Lenin's "Circulatory Disturbance of the Brain" - What if Ilyich lived longer?

Earlier today, after having finished Victor Sebestyen’s biography of Lenin, I was curious as to why Lenin died at a relatively young age compared to others like Stalin (74); I stumbled across some articles and a paper from 2012 that concludes with some certainty that Ulyanov died from a rare mutation (something to do with the NT5E gene) inherited from his father that lead to “premature cerebrovascular disease”, strokes very early in life, and his eventual death*.

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It remains a puzzle as to why a man as young as Lenin and seemingly as vigorous, with few classical risk factors for cerebrovascular disease [18], would develop such severe— indeed rapidly fatal—atherosclerosis in middle age. He had migraines, which rarely are associated with paralysis, especially the hemiplegic migraine variant; however, though they can cause long-term neurological sequelae, permanent hemiplegia is not one of them [19]. Furthermore, severe atherosclerosis of the basal arteries is not a feature of hemiplegic migraine. With regard to other classic risk factors, Lenin was a non-smoker and judging from his necropsy findings, not hypertensive.

Could stress have had a role in Lenin's premature atherosclerosis? His career as revolutionary and politician during the most turbulent of times certainly involved stress, the magnitude of which few of us can even imagine— witness several failed assassination attempts. However, stress is difficult to quantify and affects people in different ways. Therefore, invoking it as a risk factor for stroke or, for that matter, any other disorder must be done with caution. Nevertheless, an expanding body of evidence does suggest that psychological stress predisposes to atherosclerotic cardiovascular disease [20–27]. The precise mechanisms by which stress contributes to the development of athero- sclerosis are poorly understood, but are thought to involve invasion of vascular endothelium by monocytes in response to the influence of an over-stimulated hypothalamic- pituitary-adrenal feedback system [28]. Indeed, a recent epidemiologic study from Japan, examining the role of occupational stress in over 6000 subjects, found that men in high-strain jobs were nearly three times as likely to suffer a stroke as those with low-strain jobs; this effect was not identified among women [21].

Lenin's father expired at precisely the age his son did, apparently with similar neurological complaints; Lenin's brother died young of a myocardial infarction and another brother of “stenocardia" (angina) at age 69. A sister had a fatal stroke at the age of 71. Although certainly not conclusive, these findings suggest that there was a family predisposition to atherosclerosis inherited from the father— possibly a familial lipoprotein abnormality. However, Lenin's type of atherosclerosis was different from what one generally sees in patients with an inherited lipid disorder. His involved the cerebral vessels to a greater extent than those of the heart and exhibited a degree of calcification unprecedented in the experience of one of the authors of this paper (H.V.)—a neuropathologist with over three decades devoted to the study of cerebrovascular disorders. In that Lenin's vascular abnormality was so unusual, we suspect that its etiology was also unusual.

In February of 2011, St. Hilaire, Ziegler, Markello and colleagues published a report in the New England Journal of Medicine [29] describing nine persons in three families with markedly calcified arteries of the lower extremities as well as calcification of the joints of the hands and feet. Most of the patients had a history of long-standing pain in the calves and buttocks with exertion and painful feet at rest. When their personal physicians could not give them a diagnosis, they found their way to Dr. St. Hilaire's Undiagnosed Diseases Program (UDP) at the National Institutes of Health, in search of an explanation for their strange vascular disorder. The UDP team conducted their own comprehensive clinical and radiographic evaluation and then performed genetic studies on the three families. In each family they found a mutation of a gene involved in the calcium metabolic pathway, the NT5E gene, which they believe had a role in causing their patients' arteries and joints to become calcified.
Given the similarity of the disorder described above with that of Lenin (and likely Lenin's family), a final possible explanation for Lenin's highly unusual form of atheroscle- rosis is an as yet undiscovered variant of the disorder described by St. Hilaire and colleagues. Lenin's variant, if it existed, was one associated with extensive calcification of the major vessels of the brain, rather than of the legs, and also characterized by long-standing head pain (migraines), rather than leg pain (claudication). This hypothesis could be tested if genetic studies were performed on Lenin's tissues preserved in his mausoleum just outside the Kremlin wall or on those stored in the Moscow Brain Institute. However, it is not likely that permission to do so will be granted any time soon.

Essentially, assuming the paper’s hypothesis about a rare inherited gene mutation is correct, what would the politics of the Soviet Union look like if Vladimir Ilyich had not inherited this mutation and lived another two decades or so? What course would the NEP take with Lenin staying at the helm of state? What would happen to the Stalin, Kamenev, and Zinoviev vs Trotsky feud? The struggle really came into it’s own when it became clear Lenin was going to be dead soon, so I assume it would remain at a low intensity and Stalin would continue to play up to Lenin. What of Soviet foreign policy with a wildcard Germany and what is his reaction to Italian Fascism? And, the more most interesting in my opinion, what role does Lenin play when (or if I suppose with butterflies) the Stock Market crashes and the Great Depression hits? There’s a lot of possibilities here and I think it would make a great timeline (I’m playing around with ideas for a TL in this period). As a side PoD that I haven’t found too many threads on, what would be the ramifications of a surviving Yakov Sverdlov? Given his goodwill with Lenin and capable work ethic, he would probably be in prime position to assume power when Lenin kicks the bucket which could result in an interesting Soviet political climate.

* In the concluding remarks, the paper mentions that Lenin’s multiple requests for cyanide from Stalin might have been what killed him, since his terminal seizures corresponded medically more to acute cyanide poisoning than to stroke.
 
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Anyone? Strongly considering doing a timeline on the “Lenin lives” premise, any ideas would be much appreciated
 
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Anyone? Strongly considering doing a timeline on the “Lenin lives” premise, any ideas would be much appreciated
I am wondering the development of the Union under Lenin.
Would he drastically industrialize like Stalin? or seek to slowly develop industry?
We know he believed in the world revolution, so how far would he be willing to go?
I feel like Lenin died when his idea of the union was half baked.
 
I feel like Lenin died when his idea of the union was half baked.

Definitely, Moshe Lewin wrote a bit about Lenin’s unfinished plans at the time of his death in “Lenin’s Last Struggle” (and Sheila Fitzpatrick also discussed the ideas in Lenin’s Testament IIRC) and you definitely get the sense there was so much more he wanted to accomplish like reforming the Civil War bureaucracy that had set in after War Communism. It would definitely be a heavy task but with an alliance with Party “outsiders” like Trotsky, I think it could be accomplished:


[ It is easier to imagine Lenin himself perishing in prison than inflicting such an insane hemorrhage on his country. A coali- tion of Lenin with Trotsky and others would have enabled a rational use of the best cadres, instead of their elimination. Of course, this mass of individuals would not only have helped to carry out Lenin's program; they would also have been a seedbed of opposition that tried to outflank him some- times from the left and sometimes from the right. But Lenin would certainly not have used Stalinist methods against them. On the other hand, it would be nothing more than speculation to affirm that Lenin would have succeeded without any doubt. He too might have succumbed and ended, like so many others, as a "deviationist." But what may be said with cer- tainty is that he would have done his utmost to combat the processes that were to make the Stalinist period what it was.

In order not to be beaten, Lenin would have had to show quite extraordinary skill and daring as a political manipula- tor and innovator; he is known to have possessed these qualities in ample measure. He would have had, in his own words, to act with "devilish persistence." He was probably quite capable of it. It is legitimate to believe that Lenin, acting in concert with Trotsky and others, would have been able to bring Soviet Russia through a less tragic, more rational and, for the cause of socialism, less compromising path. In fact, Lenin needed Trotsky to realize his idea. It was not merely because of his illness that he called in Trot- sky's assistance. The two men complemented each other very well, even if they would not have produced the symbiosis that Lenin had wanted between Krzhizhanovsky and Pyata- kov at the Gosplan.

Between them, they symbolized the motive force of the October Revolution. Trotsky alone would not have been capable of carrying out the reorganization and consolidation and the preservation of those later to be purged. Deutscher explains very well why he could not be Lenin's "heir": when Lenin finally succumbed to paralysis, for example, he concluded the very kind of "rotten compromise" that Lenin had warned him against. He calmed Kamenev's fears by telling him that although he was in agreement with Lenin on fundamentals, he did not agree to "finishing with Stalin, or to expelling Ordzhonikidze, or to removing Dzerzhinsky from the Com- missariat of Communications." He merely scolded Stalin. saying, "There should be no more intrigues, but honest co- operation."4 He wanted to show magnanimity, believing that, with Lenin's support enshrined in the "Testament," he could afford to do so. This merely showed that he had not under- stood Lenin's essential recommendations.

He also had the weakness of a man who was too haughty and, in a sense, too idealistic to indulge in the political machinations inside the small group of leaders. His position as an outsider, on account of his past and his style, prevented him from acting when the moment came--for him, it only came once-with the necessary determination. He suc- cumbed to a fetishization of the Party, to a certain legalism and to scruples that paralyzed him and prevented him from reacting unhesitantly, as Lenin would have done, to what his enemies were doing against him. As the founder, Lenin was not afraid of unmaking and remaking what he had made with his own hands. He was not afraid of organizing the people around him, of plotting, of fighting for the victory of his line and of keeping the situation under control. Trotsky was not such a man. Lenin disappeared and Stalin was assured of victory. ]
 
Those who lived under the harrow had their own opinions. Like this Czech historian teaching a Soviet officer:

The Liberators (Viktor Suvorov) said:
‘. . . Did you know that, in comparison with Lenin, Stalin was a pitiful amateur and ignoramus. Lenin was an out and out sadist, one of those degenerates who happens only once in a thousand years!'

'But Lenin didn't annihilate as many innocents as Stalin did!'

'History stopped him in time. It removed him from the scene at the right time. But remember that Stalin didn't let himself go completely from the very outset, but only after ten to fifteen years of unlimited power. Lenin's start had much more impetus. And, if he had lived longer, he would have done things which would have made Stalin's thirty million dead look like child's play in comparison. Stalin never, I repeat never, signed orders authorising the killing of children without trial. And Lenin did so in his very first year of power, isn't that so?'

'But, under Stalin, children were shot in their thousands.'

'That's right, Comrade Colonel, quite right, but you just try and name me at least one child who was shot without trial on Stalin's orders! There you are, you can't say anything! I repeat, Lenin was one of the most bloodthirsty degenerates who ever lived. Stalin at least tried to conceal his crimes, not so Lenin. Stalin never gave official orders for the murder of hostages. But Lenin killed children as well as hostages and never felt the least compunction about it. Lenin, Comrade Colonel, should be read attentively!'
 
And, if he had lived longer, he would have done things which would have made Stalin's thirty million dead look like child's play in comparison.
I don't dispute that there would be a significant amount of dead left behind, but I don't think that Lenin would go beyond Stalin in his bloody purges - he was no stranger to terror as a political tool obviously, but a wide reaching decimation of the Party and citizenry beyond Stalin's brutal level doesn't seem likely. Allow me to quote from Moshe Lewin again because the last section of his book on this hypothetical is quite good:

[ The absence, in the "Testament," of any mention of the prohibition of factions is made all the more significant by the fact that there is also no mention of terror as a means of promoting the execution of the government's plans. Terror had occupied a fairly considerable place in Lenin's earlier writings, and he had always defended it as an ultimate weapon. The new Volume XLV of the Works includes a number of writings that had previously been either unknown or little known in which Lenin analyzes terror as a method. It was a weapon that must always be held in reserve, Lenin reminds his readers, especially as the liberalization brought about by the NEP would tend to weaken the security of the state. In a letter to Kamenev that appeared for the first time in 1959, he declares: "It is a great mistake to think that the NEP put an end to terror; we shall again have recourse to terror and to economic terror." He explains to Kamenev that a means must be found whereby all those who would now like to go beyond the limits assigned to businessmen by the state could be reminded "tactfully and politely" of the existence of this ultimate weapon. But in other writings, which are more disturbing in view of the use to which they were later put, Lenin went further. In his amendments to the project for the penal code, he insisted that the notion of "counterrevolutionary activity" should be given the widest possible interpretation. This definition was to be linked with the "international bourgeoisie" in such a way that this kind of crime became quite imprecise from a juridical point of view and thus left the way wide open for every kind of arbitrary action. Among other things, the crime would cover "propaganda and agitation" and "participation in or aid to an organization" which might benefit that part of the international bourgeoisie that does not recognize the Soviet regime's equal rights with capitalist states and seeks to overthrow it by force. This definition was already broad enough, but what was worse, in view of the fact that the crime could carry capital punishment, was that it could be extended by analogy. Whoever "gave help objectively to that part of the international bourgeoisie" (which actively opposed the regime), and similarly whoever belonged to an organization within the country whose activities "might assist or be capable of assisting" this bourgeoisie, would also be guilty!

This case shows that at this time Lenin was anxious to leave room for the use of terror or the threat of its use (not through the Cheka alone but through tribunals and a regular procedure) as long as the big capitalist countries continued to threaten the USSR. Lenin, then, was very far from being a career liberal, incapable of taking resolute action when necessary. But unlike some of his successors, he hated repression; for him, it should be used only in the defense of the regime against serious threat and as a punishment for those who contravened legality. But to return to Lenin's last program, the use of constraint -let alone terror-is ostensibly excluded in establishing the foundations of a new society. Lenin's second What Is To Be Done? pleads for caution, restraint, moderation and patience. Lenin has not abandoned the use of constraint in the defense of the regime, but for purposes of construction all undue haste is forbidden: "We must show sound skepticism for too rapid progress, for boastfulness, etc."-these words are taken from "Better Fewer, But Better." "Better get good human material in two or even three years than work in haste without hope of getting any at all." "No second revolution!"-this was to be the interpretation of the "Testament" that Bukharin, five years later, was to throw back at Stalin, and he was right. Lenin no longer described force as the "midwife of a new society" after the seizure of power and the return of peace; the new rule in this new situation was clearly that of gradual evolution. And this rule was formulated against the whole pressure of Russian realities, which-as Lenin was very well aware-tended in the opposite direction. The rule "Better fewer, but better" would be difficult to observe, but Lenin refuses, in advance, the argument of spontaneous tendencies: "I know that the opposite rule will force its way through a thousand loopholes. 1 know that enormous resistance will have to be put up, that devilish persistence will be required, that in the first few years at least work in this field will be hellishly hard. Nevertheless, 1 am convinced that only by achieving this aim shall we create a republic that is really worthy of the name of Soviet, socialist, and so on, and so forth."

In my opinion, one can hardly describe Lenin's great objectives as utopian. Many of the objectives assigned to the regime in the fields of economic and cultural development have been attained. The other grand design, that of creating a dictatorial machine capable of controlling itself to a large degree, seems closer today, but only after an initial catastrophic failure: the Soviet regime underwent a long period of "Stalinism," which in its basic features was diametrically opposed to the recommendations of the "Testament." This fact requires some elucidation. Left-wing dictatorship is one of the most significant political phenomena of our time. Its role is an important one and its prospects of development are far from exhausted. But there is no evidence that this type of dictatorship, at a certain stage in its development, must of necessity and in every case degenerate into a personal, despotic and irrational dictatorship. From a historical point of view, there was nothing essentially utopian about Lenin's aim of achieving a rational dictatorial regime, with men of integrity at its head and efficient institutions working consciously to go beyond both underdevelopment and dictatorship. Moreover, in Lenin's own time, and in extremely difficult conditions, the Soviet dictatorial machine still functioned in a very different way from the one it was later to adopt. Lenin's plans were not put into practice because the tendencies that had emerged from the civil war could only be counteracted by daring reforms, and in the absence of a capable and undisputed leader the plans in question remained no more than mere "wishes." The machine that had been set up under Lenin found no difficulty in bypassing the dead leader's most earnest wishes; the embalming of his corpse and the posthumous cult of his person helped to dissimulate a type of dictatorship utterly foreign to his plans. ]

Essentially, while obviously it is hard to divorce from the Lenin of the Red Terror, the Lenin after the NEP and towards his death held quite a different view on the use of revolutionary violence as "the midwife of a new society." His goal seemed to be reconstructing the Party apparatus from the ground up into a "rational dictatorship" and curb a lot of the bloody excesses from the years of War Communism that your Czech historian discusses. Of course, this new path as laid out in "Better Fewer, but Better" was never implemented and it's speculative whether or not this sort of vision of his would have been followed through with, but given all of this I think it is a hard sell to argue Lenin would have gone on to exercise such brutality as to kill more than Stalin and, with the implication, decimate the Red Army and Party. He was a cruel dictator, but not one to have most of his oldest comrades taken out back and shot after a show trial for disagreeing with him on tactics like Stalin did. If he was, the Worker's Opposition that emerged in the Party like Kollontai, Shlyapnikov, and Medvedev, would have died under his supervision and not Stalins, and Lenin would not have tried to send funds to the sick Julius Martov, a leading member of the illegal Mensheviks and a fierce critic of Lenin. Stalin was the one to refuse that: Stalin was far more ruthless to political opponents within the Soviet Union than Lenin was and I don't think Lenin would have destroyed the ranks of the Party on any similar level to Stalin...
 
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  • the NEP : Lenin saw the NEP as temporary, so it would have given way eventually to collectivization, perhaps under him.
  • Stalin/Trotsky: Given the personalities of both, Stalin has a 99% chance of winning the feud. Indeed Stalin was an extraverted workaholic, less brilliant than, but more indispensable in the party apparatus than Trotsky. Trotsky was introverted, did not have many friends, despised people that were less intelligent (almost all party members), was very harsh in his critics and overall was very difficult to root for. Lenin would have continued to act as a balance between Trotsky and Stalin, but he already had named Stalin secretary of the party, and in time, Stalin would have gone on to marginalize Trotsky, and perhaps manipulate the Politburo into sending Trotsky abroad as an ambassador.
  • Foreign policy : as the war in Poland shows, Lenin was an enthusiast of revolutions abroad. He would have continued to fund communism in China, Germany, France, USA etc... However, nationalism was truly a challenge for communist thinkers as the defeat in Poland shows. Nationalism can unite people that communists would see as belonging to different classes, making class warfare rhetoric out of touch with reality. Such funding would have in the wort case insured the defeat of communist coups because the narrative of a foreign government funding terrorists within your own nation is powerful, and in the best case been not so effective because political support for revolutionary communism was only a few %, even in russia itself. Most probably the USSR would have carried on alone at least until decolonization.
 
  • the NEP : Lenin saw the NEP as temporary, so it would have given way eventually to collectivization, perhaps under him.
  • Stalin/Trotsky: Given the personalities of both, Stalin has a 99% chance of winning the feud. Indeed Stalin was an extraverted workaholic, less brilliant than, but more indispensable in the party apparatus than Trotsky. Trotsky was introverted, did not have many friends, despised people that were less intelligent (almost all party members), was very harsh in his critics and overall was very difficult to root for. Lenin would have continued to act as a balance between Trotsky and Stalin, but he already had named Stalin secretary of the party, and in time, Stalin would have gone on to marginalize Trotsky, and perhaps manipulate the Politburo into sending Trotsky abroad as an ambassador.
  • Foreign policy : as the war in Poland shows, Lenin was an enthusiast of revolutions abroad. He would have continued to fund communism in China, Germany, France, USA etc... However, nationalism was truly a challenge for communist thinkers as the defeat in Poland shows. Nationalism can unite people that communists would see as belonging to different classes, making class warfare rhetoric out of touch with reality. Such funding would have in the wort case insured the defeat of communist coups because the narrative of a foreign government funding terrorists within your own nation is powerful, and in the best case been not so effective because political support for revolutionary communism was only a few %, even in russia itself. Most probably the USSR would have carried on alone at least until decolonization.

The main point is that Lenin was not very different from Stalin. Lenin was the one to organize the shootings, arrests and banishments of the constitutionalists and the Mensheviks, as well as the forceful seizures of grain from peasants during the civil war, or the massacre of white guards, or the repression of the Kronstadt revolt that wanted the freedom of expression and freedom of the press. The ussr was already on track to dictatorship and would face the same issues as during the Stalin era if Lenin would have remained in power
 
The main point is that Lenin was not very different from Stalin. Lenin was the one to organize the shootings, arrests and banishments of the constitutionalists and the Mensheviks, as well as the forceful seizures of grain from peasants during the civil war, or the massacre of white guards, or the repression of the Kronstadt revolt that wanted the freedom of expression and freedom of the press. The ussr was already on track to dictatorship and would face the same issues as during the Stalin era if Lenin would have remained in power

I feel like this view lacks nuance though - Lenin probably would have allied himself with the left wing of the Bolsheviks (see: Trotsky) against the Stalin, Kamenev, Zinoviev troika (and Ordzhonikidze) - especially after the Georgian Affair revealed splits in the leadership. A Trotsky and Lenin continuation would have been pretty different both foreign and domestic: as far as broad trends go the course does look pretty similar but when you get into the details on strategy, government structure, personality cult, the role of the Party and the Politburo in Soviet politics, etc. it starts to alter heavily from Stalin’s course. Lenin largely lays this out in “Better Fewer, but Better” towards the end of his life, but he had plans in the works for a wholesale government restructuring and trying to reverse “disturbing trends” in the Party and State that set in after years of War Communism and the inheritance of the Tsarist bureaucratic apparatus. As pointed out here, morally Lenin and Stalin were not too different but their visions for the Soviet Union’s structure and role in the world were very different and I think a bit lacking to state that largely nothing would change.
 
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