The causes of Friedrich Nietzsche’s mental breakdown in early 1889 and of the subsequent slow decay to end-stage dementia along ten years will possibly remain open to debate. The diagnosis of syphilitic dementia paralytica, based only on medical anamnesis and physical examination, was considered indisputable by Otto Binswanger. On the other hand, taking into account recently described diseases, selectively collected evidence lend some support to alternative hypotheses: basal forebrain meningioma, CADASIL, MELAS and frontotemporal dementia.
19th Century; history of medicine; neurosyphilis; diagnosis
(A) Friedrich Nietzsche. Photograph from the series „Der kranke Nietzsche“ (“The ill Nietzsche”) by Hans Olde, between June and August 1899. Original at Goethe- und Schiller-Archiv Weimar, signature GSA 101/37. In public domain: https://commons.wikimedia.org/wiki/File:Nietzsche_Olde_11.JPG (B) Friedrich Nietzsche. Photograph from the series „Der kranke Nietzsche“ (“The ill Nietzsche”) by Hans Olde, between June and August 1899. Original at Goethe- und Schiller-Archiv Weimar, signature GSA 101/37. In public domain: https://commons.wikimedia.org/wiki/File:Nietzsche_Olde_07.JPG