surgeons
LEON TROTSKY WAS one of the founders of the Soviet Union and an obvious candidate to
replace Lenin after his death. Unfortunately for him, it was Joseph Stalin who came to
power, and Trotsky went into a long forced exile that eventually took him to Mexico, where
he found asylum. On August 20, 1940, a Stalinist agent wounded Trotsky in the head with
an ice axe in his house in Coyoacán, Mexico. Just a few hours later, Mexican neurosurgeons
operated on him at the Cruz Verde Hospital in Mexico City. The axe had broken Trotsky’s parietal bone and, after tearing the meninges, had damaged the encephalon. Despite the care
provided by physicians and nurses, Trotsky passed away 25 hours after he was attacked, a
victim of bleeding and shock. This article presents a review of Trotsky’s last day, with special emphasis on the doctors who performed the surgery and who took care of the Russian
revolutionary in his final moments. The results of Trotsky’s autopsy are also discussed. The
assassination of Leon Trotsky is one of the most dramatic events of the first half of the 20th
century to have taken place on Mexican soil, and those final hours are an important moment
in the history of Mexican neurosurgery and in the history of the world.
KEY WORDS: Craniocerebral trauma, Famous persons, Homicide, Penetrating head injuries, 20th century history, Stab wounds
Neurosurgery 67:417-423, 2010
DOI: 10.1227/01.NEU.0000371968.27560.6C
www.neurosurgery- online.com
I
n the spring of 1918, Leon Trotsky was arguably one of the
most powerful men in Soviet Russia (Figure 1). As the head of
the Red Army, he led one of the largest war machines ever built
and was an obvious candidate for succeeding Lenin as head of
state. Only 22 years and a few months later, however, Trotsky
struggled for his life in a bed in a hospital in Mexico City, thousands of miles away from his homeland, injured by an assassin
working for the same political apparatus that he helped to build.
The once powerful commander was now a dying man, wounded
by an ice axe swung into his skull, and despite the work of the
Mexican neurosurgeons, nothing could be done for him.
RISE TO POWER
Leon Trotsky, born Lev Davidovich Bronstein, was one of the
most prominent leaders of the Russian October Revolution that
brought the Bolsheviks to power. He was also a writer and a theorist, publishing several books and dissertations on Marxism and
Communism. His ideas are the basis for a school of thought that
opposed Stalinism, which became the official view of communism in the Soviet Union after Lenin’s death.
Trotsky was born in the village of Yanovka, in present-day
Ukraine, to a family of Jewish farmers.1 He spent his youth in the
cosmopolitan and culturally diverse port city of Odessa and in
the town of Nikolaev, where he became involved with other students and young workers who were determined to overthrow the
Tsar. It was in those student groups where Trotsky first became
exposed to the ideas of socialism and also where he became known
NEUROSURGERY
FIGURE 1. One of the last photographs of Leon Trotsky, taken just days before
his death. Photograph by Arturo Horta. (Reproduced with permission from
Hemeroteca Nacional de México, UNAM. The Death of Leon Trotsky [in
Spanish]. Novedades Sección de Rotograbado (Mexico City). August 25,
1940; Sect 1 to 4.27)
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SOTO-PÉREZ-DE-CELIS
as an audacious and determined speaker. He was one of the founders
of the South Russian Workers’ Union, and because of that, he was
arrested in 1898 and sent to Siberia, his first exile.2 He escaped
in 1902, using the pseudonym “Trotsky” for the first time in his
forged passport.3 After leaving Russia, he moved to London and
joined the ranks of the Marxist newspaper Iskra, where he met
Vladimir Ilich Ulyanov, better known as Lenin. It was in that city
that he also met the woman that would be his companion up until
the day of his death, Natalia Sedova.3
After the events of the 1905 Revolution, Trotsky returned to
Russia and settled in St. Petersburg, where he headed the St.
Petersburg Council of Workers’ Deputies. By then, Trotsky was
convinced that the only way to change Russia was to establish a
“permanent revolution,” led by workers and intellectuals and
founded upon Marxist ideology.1 He was once again arrested and
exiled to Siberia in 1907, but he escaped and started a long emigration that took him to Austria, Switzerland, France, Spain, and
the United States. He was living in New York when Tsar Nicholas
II abdicated after the success of the 1917 February Revolution,
and he made his way back to his homeland to be part of the new
country that was being born.4
After the Bolsheviks came to power, Trotsky became People’s
Commissar for Foreign Affairs and then Commissar of Army and
Navy Affairs. As such, he was the head of the Red Army during
the Russian Civil War, in which the Bolshevik forces defeated a
combined Allied Force, named the White Army, after more than
3 years of fighting. It was during this war that conflict first arose
between Trotsky and Joseph Stalin, one of the members of the
Politburo, who openly challenged many of Trotsky’s decisions as
head of the army.2
DECLINE
After the Civil War was won by the Bolsheviks, Trotsky faced
what was perhaps an even harder struggle inside the ranks of his own
party. His confrontation with Stalin grew even more after Lenin’s
death, and this buildup of conflicts eventually led to Trotsky’s
expulsion from the Central Committee of the Communist Party
in 1927. Stalin, who was by then the Head of the Soviet Union, outlawed any opposition to him and forced Trotsky and his followers
into exile in 1928.5 Trotsky was sent in exile to Kazakhstan, followed by expulsion from the USSR to Turkey, and then to France
and Norway. However, his stay in those countries was brief, owing
to the pressure from the Stalinist government, who resented having Trotsky so close to the Soviet border. In August 1936, the final
blow was dealt against Trotsky and the rest of the old Bolsheviks with
the first of many show trials, staged by Stalin as part of his Great
Purges. In the first trial, 16 former members of the party, including distinguished revolutionaries such as Kamenev and Zinoviev,
were found guilty of multiple crimes and executed.6 Although
Trotsky was not officially indicted in the show trials, he had already
been judged and sentenced to death by Stalin himself. By then,
the Norwegian authorities had placed Trotsky under house arrest,
so he was grateful when he was rescued by an invitation to live in
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Mexico. Trotsky’s move to America in January 1937 was made possible both because of the intervention of famous Mexican painter
Diego Rivera (who was also a fervent communist) and by the liberal government headed by President Lázaro Cárdenas.7
In Mexico, Trotsky was free to travel, write, and express his ideas
and theories. During his stay in the country, he founded the Fourth
International, a communist organization that was meant to be an
oppositionist force to Stalinism. He also became a prominent personality in Mexican society and mingled with famous people like Diego
Rivera, Frida Kahlo, and André Breton. His house in the Coyoacán
neighborhood of Mexico City was filled with visitors who wanted
to know Trotsky and to hear his ideas. This freedom, however, also
made him an easy target for the Stalinist agents who wanted him dead.
The first attack on Trotsky took place on May 24, 1940, when a
group of armed men led by painter David Alfaro Siqueiros fired
hundreds of bullets at Trotsky’s house on Viena Street. Luckily,
Trotsky and his family were not injured in the shooting.6
After the assassination attempt, security around Trotsky was
doubled, and his house became a fortress guarded by Mexican
policemen and several American bodyguards, hired by Trotsky’s
friends in the United States. These measures, however, were soon
proven inadequate.
THE ATTACK
At approximately 6:00 PM on the afternoon of August 20, 1940,
the Cruz Verde Hospital in Mexico City received an emergency
phone call from the Coyoacán police office. They quickly dispatched an ambulance, driven by Ramón Cruz, to the house on
Viena Street. When the paramedics arrived on scene, they found
Trotsky’s wife, Natalia Sedova, leaning over his body, covered in
blood. At first, the paramedics thought he was dead, but after
examining him, they discovered that he was still breathing and
he was rushed to the hospital 9 km away.8
About 40 minutes before the call was received, a visitor arrived
at Trotsky’s house. His name was Frank Jacson, a Canadian citizen who was also the boyfriend of Silvia Ageloff, one of Trotsky’s
associates from New York. Jacson had become a frequent visitor
to the house, and he often showed his manuscripts and discussed
current topics with Trotsky. That particular day, Jacson was carrying a hat and an overcoat, despite the fact that the weather was
quite good. Natalia Sedova escorted Jacson to Trotsky’s studio and
closed the door behind her. A few seconds later, she heard a terrible scream, and when she rushed to the studio, she found her husband resting against the wall of the dining room with his head full
of blood. The assassin was carrying an ice axe concealed in the
overcoat, and when Trotsky sat down at his studio table, he stood
up, took the weapon out and dealt a blow to Trotsky’s head.8 A
mountaineering ice axe is a tool used both as a walking stick and
as a security anchor when going uphill. It has a narrow end, called
the pick, and a flat, wide end used for chopping steps called the
adze.9 It was with the adze of the axe that Jacson wounded Trotsky
in the head, hitting him on the right side of the skull, fracturing the
parietal bone and penetrating 7 cm into the encephalon.8 Trotsky
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THE DEATH OF LEON TROTSKY
FIGURE 2. Trotsky’s studio minutes after he was attacked by Jacson. Photograph
by Arturo Horta. (Reproduced with permission from Hemeroteca Nacional
de México, UNAM. The Death of Leon Trotsky [in Spanish]. Novedades
Sección de Rotograbado (Mexico City). August 25, 1940; Sect 1-4.27)
did not lose consciousness right away; as a matter of fact, he was
able to speak and tell his bodyguards to spare Jacson’s life for him
to tell his story (Figure 2).8
The first doctor to examine Trotsky at his house was his head
physician, Wenceslao Dutrem Domínguez, brought by his bodyguards from his nearby home. Dr. Dutrem was a Spaniard exiled
to Mexico after the Civil War who had practiced medicine and
pharmacology in Barcelona, where he prepared a medication called
Erotil, marketed as a cure for erectile dysfunction.10 Dutrem found
that Trotksy’s left hand and arm were paralyzed and that the movements of his right hand were clumsy and uncoordinated.8 He
stood by his patient and Natalia Sedova until the ambulance
arrived, but he was not able to do anything to help Trotsky.
FIGURE 3. Trotsky’s alleged radiographic study, taken
before surgical intervention at the Cruz Verde Hospital.
Written on the image are the words “Entrada del piolet,”
which means “Entrance site of the ice axe,” which were
added by the editors of the Novedades newspaper. Because
of the poor quality of the image, it is impossible to know
whether such markings truly represents a fracture.
Photograph by Arturo Horta. (Reproduced with permission from Hemeroteca Nacional de México, UNAM.
Tragedy in Coyoacan [in Spanish]. Novedades (Mexico
City). August 22, 1940; Sect 1-9.28)
THE SURGERY
When the ambulance arrived at the Cruz Verde Hospital, which
was located at the corner of Victoria and Revillagigedo Streets,
Trotsky was immediately transferred to the operating room. There,
a group of surgeons and other specialists in medicine had already
been assembled.11 The main surgeon was Dr. Joaquín Mass Patiño,
who also worked at the nearby Hospital Juarez. Mass was one of
the first neurosurgeons in Mexico, alongside Manuel Velasco
Suarez, and the founder of the first neurosurgical ward and neuroradiology service in the city.12 Not much has been written about
Mass, but he did write a paper in December 1957 describing his
method for treating penetrating gunshot wounds to the skull. In
that article, Mass concluded that the first step when treating any
penetrating wound to the head was to treat edema and that trying to stop bleeding from the encephalon was useless because it was
always found to be uncontrollable and the surgical intervention only
added “surgical shock and anesthetic intoxication.” In that same
article, he also stated that perhaps one of the only advantages of
early surgical management was to extract pieces of the skull found
in the wound’s trajectory because they could become foci for infection.13 Aiding Dr. Mass was Dr. Rubén Leñero Ruiz, a young surgeon who had a meteoric career in the medical services of Mexico
City. At the age of 38, he was already the Director of Medical
NEUROSURGERY
Services of the city and creator of the Mexican Society of Trauma.
Dr. Leñero passed away only 2 years after Trotsky, a victim of
typhus, and the flagship hospital of Mexico City’s health services
is currently named after him.14 The third celebrity physician caring for Trotsky was Dr. Gustavo Baz Prada, who at that time was
the rector of Mexico’s National Autonomous University. Dr. Baz
was sent to the Cruz Verde as a representative of President Cárdenas
himself, who was particularly fond of Trotsky (he would later
declare Trotsky’s assassination the dirtiest crime ever committed
on Mexican soil).15 Dr. Baz would go on to become the head of
Mexico’s Secretariat of Health and the governor of the State of
Mexico.16 Finally, another spectator of the surgery was Dr. Jacinto
Segovia, a Spanish physician who was a former professor of surgical pathology at the University of Madrid and who exiled himself to Mexico at the onset of the Spanish Civil War.17 The remaining
members of the team were surgeon Everardo García Espino and
anesthesiologist Salvador Méndez.11
After performing a radiographic study of Trotsky’s skull (Figure
3), Mass started the surgical intervention at 9:00 PM, roughly 3 hours
after the attack. Trotsky’s hair was shaved and a 25-cm2 trepanation was done to the skull, finding a comminute fracture of the parietal bone with bony fragments inside the cranial vault. The meninges
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FIGURE 5. Trotsky lies in his bed at the Cruz Verde Hospital. Watching over
the fallen revolutionary, from left to right, an unidentified police officer;
General Nuñez, head of police; an unidentified nurse; Dr. Ruben Leñero,
and Dr. Everardo García Espino. Photograph by Arturo Horta. (Reproduced
with permission from Hemeroteca Nacional de México, UNAM. Trotsky is
dying [in Spanish]. Novedades (Mexico City). August 21, 1940; Sect 1-10
(Col 3-6).29)
FIGURE 4. Doctors Ruben Leñero ( left) and Everardo García Espino ( right)
look at Trotsky’s radiographs after surgery. Photograph by Arturo Horta. (Reproduced
with permission from Hemeroteca Nacional, UNAM. Tragedy in Coyoacan [in
Spanish]. Novedades (Mexico City). August 22, 1940 ; Sect 1- 9.28)
were torn and the encephalon was herniated through the wound.
Dr. Mass extracted the bony fragments and cleansed the wound
thoroughly, after which the operation was concluded.8 Trotsky
was moved to a room in the adjacent ward at 10:00 PM. Dr. Leñero
ordered the administration of oxygen and instructed orderlies and
nurses to avoid puncturing the patient’s veins to avoid worsening
the “traumatic shock” suffered during surgery (Figures 4 and 5).11
Dr. Baz spoke to the press after the surgery and told reporters that
there was a 90% chance of death because the injury was lifethreatening. Dr. Segovia was also pessimistic when he spoke to
the newspapers.11
Trotsky’s North American associates desperately started looking for support from physicians in the United States. According
to the press, they contacted Dr. Walter Dandy from Johns Hopkins
and arranged a plane to take him to Brownsville, Texas, from where
he was to be flown to Mexico City to direct Trotsky’s care.18 At the
time of the assassination, Dandy had already established his famous
“Brain Team” at Johns Hopkins.19 Even though Dandy was arguably
the world’s foremost expert in neurocritical care and neurosurgery
at the time, it is difficult to say whether he could have done anything else for the fallen Russian leader, given the nature of his
injury. The plans to take Dandy to Mexico, however, could never
be materialized because of Trotsky’s death (Figure 6).
420 | VOLUME 67 | NUMBER 2 | AUGUST 2010
During the morning of August 21, Trotsky’s health deteriorated, and he was not able to recover consciousness. The doctors
administered physiological serum and oxygen, but no improvement was noticed. By midday, Dr. Mass noted that the wound
was bleeding profusely and pointed out that the ventricles were
filling up with blood.20 In the afternoon, Trotsky’s breathing
became fast and erratic and Natalia Sedova was told by physicians that her husband was about to die.8 The last medical report
signed by Dr. Mass came out at 6:00 PM, stating that Trotsky’s
status was “Critical. Temperature 38.1°C. Pulse 140. Breathing
41. Blood pressure in the right arm 78 × 68. Left arm 78 × 64.”
The diagnosis given in the report was that of “flooding of the
cerebral ventricles, an extremely severe injury that darkens the
prognosis.”21 An hour and 25 minutes later, Trotsky’s pulse became
weak, and the doctors administered an injection of adrenaline
with no effect. Dr. Leñero examined the patient and found that
his pupils were nonresponsive, declaring him dead at 7:25 PM
on August 21, 1940, 25 hours and 35 minutes after being attacked
by Jacson.8,20,21
THE AUTOPSY
Trotsky’s remains were moved to the Alcazar funeral home in
downtown Mexico City on the morning of August 22. At 2:00
PM, his casket was taken to the embalming room and the body
was extracted. The corpse was still dressed in the Cruz Verde gown,
and blood was still dripping from the bandages placed on the
wound. In the room were surgeons Dr. José Rojo de la Vega and
Dr. José Edmundo Sol, Dr. Erasmo Marín, director of the city’s
medicolegal service, and Arturo Orozco and Francisco Ortega,
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THE DEATH OF LEON TROTSKY
refused to grant permission for such a transfer to avoid political
demonstrations.8,24 After several days in the funeral home, Trotsky’s
body was cremated. His ashes rest in a monument built in the garden of the house on Viena Street; just a few steps away from the place
were he was murdered.
AFTERMATH
FIGURE 6. Trotsky minutes after his death. Photograph by Arturo Horta.
(Reproduced with permission from Hemeroteca Nacional de México, UNAM.
The Death of Leon Trotsky [in Spanish]. Novedades Sección de Rotograbado
(Mexico City). August 25, 1940; Sect 1-4.27)
official embalmers of the Alcazar home. Also present were Dr.
Mass and General José Luis Nuñez, chief of police.22
The doctor in charge of the autopsy was José Rojo de la Vega,
a famous surgeon who achieved his fame by operating on bullfighters in the Plaza México, one of the world’s premium bullfighting arenas.23 After the police handed him the court order
to carry on with the autopsy, de la Vega started the procedure.
Using a surgical knife, he dissected the scalp and uncovered the
skull, finding an injury of approximately 3 cm in diameter in
the right parietal bone, 4 cm from the midline and 12 cm above
the right eyebrow. de la Vega opened the skull and extracted
the brain, finding a subdural hematoma and a 2-cm wide and
7-cm deep wound in the right hemisphere. According to the
official report, the injury was located in the “second parietal
circumvolution, above the curved fold of the rolandic fissure.”22
Taking into account Trotsky’s symptoms (paralysis of the left
hand and arm), one can hypothesize that the axe damaged the
motor neurons in the cortex of the precentral gyrus. It is also possible that these symptoms resulted from cerebral compression
by acute subdural hematoma. The trajectory of the weapon was
determined by the doctors to be from up to down, from front
to back and from right to left, proving that the assassin stood
right in front of Trotsky when he dealt the blow.22 The wound
involved both the white and gray matter and penetrated to the
right lateral ventricle, which was flooded with blood. The cerebellum and medulla oblongata were found to be pale, which
was attributed to the loss of blood. The weight of Trotsky’s left
hemisphere was 780 g and that of his right hemisphere, the
injured one, 770 g, totaling 1550 g.8
After the autopsy, Ortega closed the cavities, and the body was
taken to the main hall of the funeral home. In the following days,
thousands of Mexicans marched in front of the remains to show their
respect to the fallen leader. Initially, Trotsky’s associates planned
to take the body to the United States, but the American government
NEUROSURGERY
Trotsky’s assassination is one of the most dramatic events of the
first half of the 20th century in Mexico. Even though history has
mostly ignored Trotsky, he is undoubtedly one of the most important figures of the 20th century because he was an essential character in the construction of the Soviet Union.
His assassin, Frank Jacson, who also held a Belgian passport
under the name Jacques Mornard, was later found to be a Spanish
communist named Jaime Ramón Mercader del Río Hernández,
who had important connections with the GPU, Stalin’s secret
police. Mercader was imprisoned in Mexico City’s Palacio de
Lecumberri for 20 years, without ever confessing the true reasons for his crime. After his release from prison, he spent his time
between Cuba and the Soviet Union, where he shamefully received
the nation’s highest distinction, the Hero of the Soviet Union
medal. Mercader passed away in 1978 and is buried in Moscow’s
Kuntsevo Cemetery.25
Natalia Sedova stayed in Mexico, living in the house that she
shared with Trotsky and dedicated her life to her family. She died
in Paris in 1962 and her ashes are buried next to those of Trotsky
in their Coyoacán home, which is now a museum.
Trotsky was never “rehabilitated” in his homeland, and even
Mikhail Gorbachev, the last Head of the Soviet Union, delivered
a speech denouncing Trotsky in traditional Stalinist terms in
1987.26 Just 4 years later, the Soviet Union ceased to exist, and
Trotsky’s ideas were no longer officially frowned upon.
Ironically, it was Trotsky who more than half a century before had
warned that with its complete disregard for the working class,
bureaucracy would ultimately destroy the Soviet Union and clear
the path for the return of capitalism. His death was as much a result
of neurotrauma as of hatred and revenge. The doctors and surgeons who took care of him during his last hours did as much as
they could, given the severity of the wound and the resources available. Those last hours, however, are an important moment in the
history of Mexican neurosurgery and in the history of the world.
Disclosure
The author has no personal financial or institutional interest in any of the drugs,
materials, or devices described in this article.
REFERENCES
1. Renton D. Trotsky. London, England: Haus Publishing Limited; 2004.
2. Thatcher ID. Trotsky. New York, NY: Routledge; 2003.
3. Deutscher I. The Prophet Armed: Trotsky 1879-1921. London, England: Verso;
2003.
4. Trotsky L. My Life. New York, NY: Charles Scribner’s Sons; 1930.
5. Deutscher I. The Prophet Unarmed: Trotsky 1921-1929. London, England: Verso;
2003.
VOLUME 67 | NUMBER 2 | AUGUST 2010 | 421
SOTO-PÉREZ-DE-CELIS
6. Deutscher I. The Prophet Outcast: Trotsky 1929-1940. London, England: Verso;
2003.
7. Gall O. Trotsky in Mexico [in Spanish]. Mexico City, Mexico: Ediciones Era; 1991.
8. Sánchez-Salazar LA. This Is the Way They Killed Trotsky [in Spanish]. Mexico City,
Mexico: Populibros La Prensa; 1955.
9. The Mountaineers. Mountaineering: The Freedom of the Hills. 7th ed. Seattle, WA:
The Mountaineers Books; 2003.
10. Massons J. The work of Frederic Duran i Jorda lived by me [in Catalan]. Rev R
Acad Med Catalunya. 2006;21(1):52-55.
11. Trotsky, wounded [in Spanish]. El Universal (Mexico City). Aug 21,1940:Sect 1-4
(col. 6-8).
12. Mateos-Gomez H. Neurosurgery in Mexico [in Spanish]. Arch Neurocien (Mex).
2007;12(4):252-253.
13. Mass-Patino J. Diagnosis and treatment of craniocerebral gunshot lodged in the
brain [in Spanish]. Cir Cir. 1957;25(12):645-652; discussion 653-659.
14. Fajardo OG. Dr. Ruben Leñero Ruiz (1902-1942): a hospital carries his name [in
Spanish]. Bol Mex His Fil Med. 2002;5(1):27-28.
15. The dirtiest crime ever committed in Mexico [in Spanish]. El Universal (Mexico
City). Aug 23, 1940:Sect 1-1 (col. 1).
16. Aréchiga H. Science, University and Medicine [in Spanish]. Mexico City, Mexico:
Siglo Veintiuno Editores; 1997.
17. Matesanz JA. The Roots of Exile: Mexico and the Spanish Civil War 1936-1939 [in
Spanish]. Mexico City, Mexico: El Colegio de México; 1999.
18. Trotsky’s secretary blames the GPU [in Spanish]. El Universal (Mexico City). Aug
22,1940:Sect 1-7 (col. 4).
19. Sherman IJ, Kretzer RM, Tamargo RJ. Personal recollections of Walter E. Dandy
and his Brain Team. J Neurosurg. 2006;105(3):487-493.
20. Trotsky’s murder a work of the GPU [in Spanish]. El Universal (Mexico City). Aug
22,1940:Sect 2-1 (col. 2-7).
21. James Cannon will be Leon Trotsky’s successor [in Spanish]. Excelsior (Mexico City).
Aug 22,1940:Sect 1-1 (col. 3).
22. The Brain of Leon Trotsky [in Spanish]. El Universal (Mexico City). Aug 23,1940:Sect
1-2 (col. 1-5).
23. Murrieta H. One Hundred Taurine Thursdays [in Spanish]. Mexico City, Mexico:
Fernández Cueto Editores; 1995.
24. The American consul denied the permission [in Spanish]. Novedades (Mexico City).
Aug 24,1940:Sect 1-1 (col. 3)
25. Garmabella JR. Trotsky’s Scream: Ramón Mercader, the Man Who Killed the Revolutionary
Leader [in Spanish]. Mexico City, Mexico: Debate; 2006.
26. Wren C. Trotsky still shrouded in non-personality cult. The New York Times. Nov
8,1987:Sect. 4:3.
27. The death of Leon Trotsky [in Spanish]. Novedades Sección de Rotograbado (Mexico
City). Aug 25, 1940:Sect 1-4.
28. Tragedy in Coyoacan [in Spanish]. Novedades (Mexico City). Aug 22, 1940:Sect 19.
29. Trotsky is dying [in Spanish]. Novedades (Mexico City). Aug 21,1940:Sect 1-10
(col. 3-6).
Acknowledgments
The author thanks Tita Pérez de Celis Herrero for her invaluable help with this
article.
COMMENTS
T
he most important impact of Trotsky’s assassination was not on neurosurgery, of course, but rather its effect on the history of the entire
world. Nonetheless, we can extract some interesting history of neurosurgery from it. A careful reading of the postmortem examination of the
brain, as provided by the author, does not seem to indicate a definitive explanation for Trotsky’s neurological death. That is, there is no description of
any findings related to transtentorial herniation, either central or lateral.
Transforaminal (foramen magnum) herniation was known in the later
19th century, but our modern understanding of transtentorial herniation goes back only to the 1920s. I do not know whether the pathological phenomena of the latter (eg, mesiotemporal herniation, Kernohan’s
422 | VOLUME 67 | NUMBER 2 | AUGUST 2010
notch) were widely known by 1940. On the other hand, in the 19th century and into the 20th, there was a dictum that hemorrhage into the ventricles is highly fatal per se. So Trotsky’s prosectors may have thought
that their description of intraventricular hemorrhage was sufficient to
explain his death. It would also explain why Dr Mass explicitly “pointed
out that the ventricles were filling up with blood.”
Another speculation can also be raised. The small craniectomy was
only a “25-cm2 trepanation,” which is 5 × 5 cm. Because Trotsky sustained a low-velocity injury, perhaps he might have been saved by one
of today’s large hemicraniectomies. If so, would the course of history
have been any different?
Samuel H. Greenblatt
Providence, Rhode Island
T
he article provides interesting details on the circumstances, management, surgery, and autopsy of the open head injury of Lev (Leon)
Trotsky in Mexico City in August 1940. It gives a glimpse into the history of Mexican neurosurgery and is based on anecdotal evidence of the
subject from contemporary Mexican periodicals and secondary sources.
The clinical part comprises about half of this article. Trotsky experienced a severe open head injury complicated by a depressed cranial fracture and cerebral laceration. Witness accounts state that Trotsky was
sitting at the table reading a manuscript when hit by an ax. According
to the description, there was a clear lucid interval (Trotsky tried to fight
against his assassin and was able to speak after the injury), which is typical for acute intracranial hematomas. Indeed, a subdural hematoma
was found at the autopsy. The hematoma that caused Trotsky’s death
was not diagnosed while he was alive. The reason was an inadequate
exploration of the wound during surgery. The trepanation window was
too small (25 cm2), which did not allow proper revision of intracranial
structures, hemostasis, and control of brain edema (“the encephalon was
herniated through the wound”). However, large trepanation windows
had been practiced since the late 19th century, and Harvey Cushing had
advocated decompressive trepanation to reduce increased intracranial
pressure since 1900s.1 The author quotes from the article by Dr. MassPatino who operated on Trotsky. According to Dr. Mass-Patino, it is
impossible to control cerebral bleeding, and surgical intervention only
adds shock and anesthetic intoxication. This article was published in
1957, whereas clips for hemostasis were introduced by Cushing in 1911
and electrocoagulation in 1927.
Unfortunately, the author relied on press reports and did not use
archival sources, which might be available in Mexico City (such as Trotsky’s
case records or protocols of his surgery and autopsy). Why was Trotsky’s
brain not preserved and not subjected to a neuropathological study?
To conclude, the medical part of the article by Soto-Pérez-de-Celis
vividly illustrates a low level of Mexican neurosurgery in 1930s. Had
Trotsky been in more experienced hands, he might have survived. The
author’s claim that the assassination of Trotsky “represents a landmark
in the history of Mexican neurosurgery” is unfounded. The article does
not mention any impact of Trotsky’s case on the development of neurosurgery in Mexico.
The rest of the article presents a brief biography of Trotsky. It might
be worth mentioning that there is evidence that he had epileptic seizures
in infancy. Trotsky initiated “Red Terror” after the October Revolution.
The term was coined by Trotsky and defined as “a weapon used against
a doomed class that does not want to perish.” His biography was a
subject of 2 movies: Assassination of Trotsky (France-Italy-UK, 1972) and
Trotsky (Russia, 1993). Trotsky was a protagonist of an opposition
www.neurosurgery-online.com
THE DEATH OF LEON TROTSKY
leader in 2 novels by George Orwell (Snowball in Animal Farm and
Goldstein in 1984).
Leonid Likhterman
Boleslav Lichterman
Moscow, Russia
1. Greenblatt SH. Harvey Cushing’s paradigmatic contribution to neurosurgery and the
evolution of his thoughts about specialization. Bull Hist Med. 2003;77:789-822.
T
he assassination of Trotsky, like the assassinations of Archduke Ferdinand
and John Fitzgerald Kennedy, had broad social and political repercussions. There is a rich literature on the medical aspects of the Kennedy
assassination, but little has been said about Trotsky’s. This article corrects
the oft-repeated but erroneous assertion that Trotsky was killed by an ice
pick. He was not: the medical records confirm that fatal blow was struck
with an ice ax, even though the ice pick was an assassination device in
use at the time.
The enmity between Stalin and Trotsky was long-standing. Beginning
in 1923, 6 years after the Bolshevik Revolution, Trotsky led an opposition faction within the Russian Communist Party. He protested, inter
alia, the development of a powerful, centralized and arbitrary Bolshevik
bureaucracy consolidating under Stalin. Lenin came to agree just before
his death in 1924.1
Whether or not their idea of democracy was in any way parallel to
democratic theory in the West, Trotsky and his opposition group used
the idiom of a return to the ideal of a “workers’ democracy” in attacks
on the politburo. Concessions were obtained but never implemented.
On November 7, 1927, 10 years after the Revolution, Trotsky was expelled
from the Party and forced to flee.
Immediately thereafter, Stalin began to eliminate Trotsky’s friends,
family, and colleagues. The list included almost all of Trotsky’s small circle of intimates: Joffe, Glazman, Butov, Blumkin, Sermuks, and Poznansky.
Many had played important military and political roles during the civil
war after the Revolution. Anti-Semitism played no small part in this campaign. Trotsky commented that Stalin intended to silence the writings
and consequently the political influence of the opposition by destroying
its leadership.2 Given the power ascribed to journalism, political commentary, and propaganda at the time, this strategy was pursued by the
Left and the Right alike. It was sometimes difficult to decipher which
views belonged on which side of the aisle.3
In 1928, Trotsky was exiled to Kazakhstan near the Chinese border, and
from there to Büyükada off the coast of Istanbul, Turkey, where he stayed
for the next 4 years. Members of the defeated White Army who had taken
refuge in Istanbul threatened his life, but he was protected by Communist
sympathizers and volunteers. In 1933, Trotsky was offered asylum in
France as long as he did not visit Paris. His son and political collaborator, Leon Sedov, was assassinated in France in 1937. Trotsky then became
persona non grata.
NEUROSURGERY
He was granted asylum in Norway by Trygve Lie, the Minister of
Justice. He resided near Oslo in relative freedom for 2 years. He was
then placed under house arrest and subsequently transferred to Mexico
on a freighter under secret arrangements made between Norway and
Mexico. President Lázaro Cárdenas welcomed Trotsky warmly and openly
and arranged for a special train to bring him to Mexico City from the port
of entry.
Trotsky wrote unceasingly in exile, including many of his most important works criticizing Stalin. In his diaries, for example, he wrote “Stalin
did not see that even without a secretariat I could carry on literary work,
which, in its turn, could further the creating of a new apparat. Even the
cleverest bureaucrat displays an incredible short-sightedness in certain
questions!”4
In 1939, after the German invasion of Poland, Trotsky agreed to testify
before a U.S. Congressional committee chaired by Martin Dies, who
sought to the suppress the American Communist Party. Trotsky let it be
known that he would expose and condemn the activities of the NKVD,
the Russian secret police, but would also speak in support of the American
Communist Party and would call for transformation of the World War
into a world revolution. As a result, he was denied a visa to enter the United
States. Stalin accused Trotsky of being on the payroll of the FBI.5 The
attempts to assassinate Trotsky are eloquently described in this article.
Unlike many other revolutionary figures, Trotsky was never rehabilitated, but his books became available in Russia once again approximately
20 years ago.
Ramon Mercader, the assassin, eventually returned to Moscow where
he was set to work in the Foreign Languages Publishing House. He
kept to himself and was known for his archaic Spanish (Mussa Kazhdan,
personal communication, 1983. Mercader was seated next to Mme.
Kazhdan when he returned. She and her husband, Professor Alexander
Kazhdan, a member of the Soviet Academy of Sciences, emigrated to the
United States and resided at Dumbarton Oaks in Washington. She
taught Russian to U.S. government officials and spoke of Mercader in
passing at a dinner party.)
T. Forcht Dagi
Newton Center, Massachusetts
1. Trotsky described his concerns in: Trotsky, Leon: The New Course (1923).
http://www.marxists.org/archive/trotsky/1923/newcourse/index.htm. Accessed
January 21, 2009.
2. A massive amount of Trotsky’s writings are available on-line in the Trotsky archive.
http://www.marxists.org/archive/trotsky/works/index.htm. Accessed 21 January 21,
2009. The “Trotsky Works” are also lodged at Wiedener Library at Harvard.
3. Bosworth RJB. Mussolini’s Italy. Life under the Fascist Dictatorship 1915-1945. 1st
American ed. New York, NY: Penguin 2006.
4. Trotsky L. Trotsky’s Diary in Exile—1935. Translated from the Russian by Elena
Zarudnaya. Cambridge, MA: Harvard University Press, 1958, pp. 38-40.
5. Deutscher I. The Prophet Outcast: Trotsky, 1929-1940. London/New York: Oxford
University Press, 1963, p. 482.
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