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In 1888, Nietzsche was at the height of his powers. He wrote five books – The Case of Wagner, Twilight of the Idols, The Antichrist, Nietzsche contra Wagner, and Ecce Homo. Georg Brandes, in Copenhagen, had just began a series of lectures on Nietzsche’s work which would kindle an explosion of interest in Nietzsche. Nevertheless, in January 1889 – at the age of 44 – Nietzsche collapsed into dementia, from which he never recovered. He died eleven years later. Dementia at age 44 is unusual. What was the cause of Nietzsche’s dementia? Throughout his life, beginning in childhood, Nietzsche had severe, often disabling migraines, accompanied by nausea and vomiting. He was blind in the right eye beginning in early adulthood, with extreme myopia of the right eye documented in childhood. What caused the blindness in his right eye – which is visibly bulging out in some photographs – and what caused his migraines, which were usually worse on the right side of his head? Why was the right pupil larger than the left, throughout his life – as documented by his earliest examinations in childhood? Over the past 20 years, a series of medical scholars have tried to answer each of the questions above, using modern medical insights to evaluate the rich data trove we have with regard to Nietzsche’s various ailments. Nietzsche’s medical history is remarkably well documented, beginning in childhood. We have the medical records of the many doctors who evaluated Nietzsche over the course of his life. There is one point on which the new generation of scholars agree: the diagnosis of “syphilis”, which was popular in the 20th century, cannot be sustained. For example, a trio of German and American neurosurgeons concluded that the evidence appears “to directly contradict the diagnosis of syphilis” (see Owen, Schaller, and Binder, 2007). They make a prediction regarding the correct diagnosis - meningioma - which could be tested and confirmed, or refuted, by exhuming and testing Nietzsche’s remains. Nietzsche’s various medical problems – in particular, his visual problems and his headaches – were central to his lived experience, leading to his retirement on disability at age 35. Remarkably, Prideaux shows little curiosity regarding the cause of those problems. On the contrary, she blithely asserts that the question of whether or not Nietzsche had syphilis “is unverifiable one way or the other” (p. 81). Such a broad claim might be admissible if she showed some familiarity with the conclusions reached by neurosurgeons such as Owen, Schaller, and Binder (2007). She could then explain to the reader why she believes that her judgment regarding Nietzsche’s neurological signs is more trustworthy than the judgment of the neurosurgeons and other physicians cited below. But, astonishingly, she seems not even to have read any of the papers listed below. All of these papers were published in peer-reviewed scholarly journals and all are readily available online. She never mentions any of them. Instead, she cites a 2001 work by Richard Schain, the least-persuasive of the new works questioning the diagnosis of syphilis. Nietzsche himself wrote that “the degree and kind of a man’s sexuality reach up into the highest pinnacle of his spirit” (Beyond Good and Evil, section 75). Prideaux asserts that Nietzsche had gonorrhea, again without showing any awareness of the controversy surrounding this question. How would he have contracted gonorrhea? Prideaux reports that Nietzsche’s friend Paul Rée once implied that Nietzsche had slept with prostitutes (p. 165), although she does not provide the source. Nietzsche denied having slept with prostitutes. Does Prideaux thinks Nietzsche is lying? Nietzsche laughed at bourgeois morality; why would he lie about sleeping with a prostitute? As Walter Kaufmann observed: we know of several women whom Nietzsche loved, but we know of no woman who loved Nietzsche. He may have died a virgin. In which case, how did he contract gonorrhea? Doesn’t this question merit some attention? A glance at Prideaux’s bibliography reveals very little scholarly research. She has read Nietzsche’s books and a few of his letters, as well as some of the most popular books about Nietzsche such as Sander Gilman’s Begegnungen mit Nietzsche – a book which she cites, peculiarly enough, only in the abridged and condensed English translation, not in the unabridged German original. She seems largely uninterested in what anybody else has said about Nietzsche. Nietzsche’s complete letters are available in German, in an eight-volume critical edition available at amazon.de, published in 2003. Prideaux apparently has not read them; she does not cite them. Instead, she cites the 1969 “selected letters” translated into English by Christopher Middleton. Walter Kaufmann – the dean of Nietzsche scholars – reviewed this book for the New York Times and noted that Middleton’s slim volume included only a tiny fraction of Nietzsche’s letters, and that Middleton’s translations were marred by both “errors in translation and scholarship” which “perpetuate some old errors.” Nietzsche wrote 34 letters to his friend Paul Rée; the Middleton translation includes only two of those letters. And yet this slender 1969 book is the collection of letters on which Prideaux relies. Here is the link to Kaufmann’s 1969 review: https://timesmachine.nytimes.com/timesmachine/1969/11/30/89151274.pdf. Although Prideaux refers to Kaufmann as a “great scholar” (p. 128), she seems to have read very little of Kaufmann’s work. The five papers cited below offer four different explanations for Nietzsche’s dementia. Two suggest a meningioma with onset in childhood. The other three suggest three other conditions. The one point on which all five agree is that syphilis is the least likely explanation. Prideaux shows no awareness of any of this published research. If this book were a thesis submitted for a master’s degree in philosophy, I would give it a passing mark, although I would note that it is derivative and unoriginal. Citations: Hemelsoet, Hemelsoet and Devreese (2008). The neurological illness of Friedrich Nietzsche. Acta neurologica Belgica, 108:9-16. Koszka (2009). Friedrich Nietzsche: A classical case of mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome? Journal of Medical Biography 17:161-164. Orth & Trimble (2006). Friedrich Nietzsche’s mental illness – general paralysis of the insane vs. frontotemporal dementia. Acta Psychiatrica Scandinavica 114:439-444. Owen, Schaller, and Binder (2007). The madness of Dionysus: a neurosurgical perspective on Friedrich Nietzsche. Neurosurgery 61:626-632. Sax (2003). What was the cause of Nietzsche’s dementia? Journal of Medical Biography. 2003:47-54.