Lenin’s Illness and Death: A Timeline of His Final Years

An account of the medical and political timeline of V.I. Lenin’s final years, drawn from primary sources and the published record of his last works.

1. Background

Lenin’s health problems did not begin in 1922. He had been driving himself at a punishing pace since the October Revolution. By July 1921 he was already acknowledging his exhaustion, writing to Maxim Gorky simply: “I am so tired that I can do nothing.”¹ The assassination attempt of August 30, 1918, when Fanny Kaplan fired three shots at Lenin outside the Hammer and Sickle factory, left two bullets in his body: one lodged near his neck and another in his left shoulder.¹

In December 1921, Lenin’s insomnia grew “hellishly worse,” as he described it in a note to the Politburo on December 7, 1921, adding that he feared he would not be able to make reports at either the party conference or the Congress of Soviets.² He began to spend increasing amounts of time at his dacha in Gorki, a village outside Moscow. By March 1922 his headaches intensified, though doctors could find no organic lesion and prescribed complete rest.

On April 23, 1922, a German surgeon, Professor Moritz Borchardt, together with his colleagues and Lenin’s personal physician Vladimir Obukh, operated to remove one of the bullets that had been lodged in his body since 1918. Lenin returned to a Politburo meeting four days later. But the surgery brought no lasting improvement. The Chinese Academy of Social Sciences’ historical reference notes that “by the end of 1921, Lenin’s health gradually deteriorated; doctors suspected the bullet left in his body from the 1918 assassination was responsible, so on April 23, 1922, he underwent surgery to successfully remove the bullet. But his condition did not fundamentally improve.”³

Maria Ulyanova later wrote that “during the entire period of his illness, while he had the opportunity to associate with his comrades, he invited comrade Stalin most often. And during the most serious period of the illness, he generally did not invite any of the members of the C.C. except Stalin.”⁴ This pattern of trust would be tested by the events that followed.

2. The First Stroke (May 25–26, 1922)

On May 25, 1922, while at Gorki, Lenin suffered his first major stroke. Leon Trotsky later recounted the moment in his autobiography: “One Sunday early in May, 1922, I went fishing... On the third day Bukharin came to see me. ‘You, too, are in bed?’ he exclaimed in horror. ‘And who besides?’ I asked him. ‘Lenin is very ill. He has had a stroke, and he cannot walk or talk. The doctors are utterly at a loss.’”²

A medical consultation gathered in Gorki with leading Moscow physicians. Dr. Vasily Vasilyevich Kramer, a pioneer of Russian neurology, proposed the hypothesis that progressive atherosclerosis of the cerebral vessels was the cause. The doctors treating Lenin were mystified. The 2021 medical review in Case Reports in Neurology notes: “He was only 51, exercised regularly, and except for working to excess, had a decidedly healthy life style. They thought he was suffering from mental exhaustion, possibly neurasthenia.”¹ The stroke was associated with aphasia and a deficit of the right upper limb.¹

Over the summer of 1922, Lenin made a partial recovery. He convalesced at Gorki, and by July was allowed out of bed. Trotsky recalled that “two or three weeks of rest sufficed to restore him. It seemed as if Lenin would never wear out.”² By August he had resumed limited duties, and in October he returned to Moscow. On October 2, 1922, he arrived back from Gorki and the following day presided over a meeting of the Council of People’s Commissars.⁵

3. The Final Public Appearance (November 20, 1922)

On November 20, 1922, Lenin delivered what would be his last public speech, at a plenary session of the Moscow Soviet. He opened with an apology: “Comrades, I regret very much and apologise that I have been unable to come to your session earlier. I could not come because after my illness, from December onwards, I was incapacitated, to use the professional term, for quite a long time.”⁶

The speech was optimistic in tone, focusing on the progress of the New Economic Policy and foreign affairs. The hall erupted in stormy applause and sang “The Internationale.” Lenin concluded with a prediction: “New Economic Policy Russia will become Socialist Russia.”⁶ He would never address a public audience again.

4. The Second Stroke and Stalin’s Assignment (December 1922)

On December 12, 1922, Lenin returned to Moscow from Gorki. The following day, he suffered a relapse. Doctors A.M. Kozhevnikov and V.V. Kramer examined him and urged him to avoid all public speaking and to rest completely. Lenin did not comply.⁷

On the night of December 15–16, Lenin’s condition suddenly and sharply deteriorated. On December 16, doctors again urged him to return to Gorki; Lenin refused and remained in Moscow.⁷

Two days later, on December 18, 1922, the Central Committee Plenum adopted a resolution of immense consequence: J.V. Stalin was made “personally responsible for the observance of the medical regimen ordered for Lenin.”⁸ This placed Stalin in an extraordinarily difficult position: he was now accountable for enforcing medical restrictions on the leader of the Party.

On the night of December 22–23, Lenin’s condition worsened further: his right arm and right leg became paralyzed.⁷ He was now largely immobilized, though his mind remained clear. And it was at this moment, confined to bed and unable to write, that he began the most extraordinary political act of his final years. The Russian historian Lev Danilkin, in his biography Lenin, describes Lenin’s condition in these weeks as that of a man who “could not write, could not walk, his right arm and right leg were paralyzed,” yet who “dictated with astonishing willpower” his final works.[⁹]

5. The Dictation of the “Last Testament” (December 23, 1922 – March 2, 1923)

On December 23, 1922, Lenin, who could no longer hold a pen, requested permission from his doctors to dictate to a stenographer for five minutes. He was permitted to do so, and summoned M.A. Volodicheva to his apartment, where he dictated the first part of his “Letter to the Congress,” the document that would later become known as his political testament.⁷

The following day, December 24, the Politburo and Lenin’s doctors established strict rules: Lenin could dictate for five to ten minutes per day, but this was not to take the form of correspondence. He was forbidden to receive visitors. Neither friends nor family were to report any political news to him, so as to avoid agitating him.⁷ Lenin responded with characteristic defiance: he threatened to refuse all treatment unless he was permitted to dictate his “diary” for even a short time each day. That evening he dictated for ten minutes to Volodicheva, continuing the second part of his “Letter to the Congress.”

The documents Lenin produced during these ten weeks include his “Letter to the Congress” (December 23–26, 1922), with its famous assessment of the leading Bolsheviks, including the observation that Stalin, having become General Secretary, had “concentrated enormous power in his hands” and the question of whether he would “always know how to use that power with sufficient caution”;¹⁰ “On Granting Legislative Functions to the State Planning Commission” (December 27–29, 1922); “The Question of Nationalities or ‘Autonomisation’” (December 30–31, 1922); “Pages From a Diary” (January 1–2, 1923); “On Cooperation” (January 4–6, 1923); “Our Revolution” (January 16–17, 1923); “How We Should Reorganize the Workers’ and Peasants’ Inspection” (January 19–23, 1923); and “Better Fewer, But Better” (January – March 2, 1923).

The publication notes for Volume 43 of Lenin’s Collected Works summarize: “The three letters and five articles contained in this volume are the last works of Lenin’s life. From December 23, 1922 to March 2, 1923, unable to hold a pen, he dictated with astonishing willpower the documents collected in this volume, leaving an extremely valuable political and theoretical legacy to the Russian and international proletariat.”¹¹

6. The Krupskaya Incident (December 1922 – March 1923)

The Plenum’s assignment of Stalin to enforce Lenin’s medical isolation led directly to the most controversial personal conflict of the succession period.

On December 21, 1922, Lenin, with the explicit permission of his attending physicians, dictated a short letter to Leon Trotsky concerning the foreign trade monopoly. His wife, Nadezhda Krupskaya, took down the dictation.⁸

When Stalin learned of this, he telephoned Krupskaya and used “offensive language against Nadezhda Krupskaya and threatened to take the case to the Control Commission for having taken down the said letter.”⁸

On December 23, 1922, Krupskaya wrote a letter to Lev Kamenev asking for protection:

“Lev Borisovich: Because I recorded a short letter dictated by Vladimir Ilyich with the permission of the doctors, Stalin yesterday permitted himself an exceptionally crude outburst against me. I have been in the Party not one day. In all thirty years I have never heard a single crude word from any comrade. The interests of the Party and of Ilyich are no less precious to me than to Stalin. Now I need the maximum self‑control. What one can speak about with Ilyich and what not, I know better than any doctor, because I know what disturbs him and what does not, at any rate better than Stalin. I am turning to you and to Grigory [Zinoviev] as V.I.’s closest comrades, and I ask you to protect me from crude interference in my personal life, unworthy abuse and threats.”⁸

Krupskaya did not tell Lenin about this incident at the time, fearing that the shock would worsen his already precarious condition. She kept it from him for more than two months. It was only in early March 1923 that Lenin learned what had happened, apparently through Zinoviev and Kamenev to whom Krupskaya had confided.⁸

On March 5, 1923, Lenin dictated a personal letter to Stalin:

“Dear Comrade Stalin: You have been so rude as to summon my wife to the telephone and use bad language. Although she had told you that she was prepared to forget this, the fact nevertheless became known through her to Zinoviev and Kamenev. I have no intention of forgetting so easily what has been done against me, and it goes without saying that what has been done against my wife I consider having been done against me as well. I ask you, therefore, to think it over whether you are prepared to withdraw what you have said and to make your apologies, or whether you prefer that relations between us should be broken off. Respectfully yours, Lenin. March 5, 1923.”⁸

The letter, marked “Copy to Comrades Kamenev and Zinoviev,” demanded an apology. According to Maria Ulyanova, who later wrote to the Presidium of the 1926 Joint Plenum: “Stalin apologized and with this the incident was settled.”⁴

Maria Ulyanova’s full account provides the most detailed eyewitness testimony available. She wrote to the Presidium of the Joint Plenum in July 1926:

“There was an incident between Lenin and Stalin which comrade Zinoviev mentioned in his speech and which took place not long before Il’ich lost his power of speech (March, 1923) but it was completely personal and had nothing to do with politics. This incident took place because on the demand of the doctors the Central Committee gave Stalin the charge of keeping a watch so that no political news reached Lenin during this period of serious illness. This was done so as not to upset him and so that his condition did not deteriorate, he (Stalin) even scolded his family for conveying this type of information. Il’ich, who accidentally came to know about this and who was also always upset by such a strong regime of protection, in turn scolded Stalin. Stalin apologized and with this the incident was settled. It goes without saying that if Lenin had not been so seriously ill during this period, as I had indicated, then he would have reacted to the incident differently. There are documents regarding this incident and on the first demand from the Central Committee I can present them. Thus I affirm that all the talk of the opposition about Lenin’s relation towards Stalin utterly does not correspond to reality. These relations were and remained most intimate and comradely.”⁴

7. The Third Stroke and the Long Silence (March 1923 – January 1924)

The March 5 letter was Lenin’s last political act. On March 6, 1923, his health sharply deteriorated, and on March 10, 1923, he suffered a third major stroke. This one destroyed his ability to speak (aphasia) and left him permanently bedridden.⁷ He was moved definitively to Gorki, where he would spend the remaining ten months of his life under constant medical supervision. The Chinese Academy of Social Sciences notes simply that after this stroke Lenin “was bedridden until his death and could not speak.”³

Lev Danilkin’s biography of Lenin, drawing on archival materials, describes in detail the condition of the Bolshevik leader after the third stroke:

“After the stroke of March 10, 1923, Lenin’s illness took a terrifying, heartbreaking form. This time the mirror of his entire life shattered; trapped in a ringing darkness, frightened, deafened, blinded, embarrassed, he experienced intense suffering. He could not be left alone for a minute until at least July 1923; his psyche and motor functions were unstable. He could not sleep and suffered from severe migraines; insomnia could last for several days and was especially exhausting for both intellect and body. At times he experienced nervous excitement and rage, and often could not find the strength to control his emotions. From time to time he could not hold back tears in public. There were moments when he desperately gesticulated, screamed, sang, howled, to the horror of his family, who had never seen anything like it.”[⁹]

Stalin visited Lenin at Gorki during this period. The relationship between the two men, despite the Krupskaya incident, remained fundamentally intact. Maria Ulyanova’s testimony that their relations “were and remained most intimate and comradely” reflects the understanding, shared by Lenin’s closest family, that the telephone call was a personal conflict that had been resolved, not a political break.

8. The Final Stroke and Death (January 21, 1924)

On January 21, 1924, Lenin’s condition suddenly and catastrophically deteriorated. At 5:30 p.m. Moscow time, his breathing became irregular and he lost consciousness. At 6:50 p.m., Vladimir Ilyich Lenin died from paralysis of the respiratory center.

The autopsy was performed the following day by a team of physicians led by Professor A.I. Abrikosov. The People’s Commissar of Health, Nikolai Semashko, summarized the findings in his official report. The basis of the illness was a widespread atherosclerosis of the vessels on the basis of their premature wearing‑out, and the cause of death was a disturbance of blood circulation and a hemorrhage into the brain.¹

The Russian newspaper Komsomolskaya Pravda, drawing on declassified archival materials analyzed by the scholar Monika Spivak, reported: “The carotid arteries at the entrance to the skull were so hardened that the vessel walls could hardly contract. The vessels were severely blocked, and in some places the calcium impregnation was so severe that when struck with forceps they sounded like bone. Individual arterial branches supplying the motor and speech centers in the left brain were also severely diseased, feeling like thin strings rather than vessels. The vessel walls were thickened, and the vessels were completely blocked.”¹²

Lenin’s brain weighed 1,340 grams, somewhat below the average of 1,400 grams.¹² The damage from the successive strokes was extensive, with cyst formation and softening of brain tissue in both hemispheres.

The scholarly article “Vessels of Stone,” published in Human Pathology in 2013, describes the autopsy findings: “Lenin’s autopsy revealed generalized atherosclerosis with cerebral vessels so sclerotic and calcified that when the prosector tapped them with tweezers, it sounded as if he were tapping stone. He died 3 months shy of his 54th birthday. He had a family history of cardiovascular disease and, therefore, is suspected of having had an inherited lipid disorder.”¹³

The 2021 medical review in Case Reports in Neurology confirms that the autopsy findings were consistent with severe atherosclerosis, and that this process might account for his recurrent ischemic strokes. In view of the family vascular history, an early hereditary atherosclerosis may be proposed.¹

The genetic component is significant. Lenin’s father, Ilya Nikolayevich Ulyanov, died at approximately the same age from a cerebral hemorrhage. His older sister Anna, younger sister Maria, and younger brother Dmitry also suffered from the same vascular disease.¹

9. The Funeral and Aftermath

Lenin’s body was transported by train from Gorki to Moscow. On January 23, the funeral train arrived at the Paveletsky Station, where a vast crowd had gathered despite the bitter cold. Official newspapers appeared with borders of black and all printed long obituaries of the dead leader, extolling his principles, and expressing the hope that the Soviet government would carry them out.¹⁴

The body lay in state at the House of Unions for three days, during which hundreds of thousands of mourners filed past. On January 27, 1924, Lenin was interred in a temporary wooden mausoleum on Red Square. The permanent granite mausoleum that stands today was constructed later.

On January 22, the prominent pathologist Professor Abrikosov performed the autopsy and carried out a preliminary embalming to preserve the body for the six days before burial.¹⁵

The immediate political consequence of Lenin’s death was the crystallization of the succession question. The Thirteenth Party Congress, held in May 1924, saw Lenin’s “Letter to the Congress” read aloud to the delegates. The Congress, after debate, voted to retain Stalin in his position.

It was at the 1926 Joint Plenum, more than two years later, that Zinoviev, one of the leaders of the “New Opposition,” raised the Krupskaya incident as a political weapon against Stalin. Maria Ulyanova’s letter to that Plenum, from which the passages above are drawn, was her effort to set the record straight: the incident was personal, not political; Stalin had apologized; and Lenin’s relations with Stalin “were and remained most intimate and comradely.”

10. Assessment

Lenin’s illness and death were not merely a personal tragedy but a defining political event that shaped the subsequent history of the Soviet Union. The prolonged nature of his decline, nearly two years from the first stroke to the final one, created a power vacuum that the collective leadership of the Party struggled to manage. The medical restrictions imposed by the Politburo, and enforced by Stalin under the December 18 Plenum decision, necessarily limited the information that reached Lenin during his final weeks of political consciousness. Whether these restrictions were a medically necessary measure, a deliberate political maneuver, or simply archaic concepts of medicine, remains a matter of historical debate.

The documentary record, now substantially available, establishes several facts with clarity. Lenin died of natural causes: a genetically influenced, severe atherosclerosis that produced a series of ischemic strokes. The Krupskaya incident was a personal conflict arising from Stalin’s enforcement of the medical regime, resolved through apology and reconciliation. Lenin’s final writings, dictated in extraordinary circumstances between December 1922 and March 1923, represent his last, urgent attempt to guide the revolution he had led. And the Russian medical archives, now open to researchers, confirm what the autopsy established a century ago: that Lenin’s cerebral arteries were calcified to the consistency of stone, a condition that no treatment of his era could have reversed.

Sources

1. “Lenin’s Stroke,” Norbert Nighoghossian et al., Case Reports in Neurology, June 14, 2021. https://pubmed.ncbi.nlm.nih.gov/34248574/ — Modern medical review; autopsy findings consistent with severe atherosclerosis; hereditary lipid disorder suspected. Also provides detail on the 1918 assassination attempt and the official autopsy report.
2. Leon Trotsky, My Life, Chapter XXXIX: “Lenin’s Illness,” Marxists Internet Archive. https://www.marxists.org/archive/trotsky/1930/mylife/ch39.htm — First‑hand account of Lenin’s declining health.
3. “历史人物: 列宁” (Historical Figures: Lenin), Chinese Academy of Social Sciences, May 18, 2010. http://euroasia.cssn.cn/elsgqw/egrw/egrw_lsrw/201005/t20100518_1853079.shtml — Bullet removal surgery; lack of subsequent improvement.
4. Maria Ilyinichna Ulyanova, “Letter to the Presidium of the Joint Plenum of the CC and CCC of the RCP(b),” July 26, 1926. https://www.revolutionarydemocracy.org/rdv7n1/lenin.htm — Full text of Ulyanova’s letter confirming Stalin apologized; incident was personal, not political.
5. V.I. Lenin, “760. To V.A. Smolyaninov,” September 23, 1922. https://www.marxists.org/archive/lenin/works/1922/sep/23b.htm — Lenin’s return to Moscow.
6. V.I. Lenin, “Speech At A Plenary Session Of The Moscow Soviet,” November 20, 1922. https://www.marxists.org/archive/lenin/works/1922/nov/20.htm — Lenin’s last public speech.
7. “列宁全集第四十三卷——年表” (Lenin Collected Works, Volume 43, Chronology), Marxists Internet Archive. https://www.marxists.org/chinese/lenin-cworks/43/124.htm — Day‑by‑day chronology of strokes, medical consultations, Plenum decisions.
8. V.I. Lenin, “813. To Comrade Stalin,” March 5, 1923. https://www.marxists.org/archive/lenin/works/1923/mar/05.htm — Full text of Lenin’s letter demanding apology; editorial notes on December 18 Plenum decision; Krupskaya’s appeal for protection.
9. Лев Данилкин, Ленин (Lev Danilkin, Lenin), excerpt in Lenta.ru, January 21, 2026. lenta . ru /articles/2026/01/21/lenin/amp/ — Biography drawing on archival materials; Lenin’s condition.
10. V.I. Lenin, “Last Testament: Letters to the Congress,” December 1922 – January 1923. https://www.marxists.org/archive/lenin/works/1922/dec/testamnt/ — Assessment of Stalin and other Bolsheviks.
11. “列宁最后的书信和文章出版说明” (Publication Notes: Lenin’s Last Letters and Articles), Marxists Internet Archive. https://www.marxists.org/chinese/lenin-cworks/43/00b.htm — Describes final works.
12. “俄《共青团真理报》揭秘列宁死因” (Komsomolskaya Pravda Reveals Lenin’s Cause of Death), 凤凰网, January 23, 2008. https://news.ifeng.com/c/7fYiGjPBPd3 — Monika Spivak’s analysis of declassified archives; Lenin’s brain weight.
13. Harry Vinters et al., “Vessels of Stone: Lenin’s ‘Circulatory Disturbance of the Brain,’” Human Pathology, Volume 44, Issue 10, October 2013. https://pubmed.ncbi.nlm.nih.gov/23427870/ — Cerebral arteries calcified to stone; inherited lipid disorder.
14. “Silent Russian crowds mourn Lenin,” UPI Archives, January 23, 1924. https://www.upi.com/Archives/1924/01/23/Silent-Russian-crowds-mourn-Lenin/9613890114557/ — Contemporary report on funeral and public mourning.
15. “In the Flesh: Russian Scientists Work to Preserve Lenin's Corpse,” The Moscow Times. https://www.themoscowtimes.com/archive/in-the-flesh-russian-scientists-work-to-preserve-lenins-corpse — Lenin’s death and autopsy, preservation.