How the ‘royal disease’ destroyed the life of Russia’s last tsarevich

Tsarevich Alexei with his father and sister.

Tsarevich Alexei with his father and sister.

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Tsarevich Alexei’s short life was full of pain and suffering: he was afflicted by a congenital disease his entire life, and was shot by the Bolsheviks at the age of 13.

When Alexandra Feodorovna, Nicholas II’s wife and the Empress of Russia, gave birth to a son (on July 30, 1904), it was met with much joy and celebration. Finally, after giving birth to four girls, between 1895 – 1901, Nicholas and Alexandra had a son Alexei, who became heir to the throne. 

“There are no words enough to thank the Lord for this relief he sent us in these hard times!” Nicholas II wrote joyfully in his diary. Little did he know that the boy would have a very difficult life and meet a grim fate.


Alexei Nikolaevich in his baby age (in 1904).

“It was too early to cheer and thank God,” historian and medic Boris Nakhapetov wrote in his book, Medical Secrets of the House Romanov. “Soon, the doctors found out that the child suffers from the horrendous illness of the Empress’ family – hemophilia.”

This congenital disease is marked by slow blood coagulation, and so the smallest bruise often becomes prolonged internal bleeding. Women “carry” the gene of hemophilia, but men suffer from it. Alexandra inherited the gene from her grandmother, Great Britain’s Queen Victoria.

Alexei’s symptoms first appeared when he was just several months old, and it plagued him his entire life. Anna Vyrubova, the Empress’ maid of honor, recalled the times when the sickness worsened: “It was endless torture for the boy and for each of us… he was screaming from the pain all the time, and we had to close our ears while taking care of him.”

Sometimes Alexei couldn't even walk. That's him and his 'sailor nanny' on a bicycle in Friedberg, Hesse, 1910.

The most excruciating moments for the boy were when blood seeped into his joints. “Blood destroyed bones and tendons; he couldn’t bend or unbend his arms or legs,” said Nakhapetov.

The only way to remedy the situation was through massage and exercise, but this was also fraught with the danger of more injuries and bleeding. So, from time to time, Alexei couldn’t walk at all, and servants had to carry him to official events.

'Holy' helper

Grigory Rasputin.

One of the few people in the empire who could alleviate Alexei’s suffering and relieve him was Grigory Rasputin. A famous doctor? No, a Siberian mystic and a self-proclaimed saint who made it to the court. When in 1905 Rasputin met Nicholas and Alexandra, he convinced them that he could help – and he did.

“There are many mentions that Rasputin repeatedly made the heir feel better,” Nakhapetov admits. “But there is no strong, documented data.” Nakhapetov thinks that Rasputin used hypnosis to calm Alexei, which improved his condition. One thing is clear – Alexandra and Nicholas II believed in Rasputin, and so he gained unbelievable political influence.

“The tsarevich is alive while I’m alive,” Rasputin bragged. And he wasn’t far off the mark: on Dec. 30, 1916, Rasputin was murdered by a group of aristocrats who were worried with his enormous influence at the Imperial court. Then, 18 months later, in July 1918, Alexei and his family were executed.

Russia’s little prince

Nicholas II and Alexei in the Cossack uniforms at the military parade, 1916.

When Alexei wasn’t sick, he led the ordinary life of a royal heir: studying, taking part in official events and sometimes playing. And this boy could be naughty. Georgy Shavelsky, a priest close to the court, recalled:  “While at the dinner table, the boy often threw balls made of bread at the generals… only a severe look from the Emperor could calm him down.”

At the same time, people who met him remembered the tsarevich as a kind person. “He was quick at bonding with people, loved them and tried to do all he could for them,” Anatoly Mordvinov, Nicholas II’s adjutant, wrote.

Alexei and three of his sisters in the ex-royal residence, May 1917.

On the other hand, he noted that Alexei could be stubborn, and Nicholas II used to say to his servants and advisors with pride: “He’ll give you a much harder time than I do.”

Alexei had great relations with both of his parents and four sisters, and among his closest friends was Andrey Derevenko, his personal servant and a former sailor. Derevenko was the one who carried Alexei during the worse times of his disease. Otherwise, the tsarevich loved animals, and he took his cat, Kotik, and his dog, Joy, with him to class.

Tragic end

The tsarevich was 13 when his life was turned upside down. The upheavals of 1917 destroyed Russia’s monarchy; his father abdicated, not only for himself but for the heir as well. Along with the rest of his family, Alexei was exiled to the Urals and kept under house arrest. That’s where both the disease and death cornered him.

Tsarevich Alexei Nikolaevich and Tsar Nicholas II sawing wood at Tobolsk in 1917 (just months before their death).

“All of a sudden, Alexei couldn’t walk again,” Tatiana Botkina, a medic who helped the Romanovs in Tobolsk (2,300 km east of Moscow), wrote in her memoirs. “He suffered so much from internal bleeding…” After suffering another bruise, Alexei struggled with his disease and had no time to recover. On the night of July 17, when the local Bolsheviks ordered the Romanovs to go down to the basement, Nicholas carried his son. As you know,they never saw the light of day again.

We also have an article on how the royal family of Nicholas II spent its last days before the execution – and you can read it right now.

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