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Views & Reviews Medical Classics

The Death of Ivan Ilych

BMJ 2008; 337 doi: (Published 05 November 2008) Cite this as: BMJ 2008;337:a2399
  1. Boleslav Lichterman, senior researcher, Institute for the History of Medicine, Russian Academy of Medical Sciences, Moscow
  1. lichterman{at}

    In one of his letters Tolstoy defined his novel The Death of Ivan Ilych as “a description of an ordinary death of an ordinary man.” It is based on the real story of Ivan Ilych Mechnikov, a lawyer who died at the age of 45 from sepsis. His younger brother, the Nobel medical laureate Ilya Ilych Mechnikov, wrote that Tolstoy had given “the best description of fear of death.”

    Ivan Ilych, a lawyer in a provincial Russian town, had led a life that was, Tolstoy wrote, “most simple and most ordinary, and therefore most terrible.” A successful careerist and head of the family, Ilych one day noticed a queer taste in his mouth and felt some discomfort in his left side, accompanied by irritability. His wife demanded that he visit a doctor. But “it was all just as it was in the law courts,” Ilych finds:

    The doctor put on just the same air towards him as he himself put on towards an accused person. The doctor said that so and so indicated that there was so and so inside the patient, but if the investigation of so and so did not confirm this, then he must assume that and that. If he assumed that and that, then . . . and so on. To Ivan Ilych only one question was important: was his case serious or not? But the doctor ignored that inappropriate question. From his point of view it was not the one under consideration, the real question was to decide between a floating kidney, chronic catarrh, or appendicitis.

    Ilych consults several doctors who diagnose different diseases and administer different treatments. In search of a cure he is prone to irrational behaviour: “One day a lady acquaintance mentioned a cure affected by a wonder-working icon. Ivan Ilych caught himself listening attentively and beginning to believe that it had occurred.” Soon he understands that “it’s not a question of appendix or kidney, but of life and . . . death . . . There was light and now there is darkness. I was here and now I’m going there! Where?”

    Tolstoy is known for his pejorative and unfair attitude to medical doctors. All the doctors in this novel are shown as hypocrites who constantly lie and who are indifferent to Ilych.

    The death of Ilych from cancer is described in such detail that it has been proclaimed the strongest description of this disease in literature. The veracity of the depiction is such that, a Russian professor of medicine said, not only a physician but any third year medical student would be able to diagnose the disease as an abdominal cancer localised either in the caecum or the right kidney. “Every doctor of any specialty should read this story with utmost attention to reveal a sea of horror and doubts experienced by cancer patients,” wrote A T Lidsky in a Russian medical periodical in 1929.


    Cite this as: BMJ 2008;337:a2399


    • The Death of Ivan Ilych

    • By Leo Tolstoy

    • First published in 1886