From youth onwards he was subject to dreadful headaches, often accompanied by vomiting and intense pain in the eyes. He had temporary strokes of paralysis, and sometimes lost the power of speech. Probably the disease from which he suffered was what we now call migraine or “sick headache.” This is a trouble that is almost confined to persons of active and intelligent mind, and the cause of it is quite unknown. Nietzsche, imagining that his headaches had something to do with his digestion, used to starve himself and lead the most ascetic life; but all to no purpose. Starvation rather tends to make the patient worse. As a rule this sickness tends to improve as the patient grows older; but in Nietzsche’s case advancing age brought no relief. Work was impossible, and he had to get leave of absence from his position as Professor of Classical Philology in the University of Basel in 1876. Later on he tried to resume work, but spent many years in wandering from one health resort to another in almost constant pain; indeed, he said that for him two hundred days out of every year were days of pain. This migraine is a very terrible complaint which affects mostly the elect of the earth: those whose brains are far above the average. Women are more often affected by it than men; and in them it appears to become worse periodically and at the climacteric. Afterwards it generally leaves them. Clods do not suffer from migraine; the trouble appears to be one of the prices that very clever men have to pay for their brains. Sufferers from it are generally very prone to seasickness and to trainsickness, and once an attack is in full blast no treatment whatever but natural sleep seems to relieve it. The pain appears to be so terrible that the stomach is paralysed by the sheer violence of it, and such drugs as aspirin, phenacetin, and even opium pills are useless because they are at once vomited. Sometimes symptoms indistinguishable from those of migraine persist for many years in cases of chronic Bright’s disease; and there is reason to suspect that it may be accompanied by some sudden constriction of an artery in the brain. In the worst cases the pain also affects the eye; and occasionally there is confusion of speech or even positive aphasia. Possibly even a stroke of paralysis may occur, and there is the usual fear of insanity that seems to accompany all nervous troubles in highly neurotic men. Late in the year 1888 the blow fell; and Nietzsche became definitely insane. Nietzsche’s sister has left us quite a good account of it which enables us to guess with a certain amount of probability the actual nature of his insanity; though we must always remember that he had been suffering from this terrible agony for years and had already had strokes that were probably due to a temporary constriction of a cerebral artery.