Neurology of Don Quixote
Freud consulted with Don Quixote !At the age of 27, Sigmund Freud wrote to his future wife, Martha Bernays, about the deep impression left on him by his reading of Don Quixote in Spanish . About that time, Freud was wondering whether to follow his Neuroscientific research and become a neuroscientist (understood as an analogy of the quixotic ideal) or to devote himself to the well-paid private medical practice (an analogy of Sancho, as a reality principle). Santiago Ramón y Cajal discovered Don Quixote at the age of 12, but he did not really enjoy a novel in which the hero suffered so many setbacks. This initial impression changed radically during his life, as it can be deduced from his essays, which are full of references to Don Quixote [4,5
One of my Medical Students came to me this morning and wanted to contribute to more understanding, medically, of why Don Quixote was so misunderstood. So she dug through some Neurology Abstracts and was so excited, since this is the specialty he will pursue. He is a huge fan of Don Quixote and has read everything he can get his hands on. My eager Millennial was watching me read my beBee stats, and that is how this began. There were medical issues with Don Quixote, I think anyone who has read his work recognizes this fact. Usually, we just think he was crazy, well, he may have been that too, but we have evidence to share that indicates that he was more than crazy! Physically, he had many issues. We are going to give links for you to explore, since they are medical. So if you really want to know, as my med student put it with his dry humor, " hey Quixote, what was your problem dude?" Love these kids ! This student is one who will go very far in her medical career and happens to be 35 years old. They are all kids to me and I love working with them. I am constantly being educated. It's all good. This was a fascinating project inclusive of more young med students to read this amazing research from the credits at the bottom of this page.
Excellent works on some of the medical conditions mentioned in Don Quixote exist [8,9,10,11,12,13]. However, to date, no one has yet tried a comprehensive study of the many references to neurology scattered throughout the text. In this work, we attempted to read Don Quixote from a neurologist’s point of view, studying the neurological terms and conditions that appear in the novel, reviewing Cervantes’ sources of neurological information, and hypothesizing whether Don Quixote’s symptoms were actually due to a neurological disease.
Neurological Conditions in Don Quixote
Among the neurological signs and symptoms that appear in the course of Don Quixote are the following:
There are more than 10 references to tremulous conditions, mostly related to the emotion of fear: ‘I hung upon his words, my legs trembling under me so that I could scarcely stand’ (part I, ch. 27); ‘But she had hardly heard two lines, as the singer continued, when a strange trembling seized her, as if she were suffering from a severe attack of quartan ague’ (part I, ch. 43); or related to the feeling of anxiety: ‘Don Quixote, then, having risen to his feet, trembling from head to foot ..., said in a hurried, agitated voice, ...’ (part II, ch. 32). However, in this context, tremor must not be considered a disease itself, but rather a physiologic consequence of the emotional circumstances of the plot. At that time, the heart was supposed to be the seat of emotions, and when these emotions were disturbed, the changes of the cardiac rhythm could reach the arms and the hands, giving rise to tremor. This conception was supported by several authors, including Juan de Barrios (1562–1645), who explained in the 34th chapter (entitled ‘About palpitations, tremors and heart beats’) of his work Verdadera medicina, cirugía y astrología (True medicine, surgery and astrology), published in Mexico in 1607, that ‘tremor is a palpitation of the heart that can arise in any part [of the body]’. A similar view can be found in Quaestiones practicae, medicae et chirurgicae (1589) by Agustín Vázquez, Chair of Medicine at the University of Salamanca.
Throughout the novel, there are some curious mentions of mercury-induced tremor: ‘... at which spectacle Sancho began to shake like a man dosed with mercury, and Don Quixote’s hair stood on end’ (part I, ch. 19). Mercury was first used in the 16th century to treat syphilis, giving rise to the saying: ‘One night with Venus, a lifetime with Mercury’. Mercury could be administered in the form of calomel (mercury chloride), an ointment, a steam bath or pill. Unfortunately, the side effects were as painful and terrifying as the disease itself. Many patients who underwent mercury treatments suffered from extensive tooth loss, ulcerations, and neurological damage (including epileptic seizures and tremors, such as the excerpt above). The use of mercury therapy continued until the first effective treatment, Salvarsan, was developed in 1910 by the immunologist Paul Ehrlich (1854–1915) .
Don Quixote suffered from chronic insomnia due to ruminations and worries: ‘Don Quixote did not sleep too much at all during the night, thinking about his lady Dulcinea’ (part I, ch. 8); or ‘on one of the nights he [Don Quixote] couldn’t sleep ... he heard someone unlocking the door’ (part II, ch. 48). Moreover, Cervantes points out that sleep deprivation contributed to the rise of Don Quixote’s madness: ‘and what with little sleep and much reading ... he lost his wits’ (part I, ch. 1). In fact, at the end of the book, as Don Quixote is suffering from fever, ‘his mind had been restored to him’ after sleeping more than 6 hours (part II, ch. 54).
Insomnia was considered a severe disease by the medical literature of that time, as Blas Álvarez de Miraval admonishes in his book La conservación de la salud del cuerpo y del alma(The improvement of the health of the body and soul), published in 1597: ‘It is a very dangerous sign that a patient cannot sleep, during the day or the night, because sleep is essential for the relaxation of the senses’ (ch. 23).
Snoring is also cited: ‘[Don Quixote] called to his squire Sancho, who was still snoring’ (part II, ch. 20). Sancho also has the habit of taking long naps: ‘Sancho replied that ... he did usually sleep four or five hours on a summer afternoon’ (part II, ch. 32). The snoring, the lengthy siestas, and his obesity suggest that, though there are no references to episodes of cessation of breathing during sleep, Sancho may have had obstructive sleep apnoea.
Siesta, still a Spanish custom, was considered a healthy habit as Ivan Sorapán de Rieros (1572–1638) pointed out in his work Medicina española(Spanish medicine), published in 1616: ‘Those who sleep at noon, even healthy or with any disease, should not change their habit.’
Finally, there is an episode where Don Quixote’s sleep behaviour is altered; he is shouting and attacking some wineskins while dreaming that he is fighting a giant:
‘and in his right hand he held his unsheathed sword, with which he was slashing about on all sides, uttering exclamations as if he were actually fighting some giant: and the best of it was his eyes were not open, for he was fast asleep, and dreaming that he was doing battle with the giant’ (part I, ch. 35).
This incident has been interpreted as a symptom of a rapid eye movement disorder . Cervantes, through Sancho Panza, also explains the idea that sleep is a passive state, similar to death, where all mental activities are almost absent (part II, ch. 58). Theories of that time were unclear about the origin of sleep and the significance of dreams. Blas Alvarez de Miraval, in La conservación de la salud del cuerpo y del alma (ch. 23–26), specifies that ‘According to Averroes, sleep comes from the heart, but according to Galen it is made in the brain’. And further on: ‘Sleep is a condition in which the senses are not as free as in wakefulness, but not as held as in the deepest sleep [death].’ Alvarez de Miraval also describes some sleep behaviour disorders, including somniloquy and somnambulism: ‘Many people speak while sleeping, and they even respond to what they are asked. Some others wander around their room.’
Episodes suggesting complex visual and auditory hallucinations include the famous struggle against the windmills: ‘There you see about thirty outrageous giants, against whom I shall fight’ (part I, ch. 8), and paranoid delusions: ‘Enchanters have persecuted me, enchanters persecute me still, and enchanters will continue to persecute me’ (part II, ch. 32); ‘Did I not tell you, sirs, that this castle was enchanted, and that a legion or so of devils dwelt in it?’ (part I, ch. 45).
Cervantes portrays some of the characteristics of cognitive impairment, including disturbances of judgment: ‘and what with little sleep and much reading his brains got so dry that he lost his wits’ (part I, ch. I); time disorientation: ‘three days passed in one hour’ (part II, ch. 23); misidentification of people, such as the episode where he identified the modest priest of his town, an old acquaintance, as the ‘Archbishop Turpin’ (part I, ch. 7), and agitation: ‘When they reached Don Quixote he was already out of bed, and was still shouting and raving, and slashing and cutting all round, as wide awake as if he had never slept’ (part I, ch. 7). Cervantes also points out how Don Quixote frequently switched from aberrant behaviour to lucid intervals: ‘His housekeeper and his niece noted that their master was sometime in his right senses’ (part II, ch. 1); ‘Don Quixote reasoned with so much direction that his two friends believed him in his right sense’ (part II, ch. 1), and ‘He is a mad man, full of lucid intervals’ (part II, ch. 18).
Spanish physicians were interested in memory; for example, Blas Álvarez de Miraval, in La conservación de la salud del cuerpo y del alma (ch. 2), declares that ‘memory and ingenuity are lost if they are not exercised’.
Loss of consciousness in Don Quixote deserves itself a specific study, as it is outstandingly recurrent throughout the novel. Women are more prone to pass out, particularly in the context of a great emotion; often, episodes of loss of consciousness are rapidly reversible, suggesting a hysterical origin, which is evident in certain passages: ‘He will sigh, she will swoon, and the damsel will fetch water, much distressed because morning approaches’ (part I, ch. 21), and ‘The bridegroom then approached to embrace his bride; and she, pressing her hand upon her heart, fell fainting in her mother’s arms. ... They were all thrown into confusion by Luscinda’s fainting, and as her mother was unlacing her to give her air ...’ (part I, ch. 21). These women might be suffering from conversion disorder, although in other excerpts, a factitious origin of the loss of consciousness seems obvious: ‘At this moment Camilla, throwing herself upon a bed that was close by, swooned away. ... Camilla was not long in recovering from her fainting fit and on coming to herself she said ...’ (part I, ch. 34). ‘... the instant Altisidora saw him she pretended to faint, while her friend caught her in her lap, and began hastily unlacing the bosom of her dress’ (part II, ch. 46). Intense physical and psychological activity may also trigger syncope: ‘They rubbed him down, fetched him wine and unbound the shields, and he seated himself upon his bed, and with fear, agitation, and fatigue he fainted away’ (part II, ch. 53).
Within the Spanish medical literature of that time, syncope is unusually well described in the last chapter of Tratado repartido en cinco partes principales que declaran el mal que significa este nombre: Peste (Treatise with five main parts in which the evil of this name is explained: Plague), published in 1601 by Ambrosio Nunes (1530–1611), a Portuguese physician (Portugal was a kingdom which formed part of the Spanish Empire at that time). Nunes explains that
‘Syncope is a Greek term that means “faint”. Of this, there are four differences: the first, “Echlysis”, means “faint of spirit”, because the sense and movement are not lost, but strength seems to fail. The second, “Lypothomia”, means “faint”, because intellect and movements are lost, although they are recovered promptly. The third, “Lypopsychia”, is a kind of faint, with a similar duration, more or less. The fourth is “Syncope”, in which strength seems to be knocked off.’
There is a brilliant description of an epileptic patient:
‘My son is possessed of a devil, and there is not a day but the evil spirits torment him three or four times; and from having once fallen into the fire, he has his face puckered up like a piece of parchment, and his eyes watery and always running; but he has the disposition of an angel, and if it was not for belabouring and pummelling himself he’d be a saint’ (part II, ch. 47).
And there is also a brilliant description of an absence seizure in the character of Cardenio, a young man who was driven mad after his beloved Luscinda had married another man, and who lives alone in the Sierra Morena:
‘But in the midst of his conversation he stopped and became silent, keeping his eyes fixed upon the ground for some time ...; and with no little pity, for from his behaviour, now staring at the ground with fixed gaze and eyes wide open without moving an eyelid, again closing them, compressing his lips and raising his eyebrows, we could perceive plainly that a fit of madness of some kind had come upon him; ... for he arose in a fury from the ground where he had thrown himself’ (part I, ch. 20).
Some authors consider this excerpt to be an episode of functional neurological deficits in the context of a hysterical conversion disorder .
Epilepsy was well known by Spanish physicians of the Golden Age. Luis Lobera de Ávila (1480–1551), physician to Emperor Charles V, published in 1542 Remedio de cuerpos humanos(Remedies of human bodies) in which he explains the different terms given to epilepsy, including ‘gota coral’, ‘morbus sacrum’, ‘morbus comicialis’, and ‘alpheresy’. Lobera de Ávila points out how ‘primary causes of this disease can be to stare at the things that are moving around, and also strong smells. It is recognized because the paroxysmal episode lasts for little, ... and they have astonishing movements.’ Some years later, in 1611, Francisco Pérez Cascales published Liber de Affectionibus puerorum, a treatise on pediatrics. It is divided into four chapters, the first of them about several diseases exposed ‘a capite ad calcem’ (‘from head to feet’), including neurological diseases such as palsy, rabies, hydrocephalus, and epilepsy. He defines this latter one as the ‘paroxysmal phenomenon in which all parts of the body suffer a seizure, and external and internal senses are lost’. Non-epileptic psychogenic seizures are also described with outstanding precision by Pérez Cascales, who explains that non-epileptic psychogenic seizures have a hysterical/uterine origin, and they are, in all cases, different from epilepsy as ‘women are shocked by violent seizures in the whole body, they can see and listen, but they have lost the control of themselves due to the violent movements’ .
Paralysis (Perlesy, Apoplexy)
The father of the epileptic patient described above (part II, ch. 47) wanted to engage his son to a paralytic girl: ‘This son of mine who is going to be a bachelor, fell in love in the said town with a damsel called Clara Perlerina ...; and this name of Perlerines does not come to them by ancestry or descent, but because all the family are paralytics’ (part II, ch. 47). Some have hypothesized that the cause of the palsy in this family may have been a smallpox epidemic , but other hereditary diseases, such as spastic paraparesis, could be considered.
Cervantes could be describing a wake-up stroke in the next extract: ‘nobody knows what will happen; ... many a one goes to bed in good health who can’t stir the next day’ (part II, ch. 19). However, specific allusions to apoplexy are not found in Don Quixote.
During the 16th and 17th centuries, perlesy was considered a consequence of the obstruction of the nervous flow, due to a thick humour or a tumour. Jerónimo Soriano (1560–?), in his work Método y orden de curar las enfermedades de los niños (Method and order to heal the diseases of the children) classifies perlesy into ‘perfect, in which sensation and movement are lost; less perfect, in which only movement is lost; and imperfect, in which only sensation is lost’.
Preventive measures of stroke were already known; for example, Lobera de Ávila, in Remedio de cuerpos humanos, points out that ‘the causes of apoplexy are to stuff oneself with foods and delicacies, even in spite that they are good, because they thicken the blood and the humours’.
Traumatic Head Injury
Head trauma is frequently encountered in Don Quixote, mostly as a consequence of struggles and fights:
‘dropping his buckler he lifted his lance with both hands and with it smote such a blow on the carrier’s head that he stretched him on the ground ... Shortly after this, another ... came with the same object of giving water to his mules ... when Don Quixote ... once more dropped his buckler and once more lifted his lance, and without actually breaking the second carrier’s head into pieces, made more than three of it, for he laid it open in four’ (part I, ch. 3); ‘The cuadrillero ... lost his temper, and raising the lamp full of oil, smote Don Quixote such a blow with it on the head that he gave him a badly broken pate’ (part I, ch. 17); ‘And lifting his pike, which he had never let out of his hand, [Don Quixote] delivered such a blow at his head that, had not the officer dodged it, it would have stretched him at full length’ (part I, ch. 45), and ‘The unlucky wight did not speak so low but that Roque overheard him, and drawing his sword almost split his head in two’ (part II, ch. 60).
Cervantes seems to be describing a basilar skull fracture in the next excerpt: ‘Grasping his sword more firmly with both hands, he came down on the Biscayan with such fury, smiting him full over the cushion and over the head, that as if a mountain had fallen on him, he began to bleed from nose, mouth, and ears’ (part I, ch. 9).
As pointed out in previous works , almost 100 references to pain can be found in Don Quixote; however, specific allusions to headache are scarce: ‘I mean to say, that when the head suffers all the members suffer’ (part II, ch. 2). This excerpt has some similarities to Dionisio Daza Chacón’s (1510–1596) theory of pain, in his Práctica y teórica de cirugía (Practice and theory of surgery), where he points out that ‘the part which is having the pain is not feeling the pain, because it is the brain the only one that feels; The pain is not in the foot, but in the brain, which is the one that feels’.
Throughout Don Quixote, headache is usually a consequence of traumatic injury: ‘Don Quixote, who, with his hand to his head, was bewailing the pain of the blow of the lamp’ (part I, ch. 17).
A curious description of pica (the compulsive desire to eat materials such as soil, clay, plaster, etc.) can be found: ‘I am now labouring under that infirmity which women sometimes suffer from, when the craving seizes them to eat clay, plaster, charcoal, and things even worse, disgusting to look at, much more to eat’ (part I, ch. 33). This compulsive behaviour can be present in pregnant women as well as in neuropsychiatric disorders, such as autism, schizophrenia, or Kleine-Levin syndrome. Cervantes also describes what could be considered a heat stroke: ‘and all the while he rode so slowly and the sun mounted so rapidly and with such fervour that it was enough to melt his brains if he had any’ (part I, ch. 2). Syphilis is mentioned too: ‘[Virgilius] forgot to tell us who was the first man ... to try salivation for the French disease’ (part II, ch. 22). In Cervantes’ day, syphilis was termed ‘the French disease’ in Spain, and ‘the Spanish disease’ in France.
Cervantes’ Neurological Sources: Neurology during the Spanish Golden Age
There are some factors that explain Cervantes’ medical knowledge. First, there is evidence that, while he was living in Seville, Cervantes frequently visited the Hospital de Inocentes, a mental asylum that served as a holding place for the mentally disabled, criminally insane, epileptics, and the poor .
Secondly, he was born in a family of physicians: his father, Rodrigo de Cervantes (1509–1585), was a surgeon-bleeder, and his sister, Andrea de Cervantes (1545–1609), was a nurse , suggesting that he grew up in a medical atmosphere. Moreover, many of Cervantes’ friends were acclaimed physicians  such as Francisco Díaz (1527–1590), who wrote a treatise on urology , and Antonio Ponce de Santa Cruz (1561–1632), physician to King Philip III and King Philip IV, who published, in 1631, a treatise on epilepsy .
Cervantes lived during the late 16th and early 17th centuries, known as the Spanish Golden Age, a period of flourishing in painting (with leading artists such as El Greco, Ribera, Velázquez, Murillo, and Zurbarán); music (with outstanding composers such as Tomás Luis de Victoria, Francisco Guerrero, and Cristóbal de Morales), and literature (with Lope de Vega, Calderón de la Barca, and Cervantes himself). The Spanish Empire was global, and the influence of Spanish culture was so ubiquitous that Spanish is still the native tongue of approximately 500 million people. Also, the Spanish hegemony was patent in technical, social and biological sciences, and Spanish physicians led Western medicine too [24,25].
In this context, there is evidence that Cervantes owned a private library with more than 200 volumes, including medical books written by acclaimed Spanish physicians . One of these volumes was Examen de ingenios (The examination of men’s wits), written by Juan Huarte de San Juan (1529–1588) (fig. 3). This immortal and unique work, printed in 1575, reprinted at least 80 times, and translated into seven languages , is considered a founding work of neuropsychology, as Huarte strove to establish the relationships between brain, temper, and ingenuity from a mechanistic point of view . Interestingly, some of the paragraphs of the Examen de ingenios can be found, virtually word for word, in Don Quixote; even the title (The ingenious gentleman Don Quixote de la Mancha) is obviously based on it.
Juan Huarte de San Juan published the first edition of his Examen de ingenios
in 1575, which won him a European reputation. Though now superseded,
Huarte’s treatise is historically interesting as the first attempt to
show the connection between psychology and physiology. Despite its
initial proscription by the Inquisition, the Examen became
popular in Spain and Europe.
In conclusion, we can securely state that Don Quixote had severe physical neurological programs. Below we have provided the line to the Abstract and the completion of this article which is so highly educational considering how primitive medicine was, at this time. Truly a fantastic analogy with today's advances in medicine. We hope you enjoy this.
Neurology and Don QuixotePalma J.-A.a · Palma F.b
aClinical Neurophysiology Section, Department of Neurology, University Clinic of Navarra, Pamplona, and bFellow of the Royal Academy of Medicine of Granada, Granada, Spain Corresponding Author
Dr. J.A. Palma
Clinical Neurophysiology Section
University Clinic of Navarra
ES–31008 Pamplona (Spain)
Tel. +34 94 825 5400, E-Mail firstname.lastname@example.org
Many thanks for this research information
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