The Death of Leon Trotsky - Semantic Scholar · Services of the city and creator of the Mexican...

Enrique Soto-Pérez-de-Celis, MDDepartment of Internal Medicine,Instituto Nacional de Ciencias Médicas yNutrición Salvador Zubirán,México City, Mexico

Reprint requests:Enrique Soto-Pérez-de-Celis, MD,Camino a Santa Teresa 890 Torre XIIIDepartamento 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 theCongress of Neurological Surgeons

In the spring of 1918, Leon Trotsky was arguably one of themost powerful men in Soviet Russia (Figure 1). As the head ofthe Red Army, he led one of the largest war machines ever built

and was an obvious candidate for succeeding Lenin as head ofstate. Only 22 years and a few months later, however, Trotskystruggled for his life in a bed in a hospital in Mexico City, thou-sands of miles away from his homeland, injured by an assassinworking for the same political apparatus that he helped to build.The once powerful commander was now a dying man, woundedby an ice axe swung into his skull, and despite the work of theMexican neurosurgeons, nothing could be done for him.

RISE TO POWER

Leon Trotsky, born Lev Davidovich Bronstein, was one of themost prominent leaders of the Russian October Revolution thatbrought the Bolsheviks to power. He was also a writer and a the-orist, publishing several books and dissertations on Marxism andCommunism. His ideas are the basis for a school of thought thatopposed Stalinism, which became the official view of commu-nism in the Soviet Union after Lenin’s death.

Trotsky was born in the village of Yanovka, in present-dayUkraine, to a family of Jewish farmers.1 He spent his youth in thecosmopolitan and culturally diverse port city of Odessa and inthe town of Nikolaev, where he became involved with other stu-dents and young workers who were determined to overthrow theTsar. It was in those student groups where Trotsky first becameexposed to the ideas of socialism and also where he became known

LEGACY—INSTITUTIONS AND PEOPLE

NE UROSURGERY VOLUME 67 | NUMBER 2 | AUGUST 2010 | 417

The Death of Leon TrotskyLEON TROTSKY WAS one of the founders of the Soviet Union and an obvious candidate toreplace Lenin after his death. Unfortunately for him, it was Joseph Stalin who came topower, and Trotsky went into a long forced exile that eventually took him to Mexico, wherehe found asylum. On August 20, 1940, a Stalinist agent wounded Trotsky in the head withan ice axe in his house in Coyoacán, Mexico. Just a few hours later, Mexican neurosurgeonsoperated on him at the Cruz Verde Hospital in Mexico City. The axe had broken Trotsky’s pari-etal bone and, after tearing the meninges, had damaged the encephalon. Despite the careprovided by physicians and nurses, Trotsky passed away 25 hours after he was attacked, avictim of bleeding and shock. This article presents a review of Trotsky’s last day, with spe-cial emphasis on the doctors who performed the surgery and who took care of the Russianrevolutionary in his final moments. The results of Trotsky’s autopsy are also discussed. Theassassination of Leon Trotsky is one of the most dramatic events of the first half of the 20thcentury to have taken place on Mexican soil, and those final hours are an important momentin the history of Mexican neurosurgery and in the history of the world.

KEY WORDS: Craniocerebral trauma, Famous persons, Homicide, Penetrating head injuries, 20th century his-tory, Stab wounds

Neurosurgery 67:417-423, 2010 DOI: 10.1227/01.NEU.0000371968.27560.6C www.neurosurgery- online.com

FIGURE 1. One of the last photographs of Leon Trotsky, taken just days beforehis death. Photograph by Arturo Horta. (Reproduced with permission fromHemeroteca Nacional de México, UNAM. The Death of Leon Trotsky [inSpanish]. Novedades Sección de Rotograbado (Mexico City). August 25,1940; Sect 1 to 4.27)

as an audacious and determined speaker. He was one of the foundersof the South Russian Workers’ Union, and because of that, he wasarrested in 1898 and sent to Siberia, his first exile.2 He escapedin 1902, using the pseudonym “Trotsky” for the first time in hisforged passport.3 After leaving Russia, he moved to London andjoined the ranks of the Marxist newspaper Iskra, where he metVladimir Ilich Ulyanov, better known as Lenin. It was in that citythat he also met the woman that would be his companion up untilthe day of his death, Natalia Sedova.3

After the events of the 1905 Revolution, Trotsky returned toRussia and settled in St. Petersburg, where he headed the St.Petersburg Council of Workers’ Deputies. By then, Trotsky wasconvinced that the only way to change Russia was to establish a“permanent revolution,” led by workers and intellectuals andfounded upon Marxist ideology.1 He was once again arrested andexiled to Siberia in 1907, but he escaped and started a long emi-gration that took him to Austria, Switzerland, France, Spain, andthe United States. He was living in New York when Tsar NicholasII abdicated after the success of the 1917 February Revolution,and he made his way back to his homeland to be part of the newcountry that was being born.4

After the Bolsheviks came to power, Trotsky became People’sCommissar for Foreign Affairs and then Commissar of Army andNavy Affairs. As such, he was the head of the Red Army duringthe Russian Civil War, in which the Bolshevik forces defeated acombined Allied Force, named the White Army, after more than3 years of fighting. It was during this war that conflict first arosebetween Trotsky and Joseph Stalin, one of the members of thePolitburo, who openly challenged many of Trotsky’s decisions ashead of the army.2

DECLINE

After the Civil War was won by the Bolsheviks, Trotsky facedwhat was perhaps an even harder struggle inside the ranks of his ownparty. His confrontation with Stalin grew even more after Lenin’sdeath, and this buildup of conflicts eventually led to Trotsky’sexpulsion from the Central Committee of the Communist Partyin 1927. Stalin, who was by then the Head of the Soviet Union, out-lawed any opposition to him and forced Trotsky and his followersinto exile in 1928.5 Trotsky was sent in exile to Kazakhstan, fol-lowed by expulsion from the USSR to Turkey, and then to Franceand Norway. However, his stay in those countries was brief, owingto the pressure from the Stalinist government, who resented hav-ing Trotsky so close to the Soviet border. In August 1936, the finalblow was dealt against Trotsky and the rest of the old Bolsheviks withthe first of many show trials, staged by Stalin as part of his GreatPurges. In the first trial, 16 former members of the party, includ-ing distinguished revolutionaries such as Kamenev and Zinoviev,were found guilty of multiple crimes and executed.6 AlthoughTrotsky was not officially indicted in the show trials, he had alreadybeen 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

Mexico. Trotsky’s move to America in January 1937 was made pos-sible both because of the intervention of famous Mexican painterDiego Rivera (who was also a fervent communist) and by the lib-eral government headed by President Lázaro Cárdenas.7

In Mexico, Trotsky was free to travel, write, and express his ideasand theories. During his stay in the country, he founded the FourthInternational, a communist organization that was meant to be anoppositionist force to Stalinism. He also became a prominent per-sonality in Mexican society and mingled with famous people like DiegoRivera, Frida Kahlo, and André Breton. His house in the Coyoacánneighborhood of Mexico City was filled with visitors who wantedto know Trotsky and to hear his ideas. This freedom, however, alsomade him an easy target for the Stalinist agents who wanted him dead.The first attack on Trotsky took place on May 24, 1940, when agroup of armed men led by painter David Alfaro Siqueiros firedhundreds 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 wasdoubled, and his house became a fortress guarded by Mexicanpolicemen and several American bodyguards, hired by Trotsky’sfriends in the United States. These measures, however, were soonproven inadequate.

THE ATTACK

At approximately 6:00 PM on the afternoon of August 20, 1940,the Cruz Verde Hospital in Mexico City received an emergencyphone call from the Coyoacán police office. They quickly dis-patched an ambulance, driven by Ramón Cruz, to the house onViena Street. When the paramedics arrived on scene, they foundTrotsky’s wife, Natalia Sedova, leaning over his body, covered inblood. At first, the paramedics thought he was dead, but afterexamining him, they discovered that he was still breathing andhe was rushed to the hospital 9 km away.8

About 40 minutes before the call was received, a visitor arrivedat Trotsky’s house. His name was Frank Jacson, a Canadian citi-zen who was also the boyfriend of Silvia Ageloff, one of Trotsky’sassociates from New York. Jacson had become a frequent visitorto the house, and he often showed his manuscripts and discussedcurrent topics with Trotsky. That particular day, Jacson was carry-ing a hat and an overcoat, despite the fact that the weather wasquite good. Natalia Sedova escorted Jacson to Trotsky’s studio andclosed the door behind her. A few seconds later, she heard a terri-ble scream, and when she rushed to the studio, she found her hus-band resting against the wall of the dining room with his head fullof blood. The assassin was carrying an ice axe concealed in theovercoat, and when Trotsky sat down at his studio table, he stoodup, took the weapon out and dealt a blow to Trotsky’s head.8 Amountaineering ice axe is a tool used both as a walking stick andas a security anchor when going uphill. It has a narrow end, calledthe pick, and a flat, wide end used for chopping steps called theadze.9 It was with the adze of the axe that Jacson wounded Trotskyin the head, hitting him on the right side of the skull, fracturing theparietal bone and penetrating 7 cm into the encephalon.8 Trotsky

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SOTO-PÉREZ-DE-CELIS

Services of the city and creator of the Mexican Society of Trauma.Dr. Leñero passed away only 2 years after Trotsky, a victim oftyphus, and the flagship hospital of Mexico City’s health servicesis currently named after him.14 The third celebrity physician car-ing for Trotsky was Dr. Gustavo Baz Prada, who at that time wasthe rector of Mexico’s National Autonomous University. Dr. Bazwas sent to the Cruz Verde as a representative of President Cárdenashimself, who was particularly fond of Trotsky (he would laterdeclare Trotsky’s assassination the dirtiest crime ever committedon Mexican soil).15 Dr. Baz would go on to become the head ofMexico’s Secretariat of Health and the governor of the State ofMexico.16 Finally, another spectator of the surgery was Dr. JacintoSegovia, a Spanish physician who was a former professor of sur-gical pathology at the University of Madrid and who exiled him-self to Mexico at the onset of the Spanish Civil War.17 The remainingmembers of the team were surgeon Everardo García Espino andanesthesiologist Salvador Méndez.11

After performing a radiographic study of Trotsky’s skull (Figure3), Mass started the surgical intervention at 9:00 PM, roughly 3 hoursafter the attack. Trotsky’s hair was shaved and a 25-cm2 trepana-tion was done to the skull, finding a comminute fracture of the pari-etal bone with bony fragments inside the cranial vault. The meninges


THE DEATH OF LEON TROTSKY

did not lose consciousness right away; as a matter of fact, he wasable to speak and tell his bodyguards to spare Jacson’s life for himto tell his story (Figure 2).8

The first doctor to examine Trotsky at his house was his headphysician, Wenceslao Dutrem Domínguez, brought by his body-guards from his nearby home. Dr. Dutrem was a Spaniard exiledto Mexico after the Civil War who had practiced medicine andpharmacology in Barcelona, where he prepared a medication calledErotil, marketed as a cure for erectile dysfunction.10 Dutrem foundthat Trotksy’s left hand and arm were paralyzed and that the move-ments of his right hand were clumsy and uncoordinated.8 Hestood by his patient and Natalia Sedova until the ambulancearrived, but he was not able to do anything to help Trotsky.

THE SURGERYWhen 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 alreadybeen assembled.11 The main surgeon was Dr. Joaquín Mass Patiño,who also worked at the nearby Hospital Juarez. Mass was one ofthe first neurosurgeons in Mexico, alongside Manuel VelascoSuarez, and the founder of the first neurosurgical ward and neu-roradiology service in the city.12 Not much has been written aboutMass, but he did write a paper in December 1957 describing hismethod for treating penetrating gunshot wounds to the skull. Inthat article, Mass concluded that the first step when treating anypenetrating wound to the head was to treat edema and that try-ing to stop bleeding from the encephalon was useless because it wasalways found to be uncontrollable and the surgical intervention onlyadded “surgical shock and anesthetic intoxication.” In that samearticle, he also stated that perhaps one of the only advantages ofearly surgical management was to extract pieces of the skull foundin the wound’s trajectory because they could become foci for infec-tion.13 Aiding Dr. Mass was Dr. Rubén Leñero Ruiz, a young sur-geon who had a meteoric career in the medical services of MexicoCity. At the age of 38, he was already the Director of Medical

FIGURE 2. Trotsky’s studio minutes after he was attacked by Jacson. Photographby Arturo Horta. (Reproduced with permission from Hemeroteca Nacionalde México, UNAM. The Death of Leon Trotsky [in Spanish]. NovedadesSección de Rotograbado (Mexico City). August 25, 1940; Sect 1-4.27)

FIGURE 3. Trotsky’s alleged radiographic study, takenbefore 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 wereadded by the editors of the Novedades newspaper. Becauseof the poor quality of the image, it is impossible to knowwhether such markings truly represents a fracture.Photograph by Arturo Horta. (Reproduced with permis-sion from Hemeroteca Nacional de México, UNAM.Tragedy in Coyoacan [in Spanish]. Novedades (MexicoCity). August 22, 1940; Sect 1-9.28)

During the morning of August 21, Trotsky’s health deterio-rated, and he was not able to recover consciousness. The doctorsadministered physiological serum and oxygen, but no improve-ment was noticed. By midday, Dr. Mass noted that the woundwas bleeding profusely and pointed out that the ventricles werefilling up with blood.20 In the afternoon, Trotsky’s breathingbecame fast and erratic and Natalia Sedova was told by physi-cians that her husband was about to die.8 The last medical reportsigned by Dr. Mass came out at 6:00 PM, stating that Trotsky’sstatus was “Critical. Temperature 38.1°C. Pulse 140. Breathing41. Blood pressure in the right arm 78 × 68. Left arm 78 × 64.”The diagnosis given in the report was that of “flooding of thecerebral ventricles, an extremely severe injury that darkens theprognosis.”21 An hour and 25 minutes later, Trotsky’s pulse becameweak, and the doctors administered an injection of adrenalinewith no effect. Dr. Leñero examined the patient and found thathis pupils were nonresponsive, declaring him dead at 7:25 PMon August 21, 1940, 25 hours and 35 minutes after being attackedby Jacson.8,20,21

THE AUTOPSY

Trotsky’s remains were moved to the Alcazar funeral home indowntown Mexico City on the morning of August 22. At 2:00PM, his casket was taken to the embalming room and the bodywas extracted. The corpse was still dressed in the Cruz Verde gown,and blood was still dripping from the bandages placed on thewound. In the room were surgeons Dr. José Rojo de la Vega andDr. José Edmundo Sol, Dr. Erasmo Marín, director of the city’smedicolegal service, and Arturo Orozco and Francisco Ortega,



were torn and the encephalon was herniated through the wound.Dr. Mass extracted the bony fragments and cleansed the woundthoroughly, after which the operation was concluded.8 Trotskywas moved to a room in the adjacent ward at 10:00 PM. Dr. Leñeroordered the administration of oxygen and instructed orderlies andnurses to avoid puncturing the patient’s veins to avoid worseningthe “traumatic shock” suffered during surgery (Figures 4 and 5).11

Dr. Baz spoke to the press after the surgery and told reporters thatthere was a 90% chance of death because the injury was life-threatening. Dr. Segovia was also pessimistic when he spoke tothe newspapers.11

Trotsky’s North American associates desperately started look-ing for support from physicians in the United States. Accordingto the press, they contacted Dr. Walter Dandy from Johns Hopkinsand arranged a plane to take him to Brownsville, Texas, from wherehe was to be flown to Mexico City to direct Trotsky’s care.18 At thetime of the assassination, Dandy had already established his famous“Brain Team” at Johns Hopkins.19 Even though Dandy was arguablythe world’s foremost expert in neurocritical care and neurosurgeryat the time, it is difficult to say whether he could have done any-thing else for the fallen Russian leader, given the nature of hisinjury. The plans to take Dandy to Mexico, however, could neverbe materialized because of Trotsky’s death (Figure 6).

FIGURE 4. Doctors Ruben Leñero ( left) and Everardo García Espino ( right)look at Trotsky’s radiographs after surgery. Photograph by Arturo Horta. (Reproducedwith permission from Hemeroteca Nacional, UNAM. Tragedy in Coyoacan [inSpanish]. Novedades (Mexico City). August 22, 1940 ; Sect 1- 9.28)

FIGURE 5. Trotsky lies in his bed at the Cruz Verde Hospital. Watching overthe 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. (Reproducedwith permission from Hemeroteca Nacional de México, UNAM. Trotsky isdying [in Spanish]. Novedades (Mexico City). August 21, 1940; Sect 1-10(Col 3-6).29)

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 bull-fighters in the Plaza México, one of the world’s premium bull-fighting arenas.23 After the police handed him the court orderto carry on with the autopsy, de la Vega started the procedure.Using a surgical knife, he dissected the scalp and uncovered theskull, finding an injury of approximately 3 cm in diameter inthe right parietal bone, 4 cm from the midline and 12 cm abovethe right eyebrow. de la Vega opened the skull and extractedthe brain, finding a subdural hematoma and a 2-cm wide and7-cm deep wound in the right hemisphere. According to theofficial report, the injury was located in the “second parietalcircumvolution, above the curved fold of the rolandic fissure.”22

Taking into account Trotsky’s symptoms (paralysis of the lefthand and arm), one can hypothesize that the axe damaged themotor neurons in the cortex of the precentral gyrus. It is also pos-sible that these symptoms resulted from cerebral compressionby acute subdural hematoma. The trajectory of the weapon wasdetermined by the doctors to be from up to down, from frontto back and from right to left, proving that the assassin stoodright in front of Trotsky when he dealt the blow.22 The woundinvolved both the white and gray matter and penetrated to theright lateral ventricle, which was flooded with blood. The cere-bellum and medulla oblongata were found to be pale, whichwas attributed to the loss of blood. The weight of Trotsky’s lefthemisphere was 780 g and that of his right hemisphere, theinjured one, 770 g, totaling 1550 g.8

After the autopsy, Ortega closed the cavities, and the body wastaken to the main hall of the funeral home. In the following days,thousands of Mexicans marched in front of the remains to show theirrespect to the fallen leader. Initially, Trotsky’s associates plannedto take the body to the United States, but the American government

refused to grant permission for such a transfer to avoid politicaldemonstrations.8,24 After several days in the funeral home, Trotsky’sbody was cremated. His ashes rest in a monument built in the gar-den of the house on Viena Street; just a few steps away from the placewere he was murdered.

AFTERMATH

Trotsky’s assassination is one of the most dramatic events of thefirst half of the 20th century in Mexico. Even though history hasmostly ignored Trotsky, he is undoubtedly one of the most impor-tant figures of the 20th century because he was an essential char-acter in the construction of the Soviet Union.

His assassin, Frank Jacson, who also held a Belgian passportunder the name Jacques Mornard, was later found to be a Spanishcommunist named Jaime Ramón Mercader del Río Hernández,who had important connections with the GPU, Stalin’s secretpolice. Mercader was imprisoned in Mexico City’s Palacio deLecumberri for 20 years, without ever confessing the true rea-sons for his crime. After his release from prison, he spent his timebetween Cuba and the Soviet Union, where he shamefully receivedthe nation’s highest distinction, the Hero of the Soviet Unionmedal. Mercader passed away in 1978 and is buried in Moscow’sKuntsevo Cemetery.25

Natalia Sedova stayed in Mexico, living in the house that sheshared with Trotsky and dedicated her life to her family. She diedin Paris in 1962 and her ashes are buried next to those of Trotskyin their Coyoacán home, which is now a museum.

Trotsky was never “rehabilitated” in his homeland, and evenMikhail Gorbachev, the last Head of the Soviet Union, delivereda speech denouncing Trotsky in traditional Stalinist terms in1987.26 Just 4 years later, the Soviet Union ceased to exist, andTrotsky’s ideas were no longer officially frowned upon.

Ironically, it was Trotsky who more than half a century before hadwarned that with its complete disregard for the working class,bureaucracy would ultimately destroy the Soviet Union and clearthe path for the return of capitalism. His death was as much a resultof neurotrauma as of hatred and revenge. The doctors and sur-geons who took care of him during his last hours did as much asthey could, given the severity of the wound and the resources avail-able. Those last hours, however, are an important moment in thehistory of Mexican neurosurgery and in the history of the world.

DisclosureThe author has no personal financial or institutional interest in any of the drugs,

materials, or devices described in this article.

REFERENCES1. 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.



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)

notch) were widely known by 1940. On the other hand, in the 19th cen-tury and into the 20th, there was a dictum that hemorrhage into the ven-tricles is highly fatal per se. So Trotsky’s prosectors may have thoughtthat their description of intraventricular hemorrhage was sufficient toexplain his death. It would also explain why Dr Mass explicitly “pointedout that the ventricles were filling up with blood.”

Another speculation can also be raised. The small craniectomy wasonly a “25-cm2 trepanation,” which is 5 × 5 cm. Because Trotsky sus-tained a low-velocity injury, perhaps he might have been saved by oneof today’s large hemicraniectomies. If so, would the course of historyhave been any different?

Samuel H. GreenblattProvidence, Rhode Island

The article provides interesting details on the circumstances, manage-ment, surgery, and autopsy of the open head injury of Lev (Leon)

Trotsky in Mexico City in August 1940. It gives a glimpse into the his-tory of Mexican neurosurgery and is based on anecdotal evidence of thesubject from contemporary Mexican periodicals and secondary sources.The clinical part comprises about half of this article. Trotsky experi-enced a severe open head injury complicated by a depressed cranial frac-ture and cerebral laceration. Witness accounts state that Trotsky wassitting at the table reading a manuscript when hit by an ax. Accordingto the description, there was a clear lucid interval (Trotsky tried to fightagainst his assassin and was able to speak after the injury), which is typ-ical for acute intracranial hematomas. Indeed, a subdural hematomawas found at the autopsy. The hematoma that caused Trotsky’s deathwas not diagnosed while he was alive. The reason was an inadequateexploration of the wound during surgery. The trepanation window wastoo small (25 cm2), which did not allow proper revision of intracranialstructures, hemostasis, and control of brain edema (“the encephalon washerniated through the wound”). However, large trepanation windowshad been practiced since the late 19th century, and Harvey Cushing hadadvocated decompressive trepanation to reduce increased intracranialpressure since 1900s.1 The author quotes from the article by Dr. Mass-Patino who operated on Trotsky. According to Dr. Mass-Patino, it isimpossible to control cerebral bleeding, and surgical intervention onlyadds shock and anesthetic intoxication. This article was published in1957, whereas clips for hemostasis were introduced by Cushing in 1911and electrocoagulation in 1927.

Unfortunately, the author relied on press reports and did not usearchival sources, which might be available in Mexico City (such as Trotsky’scase records or protocols of his surgery and autopsy). Why was Trotsky’sbrain not preserved and not subjected to a neuropathological study?

To conclude, the medical part of the article by Soto-Pérez-de-Celisvividly illustrates a low level of Mexican neurosurgery in 1930s. HadTrotsky been in more experienced hands, he might have survived. Theauthor’s claim that the assassination of Trotsky “represents a landmarkin the history of Mexican neurosurgery” is unfounded. The article doesnot mention any impact of Trotsky’s case on the development of neuro-surgery in Mexico.

The rest of the article presents a brief biography of Trotsky. It mightbe worth mentioning that there is evidence that he had epileptic seizuresin infancy. Trotsky initiated “Red Terror” after the October Revolution.The term was coined by Trotsky and defined as “a weapon used againsta doomed class that does not want to perish.” His biography was asubject of 2 movies: Assassination of Trotsky (France-Italy-UK, 1972) andTrotsky (Russia, 1993). Trotsky was a protagonist of an opposition



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 1-

9.29. Trotsky is dying [in Spanish]. Novedades (Mexico City). Aug 21,1940:Sect 1-10

(col. 3-6).

AcknowledgmentsThe author thanks Tita Pérez de Celis Herrero for her invaluable help with this

article.

COMMENTS

The most important impact of Trotsky’s assassination was not on neu-rosurgery, of course, but rather its effect on the history of the entire

world. Nonetheless, we can extract some interesting history of neuro-surgery from it. A careful reading of the postmortem examination of thebrain, as provided by the author, does not seem to indicate a definitive expla-nation for Trotsky’s neurological death. That is, there is no description ofany findings related to transtentorial herniation, either central or lateral.Transforaminal (foramen magnum) herniation was known in the later19th century, but our modern understanding of transtentorial hernia-tion goes back only to the 1920s. I do not know whether the patholog-ical phenomena of the latter (eg, mesiotemporal herniation, Kernohan’s

leader in 2 novels by George Orwell (Snowball in Animal Farm andGoldstein in 1984).

Leonid LikhtermanBoleslav LichtermanMoscow, Russia

1. Greenblatt SH. Harvey Cushing’s paradigmatic contribution to neurosurgery and theevolution of his thoughts about specialization. Bull Hist Med. 2003;77:789-822.

The assassination of Trotsky, like the assassinations of Archduke Ferdinandand John Fitzgerald Kennedy, had broad social and political reper-

cussions. There is a rich literature on the medical aspects of the Kennedyassassination, but little has been said about Trotsky’s. This article correctsthe oft-repeated but erroneous assertion that Trotsky was killed by an icepick. He was not: the medical records confirm that fatal blow was struckwith an ice ax, even though the ice pick was an assassination device inuse at the time.

The enmity between Stalin and Trotsky was long-standing. Beginningin 1923, 6 years after the Bolshevik Revolution, Trotsky led an opposi-tion faction within the Russian Communist Party. He protested, interalia, the development of a powerful, centralized and arbitrary Bolshevikbureaucracy consolidating under Stalin. Lenin came to agree just beforehis death in 1924.1

Whether or not their idea of democracy was in any way parallel todemocratic theory in the West, Trotsky and his opposition group usedthe idiom of a return to the ideal of a “workers’ democracy” in attackson the politburo. Concessions were obtained but never implemented.On November 7, 1927, 10 years after the Revolution, Trotsky was expelledfrom 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 cir-cle of intimates: Joffe, Glazman, Butov, Blumkin, Sermuks, and Poznansky.Many had played important military and political roles during the civilwar after the Revolution. Anti-Semitism played no small part in this cam-paign. Trotsky commented that Stalin intended to silence the writingsand consequently the political influence of the opposition by destroyingits leadership.2 Given the power ascribed to journalism, political com-mentary, and propaganda at the time, this strategy was pursued by theLeft and the Right alike. It was sometimes difficult to decipher whichviews belonged on which side of the aisle.3

In 1928, Trotsky was exiled to Kazakhstan near the Chinese border, andfrom there to Büyükada off the coast of Istanbul, Turkey, where he stayedfor the next 4 years. Members of the defeated White Army who had takenrefuge in Istanbul threatened his life, but he was protected by Communistsympathizers and volunteers. In 1933, Trotsky was offered asylum inFrance as long as he did not visit Paris. His son and political collabora-tor, Leon Sedov, was assassinated in France in 1937. Trotsky then becamepersona non grata.

He was granted asylum in Norway by Trygve Lie, the Minister ofJustice. He resided near Oslo in relative freedom for 2 years. He wasthen placed under house arrest and subsequently transferred to Mexicoon a freighter under secret arrangements made between Norway andMexico. President Lázaro Cárdenas welcomed Trotsky warmly and openlyand arranged for a special train to bring him to Mexico City from the portof entry.

Trotsky wrote unceasingly in exile, including many of his most impor-tant works criticizing Stalin. In his diaries, for example, he wrote “Stalindid 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 thecleverest bureaucrat displays an incredible short-sightedness in certainquestions!”4

In 1939, after the German invasion of Poland, Trotsky agreed to testifybefore a U.S. Congressional committee chaired by Martin Dies, whosought to the suppress the American Communist Party. Trotsky let it beknown that he would expose and condemn the activities of the NKVD,the Russian secret police, but would also speak in support of the AmericanCommunist Party and would call for transformation of the World Warinto a world revolution. As a result, he was denied a visa to enter the UnitedStates. Stalin accused Trotsky of being on the payroll of the FBI.5 Theattempts to assassinate Trotsky are eloquently described in this article.

Unlike many other revolutionary figures, Trotsky was never rehabili-tated, but his books became available in Russia once again approximately20 years ago.

Ramon Mercader, the assassin, eventually returned to Moscow wherehe was set to work in the Foreign Languages Publishing House. Hekept 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 AlexanderKazhdan, a member of the Soviet Academy of Sciences, emigrated to theUnited States and resided at Dumbarton Oaks in Washington. Shetaught Russian to U.S. government officials and spoke of Mercader inpassing at a dinner party.)

T. Forcht DagiNewton Center, Massachusetts

1. Trotsky described his concerns in: Trotsky, Leon: The New Course (1923).http://www.marxists.org/archive/trotsky/1923/newcourse/index.htm. AccessedJanuary 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. 1stAmerican ed. New York, NY: Penguin 2006.

4. Trotsky L. Trotsky’s Diary in Exile—1935. Translated from the Russian by ElenaZarudnaya. Cambridge, MA: Harvard University Press, 1958, pp. 38-40.

5. Deutscher I. The Prophet Outcast: Trotsky, 1929-1940. London/New York: OxfordUniversity Press, 1963, p. 482.



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