Review

Reviewed Work(s): The Legend of Nietzsche's Syphilis. Contributions in Medical Studies,

no. 46 by Richard Schain
Review by: Francis Schiller
Source: Bulletin of the History of Medicine, Vol. 77, No. 2 (Summer 2003), pp. 439-441
Published by: The Johns Hopkins University Press
Stable URL: https://www.jstor.org/stable/44447759
Accessed: 07-04-2020 13:30 UTC

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 book reviews Bull. Hist. Med., 2003, 77 439

Emergence of Psychology from Erasmus Darwin to William James (1998); Reed makes
much of Mary Shelley's Frankenstein as a key event in that history, and, with
Redden 's help, it, too, can be viewed under the mysterious light of melancholy.
While Burton's Melancholy (1621) enjoys condnuing acclaim, his reliance on
Timothie Bright comes as interesting news. Bright, whose Treatise on Melancholy
(1586) was one of the first books on mental disorder from a medical perspective,
was the only English author on melancholy cited by Burton. Bright's other
interests eclipsed his investment in medicine:

He had developed a form of shorthand, a skill known to the ancient world but
reinvented by Bright, and devoted much energy to ensuring its widespread
adoption. In addition, he published a popular abridged version of the reli-
gious classic, John Foxe 's Book of Martyrs. By 1591, he was so negligent of his
medical duties at St. Bartholomew's that he was dismissed. From then until his

death in 1615, Bright was employed as a member of the clergy, although he

continued to see patients, (pp. 119-20)

There is pleasure in such learning: the little joy of melancholy.

E.James Lieberman
George Washington University School of Medicine

Richard Schain. The Legend of Nietzsche's Syphilis. Contributions in Medical Stud-

ies, no. 46. Westport, Conn.:' Greenwood Press, 2001. xiii + 130 pp. 111. $62.95 (0-
313-31940-5).

As the title indicates, Richard Schain 's biography of the great philosopher is an
attempt - a successful one, it seems to this reviewer - to show that he did not
suffer (as is usually claimed) from syphilitic, but from schizophrenic madness.
(The serologic test to diagnose the sexually acquired mental illness was intro-
duced by Wasserman only six years after Nietzsche's death.) In contrast or in
addition to the many previous biographies, this book focuses on the medical
aspects of Nietzsche's life. He shared both migraine and epilepsy with several
members of his family; he had cholera twice, as well as diphtheria and dysentery.
Nietzsche's talents were many, especially musical: he played the piano once in
a brothel, and even composed music. He studied theology and philology, and in
1869 he went to Basel, becoming professor of philology and a Swiss citizen - but
then he joined the Prussian army fighting the French. Returning to his sister in
Saxony, now age thirty-four, he wrote: "My existence is a Tearful' burden," yet,
"this pleasure in knowledge brings me to heights in which I am victorious" (p.
26). At age forty-nine, after having completed Also Sprach Zarathustra, he wrote:
"everything is boring, painful, dégoûtant. . . . I . . . have a sense of imperfection"
(p. 29).

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440 book reviews Bull. Hist. Med., 2003, 77

Nietzsche never used the typewriter given him as a present. He drank no

alcohol or coffee, according to Stefan Zweig. He lived in a shabby chambre garnie,
his clumsy wooden trunk containing only a second old suit - but there were lots
of books and manuscripts, and boxes of tinctures against headaches such as
chloral and veronal, which often made him groggy. For his chorioretinitis he saw
the famous A. Graefe in Halle and received a poor prognosis. In his works
between 1880 and 1884 there are passages about madness, one about the mad-
man seeking God with a lantern. He quotes Plato saying "the greatest benefits
have come to Greece through madness" (p. 34) .
Chapters 6, 7, and 8 are about the philosopher's breakdown in Turin, his
fourteen months in a Jena madhouse, and his "descent into apathy," with con-
stant headache and vomiting in the summer of 1888 "in which the whole
machine isn't good for anything. Or rather I can think clearly but not favorably
over my situation" (p. 37) . He had completed his last three works. From Novem-
ber 1888 to 6 January 1889 he wrote one hundred letters; Schain quotes from one
of the last week (a whole printed page long) , containing such phrases as: "Since I
was condemned to spend the next eternity making bad, so I do a little writing
here which really doesn't require much, very pretty, and not at all demanding"
(p. 40).
In the spring of 1888, aged forty-four, Nietzsche traveled to the important city
of Turin, recommended to him by a friend. It was here that he spent the rest of
the year and lapsed into acute mania after finishing Ecce homo, his autobiographic
masterpiece. He also exchanged letters with August Strindberg. On his admis-
sion to the asylum in Friedensblatt he recognized the admitting physician, whom
he had met several years before, and remained "obedient and obliging," enjoying
his meal and bath (p. 50); the diagnosis was "progressive paralysis." At his
mother's request he was transferred to the Jena asylum, closer to her home. He
stayed there for fourteen months, under Binswanger, and under the influence of
Griesinger.
Today Nietzsche's symptoms would be characterized as a manic psychosis.
Although he was quite reasonable at times, he would also urinate in his water
glass, among other psychotic activities (such as breaking a window when he saw a
rifle behind it). The treatment was urinary "inunctions." He recognized his
mother and spoke quite intelligibly with her, went for walks with her, and was
finally discharged to home care - but in a suppressed paragraph of Ecce homo he
blamed his mother and sister for maltreating him. In the last two years of his life
there occurred two stroke-like episodes while he was in a state of inactive demen-
tia, and he presumably died of pneumonia. There was no autopsy.
In chapter 9 Schain gives an excellent history in support of the argument of
dementia paralytica versus dementia praecox, starting with Phillipe Pinel (1745-
1826). In 1894 Binswanger maintained that "overexertion" of the brain may lead
to paresis. Emil Kraepelin coined the label "dementia paralytica" in 1896. De-
mentia praecox (schizophrenia), "its mirror image," was Kraepelin 's idea, while
the Swiss psychiatrist Eugene Bleuler coined the term "schizophrenia." Wilhelm
Zeb et al. in 1960 "gave the final coup de grace " to the idea that paresis could be

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 BOOK REVIEWS Bull. Hist. Med., 2003, 77 441

diagnosed by clinical psychiatric means (pp. 73-74). There follows an excellent

clinical description.
Chapter 10 illuminates the "Controversies over Diagnosis." Schain correctly
states that it is rather irrelevant whether Nietzsche contracted primary syphilis as
a youngster. He quotes many opinions expressed in the psychiatric literature, but
he does not give his conclusion. Aside from hereditary migraine, mania and
hallucinations - rather than dementia - were the symptoms (until the last two
years) , suggesting schizophrenia, rather than syphilitic general paresis. Chapter
11, "Six-Sevenths Blind," is about the defects troubling Nietzsche since child-
hood: myopia, unequal and unresponsive pupils, and strabismus. In the next
chapter, "What Caused Nietzsche's Breakdown?," the author lists his symptoms in
the two years before his death: the behavioral abnormalities that did not inter-
fere with his memory and abstract thinking, followed by manic behavior, flight of
ideas, delusions of grandeur, and splitting of thought - but without neurological
symptoms, except for being wheelchair-bound. All these abnormalities point to a
schizophrenic disorder, associated with some metabolic and cortical defects.
This excellent, thoughtfully documented book ends with an appraisal of
"Nietzsche's legacy," including his appeal to the Nazis; a denial of his worth as an
idol, but his popularity in America; and his own self-criticism.

Francis Schiller

University of California, San Francisco (emeritus)

Keir Waddington. Chanty and the London Hospitals , 1850-1898. Royal Historical
Society Studies in History, New Series. Woodbridge, U.K.: Boydell Press, in
association with the Royal Historical Society, 2000. xi + 252 pp. 111. $75.00 (0-
86193-246-3).

In his introduction to this volume, Keir Waddington quotes the well-respected

health reformer and hospital governor Henry Burdett stating in 1895 that "it was
London's hospitals 'not our bridges, or railways or telephones' that were 'the real
glory and abiding distinction of our civilisation'" (p. 13). It is a quotation illustra-
tive of one of this book's great strengths: lucid discussion of the personalities and
groups associated with the tumultuous changes occurring within the institutions
of nineteenth-century medicine, as seen through the lens of economic and social
change in mid- to late-Victorian British society. Waddington 's research is original
and his findings elegantly presented. He weaves a vast collection of primary
source materials into an account offering considerable depth and breadth of
comparison. This fine-grained approach enables him to address questions for
which reliable answers are rare and hard-won: exactly how, and (to an extent) why,
did the public give? and, of equal interest, just how did hospital administrators
manage and develop both benevolent and noncharitable sources of income?

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