HISTORY OF MEDICINE
|Year : 2015 | Volume
| Issue : 4 | Page : 387-390
Adolf Hitler and His Parkinsonism
Kalyan B Bhattacharyya
Department of Neuromedicine, Radha Gobindo Kar Medical College, Kolkata, West Bengal, India
|Date of Submission||09-Jun-2015|
|Date of Decision||12-Nov-2015|
|Date of Acceptance||12-Nov-2015|
|Date of Web Publication||17-Nov-2015|
Kalyan B Bhattacharyya
Amrapali Point, Flat 1C, 59F, Bosepukur Road, Kolkata-700 042, West Bengal
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Research works have suggested almost incontrovertibly, that Adolf Hitler suffered from Parkinsonism. However, the precise nature of his illness had always been controversial and post-encephalitic and idiopathic varieties were the ones which were most commonly thought as the possible etiology. He displayed features like oculogyric crisis, palilalia, and autonomic symptoms which strongly implicate post-encephalitic etiology in the genesis of his illness. Others on the contrary, observed premorbid personality traits like non-flinching mental rigidity, extreme inflexibility, and awesome pedantry; which are often observed in idiopathic Parkinson's disease. Moreover, nonmotor symptoms like disturbed sleep, proneness to temper tantrums, phases of depression, suspiciousness, and lack of trust on colleagues have also been described by various authors. Additionally, he was prescribed methamphetamine by his personal doctor and that might have led to the development of some of the later traits in his personality.
Keywords: Adolf Hitler, hitler, idiopathic Parkinson′s disease, Parkinsonism, post-encephalitic, post-encephalitic Parkinsonism
|How to cite this article:|
Bhattacharyya KB. Adolf Hitler and His Parkinsonism. Ann Indian Acad Neurol 2015;18:387-90
| Introduction|| |
A good number of research works have indicated that Hitler suffered from various ailments like irritable bowel syndrome, skin lesions, cardiac dysrhythmia, coronary arterial disease, syphilis, borderline personality disorder, amphetamine addiction, and importantly, Parkinson's disease. ,,, However, medical historians were mostly interested in Hitler's suspected Parkinsonism More Details.
Abraham Lieberman wrote a classic treatise entitled, 'Adolf Hitler had post-encephalitic Parkinsonism' in 1992 that was published in the journal Parkinson's Disease & Related Disorders.  After rummaging through a host of literature, he affirmed that the illness was of the post-encephalitic variety. Importantly, Hitler's last remains were destroyed by his sworn and committed army minutes after he committed suicide on the 30 th April, 1945 and only a part of his lower jaw could be recovered and therefore, no autopsy on his brain could be performed.  Lieberman stated that the illness started in 1933-1934 when Hitler was around 45 years of age and his close associates were aware of the fact and though his physicians knew he had tremor, nobody diagnosed it as Parkinsonism.  It has been said that Lindin, Hitler's ophthalmologist, first diagnosed the condition and Max de Crinis, a member of the Nazi Party, a professor of psychiatry and medical expert for the Action T4 Euthanasia Program, informed Heinrich Himmler, the military commander, about his ailment. Initially, the tremor was intermittent and Hitler used to conceal it by tucking his left hand in his pocket or holding some object, for example, a cane stick. As the disease advanced he made lesser public appearance and allowed himself to be photographed only from angles that did not reveal his shaking left hand.  Hitler dearly wanted to keep his ailment a secret since he feared that the Germans would associate his tremor with senility and this symptom was not mentioned in the memoirs of men close to him, with the exception of Speer, Hitler's Armament Minister. ,,, His biographers too, were shy about expounding on it. ,,
The general view is that Hitler's Parkinsonism came to light for the first time in 1945 when a Swedish newsreel was smuggled out deluding German vigilance.  It shows Hitler walking slowly with diminished swing in the left hand, suggesting bradykinesia, along with masked face, stooped posture, and rest tremor.  Other sources that hinted at his illness include photographs, eyewitness reports, physician's prescriptions, and his declining handwriting and the resultant micrographia.
Speer wrote in his memoirs;
"In 1944 Hitler was shriveling up like an old man. His limbs trembled, he walked stooped with dragging footsteps. His uniform, which in the past he had kept scrupulously neat was stained by the food he had eaten with a shaking hand, his right hand, indicating that, in 1944, his Parkinsonism was bilateral." ,
"Hitler developed a tremor which affected only his left side. It is possible that his tremor developed sometime in mid-30s. His left arm was kept hanging down and he dragged his left foot. His speech was low pitched and hardly intelligible. His facial expression became rigid and saliva occasionally escaped from the corner of his mouth."
And finally William Shirer, author of 'The Rise and Fall of the Third Reich', described;
"The generals who assembled at the Führers headquarters at Ziegenberg on the evening of December 12 th , ... found the Nazi warlord ... 'a stooped figure with a pale and puffy face, hunched in his chair. His hands trembling, his left arm subject to a violent twitching which he did his best to conceal [Figure 1],[Figure 2] and [Figure 3]. When he walked, he dragged one leg behind him.'" 
|Figure 1: The useless left hand of Hitler held in a semiflexed position and tucked against the buckle of his belt in order to conceal the tremor, while he is addressing a gathering. Source: www.birminghammail.co.uk|
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|Figure 2: Walking and holding a cane with the left hand to conceal the tremor. Source: www.afarminiiceland.com|
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|Figure 3: Left hand adducted at the shoulder and flexed at the elbow, wrist, and fingers. He is holding his cap to conceal the tremor. Source: www.theguardian.com|
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Everything gainsaid, judging by the plethora of photographs there can be little controversy that Hitler hardly ever used his left hand on occasions like, delivering a fiery speech before public, talking to his lieutenants in quieter moments, or walking in a demure manner in isolation. Lieberman in his masterly treatise found evidence to suggest that Hitler presented with a number of symptoms suggestive of post-encephalitic parkinsonism. Firstly, Hitler belonged to the period when encephalitis lethargica following the devastating epidemic from 1915 to 1926 swept the world and Constantin von Economo from Romania described the clinical features and pathological findings before the Vienna Psychiatric Society in 1917 and many cases of post-encephalitic Parkinsonism were seen during the period 1920-1940. Secondly, Hitler suffered from oculogyric crisis as reported by E Daladier, the then Prime Minister of France. During a meeting at Munich in 1938, he saw, 'Hitler's dull blue eyes had a hard strained look and suddenly turned upwards.' , Additionally, Stock presented a video clip, 'Suddenly Hitler's face becomes expressionless as he struggles against a spasm of his eyes. He twitches his eyebrows, and tilts his head to the right. It is not certain if this is an oculogyric crisis.'  Finally, there is enough evidence to suggest that Hitler demonstrated features of palilalia. B Dahlerus, a Swedish businessman, came in close contact with Hitler in 1939 and observed, 'Suddenly Hitler, stopped and stared into space. His voice became hollow and his whole behavior seemed quite abnormal. He said, 'If there is a war, I will build U-boats! U-boats! U-boats! ... I will build airplanes! Airplanes! Airplanes! ... I will build airplanes! Airplanes! Airplanes!' , Lieberman, however, adds that whether this was an instance of Hitler's oratorical skill and rhetorical flourish is difficult to make out. 
There is some compelling evidence that Hitler suffered from autonomic dysfunctions and this further lends credence to the post-encephalitic nature of his illness.  He did not sleep well, sweated excessively, and took several bath a day; suffered from abdominal distension and constipation; and was uncomfortable in getting his sleep in the early part of the night, and fell into deep slumber in the early morning.  He developed this sleep problem during World War I, though there is some suggestion that it was related to the intake of methamphetamine.  Additionally, Hitler was prone to lose his temper at the slightest provocation. This happened after 1918 and the rage attacks were similar to those described in post-encephalitic Parkinsonism. 
An important issue is whether post-encephalitic Parkinsonism changed Hitler's personality. RLG Waite and Abraham Liebermann commented;
"Distrust of others entered into the routines of Hitler's life. Borderline personalities consider about themselves especially privileged persons, selfish, and narcissistic; they often display a contradiction between an inflated concept of themselves. Patients exhibit dramatically opposing personality traits: they are cruel and kind, sentimental and hard, creative and destructive." ,
Interestingly, Hitler, who was so harsh and severe on the Jews, was extremely fond of children and animals. His heart, as it is mentioned, used to bleed at the thought of lobsters being boiled live before consumption. It is also stated that he had great difficulty in shooting his pet dog before he committed suicide.  Many authorities feel that this dichotomy in his behavior of unrepentant ruthlessness on one hand and tender compassion on the other hand, is indicative of borderline personality disorder. Later in his life, he developed a perverse distrust towards his closest associates and it has been suggested that the disease turned Hitler into a hurried man, which might had led him compulsively to invade Soviet Russia at a critically miscalculated and wrong time.  Theo Morrell, Hitler's personal physician, administered amphetamine; which might have resulted in paranoia, loss of impulse control, lack of concentration, disorganization of thought, lack of insight, and inability to carry out daily activities.  However, this has been refuted by Liebermann in his scholarly paper; and gambling, often cited as a behavioral trend in Hitler, was presumably there much before the onset of his illness.  Morrell was known for his unconventional and alternative forms of therapy. He kept the details of Hitler's medical treatment and the book 'The Secret Diaries of Hitler's Doctor' written by David Irving contains detailed account of Morrell's methods.  It is reported that Hitler was administered 28 different pills a day and Morrell prescribed subcutaneous injections of Harmin, a mono amino oxidase (MAO)-inhibitor, and Homburg, an anticholinergic, in increasing dosage till Hitler got rid of him a week before his death saying that he did not need any more medical assistance.
Nassir Ghaemi, a professor of psychiatry has referred to the paper of Heston et al., and felt that Hitler suffered from bipolar disease. , He wrote that Hitler had distinct manic and depressive episodes throughout his life and August Kubizek, his closest friend from young adulthood, described phases of depression in him in his memoirs. He wrote that during such periods he was inaccessible, uncommunicative, and distant; and he would often wander around aimlessly and alone for days and nights. Heston felt that the combination of bipolar disease and the use of amphetamine were responsible for Hitler's mental decline in the last few years of his life. 
Though Liebermann advanced a lot of evidence to suggest that Hitler suffered from post-encephalitic Parkinsonism, it has been refuted by Gerstenbrand and Karamat.  They found no reason to believe as such and felt that his Parkinsonism was idiopathic in nature. They also studied in detail the traits in Hitler's personality and arrived at the conclusion that he displayed some features of premorbid personality of Parkinsonism like rigidity and viscosity of thought and extreme inflexibility. On the other hand, he had an antisocial personality characterized by lack of ethical and social values, tendency to betray, and uncontrollable emotional reactions. 
When Hitler lost the war, his Parkinsonism was presumably in the stage 2 or 3 of Hoehn and Yahr grading, which limited his mobility and there was tell-tale evidence of micrographia.  His signature from time-to-time shows the gradual decline to the point of illegibility and the last specimen is dated just 1 day before he committed suicide [Graph 1].
| Discussion|| |
There is almost irrefutable evidence that leads one ineluctably to assume that Adolf Hitler suffered from Parkinsonism, though there is much debate about its precise nature. Judging by descriptions of the symptoms from those who were close to him and who followed him till his last days, the possibility of post-encephalitic Parkinsonism seems to be high on the card. The nature of his personality raises serious questions whether he truly suffered from the nonmotor symptoms of Parkinsonism as well. Paranoid delusions, persecution mania, and selfish and narcissistic attitude characterized him to his final days and contrasting attitudes towards the Jews and animals point towards a serious personality disorder, as suggested by a number of researchers. It is difficult to assess how much damage did amphetamine and other curious agents prescribed by Morrell, caused to him. On the contrary, the work of Gerstenbrand and Karamat, who strongly contested Lieberman's hypothesis and felt that Hitler suffered from idiopathic Parkinson's disease is a case in point. Incidentally, micrographia, clearly evident in Hitler's numerous written accounts, points towards the idiopathic nature of his illness. Surely, much research is needed to clarify and precisely understand the alleged neurological problems of Adolf Hitler, if any, who was by every analysis, one of the most significant characters in the 20 th century and whose rise and fall changed the course of world history forever.
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[Figure 1], [Figure 2], [Figure 3]