In the winter semester 1888-89 I was a medical student in Jena and attended the lecture and clinic of the famous psychiatrist Professor Otto Binswanger. One day—it must have been in January 1889—a patient who had recently been brought in was led into the classroom. Binswanger presented him to us as … Professor Nietzsche! Now one thinks that this would have caused a mighty uproar! Not a trace. Although as early as 1888 Georg Brandes had given lectures on him in Copenhagen, the name Nietzsche was practically unknown in Germany, not only to us clinicians in Jena but also to quite different people. There is a classical witness to this fact: Nietzsche is not to be found in the fourth edition of Meyers grosses Konversationslexikon from the year 1889. And how many small feathered creatures can be found there—and in the year 1889 Nietzsche's literary activity was finished forever. So Professor Binswanger should not be blamed if all he could tell us about Nietzsche's writing activity was that Nietzsche had formerly been active as a zealous Wagner-apostle but that he had in recent years become just as fanatical a Wagner-enemy, and that this change had perplexed his friends. I, for myself, when I heard the name Nietzsche, recalled having read it once in the writings of the outstanding Viennese music critic Eduard Hanslick, namely in an essay written in the year of the first Bayreuth Nibelungen festivals (1876), in which the Wagner literature of that time was examined critically. Two books which Nietzsche had in print at that time, belonging to this circle were: The Birth of Tragedy from the Spirit of Music and "Richard Wagner in Bayreuth." Hanslick dismissed them with a gesture of contempt and characterized the writer as a crazy philologist who really had no idea of music. At the time when he was brought into the Jena psychiatric clinic, Nietzsche was unknown to the German public, and it must well be the greatest irony of literary history that people were beginning to read his works precisely when he stopped writing: one or two years later Nietzsche was the great literary fashion.

But let us return to that Jena classroom. The man sitting before us did not at first sight have the external appearance of a sick man. He kept his figure, of middle height, in a stiff position; his face was haggard, but not exactly emaciated—his face, which a short time later the whole world knew from countless pictures: the magnificent forehead bordered by thick, plain, dark brown hair, the spirit-filled eyes under strong brows, the nose short as Bismarck's, and under it, also suggestive of Bismarck, the mustache that covered the beautifully matched lips, and to top the whole thing off, an unspeakably beautiful chin. The clothing simple, but clean and neat. However, the patient seemed to be having one of his good days: he was of clear consciousness and good memory-capacity. Professor Binswanger began a conversation with him about his former life. We learned to our astonishment that he had been a professor in Basel at just twenty-four years of age, even before receiving his doctorate, and that later persistent headaches had forced him to resign from his office. He did not say a word about his activities as a writer. Finally, as he reported, he had lived in Turin, and he began to praise this place, which had particularly suited him since it combined the advantages of the big city and the small town. This discussion made us all listen attentively, for we had never heard a man speak this way. And in Jena we were spoiled on this point, for teaching there at the same time were people like Ernst Haeckel, Rudolf Eucken, Otto Liebmann, Wilhelm Preyer, all not only famous scientists but also brilliant speakers. But this Basel professor emeritus was quite something else! Later, when I read Nietzsche's works it became clear to me what had startled me. I had just felt the magic power of the Nietzsche style for the first time. For he spoke as he wrote: short sentences full of peculiar word combinations and elaborate antitheses: even the scattered French and Italian expressions which he so loved, especially in his last writings, were not missing. His way of speaking had nothing of the lecturing professor about it. It was "conversation," and by the soft tone of the pleasant voice one recognized the man of best education. Unfortunately he did not finish his discussion. His thread broke off in the middle of a sentence and he sank into silence. Professor Binswanger then wanted to demonstrate a few disturbances in the patient's gait. He asked Nietzsche to walk back and forth in the room. But the patient did this so slowly and lazily that one could not perceive the phenomenon in question. "Now, professor," Binswanger said to him, "an old soldier like you will surely be able to march correctly!" This memory of his military time seemed to have a stimulating effect on him. His eyes lit up, his form straightened up, and he began to pace the room with a firm stride.

I subsequently saw Nietzsche quite often during visits to the patients' ward which our teacher used to make with us. His health varied: sometimes one saw him quiet and friendly, sometimes he had his bad days. When I saw him for the last time, he presented a different picture than the first time: he was in a highly excited state, and his consciousness was apparently troubled. He sat there with a strongly reddened face and eyes that flared up wildly and painfully, guarded by a keeper. On the whole, however, institutional treatment had a favorable effect on him. He calmed down and could for a time be left in the care of his mother and sister, who took him to their home in Naumburg.

—Simchowitz, S. "Der sieche Dionysos: Eine persِnliche Erinnerung," Kِlnische Zeitung, August 29, 1925, from Conversations with Nietzsche: A Life in the Words of His Contemporaries (Oxford Univ. Press, 1987), pp. 222-225.